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 trust next door
When the management agreement between “outstanding” Western Sussex Hospitals Foundation Trust and Brighton and Sussex University Hospital Trust was announced three years ago, cynics wondered what good would come of it.
BSUH was viewed as one of the most troubled trusts in the country, with an “inadequate” Care Quality Commission rating and a history of poor relations with BAME staff. And it is a complex regional centre, not a minnow. Western Sussex’s chief executive, Dame Marianne Griffiths, was highly regarded but inevitably some were sceptical that she could repeat her success at the more challenging BSUH.
Today that cynicism seems misplaced. BSUH’s CQC rating has jumped to “good”, its deficit now seems under control, and the two trusts have just announced they will in future operate as a group with a shared leadership team.
The CQC has dropped a prosecution against United Lincolnshire Hospitals Trust for duty of candour breaches due to a lack of evidence.
The watchdog had been investigating the Lincolnshire trust, which is in special measures, over its failure to investigate the death of patient Elaine Bradbrook, who died in April 2017. A coroner was also critical of the trust’s failure to carry out an investigation or contact the family after her death.
Quality assessment who?
There is broad agreement that moving some of Public Health England’s screening programme work to NHS England is a good idea.
One of the recommendations of Sir Mike Richards’ report, published on Wednesday morning, is the quality assurance part of PHE should move to NHSE, along with the direct responsibility for commissioning these vital services.
Sir Mike was careful to stress the quality assessment teams — who keep an eye on standards — should be ringfenced if (when, really) they get moved.
It is fair to say their work is currently not well known. The actual work of routine screening is usually carried out by trusts themselves, and, as with everything done by trusts in the NHS, there is some variation. Often, a lot of it.
Health Education England has spent time and money surveying its stakeholders to allow it to issue a not so subtle declaration that it should remain an independent body.
The education and training quango has come under increasing pressure from NHS England and Improvement, with the latter’s chair leading on the NHS People Plan, and NHSE’s recent legislation proposals alluding to the fact the government should review workforce policy decision making.
HEE’s demise as an independent body has been mooted for a long time. It is blamed for failing to adequately respond to the workforce crisis.
But scrapping HEE would still be a highly questionable move — and its “stakeholders” seem to agree. The workforce crisis of today has its roots in the plundering of health authority education budgets when they were part of the NHS system.
Something to ease the pain
Being made redundant is never pleasant, even for those leaving under the NHS’ relatively generous redundancy terms.
HSJ has discovered 33 clinical commissioning group staff have left with at least the maximum pay out of £160,000 over the last three years. Around a third of those left with a little bit extra to ease the pain of parting — generally pay in lieu of notice of up to £60,000.
CCGs were swift to point out these additional payments were in line with terms and conditions but it does raise the question of why senior staff were not working out their notice.
Perfect storm incoming
The CQC has delivered its annual state of care report which made for grim reading for health secretary Matt Hancock and NHSE chief executive Simon Stevens. The watchdog made clear the pressure on hospitals from an underfunded social care system and poorly designed community and mental health services was leaving millions of patients facing poor care.
Chief inspector of hospitals Ted Baker was explicit during a press conference on Monday that the “ever open” doors of emergency departments were naturally the option chosen by families when other services could not meet their needs.
Add to this the fragmentation of care, the dire workforce shortages affecting health and social care, and the near decade squeeze in funding and it’s no surprise that the CQC felt the need to warn of a perfect storm.
Safe care in long stay units
A recent care quality theme has been repeated and growing concern about mental health, learning disability and autism hospitals.
There have been a number of terrible cases. Often, though far from universally, the concerns seem to relate to independent providers.
We have covered much of this mounting concern, and lately have been analysing the CQC’s interventions — called actions — on this.
In relation to “safe care and treatment” independent providers have indeed seen substantially more interventions than the NHS since 2017. These actions cover some of the big areas of concern, like ability to assure residents’ safety and protection, including staff supervision and training.
But it is far from a simple picture: The NHS provides many more beds in these categories, but the most complex and long-stay patients are often in private sector units — and these often have the biggest problems.
Queen’s Speech or Conservative party manifesto?
With the Brexit deadline, a minority government, and the looming prospect of a winter general election, it’s hard to say if any of the 26 bills proposed on Monday will be anything more than campaign fodder.
Two of those bills concern the health service: a medicines and medical devices bill that would seek to loosen up regulation on trials and potentially see more professions prescribing; and a patient safety bill that would put the Health Service Safety Investigations Body on a statutory footing.