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

Bid for your buildings

Perhaps given the lack of capital available for the NHS to spend on its estate, Department of Health and Social Care officials have turned their attention to making the best of what the service already has. 

One example of this thrifty thinking is a recently revealed policy that allows trusts to apply for ownership of buildings which are on their estate but currently belong to NHS Property Services and Community Health Partnerships.

The scheme has potential – the combined portfolio of the two organisations accounts for over 10 per cent of the overall NHS estate.

It is likely to be of particular interest to community trusts, whose estate commonly comprises many different types of buildings scattered around their patch. Acute trusts considering taking over GP surgeries will also likely be studying the guidance closely.

But, as appears to be the case with most NHS estates projects, the process of getting approval for transfer of ownership looks complicated and involves a lot of different people.

Trusts must demonstrate the strategic, economic, commercial, financial, and management benefits of the project, before getting those benefits endorsed by the relevant clinical commissioning group(s) and the NHS England/NHS Improvement regional team.

And then NHS Property Services or CHP will also have their say. Plus the views of the tenant of the building must be taken into account, and their feedback will be considered by the DHSC bid team.

The good news is that the DHSC has committed to assessing bids within six weeks of submission. This certainly demonstrates a willingness from the centre to speed up the process for delivering such projects, and goes a little way in offering an olive branch to trust estates directors who have grown weary of battling to unlock allocated capital funds.

Injustice for the vulnerable

The care of patients with learning disabilities has – rightly – risen up the agenda in recent years, with policy struggling to catch up as families increasingly find their voice over the injustices some are suffering.

The national learning disabilities mortality review programme, or LeDeR, was designed to offer a system for local areas to review cases, learn from mistakes and implement changes. At the same time, the process would provide data and key messages for the wider system, compiled in the eagerly awaited annual reports.

But, for this system to work, families must have confidence in it.

So HSJ’s revelation of how one CCG tampered with a high-profile report into the death of 18-year-old Oliver McGowan paints a bleak picture of a process susceptible to watering down and altering by local commissioners and decision-makers who were not involved in the original reviews. 

As one CCG mortality lead reviewer told us, the way the process has been developed – with no clear legal framework or guidance from NHS England – means CCGs are capable, should they wish, of making significant alterations.

Oliver McGowan’s case may be just one in more than 4,000 deaths reported to the LeDeR process for review.

But, if it can happen in one case, then – as his parents say – it can happen elsewhere.

There is now an urgent need to ensure LeDeR is safe from tampering and being delivered in a way which can guarantee families true independence. Without this, the system may continue to inflict further injustices on some of the most vulnerable patients it is charged to care for.