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

Wake-up call

After confirming that he intends to remain in post for at least another year, NHS England chief Simon Stevens made a prediction which marks the clearest change yet from a long-standing policy.

In a wide-ranging speech to delegates at the NHS Confederation conference in Manchester, Mr Stevens said he expected the NHS would need to increase its acute bed base over the next five years.

The NHS long-term plan hinted at this but was less explicit. Mr Stevens went on to say hospitals’ bed stock is “overly pressurised” and that “increased capacity” is likely to be needed.

According to official figures, the NHS’ acute bed base has been falling consistently since 1987. However, in the last quarter of 2018-19 the number grew by around 2,500 compared to the previous quarter.

Whether this growth continues in the long term remains to be seen, and it will depend largely on trusts being able to afford to open more beds and then staff them safely.

Daily Insight’s favourite moment of the speech came right at the end when Mr Stevens playfully hijacked session chair Niall Dickson’s autocue by reading out the Confed CEO’s own specially prepared announcement (the merger of the Confed and Expo conferences). Maybe cue cards are a safer bet next time, Niall.

 

Avoidable harm

The most recent inpatient survey found public dissatisfaction with waiting times starting to grow.

It also noted a worsening in how long people had to wait for a bed once they were in hospital.

This is perhaps to be expected considering the lack of beds in the English NHS, indeed it’s a little surprising this didn’t show up in the inpatient survey earlier (and probably a testament to staff that it didn’t. The survey found faith in doctors and nurses had stayed high.)

What’s a little disturbing is the NHS England response to the data.

A spokeswoman replied that the findings, taken as a pretty significant warning sign by everyone else, were mainly a “useful way” for trusts to “learn and improve”.

They also cited the British Social Attitudes Survey, saying it showed “for the third year in a row public concerns about waits have reduced”.

This might be why of the three main performance targets, the elective one was so obviously de-prioritised.

This might be why Parliament’s public accounts committee said the centre appeared to “lack curiosity” about the effect of longer elective waits on patients.

Serious enough for any procedure, but particularly ophthalmology, where people have already avoidably lost some of their sight.

There is some scepticism about the assessments of patient harm carried out at trust level when a hospital loses track of its waiting list and follow ups (trusts marking as they do, their own homework).

But even if it’s true that no one has come to “harm” as a result of sometimes hugely delayed treatment, these assessments don’t take account of suffering and inconvenience very well.

NHS England has already effectively pre-abolished the national accident and emergency measure (stopping reporting at 10 per cent trusts where the new measure is being trialled ends the comparability of a data set going back 18 years – convenient as performance gets worse and worse).

A new standard is also being introduced for cancer (the main old cancer standard not having been hit for some time).

The danger with de-prioritised RTT and non comparable A&E and cancer is that the right things don’t happen with services because the picture has been made unclear.