The must-read stories and debate in health policy and leadership.

Norfolk’s three acute providers have set up a new “committee in common” comprising all its chiefs to oversee its major acute integration strategy, as we reported here.

The creation of such a forum should be a welcome step towards more integrated care for patients: a monthly meeting where leaders can update each other and the patients they serve, and people can be held to account for their decisions and progress.

Except, neither patients, the media, nor senior clinicians are invited to this forum: it is just for the bosses.

The trusts, Norfolk and Norwich University Hospitals and James Paget foundation trusts, and Queen Elizabeth Hospital King’s Lynn Trust, have committed to share “outcomes and decisions” via reports to individual trust board meetings. But the committees’ actual papers will not be published independently, and the meetings will take place behind closed doors.

The problem with this set-up is this: decisions and outcomes are all very well, but they derive from a process. And that process is in some part as important as the decision itself. And that process requires the chance for robust exchanges of views from all the stakeholders.   

Holding meetings in public can be messy and challenging. Moreover, there are many public meetings which are a charade, with the real decisions actually taking place behind closed doors.

But while they are not perfect, they at least allow all the voices to be heard. NHS leaders continually talk, and one hopes strive to deliver, services in which patients and clinicians have had major roles in developing.

How can that be achieved if none of these voices are represented at the top table?

The problem is partly structural, with the current legal limbo the NHS is in appearing to encourage systems to work together, but in a way which does not promote or even really require transparency.

It is worth remembering that it was secrecy in the early days of the sustainability and transformation partnerships which hugely undermined the agenda, as they quickly became perceived by the public as vehicles to cut services.

Putting arrangements like CiCs on to a statutory footing with proper governance arrangements could help save these types of arrangements suffering a similar fate. The NHS badly needs that long-promised new legislation. 

Second wave, longer waits?

The NHS has much to fear from a second wave of covid but is strangely reticent to talk about what the shape and length of that second wave might be.

So it was a surprise when three graphs, demonstrating the impact of different scenarios on hospital admissions, popped up on Medway Foundation Trust’s board papers – only to disappear as soon as HSJ asked about them.

These scenarios seem to be guiding the NHS’ preparations for a second wave in Kent and Medway, so some credence must be given to them, even if the assumptions behind the modelling are not clear.

Although the reasonable worst case scenario is frightening – a peak of admissions five times that seen in the spring – perhaps the “more likely” scenario is more revealing, showing lower levels of admissions but continuing until the middle of next year, even with re-tightening measures in place.

This could impact on the NHS’ ability to “reset” elective and diagnostic work and lead to much longer waiting times and an increase in the number of people waiting more than 18 weeks for treatment. This unwelcome news may explain why the models were so swiftly taken out of the public domain.