Daily Insight: ‘Meaningless’ metrics and a lack of discipline

The NHS acronym alphabet soup can be confusing at the best of times. But the architects of the latest round of structural change have a masochistic streak, creating Integrated Care Systems made up of Integrated Care Boards, which hold the NHS budget, and Integrated Care Partnerships, intended to involve non-NHS representatives and promote integration in the broadest sense.

As chair of the shadow ICS until it launched and leader of the county council, Surrey Heartlands ICP chair Tim Oliver has, as he put it, a “reasonable view of both sides of the fence”. The veteran local politician said NHSE has left ICPs’ role unclear and is imposing “meaningless” metrics on systems.

The Conservative councillor also warned of the challenges bringing together the health service, which doesn’t have enough money, and local government, which has even less. Already, he said, disputes were emerging over who pays for discharge to assess schemes to free up hospital capacity.

In contrast to more prudent local authorities, he suggested the NHS did not have the “same discipline” in working within its budgets.

Not quite as expected

One of the NHS’s big success stories of the last decade looks set to be taken down a notch, judging by the tone of its new chief executive.

Salford Royal Hospital is well known for its focus on patient safety and strong learning culture, and after it took over the leadership of the troubled Pennine Acute Hospitals Trust in 2016, was credited with turning that organisation around.

The trust born out of their eventual marriage in 2019 was the Northern Care Alliance, which was rated “outstanding” based on a combination of the Salford and Pennine ratings.

But CEO Owen Williams, who joined last year, told HSJ it hasn’t quite matched up to its external reputation.

Just two weeks into the job, he was told by a group of clinicians about serious concerns over culture and safety in the spinal surgery division at Salford Royal Hospital, while earlier this year, the Pennine sites suffered a huge IT outage, which lasted several weeks.

There have also been concerns around maternity and emergency services in recent months, leading to a number of reviews and inspections.

A Care Quality Commission report is due to be published in the coming weeks, which could lead to a rating downgrade.

Mr Williams said: “If you’d have said to me what was my world view and picture on the outside looking in, I would have said it’s probably not matched up…

“Those issues haven’t just suddenly magically materialised if you look at the underlying trends. You can see a build up to the place where we are now. [But] my job working with the board and colleagues is to say, ‘okay that’s our reality, now we need to drive forward and improve’.”