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

Hancock’s digital shake-up

Matt Hancock has spent the first six months in the job evangelising for a drastic improvement in NHS IT and discovering the limits on his power to make that happen.

As HSJ revealed, the health and social care secretary’s solution has been labelled NHSX and would involve a centralising of NHS digital leadership into a single unit over which he would exert more control.

The exact shape of NHSX is still up for rigorous debate and several NHS sources have suggested to HSJ that, despite Mr Hancock’s determination, it may not happen at all.

However, if it does happen, it will mean an increase in the Department of Health and Social Care’s influence over NHS IT strategy at the expense of NHS England.

NHS England currently leads on the NHS IT strategy – even if DHSC pays much of the bill, and NHS Digital and the broader NHS does a lot of the heavy lifting.

NHS England has publicly said it supports Mr Hancock’s proposal, although, with NHSX’s exact form still being debated, what it supports is not clear.

An announcement on Mr Hancock’s new NHSX structure, expected “soon”, will help bring the level of agreement, or otherwise, into sharper focus.

Getting to the heart of it

St George’s University Hospitals Foundation Trust in South London has been grappling with problems at its cardiac surgical service at its Tooting site for the best part of two years, ever since the national monitor for heart surgery outcomes alerted the trust in April 2017 that the unit’s death rate was higher than national averages suggested it should be.

The roots of the problem, however, go back much further, to at least 2010. Back then, the first of several external reviews into the surgical service identified problems among its surgeons, including “an undercurrent of cultural and racial issues” – although it did also find “no suggestion that the group, as a whole, or individual surgeons have issues with outcomes following cardiac surgery”.

Sour relations within the surgical team seemed to fester over time. After the mortality alerts, the trust commissioned another external review: the Bewick review.

Lead author Mike Bewick did not pull his punches when summarising the fundamental breakdown in relationships within the surgical unit. Perhaps most notable were the complaints of a “dark force” at work.

With external support, the trust has tried to improve matters, including recruiting a senior surgeon to oversee the improvement work and more consultants to bolster the surgical team. But it has also lost its complex case load and it has had its trainee heart surgeons moved to other trusts to complete their training.

Now, NHS Improvement has commissioned a panel of experts to review the case history of every patient who died after heart surgery at St George’s between April 2013 and September 2018.

The trust wants to reassure patients and their families that the service is safe and on the mend, but it will no doubt have its fingers crossed that this latest review does not dredge up more bad news.