Essential insight into England’s biggest health economy, by Ben Clover

How did London do during the great winter A&E crisis/“humanitarian” emergency?

Going by NHS England’s new “trusts with pressures” measure – very well. So well, that it would seem to be the rest of England that was having the humanitarian crisis, not London.

NHS England and NHS Improvement have attempted to replace the ill defined “black alert” with a four point pressures scale from one (low) to four (high) – the OPEL (operational pressures escalation level).

From the beginning of December to 8 January, there were 457 alerts at levels three and four across England. Only three of these were in London.

The alerts were at places you might reasonably have guessed: North Middlesex on 4 January, King’s on 12 December and Lewisham and Greenwich over the 7-8 January weekend. The last two inherited accident and emergency units from South London Healthcare Trust that tend to get overheated. North Middlesex has had well documented problems.

So maybe it’s the measure that is the problem here?

In the latest NHS England monthly data (the collection that actually has performance against the four hour standard), covering November, the picture is less clear.

London is home to none of the five trusts that have driven the huge spike in trolley waits. Of the 456 in England in November, 89 per cent were recorded at University Hospitals of North Midlands Trust, Pennine Acute Healthcare Trust, Worcestershire Acute Hospitals Trust, Medway Foundation Trust and tiny Weston Area Health Trust.

London did have the lowest single performance against the four hour standard in November – Hillingdon Hospitals Foundation Trust recorded a performance of 59.7 per cent – but didn’t see a single trolley wait.

More worryingly, the inner and outer north west London giants, Imperial and London North West Healthcare, saw performances against the four hour target of 68 and 65 per cent respectively.

But congratulations are due to the Homerton, with a performance of 93.3 per cent against the type one target it is the best in London and in the top 10 per cent nationally.

Kudos also to Barking, Havering and Redbridge University Hospitals Trust. In November 2015 its type one performance was 82.7 per cent. In November 2016 this was the national performance, while BHRUH scored 87 per cent when facing more or less the same number of attendances.

The trust has started reporting its elective waiting times figures too. Performance on this measure is still below the constitutional standard, but credit where credit’s due – enough for it to come out of special measures?


End of the phoney war?

The phoney war part of the congenital heart disease review may soon be coming to an end.

NHS England is due to start its consultation on the plans soon, and an early iteration saw London’s Royal Brompton and Harefield Foundation Trust in line to lose a service the commissioner considered sub-scale.

London Eye understands that although the old criteria for which trusts get to keep their services put the central London specialist trust in the firing line, it was only just below the threshold. By making some small deals with other London providers the criteria could be met, without all the knock-on effects for closing other well regarded services.

This would certainly be easier than another costly legal dispute. RBHT has already taken NHS England to the High Court once (this remains the most vigorous use of FT “freedoms” yet recorded).

Staying with the Royal Brompton, its CQC rating of requires improvement earlier this month seemed a little bit harsh – considering the infractions were fairly minor.

Not demonstrating adherence to the World Health Organisation’s surgical checklist sounds very serious, but in practice some trusts, especially the specialists, operate to their own higher spec for pre-surgery preparation.

It’s not easy, regulating even the simpler parts of complicated providers.