The must-read stories and debate in health policy and leadership.
Greater Manchester is still seen by many as one of the leading and most mature integrated care systems, with its senior folk often invited to speak at Parliamentary committees and other high profile forums.
But things don’t look so rosy underneath the bonnet, with performance problems across emergency care, electives and cancer causing concern at NHS England, which recently moved the system into its naughty “mandated support” group.
Mark Fisher, the system’s CEO, soon realised there were significant issues after joining from Whitehall last year, and commissioned Carnall Farrar to come in and review the ICS structure.
HSJ has seen an executive summary of the review, which cited widespread concerns around the allocation of resources, confusion around the role of commissioning, and “muddled” governance.
It also found: a lack of transparency and trust between partners with some only sharing a “partial overview” of performance and finances; frustration at the quantum of meetings that take place; and confusion around the roles of the integrated care and provider federation boards, particularly around the role of commissioning.
Perhaps most worrying, leaders in some boroughs felt their “ability to make progress at ‘place’ had gone backwards”, while many felt efforts to improve population health were conflicting with the need to deliver stronger performance against targets.
In a letter to system leaders prefacing the exec summary, Mr Fisher wrote: “The report offers some challenging findings, but we must remember we are early in the establishment of the ICB and ICS in its new statutory footing. What the review gives us is a clear agenda for our further development.”
Perfectly doable
Keir Starmer has promised that, if his party is voted in at the next general election, it will restore the 18-week waiting time target for elective treatment within its first term.
Given that, at the end of March, just 58.6 per cent of patients waiting to start treatment had been on the waiting list for fewer than 18 weeks and that the current focus is on cutting down waits longer than a comparatively eye-watering 65 weeks, you’d be forgiven for feeling the Labour leader’s pledge to return to the 92 per cent standard is a tad overambitious (to describe it diplomatically).
Not so, writes waiting times guru and HSJ regular contributor Rob Findlay. He points out that one big assumption about the waiting list – that there would be a “surge” of patients joining it once covid eased and everybody rushed to their GP – simply hasn’t happened. “At this point, we can probably assume that it never will,” he says.
This means returning to the 18-week standard boils down to two elements – keeping pace with demand and a one-off push to clear the backlog. And, according to Mr Findlay’s calculations, that’s perfectly doable (albeit with a few caveats) within a five-year Parliamentary term.
You can read Rob Findlay’s full analysis here.
Also on hsj.co.uk today
This fortnight’s The Ward Round takes a look at the recent surge in international recruitment and asks how the NHS can “try to get the best out of what remains an expensive and time-consuming solution”. Meanwhile, North East London ICB has suggested its GP practices only offer patients access to their records when they request it, going against NHSE’s instruction to grant automatic access by October.
