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.

Construction deconstructed

The national spending limit on NHS capital projects was raised by £1bn earlier this month, but that extra headroom will get used up fast.

The private finance initiative hospitals in Liverpool and Birmingham that had to be brought onto the government books after Carillion’s collapse caused a headache for those trying to regulate capital spending in 2018-19, and will continue demanding more of the budget.

The latest board meeting at Royal Liverpool and Broadgreen University Hospitals Trust was told that more than £300m would be needed to complete building works on the new Royal hospital, after engineers identified a series of problems with the structure.

‘Undoubtedly a concern’

New figures suggest managers are the NHS staff group most likely to cite anxiety, stress, depression or other psychiatric illness as the reason for their sick leave. The NHS Digital data – which, for the first time, revealed not just how many but why working days were lost to illness – showed 32.5 per cent of senior managers’ and 32 per cent of managers’ sick leave in April fell into this category.

By contrast, 24.7 per cent of days taken off sick by all NHS staff were down to anxiety, stress or depression – although that still dwarfs the 7.6 per cent of days lost for this reason across the UK working population in 2017, the most recent data set available from the Office for National Statistics

The high level of stress, anxiety and depression among NHS staff is worrying or, as NHS Providers director of policy and strategy Miriam Deakin put it, “undoubtedly a concern”.

Devon disappointed

“We love a vision and a plan. When it gets to a difficult decision, we go back to developing a vision and a plan.”

“Conflict is not dealt with, people just get cross and withdraw.”

Daily Insight suspects many provider and commissioning chiefs can relate to the quotes above, which were uttered by senior NHS leaders in Devon, according to a report by PA Consulting.

The hitherto unpublished document, obtained by HSJ thanks to the Freedom of Information Act, makes disappointing reading for Devon’s NHS. The region has been trying to get out of the doldrums following the imposition of NHS England’s “success regime” four years ago.

The report concluded Devon’s NHS had failed to build on progress made from NHS England’s intervention and leaders had “retrenched” back into their own organisations amid financial and performance pressures.

Everybody needs good neighbours

The full extent of the increased pressure on a struggling city hospital after the downgrading of a neighbour’s emergency department was revealed by HSJ this week and raises significant questions for the whole system.

For the past three years, Peterborough City Hospital has had to cope with accident and emergency attendances from the “patch” covered by Grantham hospital, where the A&E has been closed overnight for three years as part of a controversial reconfiguration sparked by problems staffing the unit to safe levels

The 2018-19 annual report for North West Anglia Foundation Trust revealed 1,381 additional patients from the Grantham area arrived at its Peterborough City Hospital last year. These patients accounted for 2.9 per cent of Peterborough A&E’s workload and represent a 13.4 per cent increase on the year before, when there were 1,217 additional attendances from Grantham.

The new arrivals have not happened at an ideal time either – Peterborough’s four-hour performance was just 65 per cent in February 2019 and 73 per cent in June 2019 against the 95 per cent target.

More bark than bite

Since 2015, ministers have had to approve or reject salaries which exceeded the prime minister’s pay for new executive hires at NHS trusts. They are also entitled to comment on such proposals for foundation trusts. 

But figures obtained by HSJ suggest it’s a system with more bark than bite. Ministers gave the green light to the overwhelming majority of proposed salaries in 2018-19, commenting on just three out of the 65 applications. All three were within the “established pay range” set by NHS Improvement and it’s not known whether the FTs concerned made any adjustments. 

The DHSC said scrutiny was “rigorous”.

Not immune

There has been a series of high-profile negative Care Quality Commission reports into privately-run children and adolescent mental health units over the last year.

But late last week, the regulator proved NHS-run units are not immune, after it closed a CAMHS unit at a hospital run by Tees, Esk and Wear Valleys Trust.

Concerns about the trust’s CAMHS offering have been circling for several months, sparked by the deaths of two young women who are thought to have killed themselves in the unit.