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

Winter and a nanny state debate

Regulators yesterday sent out their latest pre-winter orders to trusts in a letter calling for “faster” improvements on cutting patients’ length of stay and published a long-awaited review of lessons from last winter. The 40 worst ambulance handover delay performers this winter will receive “intensive support”, it added.

The letter also confirmed the return of the “national escalation pressures panel” model trialled last winter. It was this national group of clinical experts and system leaders which decided on extending an elective work freeze in January.

The letter, from emergency care chief Pauline Philip, also stressed that trusts must take “robust steps to move quickly to 100 per cent staff vaccination uptake”, following separate instructions to trusts on flu.

NHS bosses have long wanted to have 100 per cent uptake of flu vaccination for staff (it was around 69 per cent last winter). But making the vaccination compulsory has always been considered a step too far, and not something a state employer should foist upon its staff.

The latest winter instructions however push the choice element to the limit, suggesting that staff who aren’t vaccinated could be taken off certain duties.

It said trusts should consider “changing deployment of staffing in [high risk] areas… [as long as they can maintain safe staffing levels] to limit the exposure of the most vulnerable patients to unvaccinated staff”.

There were also issues with which flu vaccines should be administered to patients last winter, so there could be further debate to come on this issue.

Give the money to Barking

What a difference a year makes.

In its budget for 2017-18, Barking, Havering and Redbridge University Hospitals Trust decided to plan for a small surplus and go without any government cash support for the year.

Twelve months later, the trust has been bailed out to the tune of £45m and reported a deficit of £55m.

The plan for 2018-19 looks more realistic, with the trust requesting more than £100m of cash support and setting a deficit plan of £53m (it rejected a tougher target offered by NHS Improvement).

But even this looks a tall order, given that it was posting an average monthly deficit of £6m in the first third of the year. If that run-rate continues, it will end the year with a £72m shortfall.

On a brighter note, the organisation is at less risk of being cut off by its suppliers - as has been threatened recently. Its most recent board papers show a significant uptick in the number of suppliers paid within a month - the proportion rising from 26 per cent to more than 90 per cent.