The must-read stories and debate in health policy and leadership.
- Today’s moving target: Exclusive: Trial A&E target ‘driving completely the wrong behaviours’
- Today’s grand redesign: CQC lifts conditions on hospital after refurbishment work
What the Queen’s Speech means for healthcare
The briefing on Thursday’s Queen’s Speech — giving a bit of detail behind her short spoken statement — drew heavily, in places, on the Conservative’s election manifesto.
Much questioned promises feature, including that 40 new hospitals will be funded and built over the next 10 years and the NHS will have 50,000 more nurses, while the pledge that the “price for NHS drugs is not on the table” was also repeated.
The document itself gave few surprises. It included: increases to the surcharge that immigrants pay towards the NHS; enshrining in law the NHS multiyear funding settlement; introducing fast-track reduced-fee visas for NHS doctors, nurses and allied health professionals; and providing hospital parking for those in greatest need — based around disability, income and frequency of visits required.
Although not expected to, it didn’t say social care workers would be entitled to apply for NHS visas. This could cause huge problems to a social care system already struggling to cope with demand and goes against the current view on the ground that health and social care should be moving towards integration.
The paper confirmed the government’s commitment to publish a white paper on mental health reform has moved from the end of this year to “early next year”.
The government also continues to seek a cross-party agreement for a solution to the social care crisis. Although this was pledged in the run up to the election, the Conservatives might have chosen to move away from it now they have a large majority.
There was also inclusion of legislation that will speed up and ease the creation of integrated care systems, as well as a reintroduction of the Health Service Safety Investigations Bill, which reached its second reading in Parliament before it was dissolved for the general election.
This bill would beef up the current HSIB by making it an independent body and giving it statutory powers to conduct investigations.
As for the rest of the NHS legislation, it’s hard to read the government’s latest thinking precisely.
Matt Hancock’s promise to have the legislation done and dusted by the end of March — which always sounded rather ambitious — is not repeated, and the promise is of a government response to NHS England’s proposals, then “draft legislation”. Which does not sound like a hurried and unmitigated endorsement.
The paper merely said: “The government is considering the NHS’ recommendations thoroughly and will bring forward detailed proposals shortly.”
The new government’s first Budget may bring answers on NHS capital funding — and the government has now committed to publishing a national infrastructure strategy alongside this, which will set out how the government will invest £100bn.
The long wait
An audit of London trusts has shone a light on an issue which is widely accepted but for which we have little national evidence — mental health waits in accident and emergency departments.
The study of mental health patients across 25 A&Es in August found a pretty staggering 15 per cent waited more than 12 hours, while 55 per cent were not seen within the four-hour target.
Long waits for MH patients have been known about within the system but no data collection — or national target — has been collected which would provide the evidence needed to strengthen arguments for a solution to be found.
While more money is set to be poured into crisis services and community outreach, until those are up and running, mental health patients will have little choice but to keep going to A&E.
With this in mind and the fact bed capacity cannot in reality be kept down, the report makes a suggestion that all A&Es should have a dedicated mental health space.
However, HSJ readers appear sceptical, with commenters validly questioning whether a separate area would mean the “clock is stopped”, in effect hiding real waits, or could lead to patients being forgotten if not managed properly.
While separate areas may not be the solution, the report seems to have sparked a dialogue over mental health patients’ experience in A&E, which is always welcome.