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.

What gets measured gets gamed

The referral to treatment time figures show that this May was the worst May since 2008 on the 92 per cent target (or that no more than 8 per cent of people should wait more than 18 weeks, to look at it from another angle).

People are waiting longer and the waiting list is unprecedentedly big. The 4.39 million people awaiting treatment comprise 8 per cent of England’s population.

It’s against this backdrop that NHS England announced the 12 trusts that would be trialling a new way of calculating performance.

Why would we need to change this? To avoid gaming? Everything measured gets gamed to some extent.

Waiting times experts said of the new measure being trialled: “Average waiting time targets will make the numbers look smaller, but that’s about it.”

Sceptical and doubtful

Boris Johnson’s address to the Commons at Thursday lunchtime gave us some more punchy talk on the NHS. Among it was the pledge of “urgent funding for 20 hospital upgrades”. Other oaths included “drastically reducing waiting times and for GP appointments” and funding for ”winter readiness”.

Unfortunately, there was no elaboration on what exactly a “hospital upgrade” was, nor where the money to get the NHS ready for winter would actually be fed into. As for the bit about waiting times, as this week’s The Integrator notes, that sounds pretty similar to work already being carried out.

But perhaps Daily Insight is wrong. As Mr Johnson put it: “We are going to prove the doubters wrong again… with the help and the encouragement of a government and a cabinet who are bursting with ideas, ready to create change and determined to implement the policies we need to succeed as a nation.”

Also, speaking of the cabinet, one thing very much unchanged in the line up of new faces is Matt Hancock, who was reappointed as health secretary.

A case of desperation

HSJ’s exclusive on the latest accident and emergency data fiddle – this time involving several hospitals trying to artificially boost their four-hour performance data by exploiting a loophole opened up by the introduction of new emergency day care units – generated a lively debate in the comments section.

The story concerns the mandated rollout of same day emergency care units, which are designed to treat patients judged to require several hours’ worth of treatment, tests or observation, avoiding the need to admit them to an overnight bed.

Concerns have been raised to HSJ that trusts are simply rebranding part of their emergency department as an SDEC unit and saying, “these patients no longer count in the four-hour data”.

Fit and proper regulator?

For the second time, the Care Quality Commission’s handling of fit and proper person test regulations has been found to be wanting by the Parliamentary Health Service Ombudsman in a new report.

This time, the PHSO has looked at the way the regulator handled a complaint by former paediatrician David Drew against now retired NHS chief executive officer Sue James in 2015.

Merger map mania

It’s on… after many years of endless chatter about clinical commissioning group mergers, dozens are now either firmly proposing or in advanced discussion about coming together in April next year.

HSJ analysis has identified 86 groups which have confirmed or are consulting over consolidations for 2020 – 45 per cent of the current 191 groups. (We have mapped them)

If they all go ahead, the total would fall by a third to 126. That’s a lot more than the total reduction of 20 going all the way back to 2013 (9.5 per cent of the original).

That figure of 126 is smaller than the 150-odd local councils with social care responsibilities – showing NHS commissioning is now, in many areas, going big.

Cutting room floor

Health Education England has opted not to publish a much-anticipated review into community nursing, which it has been carrying out over the past year, after members of its steering group raised complaints.

According to multiple sources, the final blow came when two members of the group pulled out due to serious criticisms over the quality and focus of the report. HSJ also understands there were requests from other members of the group – which included representatives from NHS Improvement, NHS England, the Nursing and Midwifery Council and the Royal College of Nursing – that the report not be published.

Greater Manchester is still struggling on the four-hour target, despite formal intervention from regulators earlier this year.

The proportion of patients dealt with within four hours in the region, which has benefitted from a unique devolution deal which included a £450m transformation fund, was 84 per cent in the first quarter of 2019-20. This compared with 87 per cent in the north of England, and 89 per cent nationwide.