The must read stories and talking points from Wednesday

First ever STP merger

Just as Daily Insight was being filed, HSJ broke that health leaders in the North East are in discussions over merging three sustainability and transformation partnerships to create the largest in the country.

Northumberland, Tyne and Wear and North Durham STP, Durham, Darlington, Teesside, Hambleton, Richmondshire and Whitby STP and West, North and East Cumbria STP already have a number of shared work programmes. But senior sources across the region have told HSJ that discussions have been held over merging the three STPs into a single footprint.

Difficult delays

The death of a 74 year old grandfather refused potentially life saving treatment has put NHS England’s Commissioning Through Evaluation scheme under the spotlight.

With the £25m review hit by delays, and charities, cardiac specialists and tech firms united in warning that patients would die, negative headlines are inevitable.

NHS England has to ensure public money is spent on cost effective treatment enhancing or extending lives.

However, with service cuts and the relentless focus on finances, it must assure the public it is not rationing services to save money.

Even if assurance is given, delays since the review began four years ago are hard to justify.

Trusts delaying evaluation because of a failure to submit data on time must share responsibility. The knock on effect, NHS England says, is that it cannot consider funding until it has evaluated the evidence. Other patients could die because of restrictions currently in place.

But that does not explain delays in reaching decisions. Many treatments under review are used in Europe and America so NHS England can consider international research to fast track its conclusions.

Once again, the NHS appears to be failing to accept shared learning – something providers and CCGs are encouraged to do.

The Arrhythmia Alliance says the treatment denied to the 74 year old man should be offered to prevent further deaths until the review concludes.

With small numbers and the cost of the treatment just over £7,000, the national body should explain why that isn’t happening. So far, NHS England has been unable to provide HSJ with a comment.

Don’t sneeze

Freeing up delayed transfer of care beds will be vital to ensuring the NHS has enough beds to manage winter pressures and a possible flu outbreak, says Simon Stevens.

Mr Stevens told Expo 2017 this week that the priority for the next 3-5 months was to ensure that the NHS was as strong as possible to deal with winter pressures.

He said Australia and New Zealand had suffered from a major outbreak of flu, which resulted in hospitals closing their doors to new patients and long waiting lists.

The NHS England chief’s comments were echoed by his director of operations and information Matthew Swindells, who said a severe flu season in this country would increase the need for extra capacity.

This is the clearest sign yet that NHS leaders are worried about the coming winter, with NHS Improvement chief executive Jim Mackey warning urgent action was needed to ensure enough hospital beds are available over winter. He said the government’s extra investment in social care failed to reduce the number of delayed discharges.

Mr Stevens said a lot of work will need to be done over the next 6-8 weeks to prepare for the expected pressure.

This includes reducing delayed discharges to free up 2,000-3,000 beds, but there are fears that reducing DTOCs by 50 per cent or more is “undeliverable”.

Also, during the next few weeks we’ll see the party conference season and the autumn budget, but it is not yet clear if there will be more money announced to ease winter pressures.