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.

Wake-up call

After confirming that he intends to remain in post for at least another year, NHS England chief Simon Stevens made a prediction which marks the clearest change yet from a long-standing policy.

In a wide-ranging speech to delegates at the NHS Confederation conference in Manchester, Mr Stevens said he expected the NHS would need to increase its acute bed base over the next five years.

The NHS long-term plan hinted at this but was less explicit. Mr Stevens went on to say hospitals’ bed stock is “overly pressurised” and that “increased capacity” is likely to be needed.

Our favourite moment of the speech came right at the end when Mr Stevens playfully hijacked session chair Niall Dickson’s autocue by reading out the Confed CEO’s own specially prepared announcement (the merger of the Confed and Expo conferences).

* HSJ’s editor has set out Mr Stevens’ likely exit strategy, which suggests that summer 2020 will see the departure of the NHS England chief.

Avoidable harm

The most recent inpatient survey found public dissatisfaction with waiting times starting to grow.

It also noted a worsening in how long people had to wait for a bed once they were in hospital.

This is perhaps to be expected considering the lack of beds in the English NHS, indeed it’s a little surprising this didn’t show up in the inpatient survey earlier (and probably a testament to staff that it didn’t. The survey found faith in doctors and nurses had stayed high.)

What’s a little disturbing is the NHS England response to the data.

A spokeswoman replied that the findings, taken as a pretty significant warning sign by everyone else, were mainly a “useful way” for trusts to “learn and improve”.

They also cited the British Social Attitudes Survey, saying it showed “for the third year in a row public concerns about waits have reduced”.

This might be why of the three main performance targets, the elective one was so obviously de-prioritised.

Letter escalates pressure on OAP performance

The long-running saga of problems caused by inappropriate mental health out of area placements has intensified with the letter sent by NHS England’s national lead for mental health to regional directors.

Claire Murdoch singled out 10 mental health trusts for bringing down the national performance on the placements but, interestingly, chose to contact the directors rather than the trusts themselves.

She demanded action be taken and warned that future transformation funding would be denied if improvements weren’t delivered.

She told regional leads they must “take urgent action” as the 10 trusts accounted “for the majority of out of area placement activity” nationally.

The politics of cancer

An accident and emergency department has to be one of the worst ways to find out you have lung cancer.

Data from the most recent National Lung Cancer Audit shows the places where this is most common – and is a little surprising.

Strongly associated with areas with high smoking and deprivation rates, it seems unusual that Hampshire had three of the worst-performing clinical commissioning groups in this area.

For all its relative efficiency it is widely acknowledged that NHS cancer outcomes are not where they should be, largely because cancers are picked up too late. A lot of this is down to the relative lack of scanners, which is a capital funding issue. Which makes it a political issue.

Questions emerge from tragedy

On the evening of 3 June 2017, three terrorists crashed a van into people crossing London Bridge before marauding with knives through the restaurants and bars, courtyards and alleyways around Borough Market.

The hearings so far have recounted a terrifying and chaotic few hours when London’s emergency services worked feverishly to regain control.

The London Ambulance Service Trust’s operations director was up before the coroner to explain the performance of its people throughout that night. The trust has come in for criticism because three hours elapsed between police shooting the attackers and specialist paramedics entering a courtyard where five of the victims died.

The capital problem

The lack of capital investment in NHS mental health services is a well discussed trope. HSJ has revealed some of the consequences of neglecting the NHS’s mental health estate.

Data from the Care Quality Commission, revealed for the first time by HSJ, showed around 1,200 mental health beds are still placed within “dormitory-ward” style settings. This means shared rooms, with no en-suite bathroom, and often just a curtain separating the beds.

NHS England appears to have met the calls by trusts, staff and patients to end the use of these wards with a shot, quite fairly, at the government. Essentially this is a capital funding issue and the national commissioner has been pretty clear – the next spending review should see some dedicated capital for mental health.