The must-read stories and debate in health policy and leadership.
The NHS could begin the process of consigning the four-hour target to history within weeks, with the royal colleges now fully committed to its demise alongside NHS England and Improvement and health and social care secretary Matt Hancock.
The Royal College of Emergency Medicine’s president told HSJ the college wanted to begin implementing the new emergency targets regime before winter, as they view it as a vital plank of radical reforms to protect accident and emergency departments from overcrowding, which involve a raft of initiatives including “call before you walk” EDs (which you can read about here).
There is scant time for a public consultation on the targets before winter, although this will be of little concern to system leaders, who decided on their desired outcome some time ago. With NHS Confederation and NHS Providers offering little resistance, the final hurdle for proposals would appear to be signoff from the big cheeses at Number 10 and the Treasury.
This is not a foregone conclusion. But there may well be significant political appeal in ditching a target which has not been hit since July 2015 and embarrasses the government every month.
The timing is pretty good too: both early enough in the political cycle, and in such a turbulent period of history that a move which could normally command a front-page splash story is relegated to back half of the news section, if that.
The clinical backing represents a huge vote of confidence for the new bundle of metrics, and a reassurance to both NHS managers and patients.
But for anyone outside the review group, it is impossible to say whether they are making the right or wrong call, because there is no publicly available evidence on which to balance the pros and cons. This is the source of great unease to the three major health think tanks, many senior NHS managers, and to HSJ’s own Recovery Watch.
Coronavirus outbreak has changed the debate significantly and RCEM’s desire to crack on with the new bundle of metrics is understandable.
But one thing that never changes is the unintended consequences of major policy interventions. If there is no robust, external examination of the trial data or the new methodology (and there is still time), the NHS will be leaving itself even more open to some nasty surprises during a national roll-out.
Incredible claims in East Kent
The new accountable officer of Kent and Medway Clinical Commissioning Group made one of his first appearances before councillors yesterday – and found himself handling an extremely hot potato.
Wilf Williams, who took on the role in April, was asked about the high number of deaths from covid in East Kent Hospitals University Foundation Trust, where 9,000 staff were being tested to see if they had asymptomatic covid.
Mr Williams, appearing before the county council’s health overview and scrutiny committee, referred to the trust as having a “relatively low” numbers of deaths. While rates at the trust may have been low in March and April, it has had a disproportionate level since then and in the week to 17 July had 10 per cent of the national total of in hospital deaths.
Overall, it has had more deaths than its share of England’s population would suggest – but most worryingly those deaths are continuing at a time when other hospitals are only seeing the occasional fatality.
Why is still a bit of a mystery: HSJ has been told that preliminary data from the massive staff testing exercise has only revealed a handful of cases so far. But it will be the end of the week before it has full figures – which could indicate whether transmission by staff is part of the problem.