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

One small positive of the covid pandemic will be that the deeply condescending term “low-skilled worker” will have been dislodged from the minds of many, replaced with “key worker”. How long this lasts remains to be seen, of course, but for now the contribution made by people doing these key jobs is rightly being recognised.

Homerton University Hospital Foundation Trust’s decision this month to extend the contract of an external supplier for soft facilities management services, therefore, on the face of it, felt a little crass.

A third of the hospitals’ doctors wrote to the chief executive urging a rethink. It would mean the cleaners, porters and other support staff would be paid less than the Agenda For Change equivalents, they wrote, and would have sick pay in line with the statutory provision.

Now is the time to stand by their colleagues, the medics explained: “Their work is invaluable to the care we offer our patients. Without these colleagues, our hospital would run poorly.”

Terms and conditions for hospital cleaners, porters etc has come under renewed focus over the past few months as trade unions have pointed out that staff receiving statutory sick pay could face a perilous choice of self-isolation on meagre funds or working on regardless, spreading the virus.

But for the trust there is more to this decision than just the bottom line. It has not shut the door on the idea of bringing in-house some of the facilities management services, as the chief executive told the FT’s governors at a recent meeting. But it is about to embark on major estate works. Theatres, the pathology labs, pipework will be overhauled. The trust wants a degree of stability in its facilities management in the meantime.

Stand by your beds for phase three

Segregation, infection control, and the need to be prepared for covid-19 demand mean trusts will have to continue operating at reduced capacity.

HSJ understands that NHS England chief executive Sir Simon Stevens is to write to all NHS organisations early next month to lay out plans for phase three of the recovery from covid. The letter is expected to focus on the importance of working at a system level to get more services up and running.

Senior NHS sources said the recovery plans are likely to include proposals for creating pooled system-level waiting lists between trusts, but there is still internal debate over the extent to which changes could effectively be mandated; for example by attaching significant incentive funds. The move appears to be aimed at ensuring an “equitable level of care” across a patch and avoid postcode lotteries within each system.

In a statement, NHSE said individual providers’ would ultimately still have responsibility and accountability for their waiting lists, even where this might be “supplemented” by system-wide arrangements.