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

Yesterday on the morning of the Lords’ second reading of the Health and Care Bill, NHS Providers accused the government of reneging on an agreement to safeguard one of the last freedoms for foundation trusts: the ability to set their own capital spending plans.

Until now FTs have been at liberty to turn their cash reserves into capital to spend on care, looking to improve quality and performance. But this has been a bit of a problem for integrated care systems, which get issued with a capital spending limit each year and are obliged to ensure their constituent organisations stick within it.

NHSP has argued that it was unfair for boards of FTs to be held to account for performance and the quality of the care they provide while simultaneously not be allowed to spend the money that would enable them to improve quality and performance.

They agreed a compromise with ministers and the NHS to put safeguards in the NHS 2019 legislative plan that gives NHS England the power to direct FTs on their capital spending but only as a last resort.

So NHSP was understandably underwhelmed to see the Health and Care Bill contain a clause that would strip that away, giving NHS England the power unfettered to set the spending limits of FTs.

NHSP has called on the government to change course and hopes the Lords will support them in amending the errant clause. At the time of writing, only Lord Lansley had spoken out in favour of maintaining FTs’ independence. But with the draft law still to traverse through the Lords committee stage, there is still plenty of time for this issue to be addressed.

Sex misconduct shame

HSJ has learned of multiple cases of sexual misconduct against staff within ambulance trusts, perpetuated by a “macho” culture.

They include women being told that giving sexual favours would help them get on to paramedic training; a student on placement who could not take off her jacket without comments being passed on her breasts, and therefore would wear it even on the hottest days; and a student given a lift by her supervisor who proceeded to rub his hands up and down her legs during the journey.

In a freedom of information request, the 10 ambulance trusts in England were asked for the number of incidents in which allegations of sexual misconduct, harassment or abuse had been made against staff. They reported 221 cases since April 2019, of which at least 27 resulted in dismissal and at least 44 resulted in other disciplinary action, with some cases still under investigation.

In most cases, another member of staff was the person who was assaulted or harassed, but in around 50 cases a patient was the victim. In other cases, members of the public and hospital staff were involved.

Professor Duncan Lewis, a researcher at Plymouth University who has investigated issues at several trusts, has said recently: “What was very stark, to me at least, was the highly sexualised banter and sometimes more explicit behaviours reported to me by frontline ambulance staff. I would say I encountered more of these types of event in the three ambulance organisations I have worked with than all other organisations I have studied over 25 years.”

Read Alison Moore’s full investigation.