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.

HSJ100 revealed

This year’s HSJ100 is unlike any of its predecessors.

Judged amid a time of unprecedented political instability, the most recent list of power players contains no fewer than 40 new entries and 17 individuals rising or falling 20 places or more.

Meanwhile, just five individuals from last year’s top 10 – Simon Stevens, Ian Dalton, Matthew Swindells, Ted Baker and Pauline Philip – still occupy those coveted spots this year.

Despite the changes, some things have still remained the same. Mr Stevens has managed to swipe the top spot for the fifth year running.

Executive groupies revealed

After many months of umming and ahing, the top national and regional directors in the merged NHS England and Improvement management structure have been revealed.

But this is not any new top team – NHS E and I have been at pains to stress all the recruits will be part of “a single NHS Executive Group, which will be led by NHS Improvement’s chief executive, Ian Dalton and NHS England’s chief executive, Simon Stevens”.

You can see who has made the national team and who the regulators have persuaded to take up their seven joint regional director posts on HSJ.

A long-term plan for outpatients

There is wide consensus that the NHS’s often chaotic outpatient system, which costs nearly £10bn annually, needs a considerable revamp to drag it belatedly into the 21st century.

So HSJ’s exclusive revelations that regulators have already identified £700m of savings and will lay out further details on a major overhaul in the long-term plan will be largely welcomed, if cautiously in some quarters.

’Tis the season

Many in the NHS argue last winter never finished in terms of the pressure on services, but NHS England’s annual winter daily sitrep reporting season is back up and running. Expect doom laden headlines about ambulance diverts and bed occupancy every Thursday until March.

It’s hard to make a definitive judgement from one week’s data, but among all the gloom of high bed occupancy accompanied by news that four hour performance had worsened yet again, was there a ray of winter sunlight?

The NHS has set a target to clear 4,000 beds by shortening length of stay of so called super stranded patients, those who have been in hospital for more than 21 days.

For the first week of December, there were around 14,925 NHS beds occupied by super stranded patients (15.5 per cent of the 96,211 available general and acute beds).

This is compared to 16,588 for the same week last December (17.2 per cent of the 96,211 G&A beds available).

Don’t hate the player

You will be hard pressed to find an NHS leader willing to express any outward enthusiasm for “control totals” and the cash incentives on offer for hitting them.

Despite the criticism, NHS Improvement has now doubled the impact of the incentive scheme, with trusts that agree tougher “control totals” now getting £2 for every £1 of improvement, as opposed to the £1 for £1 on offer in 2017-18.

The policy was taking a predictable battering on the HSJ comment thread at the time of writing, with one reader saying: “Whilst we all understood why this started, its continuation (and ramping up) now acts as a regressive financial mechanism which locks some trusts into an underclass and others have more money than they know what to do with.”

Yet, if these are the rules of the game, then you can’t really blame trusts for acting in their own self interest when opportunity arises.

Storage space

Those feeling their cupboards are long overdue a declutter should perhaps take pity on the approximately 35 trusts which have been left with the unenviable task of finding somewhere to store their clinical waste, including human remains, for up to a fortnight.

Extra containers for temporary storage of anatomical, hazardous and other forms of waste have been installed at hospitals across England, as part of a national incident response ordered by NHS chiefs.

Proposed temporary storage receptacles include compactors, skips, and trailers, although the guidance adds anatomical waste should be stored in refrigerated units at a hospital’s mortuary if it is unlikely to be collected within 24 hours.

Service gaps

HSJ’s latest analysis of the state of crisis services for patients with learning disabilities and autism probably comes as no surprise to those familiar with the performance of the national transforming care programme.

According to information obtained under freedom of information requests, almost half of clinical commissioning groups have no short-term crisis accommodation designed to help patients with learning disabilities and autism avoid admission to inpatient units.

Equally as worrying, a third of commissioners said they did not have enhanced community services for children with learning disabilities and autism.