The must-read stories and debate in health policy and leadership

Rip ’em up

Eyes in the centre are on the NHS’s long-term funding settlement, still rumoured to be imminent.

But those within the service also have pressing operational worries on their plate.

NHS emergency care chief Pauline Philip’s latest warning this week that local plans for 2018-19 are not good enough was very ominous.

System leaders, and ministers from prime minister Theresa May downwards, continually parroted the line ahead of last winter that the NHS was “better prepared for winter than ever”.

The service went on to record its worst four-hour accident and emergency performance since records began, and even seasoned NHS chiefs said they hadn’t seen the service under so much stress since the 1990s.

The consequences of the system heading into next winter underprepared do not bear thinking about.

The short-term ramifications are that local systems face a busy summer trying to free up as much capacity as they can, with a major push on so called super-stranded patients – those who have been in hospital for over three weeks.

NHS Improvement has issued some compulsory summer reading: new guidance on reducing long hospital stays.

The hope is that the system can free up 4,000 beds. This is a very challenging target.

And even if the system does hit it, it’s at the low end of how many more beds it is estimated the NHS needs to get back to meeting statutory waiting times targets. NHS Providers estimated in March the system could be as many as 15,000 beds short.

Flat-pack clinics and land sales

The NHS estates boss Simon Corben described a confused picture when it came to refurbishing health facilities and selling unused land at this week’s NHS Confederation.

Mr Corben, who works for NHS Improvement, said while there was “lots of energy” for allocating capital money to Sustainability and Transformation Partnerships there was “no plan or template to deliver projects through”.

One of the solutions to the “longing” for simplicity and standardisation in the system was the “New for Old” programme that would standardise designs and give a clearer idea of capital costs. The idea reportedly has ministerial support.

Mr Corben repeated his call for health to be better represented on major infrastructure projects like Crossrail or the third runway at Heathrow.

But he had positive news on a revitalised NHS Property Board that was now “a testy environment” instead of a “talking shop”.

His speech came the day before government data showed NHS trusts sold £163m in surplus land in 2017-18.