HSJ’s must read stories and analysis from Monday

Handover delays under the spotlight

We revealed on Monday that Jeremy Hunt has ordered system leaders to step up efforts to curtail ambulance handover delays and draw up new plans by the middle of this month.

Long ambulance queues outside hospitals are, of course, as much as a symptom of a system under tremendous strain short due to shortage of staff and beds as they are a problem in their own right.

But despite the health and social care secretary’s intervention provoking frustration from some HSJ readers (see the comments below the article), it is welcome that ministers are prioritising the issue.

Even within the awfully constrained resources at hospitals, some of the poorer performing trusts on handovers contacted by HSJ said there was room for improvement by following best practice from better performing neighbours.

It would be wrong to dismiss this simply as a problem of funding and staffing levels.

Meanwhile, ambulance trusts are under huge financial strain and are adapting to the new targets in the midst of a major workforce shortage and with many trusts desperately needing to modernise their fleets.

Back office politics

In practice, making back office savings is a painful process.

It’s important to make the cuts if it helps protect clinical services, but you can see why trusts shy away from it where they can.

At best, it means transferring large numbers of, often part time, staff to a new provider or trying to find them other jobs in the organisation. At worst, there is a swathe of redundancies.

The Carter review of provider efficiency was supposed to hold trusts’ feet to the fire on a number of fronts, including this one.

How did it go?

Well the benchmarking, if there was any, was not revealed trust by trust.

Nevertheless, Lord Carter’s recommendation accepted by NHS Improvement was that these costs should form no more than 7 per cent of a provider’s turnover.

The savings were to have taken effect as of this month.

The results?

NHSI is not collecting this data and trusts are not being held to account for it.

The regulator says £120m of savings will be made in this area as part of the normal run of the mill cost improvement programmes (the way these savings always would have been included in cost improvement programs) but has not said where or how.

Suppliers describe the market for outsourcing these services, whether to NHS or outside suppliers, as moribund.

This part of the Carter agenda does not look to have been a success.