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

It’s rare for a trust to jump two levels in Care Quality Commission ratings – even more so when that trust has long-term issues and has been through several chief executives in a short time.

So hats off to Brighton and Sussex University Hospitals Trust, whose “good” CQC report has been released today. The report makes clear the magnitude of the change that has been achieved, with fulsome praise for the “huge improvements” and, in particular, the cultural change which staff reported. Praise for the trust – which has also come out of quality special measures – has come from both NHS Improvement and care minister Caroline Dinenage.

Chief executive Dame Marianne Griffiths – who was likely already having a great start to 2019 after her damehood in the New Year’s honours – was quick to tell HSJ there is no “silver bullet” to drag a trust off the bottom and to praise staff and the trust’s wider leadership. Nonetheless, there must be some who are wondering if her formula could be used elsewhere with the same level of success.  

The answer is probably that it is worth a try – but that, as well as exceptional leadership, the trust has been allowed to run a huge deficit (around £56m) and is going to benefit from a £500m investment in the redevelopment of its key site, the Royal Sussex County Hospital. That’s not to knock the achievement of the trust in going from “inadequate” to “good” but simply to point out its unusual, if not unique, position.

Hopefully, the momentum the trust has built up – and the prospect of a “good as new” hospital on the horizon – will also help it drive further improvement. Medway Foundation Trust – another challenged trust in the south east – came out of special measures nearly two years ago but then struggled to keep up the pace of improvement. But, as its former chief executive Lesley Dwyer admitted, moving forward from such a landmark is sometimes harder than achieving it in the first place.

A hidden epidemic?

Harm done to NHS patients who deteriorate from spending too long in hospital has hit “epidemic” levels which “dwarf the damage done by hospital acquired infections”, a senior national adviser to the NHS has warned.

Leading geriatrician Ian Sturgess told HSJ tens of thousands of patients, largely older people, could have been harmed by what he termed “hospital acquired functional decline” in the NHS over the last decade.

Dr Sturgess, who developed the stranded patient metric being used by the NHS to cut patients’ length of stay, warned the service must “wake up to the hidden epidemic of harm”.

He raises a number of practical and cultural challenges to the NHS: notably that an “inherent ageism” which assumes poor outcomes for older people was prevalent and was exacerbating the systemic problems which see patients stuck in hospital for far longer than necessary.  

System leaders have certainly put cutting patient length of stay at the forefront of their plans, with a major drive this winter on those who have been in hospital for 21 days or more. 

But the length of stay debate has largely been viewed as a resource issue, with policy makers desperate to free up beds and staff. That’s completely legitimate – but national figures could do a lot more to publicise the patient safety consequences too.