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

The more they stay the same

This year’s HSJ100 is unlike any of its predecessors.

Judged amid a time of unprecedented political instability, the most recent list of power players contains no fewer than 40 new entries and 17 individuals rising or falling 20 places or more.

Meanwhile, just five individuals from last year’s top 10 – Simon Stevens, Ian Dalton, Matthew Swindells, Ted Baker and Pauline Philip – still occupy those coveted spots this year.

Even familiar names appeared with a different job title attached to them – the perhaps most noteworthy being the seven new joint NHS England/NHS Improvement regional directors. Sir David Sloman’s move from the Royal Free to London director has bumped his ranking up 25 places to 22. Heading in the other direction, NHSI’s current chief financial officer Elizabeth O’Mahony’s new role as South West chief has knocked her down the list 27 places to 54 (although probably granted her a better quality of life).

The list has also made some positive changes in diversity. Although two thirds of the places on the list still went to white men, 17 women are now ranked in the top 50 (compared with 14 the year before) while four people from a black, Asian or minority ethnic background are within the top half of the power list (compared with one last year). 

Despite the changes, some things have still remained the same. Mr Stevens has managed to swipe the top spot for the fifth year running. 

Special mention goes to the list’s biggest faller, Jeremy Hunt, who has dropped 74 places - but stays in the list despite his move to the Foreign Office this summer.

Mr Hunt served a record term as health secretary and therefore can be relied on to tell Matt Hancock where the bodies are buried. He is also keeping a close watch on how his pet subjects of patient safety and care quality are being handled.

A long-term plan for outpatients

There is wide consensus that the NHS’s often chaotic outpatient system, which costs nearly £10bn annually, needs a considerable revamp to drag it belatedly into the 21st century.

So HSJ’s exclusive revelations that regulators have already identified £700m of savings and will lay out further details on a major overhaul in the long-term plan will be largely welcomed, if cautiously in some quarters.

There is, however, one problem with the first statement. It implies “outpatients” is one homogeneous block of activity.

If only that were true.

As most HSJ readers will know, it’s a wide basket of services covering a wide range of specialities in a wide range of locations, and reconfiguring the services will require a wide range of improvements to a wide range of supporting primary and community care services.

There is no one-size-fits-all solution nor a one-size-fits-all target. Everyone may agree that a rethink about how outpatient services are configured is long overdue but there will be a wide range of opinion on how the task should be approached.

’Tis the season

Many in the NHS argue last winter never finished in terms of the pressure on services, but NHS England’s annual winter daily sitrep reporting season is back up and running. Expect doom laden headlines about ambulance diverts and bed occupancy every Thursday until March.

It’s hard to make a definitive judgement from one week’s data, but among all the gloom of high bed occupancy accompanied by news that four hour performance had worsened yet again, was there a ray of winter sunlight?

The NHS has set a target to clear 4,000 beds by shortening length of stay of so called super stranded patients, those who have been in hospital for more than 21 days.

For the first week of December, there were around 14,925 NHS beds occupied by super stranded patients (15.5 per cent of the 96,211 available general and acute beds).

This is compared to 16,588 for the same week last December (17.2 per cent of the 96,211 G&A beds available). 

Further tracking over a longer period and analysis is required but at least one data point hasn’t headed south. For now.