HSJ’s round-up of the must read stories and debate from Wednesday

How to cope with a closure

Last September patients at Bootham Park Hospital were moved out with just six days’ notice after the Care Quality Commission ruled it was not fit for purpose and closed the site.

Many were transferred 50 miles or more while services transferred from Leeds and York Partnership Foundation Trust to new provider Tees, Esk and Wear Valleys FT.

On Wednesday, HSJ revealed the details of two reviews into what caused the closure and how it could have been handled better.

The report for York city council by former Local Government Association chief executive John Ransford doesn’t pin blame solely on individuals or organisations, but is critical of the local and national systems.

He says “the current organisation of the NHS is a factor in the difficulties which developed in this situation”.

There was lack of “strategic grip” and relationships between different bodies were “complex and fragmented” – “which makes patient centred care difficult to achieve in an integrated manner”.

Ultimately, no one “took charge” to try to turn around the situation and keep the impact on patients to a minimum.

He concludes: “All of the organisations involved contributed in some way to the unintended consequence of the sudden closure of hospital facilities.”

Meanwhile, NHS England, which carried out its own “lessons learned” review into the Bootham Park closure, is now drawing up guidance on how to handle the sudden closing of hospitals.

NAO scathing of NHS England

On Wednesday the National Audit Office issued a fairly damning assessment of NHS England’s commissioning of specialised services.

The auditor said the national commissioner did not have “an overarching vision or strategy” for specialised services and lacked the information necessary to improve them.

It also said attempts to keep a lid on the specialised services budget by tinkering with the tariff may have “impacted on providers’ financial sustainability”.

The NAO acknowledged that NHS England had taken steps to improve the data it gets on how much it is spending on individual specialised services, and what patient outcomes it is getting in return. However, it said it was currently unable to conclude that NHS England was providing “value for money”.

All in all, the report makes for pretty gloomy reading. But there’s an opportunity for NHS England here too.

Jonathan Fielden, the former medical director at University College London Hospitals Foundation Trust, has just started in the role as NHS England’s director of specialised services. His arrival on the scene provides a perfect opportunity for NHS England to begin a new chapter in the commissioning of these services.

The cost of drugs and new medical technology will continue to rise over the next few years, and NHS England is going to have to make some tough choices to keep its specialised services budget in balance. As it makes these decisions, the key thing for NHS England is to ensure it acts in a transparent way and properly communicates the changes with providers and patient groups.

Second strike

Junior doctors went back to the picket lines at 8am on Wednesday, withdrawing all service provision, including emergency care, until 5pm.

As on Tuesday, there have been no stories of doctors being called back to work or unplanned service closures.

At the time of writing, neither the government nor the BMA had changed their positions. So what happens next? Well, as HSJ revealed last week, the junior doctors’ committee has discussed a number of options, including the possibility of doctors going on strike in June without a date for returning to work.