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.

Why are we waiting?

Elective care was deprioritised a couple of years ago when the big financial incentives were placed solely on the four hour emergency target.

Then new money was offered in the 2017 budget, and a commitment made for the waiting list to be “no higher in March 2019 than in March 2018”.

But since then the list has continued to grow – from around 4.1 million to 4.3 million in Septemberprompting a drive in the summer to ensure hospitals met the target.

This has even gone so far as NHSI handing a list of 54 trusts that might need support to private sector providers, to make them aware of the opportunities.

Whether this results in a big splurge of outsourcing remains to be seen, though. Sending 200,000 extra cases to private hospitals could cost around £400m to £600m, which would threaten to tip NHS expenditure well over the permitted edge in 2018-19.

Redundancy packages

NHS England has launched an independent investigation into how two clinical commissioning group managers were given redundancy payments which appear to have breached the maximum allowed, we have reported.

Tony Bruce, former accountable officer of East Staffordshire CCG, and Wendy Kerr, the CCG’s former chief financial officer, both left the organisation in March with a payment for loss of office of £259,689 and £202,183 respectively – exceeding the £160,000 maximum allowed for very senior managers.

Beyond this, nothing has been proven. 

With huge turbulence among CCG senior leadership, there will no doubt be questions about the costs of change more widely, too.

So long, farewell

Andrew Cash, Paula Clark, David Dalton, Julie Moore and Andrew Morris – to this fast growing list of hugely experienced hospital chief executives stepping down we can now add Tony Spotswood.

While the Royal Bournemouth and Christchurch Hospitals Foundation Trust’s size pales in comparison to some of the institutions led by the above notable names (its income is around £300m), remaining in charge for 19 years is no mean feat.

Don’t ask, don’t get

The long-awaited review of the Mental Health Act was published this week. While it did not “rip up” the current legislation, as the prime minister had originally suggested it would, it did include significant recommendations to improve how the Act is used to detain patients with mental health problems.

Although the review did not offer any cost figures itself, one of the clearest calls on the government pocket was for a multi-year capital investment programme to improve mental health estate.

Two other recommendations which will require cash are, building places of safety in healthcare settings by 2023-24 (to avoid people being detained in police cells) and buying bespoke ambulance vehicles, so detained patients don’t have to ride in police cars.

There’s no guarantee Sir Simon Wessely, the review’s chair, will get everything he’s asked for but it’s a good time to ask – mental health is a prime ministerial priority (for whatever that’s worth mid-Brexit chaos) and the NHS is currently negotiating a capital funding deal as part of next year’s spending review.

A stark warning from north London

Events at the Royal Free hospital in north London this week suggest winter may have arrived after all.

It declared an internal incident and cancelled all surgeries except cancer operations and had consultants double checking every patient, ensuring everyone in a bed needed to be there as the focus was “on discharging patients safely to free up capacity”.

Some HSJ readers have questioned the newsworthiness of this episode, pointing out that such incidents are common in today’s NHS. Yet this is the first high profile one to come to light this year, and comes at the sometimes-fêted Royal Free, with one of the busiest emergency departments in England and one of the highest turnovers too.

Error messages

An internal Public Health England report, recently obtained by HSJ, discovered there had been “a lack of a strategic approach to the replacement and development of IT underlying cancer screening programmes”.

The IT systems need replacing “to allow for better functionality and performance”, the report continued.

The complexity and advanced age of “legacy systems” supporting the breast screening programme was one of three underlying causes of the national scandal uncovered earlier this year – it was revealed up to 450,000 women had not received their final breast screening test.

Email shutdown

Last Saturday, a fault in a data centre in Slough resulted in the “complete shutdown” of the NHS’ central email service.

NHS Digital, which manages the central NHSmail service, said the shutdown occurred at about 12.30pm (although some users claim they’d been shut out since 11am). They confirmed the service was back up and running by 7pm.

The exact number the shutdown affected is yet to be confirmed. However, NHS Digital has previously said there are more than 1.2 million NHSmail accounts in England and Wales.

A tidy sum

The big winner of the recent NHS clinical waste stockpiling scandal appears to be Mitie, which is earning a tidy sum for taking over services removed from under-pressure company Healthcare Environmental Services.

HES told HSJ it was charging 18 trusts in Yorkshire and Humber £3.3m a year to collect and dispose of clinical waste. That was until its contracts were cancelled after the Environment Agency closed part of one of its waste management stations for breaching permit levels.

A new deal was hastily put in place with facilities management company Mitie, which – as HSJ revealed – is charging three times the price at £10.4m per year.

The threefold sum could affect 30 other trusts whose waste services HES continues to provide, should those trusts need to move across to Mitie.

However, the Department of Health and Social Care said pricing was a matter for the companies concerned.