Labour warned against ‘disruptive’ move to ‘bypass ICSs’

Matthew Taylor, chief executive of NHS Confederation, said shadow health and social care secretary Wes Streeting was being “advised” to work directly with acute trusts on elective recovery, which he said “undermines” the role of the rest of the system.

In an HSJ interview ahead of the NHS Confed Expo conference, and in a comment piece published today, Mr Taylor has warned Mr Streeting against sending a “disruptive” message by cutting out ICSs. 

“I’m a little bit concerned when I hear there are people advising Labour, that if Labour win they should bypass ICSs and try to drive the elective target directly through working with the acutes,” he said.

“What worries me about that is it underestimates the role of the rest of the system in reducing elective [waits]. And if you [tell] the system [the secretary of state is] going to bypass ICSs and not have an approach based on integration and pathways, but just based on managing large hospitals, that is a disruptive [and] problematic message to the system. [It] misunderstands the nature of this challenge.”

However, Mr Taylor, who was a chief political strategist under Tony Blair, and has been linked to health roles in a new Labour administration, appeared to rule out becoming a government adviser.

He said leading the confederation allows him “having the freedom to develop ideas”. He said he had not been offered a job and added: “I do like my own ideas. I do like being provocative… I’m not really a back room boy. It’s not my style.”

Corridor care

In the wide-ranging interview, Mr Taylor said he opposed a recent proposal from the Royal College of Nursing to designate “corridor care” in hospitals as a “never event”, due to the patient safety risk and effect on staff.

Mr Taylor said corridor care had been “advocated explicitly as a lesser of two evils”, as it freed up accident and emergency departments to receive ambulance patients, thereby freeing up the crews and reducing ambulance wait times. He said: “I don’t think [the proposal] is helpful unless you’re addressing the reasons why leaders have to revert to that.

“I’d love to be in a world where there’s no corridor care. But it’s a really hard choice leaders have to make – and in the present circumstances, sometimes that will have to mean corridor care.”

Responding to Mr Taylor’s comments, the RCN said corridor care “is not safe and has become normalised”. Acting chief executive Nicola Ranger added: “The toughest choice will be how the system gets out of this national emergency in the next year, not temporary fixes to free ambulances.”

Investment in primary care ‘more effective’

Mr Taylor also advocated “shifting resources upstream” into primary and community care to enable better population health management and a more “proactive model”. 

He said: “Over time, we should be aiming to increase the proportion of investment that goes into prevention, primary care and community-based care.

“I spoke to a very high profile acute leader a few weeks ago and he said ‘If I could take 5 per cent of my budget, and give it to a primary, it would be transformative. [But] I can’t do that, because I’ve got a deficit.’

“So that’s what we need to think about — how do we shift the patterns of investment so that we do more work upstream? Which is, by the way, a more effective use of investment.”