The must read stories in health from Wednesday

Firing the starting gun, not the STP leader

HSJ considered earlier this week whether STPs are dead or just being born. On Wednesday, Jeremy Hunt and Simon Stevens attempted to send out a clear message that there is life in the STP process.

Hosting an event for STP leaders and other great and good, the NHS England chief executive said he was “firing the starting gun” on sustainability and transformation plans (prompting the retort from STP leader Amanda Doyle that in Lancashire they had started running hell for leather some time ago).

Mr Hunt was present, as was an all-star audience including two health ministers and NHS England’s most senior execs. King’s Fund chief executive Professor Chris Ham even broke his holiday to chair this jamboree – swapping Britain’s coastal cliffs for debating another crumbling monolith.

Mr Hunt spoke enthusiastically about the forthcoming ratings of STPs, forcing a room full of STP leaders to grit their teeth. He also rammed home a wise message, that the great risk about all this was obsessing with organisaitonal form.

Three accountable care system (super-STP) leaders gave a good account of how they were working to make things better for patients. Unfortunately Frimley’s Sir Andrew Morris soured things by blurting out a sexist comment – something pointedly critiqued on Twitter by Greater Manchester leader Jon Rouse – which could have led to some disruptive tension at the subsequent ACS/devo development session.

It was a gathering for champions of the whole system/preventative/integration way of life. Sir Andrew complained that given his area is reducing emergency and elective admissions, NHS Improvement would soon be on his back about holes in its financial plan. Mr Stevens declared that payment by results was indeed on the way out, contrary to some countervailing signals, and “planning and integration are back in fashion”.

Mr Hunt even said he wanted to see the health budget spent on sorting out damp in people’s council homes – albeit not for five years, when presumably the health budget will have grown fat and England won’t be in the grip of reactionaries and populists.

There was something in it for fans of NHS buildings and machines, too, however - to the tune of £325m. This tranche of capital funding – just a “down payment” as Mr Stevens reminded everyone – has been allocated to a spread of improvements/developments from cancer units to primary care hubs; most linked to tricky reconfigurations of some form.

It all goes to STPs rated in the top categories, and will give them a very helpful boost for winning support from local organisations, staff, public, and anyone else who wants to join the team for the gruelling health system relay race.

Culture club

The rhetoric over the need for a change in culture in the NHS when it comes to patient safety and learning from harm can seem ever present but intangible.

But there are signs that some practical steps are being taken. Mersey Care Trust has embarked on a “just culture” initiative and is seeing measurable improvements across a range of metrics.

The trust hosted Professor Sidney Dekker, author of the book Just Culture and director of the Safe Science Innovation Lab in Australia last week, and the prof granted HSJ time for an interview.

He was keen to stress that leaders shouldn’t fall into the trap of thinking they can change culture on their own and emphasised that their job was to create the environment that allows the staff to change the culture.

Professor Dekker, an authority on system learning and culture, also warned that regulators in the NHS had their own part to play in making sure chief executives had the space and “horizon” to change culture rather than chase short term goals.

Many leaders in the NHS will recognise how far the system really is from the ideals Professor Dekker sets out.

The key is trust, he said, and ensuring families are not outside the process. Organisations needed to take responsibility, he said. “Few things are as inauthentic in the eyes of families as an organisation who says ‘this wasn’t us, it was a bad apple’. Families immediately see through that and will accuse the organisation of trying to protect and distance itself from what happened.”