Daily Insight: This could be anywhere

An inspection of a hospital has found all wards were understaffed, while “tearful [and] exhausted” clinicians raised patient safety concerns to the regulator, as we reported this week.

The Care Quality Commission’s visit to Colchester hospital, run by East Suffolk and North East Essex Foundation Trust, also found patients going unfed because of low staffing ratios and patient confidentiality concerns.

The concerns were raised in a letter sent by the CQC to the trust, which also runs Ipswich hospital, ahead of publication of an inspection report for older people’s medical services, which is due later this month.

Just a few years ago, findings such as this by inspectors would have shocked some NHS leaders and made a splash in the national media.

This week’s response from HSJ readers was broadly that this could be any trust anywhere across the health service, such is the ubiquitous nature of patient safety concerns and staff suffering and burnout.

And those readers were not simply displaying a callous disregard for those involved, or trying to play down the severity: it is simply a statement of fact, that at present, stories and experience of this sort of alarming, life-threatening misery are everywhere.

Still a hot potato

The financial regulation of the NHS has genuinely shifted away from individual organisations in recent years – with performance at a system level becoming the key metric.

That means there is less to worry about with the national payment tariff, the annual planning of which used to cause almighty rows between commissioners and providers.

Now, at least in theory, how much income trusts are squeezing out of the commissioner, or vice-versa, isn’t so important because it’s all net neutral to the system.

However, the old way of thinking is still deeply embedded, and many trusts will still be paying close attention to tariff prices and doing all they can to maximise their income. They will worry about system relationships later.

Therefore, NHS England’s annual impact assessment of the new tariff prices remains of huge interest and debate. It suggests trusts in the south of England will see their tariff income rise by less than average, with Hampshire and Isle of Wight at the extreme end of the scale.

In that system, commissioner tariff spending as a proportion of total allocation is expected to rise by less than 0.4 per cent next year, which means spending being around £8m lower than it would be under the average rise.

At the other end, tariff spending by the Black Country Integrated Care Board will rise by more than 1 per cent as a proportion of allocation, which implies higher levels of income for trusts in this area. This is around £7m higher than it would be under the average spend.