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

The revolving door spins on

Tom Kark QC is banging the drum for all seven of his recommendations from his report into the Fit and Proper Person Test, published earlier this year, to be adopted by the government.

He has revealed that officials in the Department of Health and Social Care are working on a recommendation, which he believes has been adopted, about the use of mandatory references.

This is intended to stop the so-called revolving door for NHS execs, as the mandatory references will make clear the full extent of their performance, regardless of whether a compromise agreement was signed or not.

HSJ readers have been quick to point out these could lead to legal challenges and that, in any event, the revolving door is not operated by ignorance but often in full knowledge of a person’s questionable past.

Without Mr Kark’s proposal for a new “health directors standards council” with the power to investigate and bar managers guilty of misconduct, the club culture for the small minority of directors who should no longer be in such roles will continue to find ways to operate.

A long overdue independent evaluation for NHS England’s 17 flagship care model schemes for mental health has been published.

The models, launched in 2016, essentially transferred responsibility for adult secure services, children’s and adolescent mental health services, and eating disorder services to groups of local providers.

The recent evaluation, which was finished in March 2019, was published, very discreetly, on the website for Niche, the consultancy company which carried it out. 

The reason for NHSE’s lack of fanfare? Perhaps its because the findings leave us with a glass half empty – or, indeed, half full.

Using data primarily from 2017-18, Niche found no evidence that any of the eight adult secure care NCMs had produced savings.

On the other hand, it did find the other half of NCM sites – those for children and adolescent inpatient services – produced significant savings from reductions in out of area placements.

There are echoes of the dilemma over the physical-health new care models of a few years back: A general sense from those involved that they were working well was not backed up by robust financial delivery – creating much bitterness who were not getting the upfront funding.

For the mental health NCMs, the data showed length of stay remained stubborn across the sites suggesting, predictably, it is hard to repatriate or discharge patients who’ve been inpatients for longer and have the most complex conditions.

This appears to be an increasing national trend if we look at out of area placement data.

NHSE, however, has pointed to more recent data, which shows savings across the sites and a reduction in out of area placements. This is a welcome statement considering the organisation has already signalled a national rollout of the schemes by 2020.