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The Care Quality Commission’s assessments of integrated care systems (ICSs) have been put on hold at the last minute, as the government declined to sign off on the process. They were due to begin this month, following pilots in Birmingham and Solihull and Dorset ICSs, but the Care Quality Commission (CQC) has put the brakes on assessments elsewhere until it receives government approval. Under the legislation brought in when ICSs were set up in 2022, the CQC can review and assess systems, but ministers must approve its methodology. Interim chief inspector of adult social care and integrated care James Bullion wrote to integrated care board chiefs this week stating that, following discussions with the Department of Health and Social Care, the CQC had agreed to a “short delay… to allow for further refinements to our approach”. He added: “In particular we have been working with NHS England on their strengthened approach to performance evaluation and rating of the ICB elements of the ICS which we will take into account as evidence for our scoring and reporting approach.” Read full story (paywalled) Source: HSJ, 8 April 2024

A trust has appointed a chair to lead an independent review into dozens of suicides that was sparked by allegations of record tampering. Following questions from HSJ about the review’s chair and terms of reference, Cambridgeshire and Peterborough Foundation Trust said Ellen Wilkinson, a former medical director at Cornwall Partnership FT and its current chief clinical information officer, would chair the review. The trust, which is looking for a substantive CEO following Anna Hills’ departure earlier this year, said the review “will not examine individual patient deaths but will take a thematic approach and look at the learnings we can take from these tragic incidents”. The trust told HSJ the terms of reference for the review of more than 60 cases of patients who died by suicide since 2017 were still being finalised. The decision not to investigate individual cases has been criticised by the whistleblower whose concerns prompted the review in the first place, as HSJ reported in October. While an employee of the trust, Des McVey, a consultant nurse and psychotherapist, carried out an investigation in July 2021 into the case of 33-year-old Charles Ndhlovu, who died by suicide in 2017. Mr McVey told HSJ his review found Mr Ndhlovu’s patient record had been tampered with and “his care plans were created on the day after his death” – a conclusion he stands by. Read full story (paywalled) Source: HSJ, 3 April 2024

Patient safety in the Accident & Emergency unit at the Queen Elizabeth University Hospital in Glasgow will be reviewed by an NHS watchdog. Healthcare Improvement Scotland (HIS) was first contacted by 29 A&E doctors in May 2023 warning that safety was being "seriously compromised". HIS last month apologised for not fully investigating their concerns. The review will consider leadership and operational issues and how they may have impacted on safety and care. In the letter to HIS, the 29 consultants highlighted treatment delays, "inadequate" staffing levels and patients being left unassessed in unsuitable waiting areas. They claimed this resulted in "preventable patient harm and sub-standard levels of basic patient care". The doctors also said critical events had occurred including potentially avoidable deaths. The consultants said repeated efforts to raise the issues with health board bosses "failed to elicit any significant response". Read full story Source: BBC News, 4 April 2024

Patients at the hospital that treated killer Valdo Calocane were discharged too soon and released in a worse state into the community, the NHS safety watchdog has found. Serious failings by Nottinghamshire Hospital Foundation Trust in keeping patients and the public safe have been identified in a review from the Care Quality Commission (CQC). More than 1,200 patients are waiting to be seen by community services, the report found. Meanwhile, several hundred who are receiving treatment did not have a clinician overseeing their care,the CQC found. The review was launched by the government following the conviction of killer Valdo Calocane, who was under the care of the NHS trust’s community services. The CQC review said patients reported that crisis services are either “useless” or detrimental to their health. The three broad areas of concern, highlighted in the CQC’s report, were: High demand for services was leading to long waiting times for care and a lack of oversight of those waiting. The trust does not have enough staff to keep patients safe in the community and within some hospital services. Senior leaders at the trust do not have clear oversight of the risks and issues within the service. Read full story Source: The Independent, 27 March 2024

