Social care crisis leaves NHS in limbo 15 June 2018 Four themes dominated this year’s gathering of the health service clan at the NHS Confederation’s annual conference in Manchester: priorities for the new money, avoiding another winter crisis, re-energising the redesign of clinical services, and finding, keeping and training the staff to do it all. The health and social care secretary, Jeremy Hunt, indicated the shape of the offer to be made to taxpayers over more NHS funding. It will be tied to “simple goals” on priorities such as cancer treatment, maternity, waiting time standards for mental health support and integrating health and social care. Hunt and the NHS leadership are pinning their hopes on avoiding another winter dominated by the wholesale cancellation of elective surgery by freeing up 4,000 beds through slashing the number of long stayers. The plan is to cut the number of patients in hospital for more than three weeks by a quarter over the coming months. It is curious that there is not a parallel push to reduce inappropriate admissions of frail elderly people. In his first speech to the conference as chief executive of NHS Improvement (NHSI), Ian Dalton betrayed a growing intolerance of hospitals failing to get a grip on service reconfigurations, wasting money and staff. Read the full article at the Guardian Healthcare Network __________________________________________________ Loads more money will not sort NHS 2 June 2018 Forget the revelation that hospitals overspent by almost £1bn last year. The figure that really matters is the Nuffield Trust’s estimate that the true underlying deficit is closer to £4bn. One-off bungs and accounting sleight of hand may flatter the Department of Health’s end-of-year figures, but they do nothing to solve the hospital overspending problem, as the health secretary, chancellor and prime minister wrestle over the size and timespan of the anticipated long-term financial settlement for the NHS. The magnitude of hospital overspending puts the government in a horrendous bind. It propels ministers towards a substantial spending increase, but one that could be almost entirely consumed in plugging the hospital deficit, with little money left to invest in the community-based services which are crucial to tackling the root causes of galloping demand. That means that in a few years’ time there is every chance we will have to go around this block again – which is precisely why the Treasury is always so reluctant to give more money to the NHS. Read the full article at the Guardian Healthcare Network __________________________________________________ Capita services deal was doomed to fail 18 May 2018 The massive problems that have beset NHS England’s primary care support services deal with Capita, now dissected by the National Audit Office, are a textbook example of how to set up an outsourcing contract to fail. Pretty much everything that could have gone wrong went wrong, with both parties grossly underestimating the size and complexity of the task and the risks involved. The £330m, seven-year contract delivers vital support services to around 39,000 people working in primary care, including GPs, opticians and pharmacists. Each year it includes delivering more than 240,000 orders for supplies, sending out more than nine million invitations for cervical screenings, processing around £9bn of payments to GPs and pharmacists – and moving six million patient records between GP practices. It is the engine powering primary care. When NHS England inherited the services from primary care trusts in 2013 they were a mess, run out of 47 local offices with no common service standards or processes, an archaic IT system running 82 databases and many paper-based records. Meanwhile the government’s first mandate to NHS England required the organisation to deliver deep cuts in administrative costs to focus resources on the frontline – as if the two were separate. Read the full article at the Guardian Healthcare Network __________________________________________________ Hospitals try to anchor local economies 14 May 2018 UK hospitals are exploring their potential as anchor institutions to use their financial, employment, and asset muscle to support local economies and tackle social determinants of health. Neil McInroy, chief executive of the Centre for Local Economic Strategies (CLES), which works to achieve social justice and effective public services, explains the idea: “An anchor institution is a large organisation that is embedded in a place and isn’t going anywhere, employs many people, spends a lot of money on services, and has large land and investment holdings—big buildings, multiple sites, large pension pots.” It mainly includes public sector institutions such as universities and councils but can extend to enterprises such as airports, football clubs, and longstanding employers. McInroy emphasises hospitals’ substantial economic clout: “They are all across the country, they employ thousands of people stretching from high end consultants and [managers] right the way through to cleaners, so you have a massive range of skills; they have a massive spend, a lot of property and public space, and often multiple sites. “In the poorest parts of the country the hospital is, in many instances, what holds up the economy.” Read the full article at the BMJ __________________________________________________ Brexit deal must allow in health talent 4 May 2018 With chronic workforce shortages now overshadowing financial pressures as the biggest problem facing the NHS, it is vital for public services that the Brexit deal allows the health service to recruit and keep European talent. Analysis for the Chartered Institute of Public Finance and Accountancy Brexit advisory commission for public services lays bare the scale of the EU recruitment issue across the public sector and how the negotiations might address it (full disclosure: I wrote the report). EU staff make up about 5.6% of the NHS workforce in England, not far off the total of 6.9% from the rest of the world. This includes about 41,000 working as doctors, nurses, health visitors, midwives, therapists or scientific and technical staff. About 9% of doctors in England qualified in EU countries. Cities and major towns are particularly dependent on EU workers. Figures from 2015 highlight the vital importance of staff from the European Economic Area (EU plus Norway, Iceland and Lichtenstein) to a number of high-profile trusts, accounting for 20% of nurses at the Royal Brompton and Harefield, 15% at Papworth hospital and around 10% at Frimley foundation trust. Against this high-risk backdrop, the government’s hostile approach to immigration has repeatedly made a difficult situation worse. Read the full article at the Guardian Healthcare Network __________________________________________________ Global scourge of violence against staff 20 April 2018 The revelation of the sharp increase in attacks on NHS staff highlights a problem which is serious, global and growing. The survey by the Health Service Journal and Unison showed assaults in 2016-17 were almost 10% up on the previous year, driven by big increases in hospitals that were missing treatment targets or seriously in debt. Staff in mental health trusts were more than seven times more likely to be attacked than those in other trusts. The World Health Organization says health workers are at a high risk of physical violence all over the globe, and estimates that between 8% and 38% of staff in different countries suffer at some point in their careers. A study by the International Council of Nurses concluded that healthcare workers were more likely to be attacked at work than prison guards or police officers, and that female nurses were most at risk. (On top of these attacks during day-to-day work, healthcare staff dealing with health emergencies such as wars are in enormous danger. WHO figures indicate that over the two-year period to 2015, 959 such healthcare workers were killed and 1,561 injured across 19 countries.) Read the full article at the Guardian Healthcare Network __________________________________________________ Time to end 'heads on spikes' approach 6 April 2018 The leadership implosions at Liverpool community health NHS trust and Wirral University teaching hospital NHS trust have been followed by another bout of soul-searching at NHS Improvement about when and how to fire NHS managers. In an interview with HSJ, recently appointed NHS Improvement chair Dido Harding articulated widely felt disquiet over the health service’s failure to distinguish between people in senior roles whose performance has fallen short and those who have, in her words, “crossed a moral line”. She described the current approach as “a public beheading and then they pop up somewhere else, and for neither of those groups is that the right treatment”. Her comments follow HSJ’s revelation that NHS Improvement’s predecessor arranged for Liverpool’s chief executive Bernie Cuthel to move to a senior role in Manchester after the Care Quality Commission found serious failings at the trust. A subsequent inquiry uncovered bullying, patient harm and problems being hidden from regulators. At Wirral, NHS Improvement had planned to offer a secondment to chief executive David Allison after several directors raised serious concerns about culture and governance. If these are examples of the system seeking to look after those responsible for egregious failings, NHS Improvement’s national model for improving mental health care, unveiled a few days ago, highlights the dangers of sacking managers who get into difficulty while doing their best. Read the full article at the Guardian Healthcare Network __________________________________________________