Your essential update on health for the week

HSJ Catch Up

This weekly briefing 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

Room for improvement

HSJ’s revelations that members of the public with no care experience are being offered up to £1,000 a month to rent spare rooms to patients after they are discharged from hospital, under an Airbnb-style model to be piloted by the NHS, were swiftly followed up by national media.

Reactions to the story were predictably varied. Many balked at the idea of putting up patients in private residential homes after they’re discharged, raising concerns about how patient safety could be guaranteed and such a model regulated.

Some praised the company CareRooms, the Essex NHS bodies and councils involved for having the gumption to try something new to address bed shortages, with current efforts to fix the problem making little headway.

But following high profile media coverage, and groups, including unions and adult social care directors, raising concerns, Southend Hospital appears to have changed tack.

Trust deputy chief executive Tom Abell said in a statement: “Whilst we welcome and encourage new ideas and innovation, there is no intention and there never has been for the hospital to support this pilot at this time.

“We will never compromise the safety and quality of care for patients and we will not support this pilot until the necessary safeguarding and quality arrangements are in place and there has been full engagement and discussion with our local communities on the proposal, this will happen after a period of detailed work and scoping that we have requested.”

Surgery theatrics

Does the NHS have hundreds of thousands of operations’ worth of unused capacity in its theatres?

Headline findings of an NHS Improvement study briefed out on Tuesday suggest the NHS could do an extra 280,000 elective operations a year if elective operating lists were better organised.

It’s an eye-catching claim. The final study isn’t ready for publication yet, so it could be a while before we can scrutinise it in detail.

However, the Royal College of Surgeons was quick to point out that the reason some operations begin late is that there isn’t capacity elsewhere in the hospital to transfer people out to after surgery. As ever, patient flow and delayed discharges hold much of the answer.

Nigel Edwards of the Nuffield Trust added: “There is an important question about whether there would be enough capacity in other parts of the hospital, like intensive care, to do operations in this time.”

Meanwhile, NHS Providers’ head of analysis Phillippa Hentsch told us it wasn’t clear how NHSI have calculated their claim that if those extra operations went ahead “the NHS could have generated and £400m in additional income”.

We expect commissioners might have something to say about that, and look forward to the full report.

Third strike

In the last 10 days, HSJ has reported on highly critical CQC reports on three independently run mental health units for young people. All three had shared failings around staffing and management, leading to concerns about the safety of patients in their care. All three closed to new admissions – and one has closed indefinitely.

These units – run by Cygnet in Woking and Sheffield, and Huntercombe in Torquay – provided care to some of the most vulnerable young people in the country, often in psychiatric intensive care units and detained under the Mental Health Act. Most of the places were commissioned by NHS England – costing the taxpayer tens of thousands of pounds a week.

With the CQC expected to issue a report on CAMHS any day now, this rush of failing units raises questions about the model for providing care. Many tier four beds are run by private providers – but the issues around staffing are common across the NHS mental health sector as well.

Given the failings at Woking, eyebrows have been raised at the inclusion of Cygnet in one of the pioneering new CAMHS care models .

With limited tier four beds for these specialist cases, the NHS would struggle without these private providers.

E-prescribing makes sense on paper

The case for electronic prescribing and medicine administration in hospitals has been bolstered by a new study and strong words from the NHS’s top ranked digital clinician Keith McNeil.

The headline findings of the NIHR study, which is awaiting publication, echo previous international studies and what many digitally minded NHS folk have known for years.

Namely that a well-developed digital system that follows medicine from pharmacy to bedside, links to digital patient records and with clinical buy-in, saves lives (and money).

Money has been thrown at e-prescribing in the past, with limited success, and there is little specific incentive or central funding pushing uptake currently.

Dr McNeil has suggested more regulatory pressure would help.

Possibly. But for many trusts still relying on paper, investment in basic IT systems will be needed before they can even consider deploying e-prescribing.

Elective activity frozen

Winter is approaching fast and one trust has already conceded that its elective activity will suffer from the inevitable rise in demand for emergency care.

The big questions for Portsmouth Hospitals Trust are how much its elective work will reduce by, and at what cost?

New chief executive Mark Cubbon has made no secret of the fact that his organisation will “take a financial hit”.

But he is equally sure the six month plan is necessary to improve, or at best maintain, current A&E performance and patient flow.

With a savings plan of £34m already being revised, these measures are not going to make accounting at PHT any easier.

Elective work cannot be relaxed for too long, because the trust is already facing questions over waiting times and its ability to manage patients waiting for follow-up appointments.

Virgin fights commissioners

Virgin Care has begun what is likely to be a very drawn out battle with East Staffordshire Clinical Commissioning Group.

After just over a year of providing community services under a “prime provider” contract, Virgin has demanded more money for its services.

Sources told HSJ the private provider is requesting addition sums of up to £5m but the CCG was very clear in an FOI response to us that it is resisting any claims from Virgin for more money.

The unanswered questions are: Can the CCG indefinitely resist Virgin’s demands? Could the private provider hand its contract back if the CCG does not yield? And where will commissioners be left if this does happen?