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.

The long-term plan lands

One of the pre-emptive – let’s call it anticipatory – criticisms of the NHS long-term plan was that it would be short on detail. Some health leaders hankered for a granular plan for delivery – costed, staffed and timetabled to the nth degree – not an airy vision, wish list, or Forward View.

A parallel request was that the NHS shouldn’t sign up to a whole bunch of commitments it can’t and won’t deliver, thereby chipping away at credibility; on waiting times for example and the rollout of new services.

If the length of the document is equal to the number of commitments multiplied by the granularity of them, the long-term plan perhaps falls somewhere between two extremes.

At 136 pages, it’s a lot longer than 2014’s Forward View (41 pages), in the same ball park as 2000’s NHS Plan (147 pages) – but a meagre pamphlet compared to 2006’s Our Health, Our Care, Our Say at 236 pages (including the granular chapter 9, A timetable for action).

The long-term plan’s authors have listed some quite detailed intentions across a wide range of issues, but not signed up to many implementation milestones, within a five-or-10-year window, despite likely pressure from the Treasury for more specificity. It’s also done away with some of the wonkery (there’s few new care models here) in favour of a bit more pragmatism.

As our finance correspondent observes on the funding front – the long-term plan is lots about up-righting the NHS in the short term and providing a little hope.

Planning guidance and allocations

You’ve enjoyed the long-term plan, now get stuck into the short-term clamour. A more fullsome version of the planning guidance – expanding on the pre-Christmas previewwas published Thursday afternoon by NHS England and NHS Improvement, as have five-year commissioning allocations. 

Not FITting in

Cancer screening was something of a lightning rod for controversy in 2018, particularly after the NHS and Public Health England unearthed what they thought was a major crisis in their breast screening programme.

And 2019 hasn’t exactly got off to a great start, either. This week, HSJ reported the long awaited new technology for the bowel cancer screening programme has again failed to materialise.

If trial data is right, faecal testing should increase the rate at which people take part in screening. This, in turn, should mean the NHS diagnoses more cancers sooner, a priority of the long-term plan.

Stability at last?

Worcestershire Acute Hospitals Trust has had a steady turnstile of leaders in recent years, none of whom have stayed long enough to fix the organisation’s long standing difficulties – assuming that is possible.

Sir David Nicholson’s appointment as permanent chair through until 2023 will provide more stability. This month, he will be joined by Matthew Hopkins as chief executive, who is still well regarded despite the difficulties of his time at Barking, Havering and Redbridge University Hospitals Trust. For good measure, Dame Julie Moore has been appointed as “associate non-executive director”, completing what is surely one of the most formidable non-executive groups in England.

The trust now has leadership with deep experience of running hospital trusts, including those in significant difficulty on both quality and financial fronts. Whether the changes at the top will be enough to kickstart a turnaround remains to be seen.

An uphill climb

In the long-term plan, which was finally unveiled earlier this week, NHS England indicated community mental health services would become a priority with the promise to introduce national access standards for the service. To its credit, the national commissioner has openly recognised the need to focus and improve community mental health services in its 10-year plan.

But figures in an NHS Benchmarking report, revealed by HSJ, showed the average mental health trust investment in community teams decreased by 20 per cent in real terms from 2012-13 to 2016-17. This suggests NHS England faces an uphill climb – and a steep one at that – if it wishes to achieve its aims.

Good times

It’s rare for a trust to jump two levels in Care Quality Commission ratings – even more so when that trust has long-term issues and has been through several chief executives in a short time.

So hats off to Brighton and Sussex University Hospitals Trust, whose “good” CQC report has been released. The report makes clear the magnitude of the change that has been achieved, with fulsome praise for the “huge improvements” and, in particular, the cultural change which staff reported. Praise for the trust – which has also come out of quality special measures – has come from both NHS Improvement and care minister Caroline Dinenage.

Chief executive Dame Marianne Griffiths – who was likely already having a great start to 2019 after her damehood in the New Year’s honours – was quick to tell HSJ there is no “silver bullet” to drag a trust off the bottom and to praise staff and the trust’s wider leadership. Nonetheless, there must be some who are wondering if her formula could be used elsewhere with the same level of success.

A hidden epidemic?

Harm done to NHS patients who deteriorate from spending too long in hospital has hit “epidemic” levels which “dwarf the damage done by hospital acquired infections”, a senior national adviser to the NHS has warned.

Leading geriatrician Ian Sturgess told HSJ tens of thousands of patients, largely older people, could have been harmed by what he termed “hospital acquired functional decline” in the NHS over the last decade.