HSJ Weekly Catch Up: Four-hour fans, successful social enterprise and outsourcing to Oz

It’s the best we’ve got

HSJ’s exclusive poll suggests more than seven in 10 hospital trust board members want to retain the four-hour accident and emergency target, despite NHS England proposals suggesting it could be ditched next year.

But why are local NHS leaders so reluctant to ditch a target which very few trusts can hit and has widely-accepted shortcomings?

A major factor, HSJ would contend, is the fear of the unknown. Better the devil you know – it’s not perfect but it’s the best we’ve got.

This stance is understandable. But it’s also the kind of thinking that blocks the progress needed to improve the system for both staff and patients.

The future is now

Google DeepMind has revealed  AI could soon be used in NHS hospitals to predict the onset of life-threatening conditions, such as acute kidney injury.

During an interview with HSJ, Dominic King, clinical lead at the tech company, discussed research carried out in the US which used health records to predict the onset of the aggressive illness.

Such research has not previously been possible in the UK, as Dr King said it requires rich and extensive de-identified patient data, which has not been available in the country until recently. Now, he thinks a similar approach could be trialled in UK hospitals in around 18 months.

It was the best of times

In June 2015, inspectors from the Care Quality Commission highlighted concerns about Dorset Healthcare University Foundation Trust’s child and adolescent mental health services, a lack of clinical leadership at two minor injury units and “inconsistencies in the planning and delivery of a number of services across the trust”.

Handed a “requires improvement” rating overall and in four of the CQC’s five key domains (safe, effective, responsive and well-led), the trust needed to change.

Four years on, it’s clear the trust did exactly that.

The CQC’s report from an inspection in late spring this year – in which the trust was rated “outstanding” – was full of praise for the trust’s “rare” use of restraint, “gold standard” wards for older people with mental health problems, and a “strong patient-centred culture” in adult community health services.

Through many inclusive schemes, such as reverse-mentoring and more leadership support, the trust has achieved a significant turnaround.

It was the worst of times

This week, two private hospitals owned by Priory Group were rated “inadequate” and placed into special measures after inspectors uncovered a catalogue of problems within the services.

Shocking observations were recorded in the CQC reports. Some staff at Kneesworth House in Hertfordshire were accused of being “uncaring and disrespectful”, while children who were being cared for at Priory Hospital Blandford in Dorset told inspectors they did not feel safe on the wards.

Off the back of the inspection, NHS England suspended admissions at Blandford until further notice. Both hospitals now have up to six months to make improvements before another inspection.

There can only be one winner

While the rest of the country worked itself into a frenzy over which couple would secure the honour of winning Love Island’s latest instalment on Monday, Daily Insight only had eyes for another hotly-contested competition.

Redesigning adult community services in Bristol, North Somerset and South Gloucestershire has been a fairly high-profile exercise following the vocal concerns about the project from Labour Bristol South MP (and former NHS commissioner) Karin Smyth.

But the local CCG has continued with its procurement despite Ms Smyth’s protests, and revealed on Monday social enterprise Sirona has been named as preferred bidder for the contract.

Behind the headlines

Since 2017, the government has made several headline grabbing announcements about NHS capital funding, by “allocating” around £2.5bn to dozens of local schemes.

But two years on, just 3 per cent of that amount (around £92m) has so far been released to the service, in part due to the torturous sign-off processes in which projects frequently get stranded.

Despite announcing the “new” money with lots of fanfare, the Department of Health and Social Care’s budget has only increased by around £1bn in real terms since 2016-17. To reach the average level of capital spending for developed nations, it should have risen by around £3.5bn.

Unhappy union

There are a few reasons organisations are loath to formally merge.

One of the main ones is the discord and distress it causes as long-established teams realise they may have to reapply for jobs in a new structure, competing with their peers in the other organisation(s).

This is what happened in Mid Essex Hospitals, an employment tribunal judgment released last week revealed. The trust is in the process of merging with neighbours Basildon and Thurrock University Hospitals FT and Southend University Hospital FT.

The three heads of HR at Mid Essex who brought employment tribunal claims – one of them successfully – suspected the restructuring was not being carried out in good faith.

Catch-22

The NHS pensions crisis is seeing vital diagnostics work being outsourced to Oz, due to a shortage of consultants taking on additional elective work.

Doctors’ union the Hospital Consultants and Specialists Association has been told by its members the punitive pensions tax rules are forcing trusts to outsource work at great expense to keep waiting lists at bay.

Along with an increase in outsourcing, union members also reported an increased use of agency locums to manage waiting lists. Trusts are in a catch-22 situation – watch waiting lists growing or break the cap for agency spend.