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.

Echoes of Mid Staffs

Almost five years to day since the Francis report into poor care at Mid Staffordshire Foundation Trust was published, Bill Kirkup’s investigation into failings at Liverpool Community Health Trust provides new shocks to the system.

The review, covering 2010 to 2014, found a widespread culture of bullying and harassment at the Merseyside trust, which sought to “conceal” its problems from regulators and national bodies.

There were also failings at regulatory and commissioning bodies, which meant LCH’s problems went unseen for more than four years. The failure of oversight was partly attributed to NHS-wide organisational changes taking place under the Health Act 2012.

Dr Kirkup identifies repeated incidents that the trust failed to learn from because it did not escalate and investigate them properly. These included:

  • up to 19 deaths in custody at HMP Liverpool;
  • five wrong site tooth extractions in the dentistry division;
  • repeated falls and fractures on intermediate care wards; and
  • numerous community services patients with grade three pressure ulcers.

Meanwhile, there were “appalling instances of staff treatment” by the trust’s HR department, including people being suspended when they raised concerns.

Dr Kirkup’s conclusions echo many of the findings from the Francis report. In 2016, the Capsticks report into LCH also warned the trust ignored key findings from the Mid Staffs inquiry.

In a striking similarity, the Kirkup review suggests the poor culture and unsafe practices at LCH originated with its prioritisation of cost improvement plans over quality and patient safety, which were driven by its desire to obtain FT status.

The NHS plan you’ll never read

When NHS England published the Five Year Forward View many moons ago, a core message was the need to shift funding and activity from acute to primary and community services.

We’ve since had “forward views” for general practice and mental health, recognising the need to strengthen these services and set out a solid plan for their future. Surely, it would follow that the same should be done for community services?

According to an internal NHS England document leaked to HSJ, this was certainly the national commissioner’s plan – until it wasn’t.

Proposals to produce a “forward view” for community services were drawn up by NHS England officials last year. According to the leaked document, they acknowledged the risk that without a plan for community services, sustainability and transformation partnerships may not reach their full potential, efficiencies will be missed, and unwarranted variations will continue.

It is surprising then that no such community services forward view, or any other kind of national plan for the sector, has seen the light of day.

No room for ‘unrealistic’ A&E plans

NHS Improvement’s chief executive has warned that new money allocated to the NHS for 2018-19 will not help patients unless local leaders get their emergency activity forecasts right.

In an interview with HSJ – his first since taking over at NHSI in December – Ian Dalton criticised past emergency care planning for being “unrealistic”, and called on leaders to produce forecasts that reflect the “local clinical reality”, to enable trusts to build capacity during the year. The alternative just leads to extra costs when additional unplanned capacity is bought in a hurry.

Some context: last year the NHS planned for 1.2 per cent annual growth in non-elective admissions in 2017-18. At month eight, the real figure was 3.1 per cent.

Has this resulted in worse care due to capacity constraints in hospitals? Mr Dalton didn’t explicitly say so but the implication is there: “Any new money won’t make it to patients unless we collectively plan and deliver the right level of capacity… we’ve seen a significant increase in non-elective demand that has driven capacity pressures at hospitals – not least in the last few weeks.

“This year, it is essential that we agree what we’re planning for, to build capacity and get patients cared for… the system doesn’t have the headroom for unrealistic planning.

Francis five years on

On 6 February 2013, Sir Robert Francis QC published his landmark report into the Mid Staffordshire FT care scandal.

His recommendations were the catalyst for major changes in how the NHS approaches issues around patient safety, organisational culture and the workforce.

In his latest expert briefing, Shaun Lintern looks at the impact of the Francis report over the last five years and what still needs to be done to prevent another Mid Staffs.

A new year resolution for Hunt and Stevens

A leader column from HSJ editor Alastair McLellan tells the story of the 2018-19 NHS planning guidance published last week. He tells how the health secretary and NHS England chief executive have reached “a very NHS compromise” following a pre-Christmas row over health service funding and delivery asks.

The deal means the NHS enters a financial year with full clarity that it is not expecting to meet the flagship accident and emergency target, nor to make any significant reduction in the number of people (several millions) waiting for an operation (as HSJ forecast at the turn of the year).

On the plus side for the government, it can claim there is a commitment to make some form of progress with performance – and a big dollop of money is being put into a plan to eliminate deficits in both trusts and commissioners.

The Jeremy Hunt/Simon Stevens row, therefore, seems to have been “resolved with a whimper not a bang” (as we predicted). To make the hat-trick, we also foresaw the ditching of the “accountable care” label.