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.

Handover delays under the spotlight

We revealed on Monday that Jeremy Hunt has ordered system leaders to step up efforts to curtail ambulance handover delays and draw up new plans by the middle of this month.

Long ambulance queues outside hospitals are, of course, as much as a symptom of a system under tremendous strain short due to shortage of staff and beds as they are a problem in their own right.

But despite the health and social care secretary’s intervention provoking frustration from some HSJ readers (see the comments below the article), it is welcome that ministers are prioritising the issue.

Even within the awfully constrained resources at hospitals, some of the poorer performing trusts on handovers contacted by HSJ said there was room for improvement by following best practice from better performing neighbours.

It would be wrong to dismiss this simply as a problem of funding and staffing levels.

The sub 50 per cent club

It is easy to forget 2018 was supposed to be the year NHS England got the system’s accident and emergency performance back to hitting the 95 per cent benchmark, which hadn’t been met since July 2015.

The 2018 compliance target was only set out in the Next Steps on the Five Year Forward View last March but has, of course, since been postponed. And the most recent figures, published on Thursday, were a further illustration of why.

Performance against the four hour accident and emergency target hit its lowest level in 15 years last month, with two trusts sinking below 50 per cent.

Long term A&E strugglers Blackpool Teaching Hospitals and Hillingdon Hospitals both recorded performance under 50 per cent for major type one emergency attendances last month.

The figures will no doubt give ministers food for thought as they prepare their new long term plan for the NHS, as will the drop in the performance data between February and March, usually a period in which performance starts improving.

They also underline why the public is becoming increasingly anxious about the state of the NHS and the widespread support for tax rises to increase funding, as shown by the King’s Fund timely attitudes study this week.

The power of three

Three northern sustainability and transformation partnerships have appointed a single leader and are aiming to become an integrated care system by April next year.

HSJ revealed that the Northumberland, Tyne and Wear and North Durham; Darlington, Teesside, Hambleton, Richmondshire and Whitby; and West, North and East Cumbria STPs were in talks last year to form a single footprint.

This would create the largest STP in the country, covering a population of 3.2 million.

But now a briefing paper has revealed North Tees and Hartlepool FT chief executive Alan Foster has been appointed lead for the three STPs, which are aiming to form an integrated care system in 2019.

While a merger has not been ruled out, this is a major step towards the integration of commissioning and provision of care for the region.

CQC launches investigation

The Care Quality Commission has started an investigation into how mental health patients are protected from sexual abuse, after it identified 900 incidents on wards across the NHS in just three months.

The action comes after the CQC found a trust breaching guidance on eliminating mixed sex accommodation.

The regulator has written to every mental health trust nursing director about improving sexual safety on mental health wards.

In the letter, seen by HSJ, deputy chief inspector of hospitals Paul Lelliott said the CQC was working with NHS Improvement to review how specialist mental health trusts reported patient safety incidents of a sexual nature.

Back office politics

In practice, making back office savings is a painful process.

It’s important to make the cuts if it helps protect clinical services, but you can see why trusts shy away from it where they can.

The Carter review of provider efficiency was supposed to hold trusts’ feet to the fire on a number of fronts, including this one.

How did it go?

Well the benchmarking, if there was any, was not revealed trust by trust.

Nevertheless, Lord Carter’s recommendation accepted by NHS Improvement was that these costs should form no more than 7 per cent of a provider’s turnover.

The savings were to have taken effect as of this month.

The results?

NHSI is not collecting this data and trusts are not being held to account for it.

The regulator says £120m of savings will be made in this area as part of the normal run of the mill cost improvement programmes (the way these savings always would have been included in cost improvement programs) but has not said where or how.

Merger on hold

Plans to split two hospitals into emergency and elective care centres as part of a £147m reconfiguration are being held up by a judicial review, which could delay a long awaited trust merger.

Local campaigners are challenging Dorset Clinical Commissioning Group’s decision to commission emergency services from Royal Bournemouth Hospital and elective services from Poole Hospital.

The sites currently provide both services, but the CCG’s plan will see Poole’s accident and emergency department downgraded to an urgent care centre. Most of Bournemouth’s elective work will be transferred to Poole. The proposal followed a clinical services review launched in 2014.

However, the granting of the judicial review brought by the campaign group Defend Dorset NHS means the trusts must pause the estates design work.

The providers do not want to spend money on the design prior to the judicial review being resolved. It will be heard on 17-18 July.