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

NHS England employed external consultants PA Consulting on a £200,000 contract to carry out a ‘function mapping exercise’ – or, in layman’s terms, to tell NHSE what its responsibilities were.

This was done at the start of 2018, ahead of NHSE announcing a closer working relationship with NHS Improvement.

Some of the consultants earned the firm daily rates of up to £1,900.

One insider criticised the use of the consultancy firm, arguing NHS England should have the staff and ability to do that work itself, especially given much of its role is set out in legislation under the Health and Social Care Act.

NHSE, however, argues this was a complex issue and the work will contribute to the successful merger, which will ultimately save the taxpayer £100m.

More missed targets

John Appleby from the Nuffield Trust put it best – the performance results data released on Thursday “looks pretty appalling”.

With the first quarter’s accident and emergency results the lowest ever, record high elective waits and trolley waits, and missed diagnostic targets in the monthly announcement, you can understand where he’s coming from. The think tank chief economist goes as far as to express surprise there doesn’t seem to be any ministerial statement on ever-declining performance.

Yes, there are more referrals. No, there is no more (or not enough) money. So the tacit understanding is that we’re just going to keep missing these targets, or retire them?

NHS England and Improvement brief about how long it has been since the targets were created, that they’re due an overhaul.

The world of A&E hasn’t changed that much. The target was reduced from 98 to 95 per cent in 2010 – why not just overhaul the whole thing if it warped clinical priorities so?

NHSE/I also seem reluctant to release the old-style data from the 14 sites that are piloting the new measure. Why? They are collecting it, after all.  They have argued it will skew the impact of the trial.

It’s important to note from the data that is available: things have got worse this quarter compared to the last three years.

Quarter one in 2016-17, 2017-18 and 2018-19 were all around 90 per cent, so the drastic drop to 86 per cent this year augurs ill for the rest of the year.