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

Amanda Pritchard warned last month that pension tax issues were presenting a major issue for trusts seeking to gun down their waiting lists.

The issues go way back to 2016, when the government cut the tax relief thresholds on pension contributions, presenting a powerful disincentive for thousands of senior doctors to do extra shifts.

Trusts have since deployed various workarounds to mitigate the policy, including a solution where the employee leaves the pension scheme and is given additional salary in place of the employer’s normal pension contribution. 

But despite ‘pension recycling’ being endorsed by NHS England, many trusts have yet to implement it due to nervousness about the legal implications.

Internal emails suggest this was the case at Liverpool University Hospitals recently, a decision which has angered many of its consultants and now risks a “flurry” of early retirements.

At hospital but at harm

More than 38,000 patients were put at risk of harm during March – more than 4,000 of them seriously – while they waited in an ambulance outside hospital, according to estimates shared with HSJ.

The number of hour-plus delays to handing over patients from ambulances to emergency departments in March was the highest ever recorded, following steep increases since last summer.

Figures collected by the Association of Ambulance Chief Executives, and shared with HSJ, reveal that one trust recorded a delay of 23 hours during March. 

The average of the longest delays recorded across all England’s 10 ambulance trusts was 11 hours.

There were 21,639 delays of more than two hours – nearly 18 times the number in March 2021 – with 44,000 hours of time lost when crews could have been responding to other incidents.

Yesterday HSJ reported that Deborah Lee, the chief executive of Gloucestershire Hospitals Foundation Trust – which has had very high numbers of ambulances waiting to handover patients at accident and emergency – was driven to hospital with a suspected stroke rather than waiting for an ambulance.

AACE managing director Martin Flaherty told HSJ: “The most significant problem remains hospital handover delays which continue to increase exponentially, with tens of thousands of ambulance hours being lost due to hospital handover delays, causing enormous knock-on effects out in the community, where delays in people receiving the ambulance resource they need are the obvious result.”

Also on today

In news, we report that NHS England, the Care Quality Commission and other arm’s length bodies will be subject to an efficiency and performance review led by the Cabinet Office, and Julian Patterson finishes the HSJ week in entertaining style by offering some alternatives to the most misleading phrases used by doctors.