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

Screen test

Local continuing healthcare funding policies are continuing to incite controversy.

This time, HSJ has been told ward nurses are concerned West Norfolk clinical commissioning group’s locally devised screening process blocks eligible patients from receiving CHC funding.

An expert close to the process called the screening process, which is not nationally endorsed, “flawed” and raised concerns it might be forcing people to pay for social care when they might be eligible for free NHS-funded care.

This is the latest in the line of questionable local CHC policies. Last year, the Equality and Human Rights Commission threatened legal action over CCG policies which cap the amount spent on home care, branding them “dehumanising” and “unlawful”.

Despite this, CCGs still need to find ways to reduce the cost of providing CHC funding – NHS England has asked local areas to cumulatively save £855m.

Expect to see more of these controversial local schemes in 2019, as very tight local authority budgets and commissioning budgets increase the clashes that arise over such funding. 

A quiet revolution

Just before Christmas, with little fanfare, NHS Improvement published its new draft national strategy for patient safety – the vision of recently appointed national director Aidan Fowler and his team on how the health service can deliver safer high quality care.

Behind the draft document sits modelling that Dr Fowler told HSJ could save 6,000 additional lives and more than half a billion pounds in reduced costs. An economic case for patient safety in the NHS has been needed for sometime. While this may be ambitious, it’s one target the NHS should aim to meet.

For several years, patient safety has been a dominant feature of health policy in the NHS. But a persistent fear of many in the system is how difficult it seems to be to deliver consistent national improvement despite widespread evidence and knowledge of what needs to be done.

The draft national patient safety strategy is what has been lacking. It is gently taking a grip of the various approaches to safety to try and create a structure or framework within which things can be delivered.

Up until now, there has been a “1,000 flowers bloom” approach, with trusts organising their own internal approaches to safety, while regional collaboratives have variable levels of success.

The strategy also attempts to meet head on the need for a “just culture” approach – non-judgemental support for challenged trusts and a recognition that human error is not solved through blame but recognising how to design out the possibility.

It also proposes a network of senior safety specialists in every trust with the knowledge, skill and political (small p) influence to get things done. Coupled with a new approach to learning from incident reports and a national curriculum for all staff on patient safety, the draft strategy offers some sensible reforms that could lead to a quiet revolution. A consultation on the plan is open until 15 February.