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

On alert

Overstretched NHS trusts are struggling to find time to implement critical patient safety alerts, a report shared with HSJ has warned.

Action Against Medical Accidents asked trusts why they were missing deadlines to make safety changes asked for by NHS Improvement to prevent serious harm and future deaths.

The alerts not implemented by trusts — often for years at a time — related to issues such as misplaced tubes, medication, and invasive procedures.

Through Freedom of Information requests, trusts told Avma time and resource pressures were the most common reasons why these alerts had not been fully acted upon.

One trust told Avma “available resources, capacity, need for business case approval, reliance on external guidance” and delays in national codes of practice being published were among the reasons for the delays.

The report, by former head of safe medication practice at the National Patient Safety Agency and NHS England David Cousins, also raised concerns trusts are being left to develop their own solutions to long-term safety risks.

More than half of the patient safety alerts issued by the National Patient Safety Agency since 2002 have not been updated since the now-defunct agency’s website was archived in April 2012, which has caused “uncertainty” over the status of these risks, Avma said.

Airless rooms

Julie Wood has used her exit interview from NHS Clinical Commissioners to tell HSJ what keeps her up at night.

First and foremost was the concern the shift from sustainability and transformation partnerships to integrated care systems may result in losing the grit in the system that makes sure providers and commissioners are being held to account. Others have raised similar gripes but this marks the first time NHSCC has been so vocal about it.

Ms Wood, who has a long history in NHS commissioning, warned of a return to the “airless rooms” from before the internal market was introduced if commissioners are not held to account for the decisions they make for their communities. She said the new “best value test”, as set out in NHS England legislative proposals, would be crucial in ensuring this accountability but acknowledged there is a long way to go to work out how this will work in practice.

She also warned NHSE must not inadvertently trip into top down reorganisation in its pursuit of meeting the national deadline of all STPs becoming ICSs by April 2021. She said there is evidence NHSE is listening to local areas as they plot their transformation paths but added, if change was imposed again from the top, like during the Lansley era, the system would “lose at least three years’ worth of transformation”.