Daily Insight: Will Hewitt’s HARPs be heard?

Ten of the most mature integrated care systems should be given far greater control over their spending and operations from next April, Patricia Hewitt’s much-anticipated review of ICS autonomy has recommended.

HSJ’s in-depth, on-the-day coverage, with four stories and an editorial highlights the key themes from the chunky 89-page report, which makes a diverse set of recommendations from funding changes to reviving a Lansley reform proposal of giving health overview and scrutiny committees a key role in local oversight.

And one acronym you can expect to hear more about is “HARPs” – high accountability and responsibility partnerships.

Ms Hewitt wants 10 ICSs given HARP status from next April and handed “far greater financial flexibilities and freedoms than other systems”.

“The accountability would come partly through strong local accountability but also through strong transparent data sharing [and] through the enhanced role of the CQC. That would be a really exciting way to encourage the more mature systems to go as far and as fast as they can,” Ms Hewitt added.

Deadly delays

Delays to ambulance response times and hospital handovers were well documented in December as huge spikes in demand for services led to widespread pressure on the health system.

The South West was one of the worst affected regions, with the South West Ambulance Service Foundation Trust reporting up to 3,400 callouts per day at the height of the pressures.

What has been less well documented, though, is the impact these delays had on patient deaths.

SWASFT board papers published last week reported at least 104 cases where patients died after experiencing delays.

The trust has stressed the deaths were not necessarily directly caused by delays, but that delays were a “common factor” in all the cases.

The figures come from the trust’s quarterly Learning from Deaths review – a requirement for all ambulance trusts since 2019.

Of the 104 cases reviewed, four have so far been declared as meeting the threshold for serious incidents where a delayed response was “deemed to be as a result of pressures within the wider healthcare system rather than ambulance demand alone”.

According to the trust’s board papers, the “unprecedented volume” of incidents in December alone may have impacted the trust’s ability to “keep abreast of reviews” into patient deaths, meaning the exact number of patients who died after experiencing delays may be higher.