Trusts will be told to hit the four-hour A&E target in 78% of cases by next year after NHS England finally made an agreement with government, HSJ understands. The new target is just two percentage points higher than the target set for the current year of 76% – and must be hit in March 2025, according to NHS planning guidance. NHS England will also aim to maintain “core” general and acute beds at 99,000 on average across 2024-25 after funding was agreed with the government. This would maintain the beds at levels seen over recent months, but it would be a significant increase in the permanent “sustainable” beds available in the health service compared with previous years. Most trusts have fallen well short of the 76% target through much of 2023-24, and NHSE has pressed for them to make last-ditch attempts in recent weeks to try and get closer to the target ahead of the March 2024 deadline. This has included offering new capital funding rewards for improvement and telling trusts to focus on non-admitted patients. Elective recovery targets are expected to slip, and government has conceded making significant progress on these is almost impossible, with ongoing doctors strikes on top of other capacity problems. Read full story (paywalled) Source: HSJ, 27 March 2024

Trust chiefs have collectively called for the Care Quality Commission (CQC) to review its use of single-word inspection ratings, following MPs’ calls for an overhaul of Ofsted ratings for schools. In a report containing a series of recommendations for CQC reform, shared with HSJ, NHS Providers urges the regulator to re-evaluate the success of its single-word ratings, asking it to consider adding a narrative verdict as part of its new provider assessment reports. The recommendation is made “in the context of the Ofsted inquiry findings” following the death of headteacher Ruth Perry by suicide, which a coroner ruled was contributed to by an Ofsted inspection. It prompted MPs on the Commons’ education committee to call for a ban on single-word Ofsted ratings. The NHSP report said the inquiry’s concerns around inspectors’ behaviour, the complaints process, and single ratings can also be applied to CQC. The report adds: “While we recognise the differences between the two regulators’ approaches, we believe now is the right time to take stock… for example, CQC may need to consider the value of its single-word ratings, modelled upon Ofsted’s rating system. “As suggested by the Nuffield Trust and many trust leaders, a single-word rating will inevitably oversimplify what happens in a very complex organisation". Read full story (paywalled) Source: HSJ, 21 March 2024

NHS England has confirmed new financial incentives for trusts to deliver strong performance against the four-hour emergency target this month. National leaders are desperate for the NHS to hit the four-hour target in 76% of cases in March, telling trusts earlier this month that it was necessary to restore confidence in the health service. They took the unusual step at the start of the month of asking local leaders to sign a commitment to deliver the necessary performance. The recent pressure has come under criticism for encouraging hospitals to prioritise four-hour performance over caring for the sickest patients. It was also indicated there would be new financial incentives for those delivering the best performance. In a letter, NHSE confirmed a significant expansion to the criteria for trusts to claim a share of a £150m incentive fund, by improving their headline accident and emergency performance. Read full story (paywalled) Source: HSJ, 12 March 2024

The Health and Social Care Committee has launched a new inquiry to examine leadership, performance and patient safety in the NHS. Inquiry: NHS leadership, performance and patient safety MPs will consider the work of the Messenger review (2022) which examined the state of leadership and management in the NHS and social care, and the Kark review (2019) which assessed how effectively the fit and proper persons test prevents unsuitable staff from being redeployed or re-employed in health and social care settings. The Committee’s inquiry will also consider how effectively leadership supports whistleblowers and what is learnt from patient safety issues. An ongoing evaluation by the Committee’s Expert Panel on progress by government in meeting recommendations on patient safety will provide further information to the inquiry. Health and Social Care Committee Chair Steve Brine MP said: “The role of leadership within the NHS is crucial whether that be a driver of productivity that delivers efficient services for patients and in particular when it comes to patient safety. Five years ago, Tom Kark QC led a review to ensure that directors in the NHS responsible for quality and safety of care are ‘fit and proper’ to be in their roles. We’ll be questioning what impact that has made. We’ll also look at recommendations from the Messenger review to strengthen leadership and management and we will ask whether NHS leadership structures provide enough support to whistleblowers. Our Expert Panel has already begun its work to evaluate government progress on accepted recommendations to improve patient safety so this will build on that. We owe it to those who rely on the NHS – and the tax-payers who pay for it – to know whether the service is well led and those who have been failed on patient safety need to find out whether real change has resulted from promises made.” Terms of Reference The Committee invites written submissions addressing any, or all, of the following points, but please note that the Committee does not investigate individual cases and will not be pursuing matters on behalf of individuals. Evidence should be submitted by Friday 8 March. Written evidence can be submitted here of no more than 3,000 words.  How effectively does NHS leadership encourage a culture in which staff feel confident raising patient safety concerns, and what more could be done to support this? What has been the impact of the 2019 Kark Review on leadership in the NHS as it relates to patient safety? What progress has been made to date on recommendations from the 2022 Messenger Review? How effectively have leadership recommendations from previous reviews of patient safety crises been implemented? How could better regulation of health service managers and application of agreed professional standards support improvements in patient safety? How effectively do NHS leadership structures provide a supportive and fair approach to whistleblowers, and how could this be improved? How could investigations into whistleblowing complaints be improved? How effectively does the NHS complaints system prevent patient safety incidents from escalating and what would be the impact of proposed measures to improve patient safety, such as Martha’s Rule? What can the NHS learn from the leadership culture in other safety-critical sectors e.g. aviation, nuclear? Read full story Source: UK Parliament, 25 January 2024

