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

Subculture shock

Being a clinical leader in the NHS is fraught with challenges, but new research from the General Medical Council has suggested the biggest challenge of all could come from your own team of doctors.

The medical regulator has produced a report defining five clinical subcultures that could be harmful if they are allowed to develop within a team. Among them, the “diva” is highlighted as one that is most difficult to change if the “chief actor remains in situ”. However, addressing this is probably easier said than done in many cases, as this person is often powerful and, as pointed out by HSJ readers, rather good at their job.

Other interesting findings included a direct connection between showing emotions at work and the quality of care that patients experience, and good relationships between doctors and managers being a lightning rod for a collaborative culture.

The report does not reflect well on NHS England and NHS Improvement, however, as a quarter of the clinical leaders interviewed reported negative behaviour from the regulator and also from the top of their organisation.

There is little in terms of practical advice on how to dismantle harmful subcultures, but this research has certainly ignited a debate.

A muted national emergency

Across the country, it is thought around 2,500 people rely on intravenous nutritional feed because they can no longer digest normal food. These patients are literally kept alive by manufactured bags connected to IV lines which introduce the food they need directly to their bodies, bypassing their digestive system.

HSJ has reported serious delays to the supply of IV feed for hundreds of patients which has led to some, including children, being admitted to hospital to receive IV fluids after their feed bags were not delivered.

The situation is now so serious the NHS has declared a national emergency incident and is considering importing feeds from other countries.

You would be forgiven for thinking such a move would prompt a statement by the Department of Health and Social Care and health secretary, advice and information for worried patients, and a public notice of what is happening and why and when the situation will be tackled.

Nothing like this has happened and, while NHS England has provided HSJ with some answers, the details of patients affected by delays, the numbers admitted to hospital and information about the incidents being caused have not been released.

Transparency over this national emergency is seriously lacking. Clinicians, meanwhile, are battling to ensure patients get the nutrition they need but many are asking how such a situation has been allowed to come about.

Many question the tactics of the Medicines and Healthcare products Regulatory Agency, which imposed restrictions on the manufacturer Calea without warning and apparently with no contingency or attempt to plan for the inevitable disruption.

Questions over the fragility of the IV feed market and why the NHS was so reliant on a near-monopoly provider need answers.