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

COBRA and anatomical waste

There has been lots of shouting about HSJ’s story, which exposed the stockpiling of human body parts and other dangerous waste by waste management company Healthcare Environment Services.

While most of the reporting has understandably focused on some of the more gruesome elements of the story, relatively little has been said about why the government did not draw the public’s attention to HES’s failures to incinerate its waste and the knock-on effect on the NHS.

Following the story’s publication last Thursday, Yvette Cooper, the MP whose constituency includes Normanton (where excess waste was stored at five times the maximum allowed), fired off a series of questions on Twitter – including why Parliament had not been told of the issue given a COBRA meeting had been held.

Shadow health secretary Jonathan Ashworth has also got involved, asking an urgent question in the Commons on Tuesday on that exact subject.

In response, health minister Steve Barclay said Parliament could not be told because of the “commercial sensitivity” of the contracts that were being discussed and negotiated with HES and Mitie.

He did not expand, however, on exactly why highlighting HES’s failing would jeopardise the government’s ability to secure contracts with other providers.

Meanwhile, HES defiantly published a two page statement “slamming” the decision to terminate the contracts, and warned it would heap extra pressure on other providers in the waste management market.

But the implications for accountability being set against commercial confidentiality remain unclear, worryingly. It makes you wonder what other issues have been the subject of COBRA meetings without anyone outside knowing about it.


Towards the end of Tuesday, NHS England and NHS Improvement published proposals that could have far reaching consequences for the provider sector.

The document confirmed what HSJ had already learned, that the government was looking to make outpatient appointments cost the same whether or not you see a consultant. At a stroke, trusts would be incentivised to have outpatients seen by someone who is not necessarily a senior medic. Whether this is an overdue move towards a right sizing of workforce and who does what, or a dangerous incentive to have patients seen by underqualified staff remains to be seen.

The end of the marginal rate tariff was also proposed, something that will be greeted warmly by trusts, who mostly don’t have much control over who shows up at their accident and emergency.

Meanwhile, Simon Stevens – speaking at the NHS Providers conference – trailed broader changes to the NHS financial regime, including a move of money from the provider sustainability fund into tariff, but not all in one go.

It’s not clear quite what this will mean, with speculation about a possible shift of around half the fund to a form of payment for emergency care.