Daily Insight: The harm before the storm

“Meltdown” is an overused word but seems to be appropriate for what has happened to the ambulance service over the last few days. From an already horrendous situation where all trusts were at the highest level of escalation, things have got worse.

Last night HSJ revealed that, ahead of the strike, NHS leaders were pleading for NHS England chief executive Amanda Pritchard to spell out to ministers how thousands of patients were at risk of harm from not being reached by ambulances.

But the backdrop to this was a rapidly deteriorating situation over the last few days, with some trusts reporting hundreds of calls which could not be allocated an ambulance response. Response times had headed south, with the average category 2 response in the South Western Ambulance Service area being more than 3h 20m.

And by mid-morning on Tuesday more than half of the trusts had declared critical or business continuity incidents.

It’s hard to think of a worse position ahead of a strike. But things may not have reached rock bottom yet – with very little chance for systems to recover over Christmas, the next strike on 28 December is expected to be even more difficult. Follow our live strike blog here.

Orders from the top

Prior to entering politics, health and social care secretary Steve Barclay earned his living as a financial regulator, and his arrival at the Department of Health and Social Care meant there would be renewed focus on the NHS’s bottom line.

This now seems to be filtering through to decisions about the management of individual trusts, with national leaders blocking the reappointment of Sue Musson as chair of Liverpool University Hospitals Foundation Trust.

It is understood trust governors, system leaders and NHSE’s regional team all supported her reappointment for another three years, but it was blocked either by NHSE or the DHSC.

One source, who asked not to be named, said it was “intimated” to governors that the decision had come from Mr Barclay, although this is not confirmed.

LUH has been struggling on multiple fronts over the last year, performing significantly worse than average on key performance indicators for emergency, elective and cancer care.

It was rated “inadequate” for leadership by the Care Quality Commission last year, which sparked the departure of former chief executive Steve Warburton, whom Ms Musson had appointed in 2019.

It also missed its financial plan for the seven months to November by £6m, while a report by accountancy firm PwC, commissioned by the Cheshire and Mersey Integrated Care System earlier this year, has flagged various issues around financial governance at the trust.

PwC said its underlying financial deficit had deteriorated by £73m since it was formed three years ago, which was largely due to a “substantial increase in the trust’s recurrent cost base during the pandemic, with no clear plan on existing costs which were funded through non-recurrent income”.