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.

NMC held to account

A damning report by the Professional Standards Authority, published on Wednesday, puts the resignation of Nursing and Midwifery Council chief executive Jackie Smith earlier this week in new light.

The investigation by the PSA into the NMC’s handling of concerns about midwives at Morecambe Bay and how it dealt with the bereaved families delivers a devastating verdict on the regulator.

It describes the NMC ignoring real safety concerns raised with it by Cumbria Police for more than two years. These delays allowed midwives to continue working who were involved in more incidents of poor care including a death.

The NMC lost key evidence and was not open about this and even appears to have misled the health secretary in a letter saying it had carefully considered evidence, which in fact it had lost. Families were ignored, investigations were flawed, record keeping was poor. The culture of the NMC and the confidence the public can have in the regulator has been seriously undermined.

The PSA rightly suggests the NMC needs to focus on changing its culture to really appreciate its role in dealing with families’ concerns.

Fun and games in NHS finance

While the NHS waits for its long-term funding plan, provider trusts are left with no choice but to play the control total game.

On Thursday, HSJ published several stories showing the various ways providers have succeeded or failed to navigate the regime.

There are trusts rejecting control totals that require impossible savings, such as Portsmouth, and which will miss out on sustainability and transformation funding as a result.

Then others are accepting extremely tough targets that had previously been rejected in draft plans, like Kettering.

Meanwhile, Barts has revealed its missed last year’s control total by £60m, but has still been awarded most of its STF money after NHS Improvement agreed to relax its target.

And Barnet, Enfield and Haringey Mental Health Trust has managed to beat its control total and trigger a massive STF payment by selling land to the council.

Getting the basics right

The NHS’s new chief clinical information officer has acknowledged that the funding picture for technology on the NHS isn’t terribly clear.

In his first interview since being appointed in February, Simon Eccles said CIOs and CCIOs throughout the country had expressed confusion around what funding pots are available (and for what).

This, he said, should be fixed with the first quarter of 2018-19 but how far this will go remains to be seen.

Dr Eccles was also keen to stress the importance of getting some IT basics right across the NHS, such as good quality clinical coding, staff ID and medication.

The theme of doing the basics well was picked up by NHS England’s national director of operations and information, Matthew Swindells, on the stage at the e-Health Week conference in London on Tuesday.

However, Mr Swindells was more direct route than Dr Eccles, naming several trusts that were failing to get basics right on electronic referrals and reporting data on referrals to treatment.

Mr Swindells said the trusts lagging on getting “bog standard” IT right were spoiling the chances of more tech money for everyone.

Sources have told HSJ these providers are unlikely to get any central additional IT funding anytime soon, without fixing some of these basics first.

This is probably not the sort of clarity that some CIOs and CCIOs were looking for.

Sort out the A&E data mess

Public confidence in official NHS waiting times data “continues to be undermined” because of lack of action by NHS leaders. So said the government’s statistics watchdog this week. And rightly so.

The UK Statistics Authority said it was “disappointed that A&E data collection guidance, based on agreed principles, has still not been published” following concerns around the accuracy of accident and emergency waiting times statistics raised in January.

The concerns largely centre on how trusts were counting urgent care admissions (some providers have wrongly included data from local urgent care centres they do not run, for example) and how newer clinical pathways, like ambulatory care, are counted.

The issue needs addressing quickly. The longer the saga drags on, the more “it risks feeding a narrative that NHSEngland/Improvement is more interested in ‘creative’ presentation of data than solving the problem of poor emergency flow”, as one reader noted.

Moreover, HSJ has heard widespread reports of confusion at trust level about how type three data is supposed to be counted and, ultimately, that the data on which vital planning is based and funding allocated is simply not reliable.

Addressing the problem is not a simple task. NHS Improvement’s former chief executive Jim Mackey’s attempts to sort it out with a letter in October only muddied the water.

This is why HSJ called for a public consultation and transparent debate on the matter in February.

A consultation would be more time consuming in the short term than sending out another guidance letter – but the importance of the A&E data, and that the NHS is seen to be doing the right thing with it, could solve a lot of problems further down the track.