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.

The famous five

Sir David Sloman, London regional director for NHS England/Improvement since the spring, and a long-serving leader in the capital, has sought to press full steam ahead with organisational change on his patch.

On the commissioning side this has involved encouraging clinical commissioning groups to merge up to the level of their system (sustainability and transformation partnership or integrated care system) as soon as possible. This will result in five CCGs for London — a big shift from the 30-odd NHS commissioners, mainly co-terminous with local government, it has enjoyed/endured (delete to preference) for more than a decade. 

For STPs/ICS, unlike other regions, he decided to recruit chairs for all of them in one fell swoop.

On Thursday the recruits were named, and they are a not-uninteresting collection. The appointment of Marie Gabriel and Millie Bannerjee (to north east and south west London respectively), as well as coming with substantial non-executive leadership experience, will substantially increase the currently paltry racial diversity at the top of STPs and ICS.

And the appointment of Penny Dash, a senior healthcare consultant with McKinsey & Co, to north west London will raise some eyebrows, particularly of those who remember the extensive involvement of that company in providing strategic advice for that part of the world in years gone by.

Not what you expect

Cancer centres are supposed to be the hubs around which the district general hospital ‘spokes’ turn.

For a long time, the prevailing logic has been that complex work can and must be centralised at the centres of excellence with their highly specialised staff and equipment, and allied research and teaching portfolios.

So the news that clinical oncology trainees at Guy’s and St Thomas’ Foundation Trust were sometimes left to make “critical” decisions about patient care without consultant supervision is disturbing.

The issue was enough to worry the inspection team from Health Education England, and to have the trust’s very top brass show up to a follow-up meeting to discuss it.

Hancock jumps the gun

Health and social care secretary Matt Hancock’s suggestion the four-hour target should be dropped was met with a furious reaction by senior clinicians and patient groups — and justifiably so.

The Royal College of Emergency Medicine moved swiftly to contradict Mr Hancock’s suggestion on Wednesday morning that the four-hour target should be replaced on clinical grounds.

RCEM president Katherine Henderson said: “So far… we’ve seen nothing [from NHSE’s clinical review of standards] to indicate that a viable replacement for the four-hour target exists and believe that testing should soon draw to a close.”

Winter warmer

Late last year, HSJ reported NHSE/I were scrambling to provide funding for some hospitals to mitigate a winter performance crisis. Now, further details have emerged.

The centre confirmed around £22m had been allocated to trusts to outsource diagnostic and elective work to the private sector and specifically to support orthopaedic, paediatric, cardiology and gynaecology departments. It also said this money would fund some “insourcing”, as in work passed to another trust.

Perhaps surprisingly, this money was not given to trusts most under the cosh but to those with a proven track record of delivering and with a winter plan in place.

Immediate action

Regulators are calling for “immediate action” from a scandal-hit private mental health provider to improve its leadership and care quality.

The Care Quality Commission has told Cygnet Health Care — which ran Whorlton Hall before it closed in the wake of BBC investigation showing patients being mistreated — its leadership team “did not have oversight of significant risks”.

CQC inspectors also said there was a comparatively high number of restraints, seclusions, assaults and self-harm at Cygnet facilities, and there was “no clear line of accountability” across the provider’s locations.

PCN predicaments

Things have got rather heated in the world of primary care and general practice in the last week or so. The cause? NHSE’s new draft outline service specifications for the second year of PCNs.

They had been published on 23 December for consultation, with NHSE asking GPs and others in primary and community care to send in their feedback by 15 January. The specifications are the outline of what NHSE wants PCNs to deliver in the coming financial year, the product of nearly a year of work by NHS policy wonks and working groups made up of interested parties.

GPs had the Christmas and New Year period to chew over the proposals before giving their verdict: a resounding ‘no’.The British Medical Association’s GP committee went on to vote down the contract on Thursday

They contain requirements that are unworkable and unfunded, they said; they will put an intolerable strain on general practice when it is already creaking at the seams; they are too prescriptive when the PCN scheme is meant to be focussed on places and localities. If they are carried through as is, GPs will drop out of the PCN project entirely, the doctors warned.

Time is of the essence

How quickly should the NHS respond to a call from someone who is threatening to take, or who has already taken, an overdose?

The answer from many members of the public might be that these calls should be treated as emergencies with the fastest response approach possible. But many overdoses take a long time to take effect and, consequently, such callers may be treated as a category three call by ambulance services with a slower response than the 18 minutes expected of a category two.

But, as HSJ’s story on Monday demonstrates, sometimes the pressure on ambulance services will mean that category three calls won’t get a response for several hours — and that may make a difference. In two cases, women who had taken overdoses were dead by the time an ambulance crew reached them.