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 just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

Risky business

Barking, Havering and Redbridge University Hospitals Trust has published the full investigation report into its financial governance failings – revealing the shocking extent to which its cash was allowed to run dangerously low in 2017-18.

A review by Grant Thornton found patient safety was put at risk by a “significant breakdown in financial governance”, after the trust routinely delayed payments to suppliers to cope with cash shortfalls.

The delays eventually led multiple companies to cancel deliveries and threaten legal action to obtain payment.

The issues were repeatedly reported to the trust’s senior finance team from November 2016 onwards, but were not added to the risk register until October 2017.

It seems the “operational management group” didn’t fully grasp the urgency of the situation.

But one also has to wonder; would the trust have been allowed to exit quality special measures in February 2017 if the cash issues had been properly escalated?

Daunting challenge for teaching trust

Emergency pressures left hospitals across England creaking at the seams this winter, with some now showing cracks.

Many of the staff at Lancashire Teaching Hospitals Foundation Trust, which runs hospitals in Preston and Chorley, are now exhausted and have had enough.

Towards the end of last month, consultants at Preston accident and emergency wrote to trust leaders over unsafe staffing levels and dangerous levels of overcrowding in the department.

Then two weeks ago, the Lancashire Evening Post reported how nursing staff at Chorley A&E had also written to the board about having to work shifts of up to 17 hours due to the pressures, and were threatening to start leaving at the end of their shifts if the situation remains unresolved in a month.

But the sense of crisis intensified after the entire senior operations team handed in their resignations.

It is expected to report a £40m deficit for 2017-18, around £20m worse than planned. 

Amid all this, the board is trying to progress with long overdue, highly controversial reconfiguration of its two hospitals, which even without the operational and performance problems would be enough to cause a major headache.

International rescue required

Trust chief executives have warned they are struggling to fill rotas in their hospitals because visas for international specialist doctors are being rejected due to a government cap.

Tier two visas are given to workers who have a skilled job offer and are not from the European Economic Area. Government statistics show 2,193 certificates of sponsorship were granted in April and 1,975 were made available for allocation in May.

Meanwhile, the number of nurses and midwives from EU countries registering to work in the UK has dropped by 87 per cent since last March.

The Nursing and Midwifery Council reported that between April 2017 and March 2018, 805 EU nurses and midwives joined the register – 5,577 less than the year before.

Janet Davies, chief executive of the Royal College of Nursing, said efforts to boost the number of nurses are being dragged down by a “botched Brexit”.

Fallen five star reviews

HSJ revealed on Thursday that a much vaunted digital health firm, partnered with Uber, had been forced to remove incorrect claims about NHS partnerships from its marketing and launch a probe of five star reviews allegedly faked by its own employees.

Cera, a start-up founded by a former NHS England adviser, only took the drastic action after HSJ presented the firm with a series of allegations. It was also operating until February without registration to the Information Commissioner’s Office, which breaches the Data Protection Act.

There are lessons in this story for patients, new private healthcare providers pitching for NHS work, system leaders and regulators.

There is no doubt the NHS is behind the curve in terms of digital maturity compared to other comparable health systems, so innovative approaches should be viewed, on the whole, as opportunities rather than threats.

But those with the innovations must meet the standards set by regulators within the health system and beyond. It is simply not acceptable to be dealing with NHS commissioned services without proper sign off from all regulators, no matter how whizzy the product.

Coroner’s concerns

The safety of NHS patients treated in private hospitals has been raised directly with health secretary Jeremy Hunt following the death of an NHS patient.

Assistant coroner for Manchester West Simon Nelson has written to the health and social care secretary warning about poor processes for emergency transfers, the lack of responsibility private companies have for consultants they use, and junior doctors working alone for 24 hour shifts with a lack of training and monitoring.

He has given Mr Hunt until next month to respond, following his investigation into the care of 77 year old Peter O’Donnell. Mr O’Donnell, who was an NHS patient, died in January 2017 after hip replacement surgery at BMI Healthcare’s Beaumont Hospital in Bolton.

A review by the Care Quality Commission earlier this month highlighted concerns over the safety of private hospitals and the reliance on using 999 calls to transfer unwell patients to NHS hospitals due to a lack of critical care facilities.