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

An HSJ analysis of unpublished hospital data suggests patients are spending an extra day in hospital on average when admitted as an emergency compared to before covid.

This effect means that millions of additional “bed days” are being consumed and partly explains why fewer people are being treated in hospitals but more resources are being consumed to do so.

NHS England chief finance officer Julian Kelly told HSJ the marked increase in length of stay meant hospitals needed to focus on “discharge and decongest” of emergency care, to help recover activity rates and productivity in elective care. The NHS also needs to create more elective capacity insulated from emergency care, he said, and for “local leadership [to] keep people focused”.

The cause of longer length of stay is not certain. While many will blame social care related discharge delays, it may also be a side-effect of NHS services being overwhelmed, or because hospital patients are sicker.

It has a large impact on overall bed and staff availability, because emergency care makes up a much larger proportion of inpatient care than electives. Read all our findings in the full story here.

Sir Jim’s grim warning

Nurses will return to the picket lines today for the second day of strike action as the NHS’s nightmare before Christmas continues. 

But a senior NHSE figure, Sir Jim Mackey, warned last week that this week’s ambulance staff walkout represents a far higher risk to patient safety and services than the nurses’ strike.

He told a King’s Fund conference: “The ambulance strike is a completely different order of magnitude of risk [than the nurses’ strike]. I think that’s the main thing people are worried about because of the complexity and fragility of urgent care.”

The comments were not designed to create a competition to see which staffing group can cause more disruption, or a judgement of the relative value of either paramedics or nurses.The concerns are merely because significantly fewer paramedics means significantly more patients coming to already overwhelmed accident and emergencies, causing even longer ambulance queues and even more corridor care. 

Asked by HSJ about how much elective work should be cancelled, and if there should be national guidance on this, Sir Jim also said he was reluctant to issue national guidance, because different trusts are facing very different pressures. He said a blanket national elective ban would be “an absolute last resort”.

His concerns have been echoed privately by trust chiefs and senior clinicians across the system.     

Also on hsj.co.uk today

In North by North West this week, Lawrence Dunhill says that while clinicians may have called the shots over the past two years, the accountants have now taken back control. And in our Health Check podcast we bring you the latest on the hospital building programme, including confirmation that all new buildings must have single patient rooms.