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

Is it possible to quantify the harm being caused by delays in ambulance response times? The answer is inevitably “no” – it’s always very hard to link a specific outcome case to what may be a delay of a few minutes in an ambulance arriving.

In many cases, ambulance staff may not know what happened to a patient when they hand across care at an emergency department and so may not report it as an incident.

However, HSJ’s investigations have uncovered ample evidence that delayed responses are increasingly featuring in serious incidents being reported across the country.

Some ambulance trusts are upfront about this – West Midlands’ board papers refer to “delays… resulting in harm, serious harms and deaths” while others have responded to Freedom of Information Act requests, with figures showing increases in the numbers of serious incidents involving delays. The link may not be conclusively causative but the upward trend is telling in a period when ambulance response times have lengthened.

There is rising concern about this. The Stroke Association says that “lives and recoveries are being put at extreme risk”. Ambulance chiefs are obviously worried: some have put risk ratings related to delays at 25 – the highest possible level.

Yes, minister?

NHS England has made clear that integrated care systems must present a case to them and ministers if they want to pay their executives more than £170,000.

Leaked guidance, seen by HSJ, has set the “operational maximum” pay levels for executive roles on integrated care boards – such as chief medical officers, chief nurses and finance directors – which vary based on weighted population.

Each of the 42 systems are placed into four separate groups, with those serving up to 1.5 million people having different maximum pay levels compared to those with populations above 1.5 million.

The document said any ICB wanting to pay someone above the relevant “operational maximum” or the £170,000 ceiling, “whichever is the lower,” must “present a pay case” to NHSE and the Department of Health and Social Care.

It added: “Appointment announcements should not normally be made until the outcome of the pay case has been agreed.

“Where ministerial approval needs to be sought, candidates should be made aware that this will lead to a delay in confirming their appointment, in order to manage expectations.”

The guidance added that pay approval also applied to executives switching roles on the same salary or those appointed on a part-time basis.

Also on today

In a comment piece, Managers in Partnership chief executive Jon Restell says the money for the fight against covid is drying up, and in Recovery Watch, Matt Discombe examines the latest relaxation in infection control rules, saying that the spread of covid within hospital settings remains a significant risk.