NHS waiting lists will take more than three years to be reduced to pre-pandemic levels, according to a new analysis. Despite recent reductions in the waiting list in England, the Institute for Fiscal Studies (IFS) think tank said that it is “unlikely that waiting lists will reach pre-pandemic levels” by December 2027 – even under a “best-case scenario”. The latest figures show that the waiting list for routine hospital treatment in England has fallen for the third month in a row. An estimated 7.6 million treatments were waiting to be carried out at the end of December, relating to 6.37 million patients, down slightly from 7.61 million treatments and 6.39 million patients at the end of November, according to NHS England figures. Cutting NHS waiting lists is one of Prime Minister Rishi Sunak’s top priorities. However, the PM admitted earlier this month he would not meet his promise to reduce waiting lists. However, the new IFS analysis highlights how the NHS waiting list was already growing before the pandemic, but it rose “rapidly” during the crisis. The IFS report suggests a range of scenarios about how the waiting list could look in December 2024. Under a “more pessimistic scenario”, waiting lists will remain at the same elevated level while an “optimistic scenario” would see them fall to 5.2 million by December 2027.

Long A&E waits have got worse at more than one in five acute trusts, despite an improving trend nationally. Around 30 acute trusts have reported an increase in long accident and emergency waits, bucking the national trend. According to data covering the nine months to December, the proportion of waits more than 12 hours from time of arrival has improved to 6.3%, down from 8% during the same period in 2022. However, 28 out of 119 acute trusts reported a rise of up to 3 percentage points. HSJ’s analysis, which used published and unpublished data, showed 11 of these trusts had worsened despite improving their headline performance against the four-hour target. Adrian Boyle, of the Royal College of Emergency Medicine, said the emphasis on the four-hour target “incentivises focus on the people who are being sent home, and takes effort and attention away from the people who are being admitted to hospital”. He added: “The harms of long waits are greatest for people being admitted to hospital. We are disappointed by the current lack of focus in the planning guidance to help our most vulnerable patients.” Read full story (paywalled) Source: HSJ, 27 February 2024

NHS England is looking to ditch a key elective target that aimed to deliver large reductions in follow-up appointments, HSJ has learned. Senior sources privately admit progress has not been made against the target to cut the volume of the most common type of outpatient follow-up by 25 per cent target. This is supported by publicly available data. While this only gives a partial picture, the data suggests the volumes have actually increased compared to pre-covid levels. The volume-based target is widely viewed as unrealistic and senior figures told HSJ it had also “masked” some genuine progress trusts have made in reforming outpatient services and reducing less productive appointments. Sources familiar with discussions said having a volume-based target to reduce a subset of patients while trying to increase overall activity volumes had been logistically complex. NHSE is instead pushing for a new “ratio-based” target which sources said would be a better measure to reduce the least productive types of outpatient follow-ups and be a fairer measure of progress. Read full story (paywalled) Source: HSJ, 26 February 2024