HSJ Weekly Catch Up: Sussex’s legal directions, Manchester’s A&E performance and Lincolnshire’s ambulances

Left waiting

Lincolnshire is famous for Sir Isaac Newton, Margaret Thatcher and Alfred, Lord Tennyson. But HSJ’s research suggests one thing it will not become known for is timely arrival of ambulances.

In the area served by Lincolnshire East Clinical Commissioning Group, performance at the 90th percentile for “category two” ambulance calls is close to an hour and a half — meaning one in 10 patients who call for conditions such as suspected strokes or heart attacks wait for 86 minutes or longer.

The target times for category two calls are 18 minutes on average and 40 minutes at the 90th percentile.

Recruitment drive

First it was recently retired doctors and nurses, now the government is eyeing up another talent pool in the fight against coronavirus.

Chief medical officer Chris Whitty said on Thursday that final year medical students and first year doctors could be drafted in, along with clinicians who retired up to three years ago, if the spread of the disease increases as expected.

What’s in your basket?

We revealed on Wednesday the Royal College of Emergency Medicine and NHS Providers are both now signalling they are open to dropping the four-hour accident and emergency target.

The news comes at a crucial stage and suggests it is very likely NHS England and the government will be able to forge ahead with plans to ditch the four-hour standard. NHSE’s intentions are expected to be set out in the final recommendations of its targets review due this month.

So, what comes next? There is consensus that no one single metric can do the job and there needs to be a basket of metrics.

HSJ bureau chief James Illman explores what that basket could contain in this week’s Performance Watch. 

Risk ratings

NHSE has declared coronavirus a “level 4 incident” — the highest possible risk rating — allowing it to take command of all NHS resources across England.

In a letter sent by NHSE and NHSI strategic incident director Keith Willett and incident director Stephen Groves on Tuesday — the day before the number of UK cases jumped to 85 — the centre also warned all acute providers they could soon be called on to treat covid-19 cases. 

NHSE’s regional teams have been directing all health service resources in England through its regional teams since the decision to move to level 4 was taken a month ago — although it was only made public in Tuesday’s letter.

Normalising the unacceptable

It’s a trust that has rarely been in the headlines for the right reasons lately. Quality and financial special measures, ambulances snaking out of its emergency departments and a workforce that, by its own admission, “lack[s] a sense of pride or hope”.

Now, with its EDs both rated “inadequate” for the second time in a year, what other assessment could the boss of United Lincolnshire Hospitals Trust give?

In a frank interview with HSJ, Andrew Morgan said his organisation had on occasion “normalised the unacceptable” and admitted: “Nobody can be happy [with] where this trust is in its current position.”

How much light?

When is the right time to bring CCGs out of financial legal directions? The obvious answer might be when they appear to have got a grip on their finances and there’s some light at the end of the tunnel.

In the case of two Sussex CCGs, even a pinprick of light seems to be enough. NHS England is taking Crawley CCG and Horsham and Mid Sussex CCG out of financial legal directions just as the pair reforecast their deficit for this financial year to a whopping £71m.

That is nearly £25m more than originally planned and reflects overperformance on the main acute contract and a failure across the system to realise all the efficiencies expected.

NHSE’s actions may seem strange but are based on a belief that, despite the deficit, the CCGs are on the right track and in safe hands

Striking a different chord

The departure of Jon Rouse has led to a change in tone from Greater Manchester’s devolution team.

Shortly before moving back into local government, Mr Rouse gave an outspoken lecture which accused NHSE and government officials of paying too much attention to A&E performance, while failing to encourage local leaders to address the underlying causes of ill health. He argued constitutional waiting time standards are “not the most important goals”.

In an interview with HSJ, the devolution team’s executive lead for strategy and system development, Warren Heppolette, struck a very different chord.

“Elevation of our return to constitutional standards as a priority for Greater Manchester has to be deeply recognised,” he said.

“Our approach [must be] based upon both pursuing [population health projects] that feel like they’re working, and maintaining quite a challenging conversation with ourselves as a system around why we’ve not been able to return to constitutional standards or a level of performance that would be more typical nationally on things like A&E.”