Daily Insight: Sir Bruce lays down the law

Bed capacity row intensifies

NHS England has come under pressure to act over England’s critical care bed capacity after two recent deaths saw chief executive Simon Stevens receive a warning from coroners. Today the Royal College of Surgeons urged NHS England to carrry out a review of critical care capacity in England.

Richard Kerr, a consultant neurosurgeon and council member for the RCS warned of further risks to patient safety if some STP plans made good there threat to cut acute bed numbers.

He highlighted that according to a 2014 study England had four critical care beds per 100,000 population compared with a European average of 11.

Hours after the RCS call NHS England’s medical director Sir Bruce Keogh intervened in the row with a letter to all medical directors re-stating existing guidance that patients in need of life-saving emergency surgery should not be refused, regardless of ICU bed capacity.

As the NHS increasingly looks to centralise specialist care these issues are likely to become even more pressing in coming years and it is tragically clear that where it goes wrong patients do die.

Mackey tightens screw on locums

It’s long been known in the service that agency nurses were an easier target for reducing costs than agency doctors – now we’ve seen official recognition.

HSJ broke the news that a new raft of measures was being introduced, aiming to force doctors holding an NHS contract but working for another trust to do so on a bank rather than agency basis.

That and the HMRC rule change on staff being paid as small companies to avoid tax could make a difference in the medium term but short term will create an administrative headache for trusts.

Stevens goes full ‘abolish the purchaser-provider split’

Simon Stevens has previously danced around the policy-wonk Nirvana concept of abolishing the purchaser provider split. Keen to keep it vague, the NHS England chief executive has previously garbled: “I do think there’s real value in distinguishing the planning and funding functions from the provision. But does it for all time have to be the split that we currently have and the way we work it? No, there are various models.”

Pressed to explain how in hell he is going to make sustainability and transformation plans work, in front of the Commons public accounts committee on Monday, Stevens went somewhat further: “We are going to for probably between six and 10 [STPs] actually get them going as accountable care organisations or systems, which will for the first time since 1990 effectively end the purchaser provider split bringing about integrated funding and delivery for a given geographical population. So this is pretty big stuff and actually people are pretty enthusiastic about it.”

If the lessons of the past year are anything to go by, this might come as quite a big surprise to those in the six-10 areas. Our intelligence suggests that, despite more than a year of STP work, figuring out what they put in place of the purchaser-provider divide is still proving a splitting headache.