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.

Unintended consequences

Last week, HSJ revealed NHS England’s attempt to impose stricter conditions on the publication of national clinical audit reports. This week, clinicians have told HSJ that patients are being put at risk by the subsequent delays

Clinical audits draw on real data from the frontline, with doctors and other staff putting in huge amounts of effort. 

The audits are then able to analyse outcomes and performance, and reveal the variations in care and substandard practice in some locations. Delays mean the NHS is aware of these variations and problems, but no action is being taken to communicate that to the service.

NHS England insists its new process is designed to improve the audit process and quality of reports. The effect of this heavy handed control of the message may be an unintended consequence, but it’s one NHS England needs to seriously address as the UK’s reputation for clinical audit is being seriously put at risk.

Playing it safe

Taking an organisation out of special measures is a finely balanced decision. Many will still be in the early stages of improvement with little evidence that change has been embedded consistently across the organisation. At the same time, leaving special measures can be a significant morale booster and may drive further improvements.

Unfortunately, in recent years, a number of organisations have fallen back into special measures. Arguably, there are others which should never have been allowed to exit the regime in the first place and remain perilously close to the edge.

So the Care Quality Commission may be playing it safe with South East Coast Ambulance Service Foundation Trust. It has raised its rating to “requires improvement” but said more time is needed to see if changes are embedded before deciding on whether to take it out of special measures.

Years of chaos

At the Managers in Partnership annual summit this week, NHS Improvement’s director of people strategy Caroline Corrigan, who is leading on the workforce element of the long-term plan, remained tight lipped. Her disclosures only went as far as saying there would be a focus on the “notion of the team” and the importance of regional directors.

The room was clearly anxious about the NHSI and NHS England merger, with delegates pondering what it would mean for them. Ms Corrigan confirmed there would be an impact assessment, while NHSI and NHS England would be “rallying” to fill the gap until a chief people officer is appointed.

But, as Managers in Partnership’s chief executive Jon Restell acknowledged, managers have been tolerating “years of chaos”, so yet more reorganisation prompts more questions for this group. 

Three strikes…

Shrewsbury and Telford Hospital Trust has had three strikes in the safety and quality playoffs.

Early this week, HSJ reported the under-fire trust has received its third enforcement action notice from the CQC. It was later revealed NHSI planned to place the troubled trust in special measures

The provider, which has faced a string of critical stories regarding its safety record, has now been told it needs to address concerns within its intensive care and medical wards. The previous warnings were focussed on care in its emergency department and maternity wards.

Eastern problems exposed

A senior system leader’s concerns about the “significant problems” facing a struggling ambulance trust were laid bare in meeting minutes obtained by HSJ.

NHS England Midlands and East regional director Paul Watson raised concerns about the East of England Ambulance Service Trust including that it was appearing to prioritise less urgent patients over those in greater need.

During the meeting on 28 September, Dr Watson did acknowledge “significant improvements” in some areas at the trust.

But the detailed unpublished minutes detail a raft of fundamental concerns which follow whistleblower allegations last winter about patient harm caused by ambulance delays and cultural problems.

Take note, Treasury

Matt Hancock this week articulated his ambitions for making prevention central to the NHS. He told a room full of public health officials from around the world the NHS is not just a service; it’s a shared stake in society.

With shades of JFK, he said people must stop asking what the NHS should do for them and look to what they can do to help the NHS. They must take personal responsibility for behavioural factors of poor health. In other words: stop smoking, drink less, get more exercise, and have a better diet.

Mr Hancock may have been better off pointing his rhetoric at his Treasury colleagues because he did not address the funding crisis that has swept through public health provision in England.

Commissioning’s long tail

NHS England has made no secret of its desire to see a future consolidation of clinical commissioning groups. A reduction of CCG numbers would lower overhead costs and allow commissioners to plan for healthcare across a wider population.

To help achieve this, the shift towards sharing accountable officers across CCGs has been happening at pace. HSJ analysis has found that just under a third of the English population is now overseen by just 13 CCG leaders. In contrast, 11 sustainability and transformation partnerships have CEOs that, on average, manage a population of less than 300,000.

Julie Wood, chief executive of NHS clinical commissioners, also pointed out that a leader responsible for multiple CCGs can’t be everywhere. She predicted a significant change in the structure of leadership, with an AO having to delegate responsibilities to new roles that will spring up at a local level to help implement commissioning decisions.