The must read stories and talking points to end the week

Getting political this time

Significant variation in hospital care, outlined in the latest Getting It Right First Time report into general surgery, will surprise few (if any) people in the NHS.

What is surprising is GIRFT’s foray into the political arena, calling surgeon mortality rates and cancer targets “politically derived measures” that may even reduce quality of care.

The carefully chosen words, in the report by the national programme funded by the Department of Health, counter the health secretary’s “intelligent transparency” mantra – that standards and performance measures “unleash a powerful force” to service improvement.

More likely, the GIRFT report says, the opposite is happening in some cases. Surgeons may well be avoiding high risk operations rather than have their reputations tarnished by surgical mortality rates.

That will be uncomfortable for medical leaders to read.

For the moment, the call for a review of cancer targets relates to a specific pathway for one set of patients. However, it could be early warning that a major rethink of central performance targets may be needed.

This is only the first of 34 reports, with others at various stages of progress. If the same concerns over national targets are uncovered in other specialties, it could become increasingly difficult to justify the status quo on medical grounds.

The report also puts GIRFT on a potential collision course with surgeons over its recommendation for the “considerable” clinical autonomy in the NHS to be reviewed.

The review is supported by the Royal College of Surgeons and reassurance has been given that the review is not about stifling innovation.

However, calling for the NHS to compare the autonomy it affords clinicians compared to other countries, where surgeons have far less freedom to stray beyond defined pathways of care, will cause disquiet in the wider profession. If handled insensitively by policy makers, it is easy to see this leading to confrontation.

For the time being at least, GIRFT’s leaders seem to be willing to go wherever the evidence is leading them – regardless of how politically awkward that might end up being.

Hunt’s rallying cry

Jeremy Hunt has written a wide-ranging comment piece for HSJ covering safety, finance and Brexit.

He puts particular focus on workforce issues, writing: “Health jobs are tough jobs, not for the faint-hearted, so it is all the more important that employers have an unbending focus on improving the working lives of their staff.”