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.
Analysis by HSJ has revealed thousands of NHS staff could be at risk of losing their right to work in the UK if the government was to tighten its immigration rules – something the Migration Advisory Commission is consulting on potentially doing.
The current lack of clarity on future migration plans is concerning experts and trusts alike, with worries staff at the lower end of the salary scale and not on the shortage occupation list could be affected.
In particular, the high number of physiotherapists not on the shortage occupation list and earning below £36,700 – a salary threshold suggested by centre right think tank the Centre for Social Justice – jumped out from the data.
Moving the goalposts
The Royal College of Emergency Medicine has far from given system leaders the green light to ditch the four-hour target – but pro-reformers will view comments made by its new president exclusively to HSJ as a significant step in the right direction.
Katherine Henderson, who took up the presidency this month, said the college could support replacing the four-hour target – but only if it was satisfied a replacement regime would demonstrably improve patient outcomes and cut bureaucracy for staff.
This contrasted with her predecessor, Taj Hassan, who warned in January that “scrapping the four-hour target will have a near catastrophic impact on patient safety”.
Charity begins with data
Jeremy Hunt was a divisive health secretary. In particular, he became a comic book villain caricature for many on social media following the ill-advised war with junior doctors.
Yet Mr Hunt also won praise from many patients and those demanding reforms to improve patient safety. His decision to ignore civil service advice and meet families from Mid Staffs and Morecambe Bay clearly affected Mr Hunt, who has now revealed his plans to launch and chair a new charity called Patient Safety Watch.
Initially it will have a very small remit to commission experts to gather data on avoidable harm using an agreed methodology that can be used to track safety over time. This is reminiscent of Mr Hunt’s desire to publish the numbers of avoidable deaths at every hospital, which prompted panic among civil servants and decision-makers in the NHS hierarchy, who realised this would probably be impossible on sheer accuracy grounds as well as dangerous to the NHS’ reputation. The compromise result was the national mortality review process currently being used by hospitals.
No pressure, but…
A lot is riding on the success of primary care networks.
The NHS has bet the farm on their landmark reorganisation of primary and community care, sinking £4.5bn over the next five years into the scheme.
Meanwhile, many GPs hope they will stabilise the partnership model and reduce the load on the stretched primary care workforce. Providers, on the other hand, hope they will reduce demand at emergency departments, reduce unwarranted admissions, and provide a consistent out-of-hospital care offer to discharge patients into.
If that wasn’t enough to live up to, NHS England chief executive Simon Stevens has given his list of three “real-world” tests to determine whether PCNs have been a success. These were alleviating workforce challenges, improving patient access and bringing coherence to integrated urgent care, and linking primary and community nursing teams.
Same old spots
Can a leopard change its spots? According to Chris Hopson, chief executive of NHS Providers, members believe the national regulators are committed to change. But he makes clear this change will not happen overnight.
Mr Hopson told HSJ as NHSP’s annual conference got under way in Manchester how it is common to hear of NHS chief execs still subject to aggressive “top down command and control”.
Baroness Dido Harding, chair of NHS Improvement since 2017, has said numerous times she wants to improve the culture from the top down and the interim people plan focussed on making the NHS a better place to work.
Mr Hopson, however, warned the approaching winter would be a true test of whether Baroness Harding’s promises are more than just words.
The financial “control totals” that were introduced for all NHS trusts a few years ago represented a blanket response to ballooning deficits.
But the new regime – outlined last week by NHS England and NHS Improvement – will take a two-track approach.
Those trusts which can make a surplus (before non-recurrent support funding) will be released from control totals and given the freedom to set their own financial plan.
Those that can’t will work to rebased control totals, and will gain access to the new “financial recovery fund”. The rebased targets do require additional efficiencies, but are far more realistic than the targets handed down since 2016.
NHS England’s national director for mental health Claire Murdoch has tightened up her trust’s recruitment checks, including requiring all staff who have been subject to action from a professional body to get director approval before being hired. She is considering asking all trusts to follow suit.
Her action was prompted by the revelation that her trust, Central and North West London Mental Health Foundation Trust, hired a senior matron who was disciplined by the Nursing and Midwifery Council for falsifying the care records of Matthew Leahy – a young man who died at an Essex mental health unit.