Daily Insight: The NHS's fire safety issues go beyond cladding

The case for capital

NHS Improvement has highlighted the hopefully-obvious-to-ministers importance of capital investment to fire safety.

An investigation by HSJ, which started earlier this year, reveals a range of concerns related to outstanding enforcement notices; maintenance backlogs; problems with PFI buildings; and issues related to compartmentalisation – which is meant to restrict fires spreading.

In the wake of the Grenfell Tower disaster the use of external cladding has also come to the fore as a potential fire risk – we’ve already reported on how trusts have been asked to review their use of such materials.

However, NHS Improvement’s response to our investigation makes it clear that there is much more than cladding to worry about. Emphasising that fire safety should be an “absolute priority” for the NHS, the regulator said it was working with providers to identify risks and ensure the right action is being taken, “both in terms of cladding specifically, but also on fire risks more broadly”.

As ever – money matters. The statement continued: “The NHS is a huge and varied group of buildings and facilities, so there is some complexity in this.

“To address some of the variations involved and make sure all of that estate is as safe as it can be, we are looking at how we can generate more capital investment in the NHS – backed by a commitment from the government to spend more on NHS capital.”

If the Conservative Party’s election manifesto still matters, there was a pledge for a major capital investment programme – NHSI clearly hasn’t forgotten that Theresa May has backed the Naylor report and pledged £10bn of capital investment off the back of its recommendations.

“Spending to remedy any issues to improve fire safety should and will be an absolute priority,” said NHSI.

Neither is regulatory action on fire safety is not confined NHS Improvement. On Tuesday, the CQC (under orders from Jeremy Hunt) also asked independent hospitals, care homes and hospices to check their buildings – totalling more than 17,000 organisations.

Going soft

After plenty of tough talking, this year’s big drive to control NHS spending appears to have been softened up by regulators.

The “capped expenditure process”, which introduced a shared financial target for providers and commissioners within 14 struggling health economies, had ordered local leaders to start making “difficult choices” to control spending.

But when some of the potential implications – including lengthening waiting lists, reduced staffing levels and service closures – started to filter through to the mainstream news pages last week, it seems ministers got cold feet.

National leaders have now accepted that only around half of a near-£500m financial gap can feasibly be closed, and even that will come with a lot of risk.

As previously reported by HSJ, leaders in some of these 14 areas had considered whether to systematically draw out waiting times for planned care, including explicit consideration of breaching the 18 week waiting standard, and limiting patients’ ability to opt for non-NHS providers.

But in a letter sent out on Tuesday, NHS Improvement said providers in these areas should not be considering plans that would breach patients’ constitutional rights over elective care, and will need to ensure that patient safety and service quality are maintained.

And importantly from trusts’ point of view, it sounds like there could be more involvement – and perhaps “air cover” – from national leaders in terms of assessing the plans.

What is also interesting is that the letter has been sent only to providers, from the provider regulator, whereas previous communications were also addressed to commissioners, and sent jointly with NHS England.

The process always appeared to be predominantly driven by NHS England, so it raises questions over the lack of alignment between the two bodies.