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.

Breaking the cycle

System leaders are laying the ground for getting performance back on track. This follows years of promising to deliver ambitious targets in year, only to fall short – a cycle which has cost them serious credibility with the government.

The NHS last hit the 95 per cent target in July 2015, and system leaders have promised to get this back on course in each of the last two years. Next Steps on the Five Year Forward View, published in March 2017, pledged most trusts would be fully compliant at 95 per cent by March 2018, and the whole system by the end of 2018.

This has failed. The “rolled forward” trajectory in the 2018-19 planning guidance – aiming to get the system heading in the right direction “within the course of 2019” – is now also unlikely.

Yet news suggests the NHS long-term plan might finally break the cycle. An NHS Improvement statement – published alongside its quarter two report – said: “The long-term plan for the NHS will signal a reset on performance over the next five years…”

Takesies backsies

It has long been a baffling part of the NHS finance world that “cost improvement plans” could include income. But they do, and it forms an increasingly large proportion of the “savings” across the provider sector.

In most cases this is NHS income. This worked fine when there was more money around. But, as NHS England got tougher with clinical commissioning groups, this became more difficult.

So could some of the answer be for NHS trusts to do more private work?

Private hospital care is a £5bn industry that depends on your own consultants anyway, so why not try and grab some of that back?

The shinier, big name providers have been doing this for some time. As the most recent annual accounts data shows, the top 10 earners from private patients are still all in London. 

The news from the rest of England is not as good. Private earning outside the capital largely stagnated in 2017-18.

Shock but no surprise

Sir Ron Kerr has presented the Department of Health and Social Care with a demanding to-do list.

The Empowering NHS Leaders to Lead report, which Jeremy Hunt commissioned from the former Guy’s and St Thomas’ Foundation Trust chief executive, made sobering reading. It highlighted how the insidious pressures of leading in the NHS have resulted in bullying and discrimination becoming commonplace and led to troubled trusts with huge leadership gaps.

Sir Ron, who has 30 years’ experience occupying NHS leadership roles, has now called upon the soon to be aligned NHS England and NHS Improvement to set expectations and create a new support package between local stakeholders and an incoming chief executive to combat what he described as “bad behaviours” from the centre.

The review also recommends “a number of actions to build a modern working culture in which all staff feel supported, valued and respected for what they do and can challenge without fear”, including establishing a “leadership workstream” in the NHS long-term plan.

Deloitte’s delight

Since Lord Carter’s 2016 report into hospital efficiency, the scrutiny applied to how the NHS buys its goods and services has intensified significantly.

Lord Carter’s report was followed by the DHSC’s procurement transformation programme, which has led to a (currently ongoing) reconfiguration of the NHS Supply Chain

Now, a second – potentially larger – shake-up is on its way, under the guise of an NHS Improvement programme, thus far named the “targeted operating model”.

This programme wants to make the NHS better at buying things not provided by NHS Supply Chain, such as goods and services related to non-clinical functions like estates, facilities, IT, legal, and other corporate bits and bobs.

Somewhat inevitably – the news was met with a sigh by some trust procurement heads HSJ spoke to management consultants have been brought in to provide private sector expertise.

The NHS Supply Chain work has been heavily influenced by EY. Now, NHSI’s model will feature ideas from Deloitte, which saw off a handful of other consultancies to win a £400,000 contract.

No deal?

Simon Stevens told the Commons health and social care committee on Tuesday he intends to enact no-deal Brexit plans before Christmas, if no deal is agreed domestically by that point.

He said: “Frankly, this side of Christmas, were we to be in a no-deal scenario, some of those [NHS England] plans will have to be enacted.”

No long-term plan?

In the same committee session Matt Hancock disclosed that the NHS long term plan is no longer likely to be published next week, when many in Whitehall had it pencilled in for. He said he still wanted the plan – and the long awaited social care green paper – to be published before the end of the calendar year, but didn’t sound 100 per cent certain even this would be achieved.

NHS England, you would think, would be keen to get the plan out next week and out of the way, giving the NHS a sense of direction before the 11 December Brexit vote potentially wreaks more havoc. But the timing is not all in NHSE’s gift – Mr Hancock wants to help shape the plan, and others across government will have strong views too.

As short as possible. But no shorter.

Cutting patients’ length of stay to free up beds represents a core plank of NHS England’s winter capacity planning. And rightly so. Good patient flow represents the best outcome clinically as well as for efficiency and patient experience.

But optimal efficiency must not tip into overzealousness, with patients being discharged too soon, one of the country’s most senior geriatricians has warned.

The British Geriatrics Society’s new president Tahir Masud told HSJ trusts must closely watch emergency readmission and mortality rates at the same time as trying to cut length of stay to ensure patients are not being discharged prematurely.

Unsubtle hints

Consolidation of clinical commissioning groups has been a slow burn. We started with 211 and still have 195 more than five years later.

National leaders are hoping now is the time that changes. They are taking 20 per cent out of the groups’ admin allowance in little over a year. There are plenty of unsubtle hints that NHS England would like this to happen via merger and joint working.

It is notable – however – that at yet another policy juncture, there is still no requirement to merge, even to become an integrated care system. Many in the provider world would have liked it to be so and, were NHS England’s leadership different, this would probably have happened by now.

Long overdue

In his first indepth interview, national patient safety director Aidan Fowler has explained his emerging vision for safety in the NHS.

It is clear he believes there has been a lot of good work done but now it needs some structure. Essentially, he calls for a bit of grip to be applied, so that what has been proven to work in one region can be improved and extended nationally to ensure all areas benefit.

For too long safety, and the way it has been handled as a policy issue, has depended on where you are. Aidan Fowler’s ambition to deliver “uniformity” is long overdue and welcome.