The must read stories and debate in health today

CEO threatened by royal college

A common ingredient of the scandals that occasionally engulf the NHS is the failure of senior leaders to expose wrongdoing. It’s often not the initial error itself that turns a problem into a crisis – but the inaction or cover-up that goes with it.

It has been eight years since baby Joshua Titcombe died as a result of failures at the University Hospitals of Morecambe Bay – there have been inquests, reviews, investigations and the Kirkup inquiry into the avoidable deaths of 11 babies and one mother.

HSJ reported on Wednesday that one of the senior midwives at the centre of the scandal, Jeannette Parkinson, who was heavily criticised in the Kirkup inquiry, received an unusual exit payment from the trust in 2012, which also included a clause that the trust would not investigate her alleged poor behaviour.

This deal was uncovered after an internal investigation ordered by the trust’s current chief executive, Jackie Daniel, who has worked hard to ensure the trust learns from its troubled past. She was preparing to publish the report but was then threatened with an injunction by the Royal College of Midwives.

When asked by HSJ to comment on the existence of the report, Ms Daniel did so openly and transparently, when as leader of the trust after these events, which have been subject to so much scrutiny already, it would have been very easy to put this report in a drawer and forget it ever existed.

It is hard to recall another chief executive faced with such uncomfortable truths taking the same action as Ms Daniel has, and she deserves to be recognised for her leadership in this situation.

New drugs hurdle

NICE and NHS England have launched a consultation on introducing an affordability test into the process for authorising new treatments.

Under the test, which would be a major shift in the way NICE assesses new treatments, the introduction of a drug that would cost the NHS more than £20m a year would be delayed.

This would create an additional hurdle for drugs that are judged to be cost effective but which are expensive, and would have a big impact on NHS England’s budget. Currently, while drugs are subject to a value for money assessment, their affordability to the NHS is not considered.

The affordability of drugs has become more prominent since the introduction of new hepatitis C treatments last year. The drugs are judged to be cost effective by NICE but were subject to unprecedented restrictions on their availability because of their high cost to NHS England.

In the consultation document published on Thursday, the two organisations propose a “budget impact threshold” that would be “triggered” if a new drug is projected to cost the NHS more than £20m in any of the first three financial years following its introduction.

If the threshold is triggered the manufacturer and NHS England would enter commercial negotiation.

About 20 per cent of treatments that NICE approved between June 2015 and June 2016 would have triggered the budget impact threshold.