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.

Don’t drop the ball, Matt

There is widespread consensus in the NHS that digital technology is going to be a major driver of service improvement and cost efficiency.

Since becoming health and social care secretary, Matt Hancock has brought welcome attention to this agenda. But his unbounded enthusiasm has also raised some concern that attention has been diverted from other crucial areas.

Sir David Dalton, one of the most widely respected health leaders in the country, has warned Mr Hancock not to drop the ball on patient safety.

In an interview with HSJthe recently retired trust chief executive said: “I would urge him [Mr Hancock] to stay the course on improvement and the focus on patient safety. So much has happened in the last decade that probably wasn’t imaginable two decades ago, and it’s fabulous to see…

“There’s been enormous change because a decade ago it wasn’t like that. But these things can easily atrophy, and the benefits rapidly disappear.”

Jetting off

The Care Quality Commission’s first ever lead for mental health services has announced his intention to depart for pastures further afield.

Paul Lelliott, deputy chief inspector and lead for mental health, is due to leave his post at the end of summer to go travelling.

Having been lead for mental health at the CQC for five years, he has raised the national focus on safety within mental health services. 

It is also worth noting there has been a flurry of changing faces at the top of the CQC as of late, including a new chief executive, chief inspector of adult social care, chief inspector of primary medical services, and chief operating officer.

Cross border tension

Tensions have been fraying over who should pay what for Welsh patients receiving treatment in England.

Welsh health boards pay less than their English counterparts for treating patients (between 5 and 10 per cent depending on the treatment). The disparity is not new but the rates for the (English) 2019-20 national tariff payments have widened the gap. 

And, when Welsh patients move across the border for treatment, English trusts must accept less money for the same treatment based on the patient’s nationality.

This has left some border trusts with a potential financial shortfall. HSJ reported three trusts disclosing they would be millions of pounds out of pocket. There are almost certainly more in a similar position.

Thank you for your interest

Teeing up the leadership team for the merged Aintree University Hospital Trust and Royal Liverpool and Broadgreen University Hospitals Trust was always going to be a tall order. 

There was – or at least seemed – to be a clear cut choice for chair. After Royal’s chair Bill Griffiths stepped down earlier this year, Aintree’s Neil Goodwin looked a shoo-in.

But according to minutes from a governors’ meeting last month, NHS Improvement was less impressed with this choice of chair, thanks to Aintree’s “requires improvement” Care Quality Commission rating

This view seems to have softened after joint regional leadership was established with NHS England, with Mr Goodwin applying and interviewing for the role.

But the interview panel decided not to recommend his appointment to the council of governors, so the recruitment process is back to square one with the role being re-advertised.

Whose bill is it anyway?

Wider agendas play out beyond our revelation that government and NHS England are at loggerheads over who will fund the pay uplift for NHS staff working in public health services.

Government currently feels NHS England – whose budget is now benefitting from the uplift announced last summer in the prime minister’s five-year deal – should cough up.

NHSE is declining to pay and is likely to be keen as ever to defend the boundaries of its ring fence: £50m spent here cannot be spent on other NHS priorities, coming from the government or elsewhere. But wider agendas are also in the mix in this discussion.

For NHSE, there is the issue of funding and control of these public health services. Tacitly, the argument is: “If you want us to fund these services – go the whole hog and give us formal responsibility for doing so.”

Ward vs trolley

Just before the bank holiday weekend, HSJ revealed moves by the regulators to end long waits in emergency departments for mental health patients.

In high-level, advanced discussions, NHS England and NHS Improvement have been considering telling acute providers they cannot keep patients in accident and emergency while they are waiting for admission to a mental health bed, or for a Mental Health Act assessment.

The discussions appear to have been triggered by the high number of recorded 12-hour breaches which are mental health patients.

HSJ has heard very reliably that a letter to the system along these lines has been drafted, although we were assured one is not actually going to be sent.

The backlash from acute providers and clinicians could explain regulators’ apprehension to take the leap.