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

Lengthening life for the dying

The national clinical audits, which measure the detailed outcomes for patients in different specialties, have long had a low profile.

But they tell you hugely consequential things: the number of people injured during their cataract procedure, the number of people who have surgery for lung cancer early enough to make a difference.

So it was surprising to learn last year that the Care Quality Commission was not routinely informed about outlying trusts in the audits – you could have a service line that had demonstrably poor results for years and the national quality regulator was none the wiser.

That’s changed and audit providers are now required to tell the CQC about outliers. But, when HSJ approached those trusts flagged as outliers since 2018, the responses broke down into heartening and less heartening.

A lot of trusts say, “oh, it’s just a data problem” – but that’s hardly reassuring.

If it was a data problem, then how do you know your results in previous years, that said you weren’t an outlier, were correct? If it is just a data problem, then shouldn’t the auditors have cleared that up with you? Why is data about fundamental quality issues so flaky?

The other category of outlier responses were trusts taking quick, and often expensive, action to remedy things.

This reflects that, actually, many trusts and their clinical leaders have always taken these results seriously. Although this data is little known, the better organisations have long been using it to inform their practice.

It’s where the data fell through the cracks (because the trust did nothing, the CQC hadn’t been told and it wasn’t the auditors’ job to do anything) that it gets worrying.

HSJ’s recent story showed East Kent Hospitals University Foundation Trust as an outlier on some lung cancer measures.

It scored very low for the number of incurable, late stage patients given chemo or other treatments that would lengthen and enhance the quality of their lives.

So some patients in Kent got less time with their loved ones than they might have done if they’d lived elsewhere. That’s worth knowing.

Why that happened is less clear but the trust has since hired more cancer nurse specialists (so it was probably about money) a few years ago.

Legislation for integration

How will NHS England’s legislation plans land amid the current political stalemate? With a little difficulty, if we can judge anything from comments to HSJ by shadow health secretary Jonathan Ashworth.

Earlier this year, NHSE consulted on several proposals to change legislation which is largely seen as inhibiting its integration ambitions. The proposals included removing various competition laws. Now its finalised plans – following consultation and examination by MPs – are on the agenda for its board meeting on Thursday as a mooted “NHS Integrated Care Bill”.

Officials will be hoping the bill can form a part of a forthcoming legislative programme in a Queen’s Speech. The current government had this pencilled in for October – but this is thrown into question by Tuesday’s ruling that Parliament is no longer prorogued.

Meanwhile, while government has no Commons majority, passing any legislation will rely on cross-party support.

HSJ asked Mr Ashworth during Labour Party conference if his party would back legislative proposals from NHSE put forward by the Conservative government. His response was that Matt Hancock has “no chance” on getting legislation through. Not surprisingly, Labour won’t be keen to nod through Tory-backed legislation on this totemic left-wing subject.

Yet politics is in flux.

It was previously mooted that the bill could make its way through if put forward and championed by cross-party figures – such as Commons health committee chair and now Liberal Democrat MP Sarah Wollaston. It seems unlikely; but stranger things are happening in Whitehall.