Your essential update on the week in health

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.

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Where now for emergency care?

HSJ’s analysis suggesting 24 emergency departments, around 15 per cent of the national total, could be closed or downgraded in the next four years gives the first post-sustainability and transformation plan estimate of the number of A&Es which could be re-classified.

It was never going to be a straightforward exercise, but we can take a straightforward lesson away from it: NHS England’s vision for between 40 and 70 of the existing 185-odd accident and emergency departments to become “major emergency centres” and the rest becoming “emergency centres” has simply not materialised.

Bold action on A&E

NHS Improvement has turned its focus towards the worsening issue of handover delays.

In a letter obtained by HSJ, NHS Improvement said some trusts were applying “unacceptable rules” to delay or restrict ambulance access to hospital emergency departments.

The national regulator told trusts to stop it IN BIG BOLD CAPITAL LETTERS, warning them about the serious risks to patient safety resulting from ambulances being delayed in EDs.

In a subsequent letter, NHS Improvement told both acute and ambulance trusts that they weren’t kidding about the need to reduce handover delays and would even be launching a national support programme to help areas improve.

Worcestershire’s virtual reality

Worcestershire Acute Hospital Trust was in the news again – this time for a whistleblower’s claim that A&E staff avoided four hour target breeches by placing patients in a “virtual” ward.

In the spirit of openness and transparency, Worcestershire shared with HSJ its original investigation in to the allegations.

An internal audit found that A&E patients were recorded on the trust’s system as being in the emergency decisions unit, when in fact they still remained in A&E.

The trust is clear its investigations found no deliberate attempt to “game” the system but did admit there were some “poor processes and recording” issues.

The Dalton forward view

Never one to shy away from innovation and bold policy suggestions, Sir David Dalton has set out how the NHS can achieve the service changes promised by the Five Year Forward View much quicker than has happened so far.

“We all praised what the forward view wanted us to do – but sadly we are behind on organising how it can be delivered at pace,” the Salford Royal and Pennine Acute boss says. “Despite good work on integration and new models of care, it is taking us too long to deliver improvements.”

In an exclusive article on, he describes 10 ways to get the forward view back on schedule.

He proposes the removal of provider trusts’ “right of veto” over change and a large reduction in the number of clinical commissioning groups.

Sir David also suggests replacing national targets with locally selected indicators, as the current system “distorts real priorities” with “diminishing returns”.

Heroic leadership ‘redundant’

Chief executive of Nottingham University Hospitals Trust Peter Homa has shared his reflections on NHS leadership after announcing his retirement from the trust after a decade in charge.

Mr Homa, who has worked in the NHS for 35 years, also revealed he would have stayed on at the trust for another two if the planned merger with Sherwood Forest Hospitals had gone through.

Among some of his most interesting insights, Mr Homa said the “notion of heroic leaders” was redundant, emphasising instead the job of a chief executive was to work with their staff and to “conduct an orchestra rather than being a soloist”.

New GP contract published

GP practices that close during core hours will be cut off from receiving extra funding under new contract rules.

Under the 2017-18 contract, GPs have been told “practices which regularly close for mornings or afternoons on a week day will lose their eligibility for the current extended hours scheme”.

Rationing row continues

In the sequel to three CCGs’ high profile rationing row, we find one of the groups saying the decision to restrict knee and hip operations was a result of advice from a higher authority.

Redditch and Bromsgrove CCG, one of three Worcestershire commissioners accused of rationing the services without “clinical justification”, has said their hand was guided by an official from NHS England’s Right Care programme.

In a statement to HSJ, the CCG said it worked with an NHS England appointed partner to understand how to use Right Care data, which was subsequently used by the CCGs to make their decision on hip and knee ops.

Right Care is a programme launched by NHS England to help commissioners tackle “unwarranted” variation in care. It’s had different iterations over the years but the most recent version has seen CCGs receive data packs that compare spending, activity and outcome measures for certain procedures between commissioners with similar demographics.

According to Redditch and Bromsgrove, the packs for it and South Worcestershire and Wyre Forest CCGs showed they had higher spend and activity compared to their peers, indicating they could make £2m in savings.

Brace yourselves for bad news

In his latest expert briefing, HSJ’s finance correspondent Lawrence Dunhill sounds the alarm ahead of the release of NHS finance figures for quarter three of 2016-17.

He says: “A letter sent out by NHS Improvement last week signalled that bad news is coming on the financial plan for the provider sector. The regulator paved the way for some uglier performance figures than we got last time.”