The must-read stories and debate in health policy and leadership.
- Today’s regional reading: North by North West: Was ‘Devo Manc’ a success — part 2
- Today’s legal battle: Trust in £2m legal battle with pharma company
Liberating the NHS
HSJ deputy editor Dave West writes in an editorial that NHSE’s powers and responsibilities do indeed need a haircut — but they should be passed out to regions, systems and localities; not given to ministers.
The default candidates for NHSE to devolve power to are integrated care systems — but what form do they take, and are they really able to take on the necessary roles. In coming months the very most able and willing ICS could take over NHS England/Improvement’s “oversight” and “scrutiny” jobs. But for most, the buck will still continue to stop with NHSE.
The most likely answer at the moment from government is quite close to NHSE’s proposal from last year: perhaps creating an ICS committee named in law, mandatory nationwide, and with defined functions and membership — similar to health and wellbeing boards, and well short of becoming a “legal entity”.
It would probably mean a mandated formal role for local government, which itself could be controversial. Despite some criticism leveled at Greater Manchester’s devo efforts recently, its health and care authority could be a useful model.
And, incidentally, we have just published the second part of a series on Greater Manchester’s impact on outcomes during the time of the devo experiment, by North West correspondent Lawrence Dunhill.
A fig leaf
The idea was that tying students more closely to the cost of studying — normally by taking out a loan — could reduce the drop-out rate from nursing courses.
However, according to data from the relevant agency, the Higher Education Statistical Authority, the drop-out rate has remained stubbornly consistent despite the move.
Alison Leary, professor of healthcare and workforce modelling at London Southbank University, is clear the reason for nursing students leaving their courses is “multifactorial”, and said it was unlikely getting rid of a tax-free bursary was ever going to mean more people graduating.
Looking to the future, it will be crucial to track whether introduction this year of £5,000-£8,000 maintenance grants for nursing students — an acknowledgement, announced late last year, from government itself that the wholesale move to loans was a flop — can boost student numbers.
According to UCAS data released last week, there was a 6 per cent increase in applicants by the January deadline. If the government had moved earlier last year, it might have seen an even larger boost.