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.

More than a technicality

HSJ has revealed a warning in a Department of Health and Social Care report — momentarily published before being taken down — that clinical commissioning groups were not meeting their requirements under section 140 of the Mental Health Act

This piece of legislation requires a CCG to give local authorities a list of hospitals to which a person can be admitted “in special urgency”, and to also have a joint plan in place.

The report was not the first time HSJ had heard this was an issue, but it marks a significant acknowledgement from the DHSC that commissioners are not doing what they legally should be. 

And falling foul of the law represents far more than a technicality. When section 140 isn’t adhered to, people who need to be admitted may not be because mental health professionals are not aware of available beds they can use. 

Merging at pace

CCGs mergers are now moving at pace. By April 2020, there will be just 135 CCGs, a drop of 56 since April 2019 and of 76 since they were first set up. For the first time, the number of CCGs will drop below the count of 152 primary care trusts before Mr Lansley came along in 2010.

HSJ’s map of the mergers reveals the huge variation in merger sizes, both in numbers and in geography. For example, Kent and Medway is merging eight CCGs into one, while the second largest mergers involve six CCGs. The smallest mergers involve just two CCGs. (And of course there remain a fair few small groups which are not merging at all, so far.)

It will be interesting to see how these new CCGs develop from April. The largest will need significant management support to serve their sizeable populations, and if they’re to keep various local constituencies happy.

‘Wilful blindness’

An inquiry into Ian Paterson has warned hospitals displayed “wilful blindness” as the disgraced surgeon performed unnecessary surgery on more than 1,000 patients over more than a decade.

The Paterson Inquiry raised similar worrying themes from other healthcare scandals and inquiries — dysfunctional management, lack of challenge from senior clinicians and colleagues looking the other way, and patient safety deprioritised.

Now, the challenge for the government is to make lasting changes to prevent such harrowing malpractice from happening again.

A woman’s work is never done

Coventry and Rugby CCG, which published its 2019 gender pay gap results early, has a wider gap than any other NHS organisation posted last year. As of 31 March 2019, the group was paying women on average £18.27 less per hour than men — something it blamed on employing significantly more women in lower-band positions.

At a senior management level, the CCG has an almost even split between men and women. But between bands one to seven, virtually all roles were filled by women.

The reasons behind this gap, and whether it’s a problem, have been fiercely debated in the HSJ comments. Some readers argue gender pay gaps — which do not indicate men and women are being paid differently for equal work — are essentially a non-issue. Others argue they are an important marker for the enduring structural reasons women tend to perform lower-paid roles — and the value we place on those positions.

Crisis of confidence

Last week, HSJ revealed confidence in Care Quality Commission chief executive Ian Trenholm and his senior team has dropped 10 percentage points — to just 34 per cent — in the space of a year.

Now, five unions have confirmed they are considering industrial action.

The unions — Unison, the Royal College of Nursing, the Public and Commercial Services Union, Unite, and Prospect — are balloting their members on a vote of no confidence in the CQC’s senior leadership.

The union’s main point of contention is broadband for homeworkers. The CQC has previously provided separate broadband lines for its 2,000 homeworkers. But the regulator is planning to stop this from 1 April in a bid to save money.

To those who wait

It probably surprises no one emergency ambulances take longer to reach patients in rural areas. But HSJ’s analysis of average response times to “category one” calls — where the patient is thought to have a life-threatening condition, such as a cardiac or respiratory arrest — shows it’s more complicated than urban fast, rural slow. 

Although many rural areas faced long waits, some, such as Northumbria and much of the South West, fared much better. 

And some places with the longest waits for these ambulances would not be described by the average reader as being particularly isolated. The area covered by High Weald Lewes Havens CCG suffers from a poor road network and has an 11:29 minute average response time to match. South Kent Coast CCG, which has an average response time of 9:56, includes the Romney Marsh as well as the conurbations of Dover and Folkestone. The target time for category one calls is seven minutes. 

Above all, HSJ’s analysis shows the importance of broken-down data: most statistics on ambulance response times are only at trust level. As CCGs merge, the data showing performance at more local level risks being subsumed into what may be a very different picture of performance across a wider area. That would be a disservice to all those for whom calling an ambulance means a lengthy wait.