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

Staffing tensions simmer

The Treasury’s confirmation that the Budget will still go ahead on 11 March, despite an unexpected change of chancellor, has prompted a few funding rows to spill over into public.

On Friday, HSJ reported the major cancer charities had written to the health and social care secretary to raise concerns that NHS workforce proposals — known as the NHS People Plan — don’t promise enough by way of new staff to do what’s needed.

Their choice to write to Matt Hancock initially seemed a little odd since as the People Plan is being written by NHS England and Improvement.

But it has transpired that it is the government which is blocking the domestic training of new staff — holding, as it does, the purse strings for education and training.

No medium-term budget has been set for these and, as NHSE/I’s response to the story makes clear. And this will be needed before it can go any further on cancer or other staff training.

In a newly empowered government, NHS workforce — especially the prime minister’s central 50,000 nurses pledge — is being taken rather seriously. Yet many within government will feel they shouldn’t have to allocate the NHS any more money until, at least, a multiyear spending review later in the year.

Throw into this standoff issues like ministers seeking NHS delivery commitments on other things, like waiting times, controversy over scrapping targets, and new legislation, and the rows may just be getting under way.

Staying on target

An 11th-hour push has been made to convince NHS England to set a “maximum time-to-assessment” for accident and emergency departments — even if it decides to drop the four-hour target next month.

Healthwatch England’s intervention comes ahead of final proposals for NHSE’s clinical review of standards, expected in March.

In a report, Healthwatch said NHSE’s proposed new measure of tracking the time to initial assessment — to identify life-threatening conditions faster — is “not enough to ensure urgent cases are not missed”.

“We would like to see a maximum time-to-assessment target put in place for all those attending A&E, alongside a commitment that first assessment will be clinically and emotionally meaningful for patients,” Healthwatch said.

Healthwatch also said there should be a transition “period” where the four-hour target continues to be reported to compare performance over time.

Time spent waiting in A&E departments is not the only factor which matters to patients when considering their experience, Healthwatch added.

The report, based on 330 interviews with patients at six A&Es trialling the new measures, said quality of care, communication, staff attitudes and how well EDs are joined up to services, such as GPs and NHS 111, are also important factors behind patients’ experiences.

“Focusing performance measures on simply tracking time spent in department, however it is measured, will not necessarily drive the improvements the NHS wants to see,” Healthwatch said.