Daily Insight: Fewer priorities, more scrutiny

Just a day after Steve Barclay toured broadcast studios espousing the benefits of a drastically slimmed-down NHS bureaucracy, integrated care systems have been issued with a hefty dose of top-down guidance.

Alongside the ICS review announced by Jeremy Hunt, Mr Barclay has used recent appearances to preview a brutal pruning of priorities set by the centre. Perfect timing then, for details of the £500m winter discharge fund to arrive.

Ministers were evidently unable to resist more micromanagement, such as a directive that patients be discharged at weekend, plus mandatory progress reviews, with underperformers expected to implement any recommendations made by the Department of Health and Social Care and NHS England.

The actual cash will come in two waves in December and January – well into the period of winter pressures the fund, first announced in September, was supposed to be addressing.

Money will at least be targeted at the hardest-hit areas, which DHSC data published alongside the guidance reveals are overwhelmingly concentrated in the South West, where all of the five most affected ICSs are. Most had at least a quarter of their beds taken up by patients fit for discharge over the summer, a figure that could deteriorate further as winter takes hold.

Supply chain frustrations

NHS Supply Chain has never had an easy relationship with the trust procurement teams it serves.

Local procurement leads’ frustrations include a perceived lack of clarity and transparency from the organisation, questioning whether they are seeing the savings they were promised when the current operating model was first dreamt up.

You would be hard pressed to find someone in procurement who does not have a grumble about NHSSC. But the strength of feeling is not universal. And the arrival of a new chief executive this time last year has heralded some improvements, according to some people in local procurement.

But deep frustrations remain and this week they boiled over in the form of a highly critical letter outlining the perceived failings of the agency, delivered to NHSSC and NHSE.

A major theme of the letter was on the slow pace of change remedying problems that trusts have raised with NHSSC for several years. For its part, NHSSC argues that changes of the scale needed to improve the agency take time.

It is hard to disagree with this point. But there are only so many times you can say that change is coming, that the sunlit uplands of a transformed service are not too far away. Frustration has boiled over this week; without greater, tangible change then that frustration is only going to grow.