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A repeat of last winter’s snap blanket elective ban has been ruled out by system leaders this winter, Performance Watch can reveal, setting up both potential opportunities and dangers for trusts.
The decision to take a different tack this winter following last year’s controversial national elective moratorium, announced in December and extended in January, has been sanctioned from the health secretary downwards.
Senior sources close to the NHS leadership say they are minded to avoid such an intervention this winter. While a well placed departmental source said Matt Hancock is of the view that the move “clearly didn’t work and that’s not the way we are going to approach it this year”.
The decision to implement an elective moratorium last winter was part of a package issued by senior NHS leaders, which also included relaxing mixed sex ward rules and deferring outpatient appointments.
The move was taken as system leaders desperately tried to get a grip on deteriorating performance during a chaotic winter.
It didn’t work. The four hour accident and emergency waiting time target performance, system leaders’ number one priority last winter, hit record lows during that period. And since then the elective waiting list has spiralled up from 3.8 million in March to 4.3 million in August, the latest official data show.
The slide prompted NHS England in August to order hospitals to urgently investigate sending patients to other NHS providers as well as private hospitals to try and get back on track with locally agreed trajectories. It is not yet clear what the impact of this national drive has been.
The nationally ordered elective freeze was also unpopular with many trust leaders who felt it lacked nuance and confused both staff and patients alike. Consequently, many hospitals, most already in breach of their 18 week 92 per cent waiting time target, ignored the advice and ploughed on with their electives as planned.
This was borne out in the official data. NHS England estimated in January around 50,000 procedures would be postponed. But, as revealed in this newsletter in June, the actual figure was under half that (around 22,800).
So, it’s no surprise the move not to go down this road this winter was welcomed by NHS Providers. The lobby group said trusts were best placed to decide the safest course of action. Deputy chief executive Saffron Cordery added that national directives on what to cancel “dangerously blur accountability.”
And it seems fair to conclude that some trusts will both relish the autonomy and better manage winter without the national interference.
But, conversely, local decision making could leave some trusts vulnerable to being hung out to dry if they are forced into mass cancellations over winter and a blame game ensues (a very likely scenario in many areas).
“Trusts tell us they need freedom to make their own decisions, but they also need the national air cover of being able to cancel elective work should that be necessary,” Ms Cordery adds.
It is not, however, clear what that “air cover” will consist of, or if indeed, there will be any at all. Local organisations crave autonomy but should beware when national leaders claim to be handing them the power to decide.
It usually means it’s a decision they don’t want to make. Once shunted to the local level, they will then distance themselves if things go wrong.
The decision will also split the clinical community. The Royal College of Surgeons welcomed the move, saying a “more nuanced approach to pressures this winter”. There must be a much clearer vision of how we can reduce waiting list lengths, including improving the availability of beds and tackling the huge variation in length of stay,” said RCS president Derek Alderson.
But the plan will not please the Society for Acute Medicine who called for an eight week elective freeze starting from Christmas last month.
One point all parties are agreed on, however, is that the more elective work done now before the winter surge, the better. But with staffing levels stretched and pressure already cranking up, there is a limit to what can be achieved.
Hancock on manoeuvres but backs Philip
Mr Hancock has spent much of this week seeking to draw a line under his predecessor Jeremy Hunt’s tenure and setting out his stall: his olive branch to junior doctors being a case in point.
The management of winter is of course hugely political as well and all parties are on manoeuvres to try and best position themselves for if (when) things get ugly over the coming months.
While the ambitious new health secretary asserted there would be differences in the way winter would be run under his watch this week, one issue he did agree with Mr Hunt on was that NHS winter tsar Pauline Philip is the right person for the gig.
“Pauline has got a great grip on winter. I think she’s absolutely brilliant at her job and I have a huge amount of faith of her day to day planning and trying to help the system as much as possible,” he said of Ms Philip, who was also well regarded by Mr Hunt, during an interview with NHS Providers chief Chris Hopson screened at the provider lobby group’s conference.