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

Not going to waste

There is a phrase among leadership types about “never letting a good crisis go to waste”, and that seems to be what London’s NHS leadership have been thinking too.

As reported by HSJ this morning, NHS Improvement and England’s top team in the capital are hoping to move to a significantly different system by November 2021.

The document said: “As we move into a period in which covid continues to circulate and remains a threat, it is clear that to be the healthiest global city, we will need to fundamentally shift the way we deliver health and care – over and above those that we planned in the London Vision and our ICS plans”.

The new system would see the five integrated care systems (which still do not legally exist) as the principal organisational units of care in the capital, with the same leadership team that brought them through the covid-19 crisis.

What would that mean practically? One elective waiting list per ICS rather than per hospital trust, shared back office and support services. Effectively it would boil London’s trusts down into five big providers, each commissioned by the one big clinical commissioning group in that ICS. Or, a “provider system able to be commissioned and funded on a population health basis”, as the Journey to a New Health and Care System document puts it.

In practice the system has been moving in this direction for a little while. But the document still marks the boldest move yet in terms of just ignoring the existing laws around providers, commissioners, competition and the rest of the Lansley act.

Sir David Sloman’s team expect to “support” decisions on the concentration of cancer, paediatrics, renal and critical care capacity.

How far staff and the public buy in to a narrative that says “we must change services because of coronavirus” once the outbreak is over remains to be seen.

Keen to be remote

One of the changes system leaders are most eager to keep is remote consultation via Skype/Zoom/Other (it was one of the things mentioned in the document above).

The NHS was fortunate in the signing of one contract that allowed a lot of remote consultations to go ahead.

The Attend Anywhere software contract was only signed as the covid-19 crisis first intensified but provided nearly 80,000 sessions over April.

To be fair, this is but 1 per cent of the normal monthly outpatient appointments the NHS delivers but for many people, services will have made the difference between total shutdown and maintaining at least part of a service line.

Outpatient attendances are another big target for NHS planners. There were 96.4 milion of them in 2018-19, a 3 per cent increase year-on-year and up 59 per cent from a decade ago.

Sir Simon Stevens said nearly two years ago that the outpatients model was “obsolete” and targeted a 25 per cent reduction – so the old system could soon be replaced entirely with remote consultations.

Or replaced by nothing at all: 22 per cent of appointments go unattended, which fuels some of the interest in “patient initiated follow-ups”, ie “come in for a follow-up if you want one, but it won’t be automatically scheduled”.