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

Working together

The integration agenda has now stretched to international recruitment. New guidance produced by NHS Employers with input from NHS England, Health Education England and others has set out best practice for recruiting staff from overseas, including joining forces with other NHS organisations to boost efforts

In the form of a “toolkit”, the guidance encourages NHS organisations to work within their integrated care systems to increase the “efficiency and scale” of international recruitment. It also said using a lead provider model is the best way to ensure a reliable supply of staff and better retention.

There is a strong emphasis that international recruitment is part of the puzzle and not a long-term solution, but the toolkit is clear, in the short and medium term, it is a much cheaper option than using expensive agency staff.

This work is a consequence of the interim people plan, published last summer by NHS England/Improvement, and again emphasised by leaked people plan modelling from the autumn, which set out that the NHS needs 12,500 additional nurses from overseas over the next five years.

Despite best collaborative efforts, the lack of clarity on what the government’s refined visa points system will look like could bring new challenges to trusts looking to boost their pool of international staff.

Three years’ worth of reading

The Royal College of Obstetricians and Gynaecologists report into maternity services at East Kent Hospitals University Foundation Trust makes for grim reading. It contains a lengthy list of issues, including what appears to be poor attendance by consultants, slow responses to critical situations in labour, and midwives using drugs without a doctor prescribing them.

But what is perhaps even more shocking is that the Care Quality Commission did not see the report for nearly three years after it was written in February 2016. The CQC confirmed although it saw an action plan based on the report, its records indicate it did not see the report itself until January 2019. At that time, it was also put on the trust’s website in a section containing responses to Freedom of Information Act requests.

EKHUFT says it has made improvements to its maternity services since the report was written. But would or should the CQC — and potentially NHS Improvement/Monitor — have acted differently if they had read the full report in 2016?

Just how swiftly the trust acted to make improvements is likely to come under the spotlight later this week when an inquest concludes into the 2017 death of a baby at one of the trust’s maternity units. The trust has already said the care offered to Harry Richford fell short of the standard it expected to offer, but many of the problems encountered during his birth seem to echo those in the RCOG report. The coroner’s conclusion may be deeply uncomfortable for the trust’s leadership.

Since HSJ’s story on the report was published, the CQC has confirmed there is currently a criminal investigation taking place into the trust’s maternity services