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

Procedures of low financial value

While it’s eye catching that a hospital trust is considering approaching its local Premiership team for funding (via a surcharge on food and drink), arguably more significant is the proposal to start offering procedures of low clinical value privately.

North Middlesex University Hospital Trust admits this idea would only raise a small amount of money, but it has a policy implication that is far larger.

Procedures of low clinical value were something the NHS was supposed to stop doing because they were largely ineffective. It was sold that way, with the lowered cost of not providing them on the NHS being a happy side effect.

Offering them privately at the same facilities where they were once part of the NHS offer will be more disturbing to the public than a link up with the football club.

Imagine living locally and having to pay for a tonsillectomy (or other procedure) for one of your children when their siblings got theirs free.

Who pays for what is a fundamentally political decision.

Whether the approach to Tottenham Hotspur works or not, the system is already skewed against smaller, outer London trusts.

While the big teaching hospitals have huge charitable foundations (with funds often built up over more than a hundred years), the trusts that need the money most are not so well off.

And, even if they were, it gets into dangerous territory when the NHS is routinely dipping into its charitable funds for the day-to-day business of providing care.

The Royal Free London Foundation Trust (whose advances NMUH rejected earlier this month) did just that when its charitable arm bought one of the trust’s buildings off it.

An increased use of charitable funds by NHS trusts would be another political issue.

Would the charity be able to put restrictions on what its donation was used for? It is already a vexed issue about whether London specialists have the right to restrict out-of-area referrals. Further diversifying the funding streams complicates accountability even more.

Battle to reduce A&E cancer diagnosis goes on

Being diagnosed with cancer in an emergency department is not a good sign. It is used as a proxy indicator for late stage cancer and therefore poor rates of survival.

It is good news therefore that the variation between the best and worst performing clinical commissioning groups seems to be shrinking. Public Health England this month released the final tranche of data from 2017, giving us six complete years of data on the proportion of malignant, invasive tumours diagnosed in accident and emergency.

The data shows the range between the clinical commissioning group with the highest proportion and the lowest in 2012 was 15 per cent. Last year it was 12 per cent.

There are still plenty of CCGs reporting A&E diagnoses rates over 25 per cent and a small group of urban areas with high levels of diversity and deprivation keep popping up in the top 10 worst performers.

CCGs point to a combination of social factors, such as fear of the test and what it might say, and deprivation and smoking rates, as well as more practical issues, like not giving patients clear information on the need to be checked for cancer, or not giving that information to them in a language they can understand.