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

A Derbyshire trust has taken steps to reassure its registered clinical staff they have its support when delivering care and making difficult decisions during the pandemic.

Derbyshire Community Health Services Trust has been lauded as an example that all trusts should follow, after it set out support for staff in an email last week.

In the message the trust pledged to support staff from a “professional and regulatory perspective” if any decisions are questioned in the future.

The context is clearly soaring staff absences, very busy hospitals and emergency staffing measures introduced before Christmas.

In response to our story there was understandably scepticism from HSJ readers as to whether this would translate in reality and whether it was right that patients should be in a position where they are receiving sub-standard care in the first place.

But of course this is not the fault of the individual clinicians, but a dangerous symptom of the wider pressure the NHS remains under this winter.

Are you ‘in extremis’ yet?

The NHS has agreed a three-month nationwide ‘covid surge deal’ with independent sector providers, as we reported yesterday.

Under the deal, if a surge is triggered in a particular local area, independent providers have pledged to suspend their private activity and make their facilities and staff available to the NHS system.

A surge, which will only be defined as such if signed off by NHSE, will be triggered in areas where covid patient numbers or staff absences which “threaten the NHS’s ability to provide urgent care”.

Crucial details about how the finances will work are, however, yet to be released. 

There will surely be trusts the length and breadth of the country, which think they’ve already crossed this threshold. But it would appear NHSE chief operating officer and covid incident director, Sir David Sloman, disagrees.

Sir David stressed the surge measures were to be used “in extremis”. Indicating that such levels have not yet been breached, he said: “Just like the Nightingale hubs being created across the country, we hope never to need their support but it will be there if needed.”

The NHS has had a largely prickly relationship with the private sector during the pandemic.

Both sides of course publicly proclaim they are operating hand in glove for the public good. But privately, neither side is terribly happy, with both parties believing they’re being ripped off by the other.

The acid test of the deal will of course be whether it delivers demonstrable, material benefit, or whether NHS watchers will look back come spring time and simply lament another short-term independent sector deal which has failed to optimise England’s significant private sector healthcare capacity.