Daily Insight: All system(-level planning) go

Still the system, stupid

System control totals, system-level assurance, performance metrics for systems, and growing funding held at system-level; all these will make it hard for NHS organisations to ignore the greater good of their area. So said the planning guidance — in 2016.

And the operational guidance for 2020-21 ain’t a great deal different. “System by default” is the chosen phrase as its authors seek to take another step towards a collaborative world; while still being clear that performance and accountability remains at organisational level, too.

Perhaps only now this can become more meaningful, with a little more revenue and capital funding potentially around to use as a hard lever, with a few more years learning, and with legislation proposed to underpin system working; even if still some way from actually hitting the statute books.

A few important shifts are signalled in this week’s new guidance, however, and we have analysed them here:

• £1bn funding pot linked to ‘system performance’ — as the carrot (or stick?) to encourage collaboration gets larger.
• Trusts told to maintain ‘peak’ beds throughout whole year — and try, again, to keep the waiting list down.
• Plans to set minimum level of tech spending for trusts — and get moving on avoiding outpatient appointments.
• CCGs must visit out of area patients every two months
• NHS fails to spend £150m of apprenticeship levy — but won’t, yet, target bolstering nurse numbers by 10,000 in a year.

Saying goodbye to Sutton?

Last summer, HSJ revealed senior leaders had “buried” serious concerns over the safety of fragmented children’s cancer services in south London.

Former cancer tsar Mike Richards was enlisted to review the situation. Seven months later, his new report has confirmed the services must be reconfigured — and quickly.

At present, deteriorating children receiving cancer care at the Royal Marsden Foundation Trust’s Sutton site must be shuttled eight miles to the paediatric intensive care unit at St George’s University Hospital FT — something Professor Richards called an “inherent risk to patient safety”.

He has given commissioners three options to overhaul the services; move the Marsden’s services to Guy’s and Thomas’s FT; move them to St George’s University Hospital FT; or build a PICU at a future district general hospital adjacent to the Sutton site.

This last option hinges not only on the potential relocation of Epsom and St Helier’s district general hospital, but on the transfer of other specialised services in south London. Professor Richards said this probably isn’t viable.

Commissioners have six months to decide what to do, but it seems likely the Marsden’s children’s cancer services won’t stay in Sutton for long.