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

Regulatory lag

Regulation always lags innovation, but this week there were some signs of a catchup in the NHS.

Responding to the disruptive impact of “digital first” GP practices and the howls of protest from traditional GPs haemorrhaging patients, NHS England proposed three tweaks that would drastically reduce these practices’ NHS income.

The changes are to GP payment systems which, having not been designed to handle the impact of new tech, have been automatically making extra payments to digital practices at odds with the original intent (such as rural payments for urban digital practices).

There is only one digital practice at scale currently, GP at Hand, but NHS England clearly expects the market to expand fast and wants to correct quirks in the model beforehand.

What, if any impact, this reduction in potential income will have on new entrants remains to be seen.

Over a longer period, closer scrutiny of medical apps is planned from 2020, replacing a “fragmented” system where some manufacturers are not subjected to even the most cursory independent assessment before selling their wares.

NHS leaders are also grappling with how to assess the safety of artificial intelligence in health and how to make sure the system gets a fair return for giving digital firms, and other companies, access to NHS patient data.

For a service with a poor record of spreading innovation, the balance will be ensuring the technology is safe and effective without smothering it.

Void in the west?

A concerning leadership void has appeared in Cornwall, where the county’s acute trust (which is in special measures) will shortly be without a permanent chief executive and chair.

Royal Cornwall Hospitals Trust chair Jim McKenna departed at the end of May, and now chief executive Kathy Byrne is on her way out too, after announcing her resignation on Wednesday.

Ms Byrne’s resignation came exactly a year after Care Quality Commission inspectors visited the trust, which resulted in an “inadequate” rating and regulatory action after a number of failings were exposed.

These included patients dying or being seriously harmed due to long waits for treatment, allegations of bullying within the trust, and poor processes for investigating and learning from serious incidents and never events.

Ms Byrne came to the trust in April 2016 with a strong looking CV – having previously led health organisations in her native Australia prior to joining the NHS.

At that point RCHT was already on a slippery slope.

The trust had not hit the 95 per cent accident and emergency target for several years and had begun sliding into deficits, amid an above average turnover of top level staff – one of which turned out to be a conman.

In her resignation statement Ms Byrne said the trust was put into special measures “not long after I was appointed”, which seems a somewhat generous interpretation of time – given that she joined RCHT 15 months before the CQC inspection.

However, given the workforce and demographic challenges that a rural trust like Cornwall is always going to face, halting the organisation’s decline in that time was always going to be difficult.

And while the CQC warned in April that improvements weren’t happening fast enough, there were some positive signals emerging – such as the improved A&E performance achieved by close collaboration with neighbour organisations.

That progress will be affected by Ms Byrne’s departure, and – with a merger with the neighbour trust ruled out for now – appointing the right successor seems more crucial than ever.