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

Royal Marsden and NHS England hit by cover-up claims

Service reconfigurations are always controversial, especially when prompted by safety concerns and deaths. HSJ has published a major investigation into how NHS England “buried” concerns about the way child cancer services were organised in London, specifically the Royal Marsden’s inability to provide intensive care services.

The service has been found to be unsatisfactory by a series of expert reports and implicated in a number of incidents and deaths.

Former NHS England London medical director Andy Mitchell has publicly accused NHS England of a cover-up and said either the Marsden chief executive Cally Palmer or Simon Stevens is responsible.

Ms Palmer is accused of a major conflict of interest due to her role as national cancer director for NHS England.

These revelations are not purely historic, with the latest draft cancer standards being “softened” following interference from NHSE’s national cancer team.

Serious questions are now being asked about the probity of NHS England and next steps for the Marsden and Ms Palmer.


Letter escalates pressure on OAP performance

The long-running saga of problems caused by inappropriate mental health out of area placements has intensified with the letter sent by NHS England’s national lead for mental health to regional directors.

Claire Murdoch singled out 10 mental health trusts for bringing down the national performance on the placements but, interestingly, chose to contact the directors rather than the trusts themselves.

She demanded action be taken and warned that future transformation funding would be denied if improvements weren’t delivered.

She told regional leads they must “take urgent action” as the 10 trusts accounted “for the majority of out of area placement activity” nationally.

In March, HSJ reported that data analysis suggested the rate of total OAPs had remained relatively flat, but the proportion of those placements lasting more than 15 days had increased.

The data also showed that 96 per cent of OAPs were classed as “inappropriate”, defined by NHS Digital as caused by a lack of available beds, as opposed to, for example, being admitted after presenting at accident and emergency while away from home.

The government has said that “inappropriate” placements should be eliminated by 2020-21.