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

Trusts are being increasingly forced to make difficult decisions in the wake of rising covid pressures and diminishing resources, and senior leaders in the capital are the latest to follow.

Hospitals in London are considering diluting their nurse-to-patient ratio due to workforce shortages as a tough winter looms, according to a leading critical care nurse.

Nicki Credland, chair of the British Association of Critical Care Nurses, told HSJ’s Patient Safety Congress “certain trusts” were doing “exactly what they were worried about”.

She said: “[We are] starting to move away from those [guidelines for the provision of intensive care services] standards that we have, that protect both us as nurses but also protect the patient’s safety as well.

“In some areas, particularly down in London, there is a discussion about changing patient ratios to one nurse to 1.75 patients. Simply because ‘We don’t have enough staff.’”

This is not a unique scenario. A Midlands trust has had to restrict how much chemotherapy it can provide due to the same problem.

While senior nurses have privately expressed concerns about the plans, which Ms Credland believes could risk patient safety, this is neither the first nor last time these choices will be made.

The Wight direction

A good news week for Isle of Wight Trust, which four years after it was declared “inadequate” has been moved out of special measures and rated “good” by regulators.

The Care Quality Commission increased Isle of Wight Trust’s rating — which was most recently “requires improvement” — following an inspection in June and July.

The CQC also recommended IOWT — which is England’s only integrated acute, community, mental health and ambulance healthcare provider — be taken out of special measures after inspectors found examples of “outstanding practice” at St Mary’s Hospital and in community services.

Inspectors praised IOWT for planning major response services in innovative ways during the pandemic, including with drone supplies, armed forces and police and fire brigade support.