Your essential update on health for the week.

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories 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.

Not keeping up with demand

Six months ago, one of the most troubled trusts in the country got a boost from the Care Quality Commission — Worcestershire Acute Hospitals Trust had its overall rating raised to “requires improvement”. There was even talk of lifting the trust out of special measures, where it has lingered for about four years.

But high demand has seen two of the trust’s accident and emergency departments — upgraded to “requires improvement” in September — flipped back to “inadequate” after an unannounced inspection.

The CQC saw lengthy ambulance handovers at the overcrowded Worcestershire Royal Hospital as a particular problem. In December, 797 handovers lasted more than an hour, the bulk of which took place at the site. That number has since fallen to 566 in January and 89 in the first 10 days of February.

As one HSJ commenter points out, the unit’s emergency department is simply too small to meet local demand. Like many private finance initiative projects, it was built with the view that demand for beds would drop, not soar.

The non-sledgehammer approach

After a year of deliberation, a decision has almost been reached on whether to introduce a register for NHS directors. And it seems the current favoured option is a voluntary — rather than mandatory — register.

Tom Kark QC’s review of the fit and proper person test, published last year, recommended the creation of a new compulsory central database for all directors’ qualifications and history, and a regulator which could blacklist them.

However, the working group set up to consider the NHS’ response to the Kark review is keen to avoid the bureaucratic demand and complexity of creating a new regulator for senior managers, with one member describing it as like using “a sledgehammer to crack a nut”.

Here’s one we stockpiled earlier

Hospitals treating coronavirus patients in Wuhan, China, are running out of protective gear, and sadly are likely to need a lot more. Workers are avoiding meals and toilet breaks to preserve supplies as hospitals appeal for public donations, according to state outlet People’s Daily

In response, the Chinese government has cracked down on exports of goods including face masks and gowns. And when the world’s largest exporter stops shipping goods, you can bet it will squeeze the global supply chain. 

The Department of Health and Social Care says it has stockpiles in place to keep supplies coming as China plugs its pipelines. Luckily for the DHSC, suppliers have been hoarding goods in case of a no-deal Brexit for some time. On Wednesday evening, government asked them to hold onto those handy stockpiles.

Trusts — which, in contrast to suppliers, have been asked not to stockpile goods or make unusually large orders — have also been promised “uncapped” capital funding to build isolation units and other facilities needed to respond to the outbreak.  

Croydon’s latest claim to fame

Croydon has trams. And before too long, it will have another even more exciting claim to fame: a borough-spanning integrated health and care system formed by NHS and local authority providers and commissioners. Can you match that, north London?  

The borough’s combined acute and community provider, Croydon Health Services Trust, is at the heart of this and a key step has been aligning the trust with its commissioner.

Its chief executive, Matthew Kershaw, is now Croydon’s “place-based leader”. This means he continues to run the trust while ostensibly also running the clinical commissioning group (which remains a separate statutory body, under accountable officer Sarah Blow, who fills that role across all six of south west London’s CCGs).

The commissioners are merging. After April 2020, when they have agglomerated, Ms Blow will be AO of the unified commissioner and Mr Kershaw will be the place-based leader for the Croydon health system, with “full delegation” ensuring “decisions about Croydon are made in Croydon,” the trust told HSJ.

All this should lead to less fragmented care and improved outcomes. Understandably, this work is occupying quite a lot of the trust leadership’s time. Unfortunately, according to the Care Quality Commission, this has been to the detriment of some services which have seen quality and safety deteriorate.

Under review

The worrying case of Harry Richford — the baby who died after a chaotic delivery and resuscitation at East Kent Hospitals University Foundation Trust — was always going to need a hefty response from the trust.

It has announced it is setting up a special subcommittee to look at its maternity services. The subcommittee will be chaired by Des Holden, a respected obstetrics and gynaecology consultant who is medical director of the Kent, Surrey and Sussex Academic Health Sciences Network.

Under Dr Holden, the subcommittee will review what the trust did in response to a critical Royal College of Obstetrics and Gynaecology report in 2015-16, look at whether the trust complies with national safety standards and make sure it implements the coroner’s recommendations in Harry’s case.

A fig leaf

Scrapping the nursing bursary back in 2017 was much more about making financial savings than cutting student attrition, yet the latter was claimed by some at the time as a fig leaf justification.

The idea was that tying students more closely to the cost of studying — normally by taking out a loan — could reduce the drop-out rate from nursing courses.

However, according to data from the relevant agency, the Higher Education Statistical Authority, the drop-out rate has remained stubbornly consistent despite the move