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One of the last things NHS managers need right now is for the government-commissioned review of NHS management to turn into a “blame game”, with leaders “set up to fail [against] unrealistic expectations”.
Unfortunately, NHS Providers chief Chris Hopson has warned there is a risk of precisely this eventuality.
Mr Hopson said: “The implication of some of the stuff around the review [led by General Sir Gordon Messenger]” was that the best way to deal with some of the NHS’ most challenged trusts was to “kick out the NHS people and bring in somebody from outside the NHS”.
Speaking exclusively to HSJ ahead of the NHS Providers’ annual conference this week, Mr Hopson said a lot of troubled trusts tend to have structural issues that require systemic solutions, rather than leadership regime change.
He added: “So, we would say, isn’t it finding the answers to the structural solutions and finding ways to incentivise and support our best leaders to go into those trusts which is the right answer, rather than… saying the best thing to do is to kick out the NHS people and bring in somebody from outside the NHS, which is the implication of some of the stuff around the Messenger review.”
Mr Hopson did however suggest the die was not yet cast. With Leeds Teaching Hospitals’ well-regarded chair Dame Linda Pollard playing a central role and the review pledging to “work closely” with NHS England chief executive Amanda Pritchard, there is still hope it won’t be a pre-emptive stitch-up.
However, the aggressive briefings around the review when it was initially announced and Mr Hopson’s comments this week are ominous.
Untriaged, unanswered and at risk
No one doubts that an overstretched NHS is carrying enormous risks at the moment. From patients waiting to be seen in accident and emergency to those on waiting lists who may be deteriorating, the potential for patient harm is everywhere.
But probably some of the biggest risks lie with ambulance services at the moment. As HSJ reported, the Association of Ambulance Chief Executives has carried out a structured clinical review of handover delays over an hour which found 160,000 patients a year could potentially suffer harm – and severe harm in 12,000 cases.
That is, however, only part of the picture. It’s harder to measure the harm caused because those ambulances sitting outside A&Es are not responding to other patients who have called 999 and are waiting at home or elsewhere for one to turn up. These patients may be deteriorating and, in the case of category 1 patients, may be dying.
Repeat calls to ambulance services – often prompted by delays to ambulances turning up – are also presenting challenges to call handlers. HSJ noted last week how much longer it was taking ambulance services to answer calls as call volumes increased. No one knows if these unanswered calls are for someone in cardiac arrest or with traumatic bleeding: they are untriaged and may represent the highest risk of all.
There’s no quick or easy solution to this and AACE has been careful not to blame other parts of the NHS for the problems. While some actions may improve matters, the issue of handover delays seems likely to dog the NHS through the coming winter and possibly beyond.