Daily Insight: Mack doesn't want to give you the sack

No ‘unnecessary’ departures

A couple of weeks ago two chief executives resigned after consistent poor accident and emergency performance in their trusts. Their departures were orchestrated as a clear message to the rest of the NHS, as if one were needed, that the four hour target still mattered.

So what happens next?

In Thursday’s NHS Improvement board meeting, Jim Mackey emphasised that the system had been doing “as much as is humanly possible” in recent weeks to prepare for winter, despite ongoing struggles with demand. But, the NHSI chief executive said, tensions were becoming increasingly visible and were not going to abate any time soon.

So, don’t expect a miracle turnaround.

HSJ asked Mr Mackey whether we would see any more chief executives depart over emergency performance.

Mr Mackey’s answer was diplomatic: “No one wants to see unnecessary departures of any leaders.” (“Unnecessary” was an interesting choice of word).

He continued: “We are a very pressured system. Everyone is trying very hard in very difficult circumstances but we also continue to keep performance under constant scrutiny.

“The answer you want is a definite no. We can’t give that. If performance is really terrible in some places, we will have to act, but that won’t be our first reflex and first action.”

All of which is true, and keeps national leaders’ options open. But it hardly sounded like the words of a man looking for any excuse to dole out another round of punishment.

Crunching the numbers

A “growing gap” is appearing in mental health services from the drop in acute adult inpatient beds and fall in community care provision.

That was the message from the Centre for Mental Health in a new report compiled using data from the NHS Benchmarking Network, focusing on adult mental health in England and Wales.

The report found acute adult inpatient bed numbers fell by 15 per cent from a median of 23 per 100,000 population in 2012-13 to 19.6 in 2015-16.

But in conjunction with this, bed occupancy rose from 91 to 94 per cent, staff numbers fell and length of stay increased slightly.

This was coupled with a 6 per cent drop in overall community mental healthcare provision, leading to the charity to call for an “urgent review” by national and local policymakers

NHS England has correctly pointed out that the data pre-dates the Five Year Forward View for Mental Health implementation plan, which it published last July.

It went further, saying the report provided a “misleading” view of the situation on the ground, citing an extra 900,000 people a year getting help through local IAPT services and an increase in community beds.

But the real test will come when we see data looking at 2016-17 – the first year where improvements spelled out in the implementation plan were due to be made.

This is when we will discover if new cash pledged for new services was spent where it was promised and whether the direction of travel is the right way.