The must read stories and talking points in the NHS

Sticking plaster statistics

Cast your mind way, way back to the beginning of the very long winter, and you will recall there was a big row over whether changes to the rules on emergency activity coding were going to paint too flattering a picture of waiting times performance.

The UK Statistics Authority got involved in January, raising concerns over the accuracy of national accident and emergency performance data.

The issue arose when then NHS Improvement chief executive Jim Mackey, shortly before departing, sent a letter to all trusts, which the regulator maintains was intended to iron out “inconsistencies” between trusts on which admissions were included in A&E data.

The move was viewed as a sticking plaster solution to try and address a long standing issue quickly before winter.

Now, HSJ has revealed details of NHS England’s review of the issue.

It tells us two important things.

First, that some trusts’ activity data was “artificially inflated” as a result of changes made following the Mackey letter.

And second, and most importantly, that the effect was pretty negligible overall – between 0.11 and 0.18 percentage points on the national figure for performance against the four hour A&E target.

The NHS England review said that overall about 26,000 admissions were wrongly included over a three month period which saw 6 million such episodes overall.

However - these would have been concentrated in a few trusts rather than evenly distributed.

Norfolk and Norwich University Hospitals Foundation Trust has already been penalised for including walk in centre admissions in its A&E data. It is unlikely to be the only one.

And the NHS England review is not the end of the matter. The UKSA has said it will continue to monitor progress on these important statistics. NHS England is also continuing its own review.

A full and transparent process, which most likely includes a public consultation, to update the guidelines in a robust and evidence based manner would appear the most sensible way forward. NHS England declined to comment on whether it would be consulting.

Any new sticking plaster solutions are likely to come unstuck pretty quickly.

When propcos are a bad idea

Large scale capital decisions made more than a decade ago to the lasting detriment of the organisation are not just an NHS issue, it turns out.

The recent announcement by BMI Healthcare’s main shareholder that it was pulling out of the UK market came after five years of fruitless negotiations with BMI’s landlords – and shows it can happen to private companies too.

Netcare, which owns 57 per cent of the business, said the annual 2.5 per cent increase paid to the private equity firms who own the land was “unaffordable”.

The whole situation came about because BMI’s previous owners decided to set up a separate company to own the assets, and charge the operating company an annual fee to use the facilities.

Apart from the salutory lesson that provides, it matters to the NHS because BMI Healthcare does more than £370m’s worth of publicly funded elective procedures – up and down the land.

BMI itself, a cash rich business, said it intended to carry on as normal but its future ownership could have implications for commissioners.

The firm is the second biggest private provider of this work after Ramsay Health Care.

If Ramsay did buy it, they would have a critical mass in the market – although it may have to sell a site in the east Midlands to satisfy the Competition and Markets Authority.

A more likely option could be that the landlords take a share of the operating portion of the business. Either way an ordely exit is expected from Netcare and the position should be clearer within a year.