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

Spoil the NHS broth

Organisational restructures never seem far off the NHS’ agenda. So, amid the general kerfuffle of the long-term plan, HSJ brings you the latest chapter of the merger (sorry, “joint working”) between NHS England and NHS Improvement.

A new twist involves feedback from hundreds of staff who offered their opinions in the ongoing consultation. This included the delicate suggestion that the new management structure contained too many executive senior manager posts – a thought that won’t have escaped many of those who have reviewed the structure, frankly.

NHSE and I are proposing to cut the number of such managers from 373.8 whole time equivalents to 325.2, but, according to an email leaked to HSJ, staff are not convinced this goes far enough.

For context, the regulators between them currently employ about 7,500 people.

If those consulted get their way, managers who avoid the cull will then have the unenviable task of “bringing to life” how the new structure will make things better than before, and making it clear “why we are here, and how we support the NHS”.

On this point, the new NHS Executive Group also has its part to play.

The group, which brings together the most senior exec directors in the new structure, met for the first time two weeks ago, and members spent the session “getting to know each other”. Since 12 of the 16 appointees are already existing directors at either NHSI or E, you might have hoped they already did.

Other questions staff raised included whether the organisations have gone far enough to shift resource to the regions, and whether the proposals will actually make both bodies more efficient.

The consultation closes next Monday.

However, with this redisorganisation not yet complete, another may throw fresh confusion into the picture. HSJ reveals today that Matt Hancock, the tech enthusiast health secretary, is keen on reorganising all the national digital leads – including those in NHSE and I – into a new unit, possibly based in his department. 

Get those organograms out again, and hand me the marker pen.

Addressing the readmission spike

The NHS’ rise in emergency readmissions – a canary in the mine for any health system – in recent years is alarming. But the drivers and consequences are not well understood.

So system leaders’ decision to, as of March, compel commissioners to publish data on the numbers of patients returning to hospital within 30 days of discharge is certainly a welcome step in trying to address the issue.

The proposals were set out in new NHS Digital guidance, published this month, and represent a fresh attempt to capture data for a notoriously complex part of patient activity, after system leaders pulled the plug on collections in 2013 amid data quality concerns.

The move follows tireless work by Healthwatch England, the Nuffield Trust, and others to ensure the worrying trend did not slip under the radar.

And, with the NHS ramping up efforts to cut patients’ length of stay in hospital, ensuring readmission rates do not rise as a result remains a vital counterbalance to make sure patients do not get trapped in a cycle of needlessly going in and out of hospital.