Your essential update on health for the week

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories from the last week in health. If you have been out of the office or otherwise just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

Shake-up in the South West

Wednesday was a big day for Dorset’s NHS as the clinical commissioning group met to decide on a host of proposals that will shape services over the next decade. 

The most controversial element was the CCG’s plan to centralise emergency and elective services at Royal Bournemouth and Poole hospitals respectively.

Chiefs in Poole were resigned to losing their emergency department last year, when the CCG made Bournemouth its preferred choice for a major emergency hospital.

But the plan prompted a predictably angry reaction from residents and NHS campaign groups.

The CCG even hired three security guards for today’s meeting, according to the Bournemouth Daily Echo, but the event appeared to pass smoothly – as did all the recommendations put in front of the governing body.

Further west, two small trusts have announced plans to merge.

Gloucester based 2gether Foundation Trust and Gloucestershire Care Trust are set to appoint a joint chief executive and chair by December.

It means an end to the trust whose unusual name prompted NHS England to issue guidance about what NHS organisations should be called.

Chief executives resign

If you were shocked by the sudden departure of two acute trust chiefs over persistent failure against the emergency target, then you were supposed to be.

Ministers and NHS Improvement want to send a clear message to the rest of the system: underperformance of the kind seen in around 20 trusts nationally cannot become “normalised”.

The departures of Matthew Kershaw from East Kent and Libby McManus from North Middlesex were announced at lunchtime on Friday.

The two resignations were voluntary, but clearly coordinated. Interestingly, NHS Improvement’s official response emphasised the need to prepare for winter and the possible coming flu outbreak.

Children’s hopsital owed millions

London specialist trusts enjoy an enviable position serving the international private patient market.

This is worth tens of millions of pounds and forms a considerable slice of the overall private work done by NHS organisations in the capital.

But there are significant headaches that go along with that, as the case of Great Ormond Street Hospital for Children shows.

Organisations are wary of losing follow-up business if debtors are pursued too vigorously.

Work from the foreign embassies in London is also lucrative, but they can be surprisingly bad customers.

GOSH has a turnover of £444m and was owed £30m for IPP work at the end of August. In the last financial year, the trust’s income from this work stream was £55.2m.

A chicken and egg scenario

Is bigger better? Not according to Steve Field, the Care Quality Commission’s chief inspector of general practice.

The professor has claimed that while “scale” enables better communication, it does not dictate whether a practice provides good care.

The CQC’s State of General Practice report says inadequate practices tend to have an average list size of 5,000 and those rated outstanding an average of 10,000.

But despite the apparent correlation, Professor Field told HSJ that scale, or rather size, is not the key factor when it comes to outstanding rated practices.

Rather it is the practice’s leadership and whether they communicate well with other GPs and other parts of the system.

Essentially, he argues that increasing scale may help where GP leaders are not good at communication, but scaling up does not automatically mean practices will perform better.

There is also the question of what we mean by scale. Some would argue that having a list of 10,000 is not necessarily working “at scale”.

NHS England has certainly indicated the ideal is GP hubs working across populations of 30,000-50,000.

Professor Field’s comments add an interesting dimension to the debate of whether bigger is better in GP land.

We seem to be in a bit of a chicken and egg situation – do better performing GPs tend to scale up or does scaling up make them better GPs?

Warnign over ‘advanced’ nurses

Concerns that NHS trusts have been wrongly branding care staff as nurses even though they are unqualified and not registered has prompted action from England’s most senior nurses.

A letter signed by NHS Improvement’s Ruth May and NHS England’s Jane Cummings has warned trusts not to describe care staff as nurses and told them to check they are not already doing so.

The chief nurses have also warned providers to make sure they advertise posts with the correct titles, linked to education and qualifications.

The letter came after research by Professor Alison Leary at London’s South Bank University revealed that hundreds of care staff had “nurse” or “advanced” in their job title when they shouldn’t have.

Professor Leary said advanced nursing practice should be regulated and the title “nurse” protected like “registered nurse” is.

Southern Health guilty again

Southern Health Foundation Trust has pleaded guilty to breaching health and safety law over the death of a teenage patient.

The prosecution was set up by the Health and Safety Executive after 18 year old Connor Sparrowhawk drowned in a bath following an epileptic fit while he was in the care of the trust at Slade House in Oxford in 2013.

Southern Health will be sentenced on 12 October – when it will also be sentenced following its guilty plea to a CQC prosecution over safety failures at Melbury Lodge, where a patient broke his neck after he fell from the roof.