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

Three strikes…

Shrewsbury and Telford Hospital Trust has had three strikes in the safety and quality playoffs.

This week HSJ reported the under-fire trust has received its third enforcement action notice from the Care Quality Commission.

The provider, which has faced a string of critical stories regarding its safety record, has now been told it needs to address concerns within its intensive care and medical wards. The previous warnings were focussed on care in its emergency department and maternity wards.

Several HSJ readers have commented on the frequency of the issues uncovered at this trust over the past few months. With its CQC report due out very soon, some may wonder how many strikes the organisation has left.

Eastern problems exposed

A senior system leader’s concerns about the “significant problems” facing a struggling ambulance trust were laid bare in meeting minutes obtained by HSJ.

NHS England Midlands and East regional director Paul Watson raised concerns about the East of England Ambulance Service Trust including that it was appearing to prioritise less urgent patients over those in greater need.

During the meeting on 28 September, Dr Watson did acknowledge “significant improvements” in some areas at the trust.

But the detailed unpublished minutes detail a raft of fundamental concerns which follow whistleblower allegations last winter about patient harm caused by ambulance delays and cultural problems.

The concern raised about clinical prioritisation should raise alarm bells not just at NHS England but at the CQC.

“[Dr Watson] challenged [the trust] on over performance for category 4 calls [the lowest risk category] at the apparent expense of more clinically urgent C2 patients in particular,” the minutes said.

The trust insists it will prioritise the most seriously ill patients, but such an allegation from a senior figure cannot be taken lightly.