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

Decision makers in the NHS are too far removed from the lives of the people they’re making decisions about, according to an NHS England director.

Olivia Butterworth, NHSE’s deputy director of people and communities, said none of the work being done to reform patient-reported outcome measures “starts with conversations with people about what do they value and what they want to measure”.

She told a public event hosted by the New Local think tank recently: “We have system-driven metrics that are largely [driven by] ‘how many people have you seen?’ We don’t talk about the quality of the experience they’ve had whilst they’re being seen. Or what’s different as a result of that intervention for them.”

Asked whether NHS England’s top leadership is “paying lip service” to patient engagement, Ms Butterworth said: “I think often everybody pays lip service to it. We all use the right words. But whether it’s local government, whether it’s the NHS we know the words to use, but do we really live that in our actions in the way that we really like to change things?

“Or do we just blame the system for being too complex and it is the system that won’t let us, without recognising that we are the system, we make the system, we run the system, the system is people.”

Professor Donna Hall, chairwoman of Bolton Foundation Trust and New Local, who was also part of the panel, said her trust taken on 230 voluntary community champions and is working with its community outreach midwife to identify and act upon health concerns raised by women and their families.

Easter break… or breaking point?

The NHS goes into the Easter break in a more fragile state than in any previous winter since, at least, the 1990s, says our editor Alastair McLellan in his comment piece.

This is not just the direct result of covid hospitalisation, he writes, pointing out that “covid’s greatest continuing impact is on growing staff absences and the pernicious impact it is having on the long-term health of those who had the disease – even in some cases where it has been relatively mild”.

For the tens of thousands who have been hospitalised with covid, the consequences for their long-term health look more serious every day, he adds.

“Much of this new workload is ending up at the doors of primary and community care – and displacing other needs and services just when they are most required after two years of coping with the pandemic.”

The NHS’s elective recovery programme has effectively been stopped in its tracks in many places – and the target to end two year waits by July looks in severe danger of being missed.

The situation in the nation’s accident and emergency departments is grimmer than in any winter experienced for at least two decades. Long waits in A&Es have for some time been at levels unheard of before the pandemic.

Alastair writes: “And then waiting times for ambulances… Oh. My. God.”

Read his full take on the state of ambulance services and why the NHS has got into the dire situation generally in Alastair’s full piece here.