Your essential update on health for the week

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.

A fly on the wall

Tales of Jeremy Hunt’s Monday meetings have gained a level of infamy among NHS leaders, and after some negotiation HSJ was given unprecedented access to observe the meetings and write a ‘fly on the wall reportage’ of the discussions.

Conscious of the observer effect, this was not designed to reveal what the Monday meetings are always like, but what we were able to discern from conversations with civil servants and senior NHS figures is that the meetings are now largely welcomed as a mechanism to have a joined up view of what is going on.

Mr Hunt challenged civil servants when he felt their proposals were lacking in ambition and he clearly showed a tendency to make a sudden decision and move on. But elsewhere he invited challenge and asked to be told his view was “complete nonsense”.

What our observations revealed was what many taxpayers might be forgiven for thinking was always the case; that a minister with legislative responsibility to Parliament is keen to fulfil his duty to oversee the operation of the health service.

The fact the meetings have gained so much notoriety and interest says more perhaps about the state of affairs before they were established.

End of ‘bonkers’ system? 

After weeks of criticism and media pressure, the Home Office has finally agreed to review its Tier 2 visa system, for skilled workers from outside the EU.

Sajid Javid confirmed the review on the Andrew Marr show on Sunday, which will give some relief to NHS workforce leaders. 

It comes after HSJ revealed how hundreds of non-EU doctors had had their visa requests denied in recent months, including those recruited through a well-established programme run through Wrightington, Wigan and Leigh Foundation Trust.

The trust’s chief executive Andrew Foster has been doing the rounds on national media, describing the decision as “bonkers” last week.

Working on the chain

Glen Burley is growing a small empire in the West Midlands, with the announcement that he’ll soon become chief executive of a third trust.

Mr Burley will be taking over from Kath Kelly at George Eliot Hospital Trust, who announced her retirement yesterday.

As chief executive of George Eliot Hospital, Wye Valley Trust and South Warwickshire Foundation Trust, Mr Burley will preside over a chain of small combined acute and community trusts stretching across Herefordshire and Warwickshire.

This foundation group model, which George Eliot will now join, has been under development at Wye Valley Trust and South Warwickshire FT for several years.

If the model proves itself, it could be attractive for other small district hospital trusts caught between isolation and being swallowed by a larger neighbour.

Dysfunction

PwC’s health team see a lot of NHS dysfunction up-close, so it’s concerning when one of their reports says a clinical commissioning group has some of the worst problems they’ve ever seen.

That was their team’s conclusion after being sent into Cambridgeshire and Peterborough CCG (a CCG so big it is coterminous with its Sustainability and Transformation Partnership).

The review said: “Based on our experience of working with a large number of CCGs nationally, the issues facing the CCG in relation to capacity, capability and financial recovery, combined with the financial challenge facing the local health system, are among the broadest and deepest set of issues facing any CCG we have worked with.”

The issues include some old classics (continuing healthcare claims backlog - £10m), some universals (demand management scheme slips - £8.8m) and some local factors (Cambridge FT trying to activity their way out of deficit - £14.6m).

More scrutiny for private hospitals

As the private sector continues to face scrutiny over the safety of its services, HSJ has revealed the tragic death of 28-year-old who died after surgery at a BMI hospital in Croydon.

Michael Battersbee died after undergoing surgery he should never have had in the private sector. He was referred by the NHS for treatment of an epigastric hernia but he also had obstructive sleep apnoea and a high body mass index. Both should have ruled him out of private surgery under the NHS standard contract at the time in 2015.

His family are now taking legal action against BMI Healthcare after a coroner last year issued a prevention of future deaths report and criticised BMI Healthcare processes.

Nice one

With some “extremely expensive” new drugs and medical technologies expected to emerge in the coming years, there’s going to be some critical decisions required over affordability.

Sir Andrew Dillon, the chief executive of National Institute for Health and Clinical Excellence, explored this theme in an interview with HSJ, noting that NHS England is likely to be “more and more” interested in the impact of his organisation’s guidelines as costs rise.

He revealed a new panel has been convened by NHSE, NHS Improvement and Public Health England to consider guidelines which would have a “substantial net resource impact”.

Back to Black

There was plenty of scepticism when Jeremy Hunt announced a major new policy for trusts to publish data on avoidable deaths.

The key concerns raised at the time appear to have been borne out, with 26 acute trusts claiming they had zero avoidable deaths within a three-month period, out of almost 10,000 cases that were reviewed.

The vast majority of other acute trusts each reported just a handful of avoidable deaths.

An expert on the subject, Nick Black, who has previously highlighted problems with the policy, told HSJ: “Zero is not what one would expect. Our best estimate, which fits with other studies, is that four per cent of deaths from any random sample are avoidable. A recent study in Norway also confirmed that figure. If trusts are not finding that then they are sort of kidding themselves.”