Good afternoon and welcome to my latest patient safety update. This week a quick look at health and social care conference announcements; the worrying warnings on staffing from the Royal College of Midwives; and the launch of a new quango with an unpronounceable name. Plus, what the latest data says about Covid. As ever here’s the link to sign up if you have not done so. SAJ FIRST OUTING Yesterday we heard the new Health Secretary’s priorities in his Conference speech. He promised that as well as extra cash for the NHS, 2022 would be a year of “renewal and reform” launching the review by General Sir Gordon Messenger (more below). He understandably feels the pressure to deliver results having negotiated the extra £12 bn health and care levy, but addressing workforce shortages would be a more effective way of doing so that taking a pop at managers. The NHS, as you would expect from the world’s fifth largest organisation, has the normal bell-curve of managerial ability but in my experience the majority of managers are incredibly hard-working and committed - in fact I would say running a hospital remains the most difficult job in Britain today. MESSAGE FROM THE MESSENGER Former Vice Chief of the Defence Staff General Sir Gordon Messenger is leading the review and it will look into leadership in health and social care for the Health Secretary. I commissioned the Stuart Rose Review on the same issue which was published in 2016 so I hope we build on that rather than going back to square one. The four observations I would make as someone who has wearily gone down this path many times are: a) the managers we have do a heroic job but we make their job almost impossible with more - and sometimes conflicting - targets than any other part of the public or private sector so getting rid of a targets culture should be a big priority; b) Targets are a particular risk right now with the huge backlog. The natural instinct will be to copy the approach taken in the 2000s by Michael Barber and others (which Sir Michael advocates in today’s Times) but hiring and firing managers who missed targets was precisely what led to Mid Staffs and other horrific tragedies so please let’s learn from what went wrong. c) We have a lot of very talented leaders in hospitals but they are often practising clinicians rather than managers - how can we incentivise them to move over to the ‘dark side’? Thinking they will get fired for the first target they miss is hardly going to encourage them to step up. d) Finally there is one part of the public sector where we have cracked the ‘leadership’ issue which is education where we allowed inspiring heads to take over failing schools (such as the extraordinary Sir Andrew Carter who has taken over the majority of schools in Farnham in my own constituency). This is happening now in the NHS with brilliant leaders like Dame Marianne Griffiths taking over Brighton and the now retired Sir David Dalton taking over a group of hospitals near Salford Royal. Making those kinds of mergers easier should also be a priority. EFFICIENCY BY EDICT? There is a hint on that last point that plans are being developed for poorly performing hospitals to be taken over by either the centre or by other high performing Trusts with new powers to fire whole leadership teams - but on the narrow question of meeting backlog targets. Mergers can be very powerful but if cutting the backlog becomes elevated as the target above targets the risk is that corners are cut in other areas when it comes to safety and quality. Also I am very wary of the ‘centre’ taking over hospitals - where is the incentive to sort out problems on your shift or in your department if everything that goes wrong can be blamed on the department of health who are now running your hospital? Empowering local leaders to deliver shared aims is more effective (but harder) than simply ordering things to happen. A backlash has already started with unions warning managers will leave the NHS as a result of these plans. WHAT THE OTHER LOT SAY Here is the link to Labour Jon Ashworth's speech where the main announcement was a welcome doubling of funding for dementia research, somewhat overshadowed by Labour’s ridiculous opposition to the health and care levy which is almost identical to what Gordon Brown did in 2002. MIDWIFE EXODUS 57% of midwives are thinking of leaving their jobs in the next year according to a recent survey by the Royal College of Midwives. Eight out of ten of those who have either left or were thinking of leaving were concerned about staffing levels. This is yet another reason for why we need a massive overhaul of workforce planning. People working in the NHS need to know that there is a plan in place that will ensure safe levels of staffing. Nowhere is this needed more than in maternity which is why the Health and Social Care Select Committee recommended the funding for an additional 2,000 midwives and 500 obstetricians was made available with immediate effect. The government is currently considering this recommendation and so I hope to hear more on this in the Spending Review later this month. But what we really need, as you hear me go on about like a cracked record, is a radical overhaul in workforce planning in general. As I say in this article, getting the money was in many ways the easy bit, now the hard graft starts. OHID LAUNCHES These quango names get more and more awful but this one has a very important job to do. The Office of Health Improvement and Disparities has been set up to tackle health inequalities that sees men in the most deprived areas in England live 10 years less than those in the least deprived (and with nearly 20 years less healthy life expectancy). OHID will lead cross-governmental work on tackling this sort of inequality and aims to “help people live longer, healthier lives and reduce the pressure on the health and care system.” Quite a task. COVID IN NUMBERS The ONS infection survey shows a slight increase in the number of cases in the community. In the week ending 25th September there were around 650,000 people in England with the virus (1 in 85 compared to 1 in 90 the previous week). The government COVID dashboard on the other hand has all indicators coloured green (heading down). Over the last 7 days cases have dropped 2.3%, deaths declined by 15.5% and hospitalisations decreased by 7.1%. I would hope to see this trend feed through into the ONS numbers which are a week or so behind but either way things aren’t getting worse, and gradually there are signs things are getting better. BACK TO SCHOOL? That doesn’t mean Covid isn’t having an impact though as the number of pupils absent due to the virus rose by two thirds in a fortnight. With 200,000 children off for COVID related reasons (around half because they have tested positive) the overall absence rates are nearly double what they were for this time of year before the pandemic. So life is getting back to normal but it isn’t there yet. BABY LOSS Finally, although Parliament debated it a couple of weeks ago, Baby Loss Awareness Week starts on Saturday. Our thoughts are with everyone who has been effected in whatever way by such loss. Jeremy Hunt
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