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.

Digital turnaround

A year ago, the state of digital providers made for an alarming read. The Care Quality Commission thought nearly half were, in some way, not providing a safe service.

The biggest concerns were around a laissez-faire approach to prescribing medicine, including opiates, and not telling a patient’s regular GP about prescriptions.

Roughly a year on, a few of these providers have shut down (or been shut down) and a few new ones have sprung up, but the overall number remains about the same.

What has improved is quality. An HSJ analysis of CQC reports shows, at last reported inspection, only six providers were deemed to be offering care that was not safe in some way. This compares to 16 a year ago.

Furthermore, of these six, only two are operating in the NHS. Both have said they made further improvements since their last published inspection.

Systems stalled

Parliament’s public accounts committee had the great and the good before them on Wednesday as it put the NHS’ screening programme under its gaze.

But the big news of the day came when Simon Stevens declared NHS England would be taking cervical screening’s back-office functions off Capita and drawing them back in-house.

Many will see this as one in the eye for the outsourcing giant and a blow to its £330m Primary Care Support England contract. But, more broadly, this is a step towards finally upgrading some of the programme’s creaking IT infrastructure.

Proof of the pudding

Accusations from senior managers that the targets review is being used to try and divert attention away from poor performance rather than develop clinically-optimal standards are unlikely to abate any time soon.

There is no doubt an appetite to review the four-hour standard, which has been in place (albeit with a 98 per cent target until 2010) since 2004, and consider alternatives which better align with the significantly different patient pathways within the system 15 years on.

But HSJ is yet to hear from a local hospital chief who would be happy to scrap the four-hour target and impose the new metrics set out in the NHS England review published this month.

On Wednesday, we reported a few concerns.

NHS England rejects this, instead insisting it was following a process and no final decisions have been made yet.

The proof of the pudding will, of course, be in the eating.

Not business as usual

Sheffield Clinical Commissioning Group has appointed one of its own senior directors to spearhead its improvement plan following a critical NHS England review of the organisation.

In an email sent to CCG staff from accountable officer Maddy Ruff and seen by HSJ, the CCG said its director of delivery Nicki Doherty would not be “working on business as usual” and would instead be focusing on developing the improvement plan. An early draft of the plan is expected to be presented to the governing body next month, with a final version expected in May.

Work in progress

An inadequate-rated clinical commissioning group is making “good progress” in addressing a range of problems laid bare in a scathing review last March, HSJ reported on Tuesday.

Consultants PricewaterhouseCoopers said last year that Cambridgeshire and Peterborough CCG’s problems were “among the broadest and deepest set of issues facing any CCG we have worked with”.

A follow-up report by the consultants, published this month, strikes a more encouraging tone, stating it has made “good progress against a very significant improvement agenda”.

Little sympathy

Management consultants don’t get a lot of sympathy from NHS staff.

The general sentiment is that they’re hugely overpriced and “borrow your watch to tell you the time” – which is a little unfair.

It is easy to decry any spend on consultants as a waste, when surely the NHS could do this itself? But often, after cuts in staff budgets, it can’t.

Since the rules on consultancy spend were tightened in 2016, the types of projects that NHS improvement signs off on are an interesting reflection of what the centre deems important.

It can’t be a coincidence that the recent spate of invitations to tender for finance and efficiency projects – after a mini drought – comes as the quarter three results saw more than one in 10 acute trusts declare a worsening of their deficit position by £15m or more.

And this is just for the end of 2018-19. Speaking to system leaders working on plans for the next financial year and beyond, there is a sense that 2019-20 will be a “car-crash” year.

Turnaround

Far from proving a panacea, sticking two struggling acute trusts together has often intensified the problems.

There are major concerns over the planned coming together of Aintree University Hospital and Royal Liverpool and Broadgreen Hospitals later this year.

The trusts have a combined deficit of £80m – the biggest of any major city’s acute sector outside London – and are struggling with multiple performance issues.

A near full sweep of director changes at the Royal, with lots of interims now in place, only adds to the apparent fragility, while the trust is still trying to pick up the pieces from Carillion’s collapse.

Leaders in the region will hope the appointment of the well-regarded Michael Wright as a “turnaround director” at the Royal can help steady the ship.