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

An unenviable choice

HSJ’s revelations yesterday that significantly more patients could be sent to private providers as fears grow the NHS will miss its flagship elective target laid bare the tough choices facing ministers on addressing the ballooning waiting list.

Senior sources told HSJ that some system leaders had privately already all but written off the NHS’s chances of meeting its flagship 18 week elective target as NHS England and NHS Improvement geared up for one last role of the dice.

Local commissioners and providers have been ordered to draw up contingency plans setting out how they will deliver their elective trajectories and how much capacity in other trusts and/or the independent sector they believe they require.

Put simply, ministers will be given an unenviable choice: send more patients private and damage trusts’ finances, or try and deal with the list within the NHS and see the list grow.

And this is just the first of many tough choices which will be foisted on health and social care secretary Matt Hancock as winter approaches. HSJ understands there are also increasing concerns the NHS is not as well prepared for winter pressures as it was last year (see Performance Watch).

It’s going to be a long winter.

Patients treated like ‘cattle’

Bosses at Shrewsbury and Telford Hospital Trust are facing mounting challenges over the safety of the trust’s services after HSJ revealed more suspected maternity failings at the trust than previously thought, prompting the Department of Health and Social Care to widen an existing review into maternity services.

Separately HSJ has been leaked a letter to the trust from the Care Quality Commission which warned it could face legal action. The CQC letter says staff at the trust told inspectors they felt patients were being treated like “animals and cattle” in “unsafe, demeaning, undignified, and disgusting” conditions.

These are worrying comments and give an indication of the serious issues facing the trust on multiple fronts. But the issues the CQC raises cannot be said to be unique to SATH – the “boarding” of patients is a regular occurrence in NHS hospitals struggling to meet increasing patient demand with thousands fewer beds and no significant investment in community services.

The issues at SATH need tackling. But so too do the wider safety concerns that the CQC must have for the wider system.