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.

Don’t rush it

The headlines from the monthly performance data make grim reading; admissions up 6 per cent in 12 months at major accident and emergency departments, total attendances hitting a record 2.27m and four-hour performance down again last month.

The figures raise questions about why the demand continues to surge and what can be done about it. But they also prompt a more immediate question; with the system heading into what all the data indicates will be its toughest winter ever, is now the time to fast track through a new A&E performance regime?

But a rushed approach will only raise the prospect of a botched implementation without securing sector-wide buy in, which would heap further misery on a system already teetering on breaking point.

While commending system leaders for grasping the nettle on reforming and updating the performance standards, it would be wise to take a more measured, transparent approach, and the time to secure buy-in from across the health service on whatever the review concludes.

Devon exemplifies national autism challenge

Much work is being done to deliver improved autism care across the country since the long-term plan singled out the neurological disability for the first time.

A clear example of the challenge facing the NHS can be found in Devon, where children and teenagers face an average wait to be assessed following a referral of 67 weeks. The longest recorded wait is 122 weeks.

Given the fact the recommended maximum waiting time is three months, it’s clear the service is failing its users terribly.

The situation appears to have reached a tipping point now, as Devon Clinical Commissioning Group has begun the search for an extra provider to reduce the backlog.

Skunkworks

Following months of speculation, the planned structure of the NHS’ new tech unit was revealed, after a document was leaked to HSJ.

The paper shares the first details of the structure of NHSX, notably including a “skunkworks” department for specialist tech projects.

When plans for NHSX first came to light earlier this year, they were greeted with scepticism, with one source dismissing rumours of the new tech unit as “a bit barmy”.

However, the new unit officially launched last month. Responsibilities taken on by NHSX – many of which previously sat within NHS England – include setting the national NHS cyber security policy and enforcing compliance with new IT standards.

Playing catch up

Just one of the executive leads and chairs of England’s sustainability and transformation partnerships and integrated care systems has a BME background, HSJ has discovered. 

Lena Samuels, who is chair of the Hampshire and the Isle of Wight STP, as well as chair of South Central Ambulance Service Foundation Trust, was born in London, to parents from Trinidad.

Ms Samuels told HSJ the lack of diversity among STP and ICS leads likely stemmed from the limited ethnic backgrounds of the former or existing trust chiefs and chairs who make up many of the STP leads.

She said: “We haven’t got a pool at the moment of people with that level of experience which STPs and ICSs naturally go to. 

“There is a need for us to play catch up in terms of doing the talent management. In the immediate future not the long-term future.”

Genuine, new, extra money?

Under ordinary circumstances, a £1.8bn funding boost would be nothing to snort at. But, when it relates to NHS capital spending, it’s little surprise why The Health Foundation called it “little more than a drop in the ocean”. 

For starters, £1bn of the new money is stretching the definition of new. It’s money trusts thought they would have access to until NHS England/Improvement chief financial officer Julian Kelly wrote to provider chiefs in May and asked them to scale back their plans (and then wrote to them again last month and told them to scale back). 

Nuffield Trust’s senior policy analyst Sally Gainsbury likened it to “the equivalent of giving someone cash then banning them from spending it, only to expect cheers of jubilation when you later decide they can spend it after all”. 

Chris Hopson took a diplomatic approach when discussing the details of the announcement. The NHS Providers chief executive described the money as “genuine, new, extra money” in that the Department of Health and Social Care’s capital spending limit had been lifted – while noting that, because the cash had been sat on provider balance sheets all along, it could “legitimately be described as money that trusts already had”. 

Time to say goodbye

Late last week, Dominic Hardy bid farewell to his colleagues at Skipton House; he will be leaving NHS England and Improvement come October.

He is going to be chief operating officer at The Royal Berkshire FT and will work on their integrated care partnership plans as well.

Mr Hardy was appointed national director of primary care delivery at NHSE in 2017. In March this year, his role was expanded to incorporate transforming health systems, giving him oversight of the development of integrated care systems.