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

The NHS needs a “financial reset”, a leading CEO has said.

West Yorkshire Integrated Care System chief Rob Webster has called for a shift towards more medium-term financial settlements and for incentives for outcomes, rather than activity.

In an interview with HSJ, Mr Webster also disagreed with Wes Streeting’s claim the NHS is “broken”, saying it was important not to “overemphasise” either good or bad patient experiences.

He called for a “reset” away from performance incentives based on activity compared to 2019-20 levels – which he said was “getting a bit distant”.

Mr Webster also said Labour’s commitments on the NHS are “clearly aligned” with the work of ICSs, and he could not see any “dilution” of this approach at this stage.

Two emergencies, one theatre?

How far should trusts go to ensure their maternity units can safely cope with two emergencies at the same time? An HSJ investigation has shown that one third of units don’t have a second dedicated obstetric theatre, generally making use of their main theatre block if an emergency arises when the obstetric theatre is in use.

Most of the time that works okay, although it inevitably involves transfer time, mobilising a theatre team and sometimes calling in staff from home. But with a category one emergency C-section – where the baby ought to be delivered within 30 minutes – this can look challenging.

One trust told HSJ it could take up to an hour to be ready to operate while several others said it could take at least 20 minutes – making a 30 minute “decision to delivery” C-section unlikely.

And there is evidence that lack of theatre capacity can cause harm – a baby died after his mother was “third in line” for an emergency C-section and 26 trusts have had Datix/serious incidents reports relating to timely access to theatres. The numbers may not be massive but, given the costs of clinical negligence claims, trusts can’t afford to ignore this issue.

Also on hsj.co.uk

In London Eye, Ben Clover asks what last week’s Microsoft outage meant for GP practices in the capital, and we report that two East of England trusts have approved the first step of merger plans in what is understood would be the first tie-up between two standalone community service providers.