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.

Keep calm and carry on prepping

The NHS will continue its no-deal Brexit preparations despite ministers standing down cross-government planning for crashing out of the EU.

Although the pan-government no-deal preparations — code-named Operation Yellowhammer — are being paused, NHS EU exit strategic commander Keith Willett told NHS leaders preparations would continue because the UK could leave without a deal at the end of January.

With around just 50 working days to go before the next no-deal ‘cliff-edge’, this would appear a sensible strategy, albeit far from ideal given the resources the preparations are sucking out the system at both local and national level.

The danger of the system being completely overwhelmed will, of course, only increase as winter progresses. But the NHS can only play the hand it has been dealt, so keep calm and carry on prepping.

Ministers and national NHS leaders have been given plenty of stick over the last few years for giving providers impossible financial targets to hit.

There have been particular concerns over the sustainability of the acute providers in Liverpool, which both finished 2018-19 with large deficits and were this month merged together.

So, it’s encouraging to see Liverpool University Hospitals Foundation Trust given what look to be far more realistic efficiency requirements next year.

Despite being in deficit (which NHS England and NHS Improvement said would require “minimum” baseline efficiencies of 1.6 per cent), the trust has been set lower targets than this over the next few years, with substantial support from the “financial recovery fund”.

Staff facing discrimination

Stamping out discrimination in the NHS is an often-declared priority among its leaders, but the picture on the frontline can confound good intentions.

The service is also, of course, bound up with its users — and in one striking example, a small mental health trust has found nearly half of its black and minority ethnic background staff say they’ve been abused, bullied or harassed by patients and visitors, in comparison to less than a third of their white colleagues. This had increased more than 20 percentage points on the previous year.

Some NHS leaders have, admirably, been more outspoken about this kind of issue in recent months. A number of frank observations were made at an HSJ roundtable of chief executives earlier this year. Devon Partnership Trust chief executive Melanie Walker said there was “overt racism and homophobia” on her patch, while East Suffolk and North Essex FT chief executive Nick Hulme spoke in direct terms about attitudes in north east Essex.

When six become one

It may have been on the cards for a little while but the six Nottingham and Nottinghamshire clinical commissioning groups have now announced they have received NHSE’s green light for full merger.

It is the latest of a spate of merger approvals to be confirmed over the last couple of weeks — apparently we are condemned to learn of them via a drip-feed rather than a good old list of decisions from the centre.

Nottingham and Notts have been edging closer to this over the last year as Amanda Sullivan was appointed joint chief officer in 2018, but, as she told HSJ, the official seal represents a “crucial piece of architecture” for the health system.

E-prescribe, but get it right

Trusts across England are being strongly encouraged to take on e-prescribing systems as they are meant to reduce medication errors.

However, the Healthcare Safety Investigation Branch has found the use of “poorly implemented” e-prescribing systems in hospitals is putting patients’ lives at risk.

HSIB launched an investigation after an elderly cancer patient was mistakenly given two strong anticoagulant medications for two weeks in 2018 after an e-prescribing error meant her community pharmacy was not informed that one of the prescriptions was meant to be cancelled.

The pensioner died from her cancer less than three weeks after the error was made – although it is not thought the mistake contributed to her death, according to HSIB.

In tech we trust

The rise of artificial intelligence promises much to the NHS, but it is yet to revolutionise services in the way some excitable scientists have predicted.

Yet here and there, claims emerge that give a glimpse into how new analytics might one day make a real difference to the way patients are treated.

One example is within population health management. In York, the claim is that AI was deployed to identify patients at risk of returning to hospital — before a team of health nurses provided them with intensive health coaching.

The result, according to those involved, was for those patients selected for involvement, a 30 per cent reduction in unplanned hospital admissions, ditto for emergency department attendances, and a 25 per cent decrease in planned hospital admissions.