1. Notification regarding our Friday message

Just to let you know we will be taking a late summer break. After today our messages will resume on 15 October 2021.

That said, we will include any event worthy of reporting between now and then in our first message on 15 October 2021.

2. HSJ-NHS England’s promise on inequalities data is well overdue

On 15 September the Health Service Journal published an article with the above title. The full article (given its importance) reads:

Recovering services from the covid crisis is the big task for NHS leaders for the foreseeable future. The Recovery Watch newsletter tracks prospects and progress. This week by staffing and equalities correspondent Nick Kituno.

The oft-repeated phrase during the first wave of covid-19 in the UK was that the pandemic had “shone a light” on long-standing inequalities people faced.

A combination of the virus’ disproportionate impact on communities, patients and staff from minority ethnic backgrounds, as well as the anti-racism protests sparked by the murder of George Floyd in the United States, had created a potent mix.

Increased calls for actions soon became unignorable and the NHS set about expediting its efforts in tackling what some saw as deep-rooted issues going back decades or longer.

Decisions were moving a lot quicker than usual, and by August 2020 NHS England published implementation guidance for phase three of the covid response which set out some fairly specific requirements on equalities.

There was concern that, as the health service set about trying to recover from covid, minority and excluded groups might again be at the back of the queue, as is often the way.

NHSE laid out eight “urgent” actions for tackling inequalities. Among the most pressing, and with one of the earliest deadlines, was “restoring services inclusively, so that they are used by those in the greatest need”.

The guidance said: “This will be guided by new, core performance monitoring of service use and outcomes among those from the most deprived neighbourhoods, and from Black and Asian communities, by 31 October.”

That’s 31 October, last year.

Did the NHS meet this deadline? And if so, where can this “new, core performance of monitoring” be found?

The document continued: “To monitor this objective of an inclusive restoration of services, monthly NHS reporting will in future include measures of performance in relation to patients from the 20 per cent most deprived neighbourhoods — nationally and locally, using the index of multiple deprivation — as well as those from Black and Asian communities where data is available.

“Monitoring will compare service use and outcomes across emergency, outpatient and elective care, including cancer referrals and waiting time activity.”

It seemed to be a clear commitment to making public this crucial (and fairly basic) information — a move which is, anyway, long overdue. Some important questions need answering: What is the average waiting time to be diagnosed and treated for cancer for groups of different ethnic background? What is the average elective wait for those with a learning disability? How does ambulance waiting times performance vary by deprivation decile?

I understand there is still work going on behind the scenes — a “dashboard” is under development and more is promised soon. We have heard those kinds of assurances come out of officialdom many times before, and they are sadly often followed by more drawn-out, behind-the-scenes experimentation and delays.

NHSE health inequalities lead Bola Owolabi has, by all accounts, been making impressive progress on a number of fronts, and getting the attention of many of the service’s leaders at various levels.

But nearly a year on from the deadline for those NHSE commitments, it is fair to ask when they are going to be met, a question to which no one has been able to give a clear answer.

A source familiar with the ongoing inequalities work told Recovery Watch they were worried the system would take its “eye off the ball” while other things are going on, such as the Health and Care Bill making its way through Parliament and integrated care systems being put on a statutory footing.

The person said: “It is hard to be focused on outcomes, which is not something the system is great at anyway, and deal with lots of restructuring.”

Locally, some trusts and ICSs have been doing their own work in this area. Recovery Watch has heard much talk about how trusts in West Yorkshire have explored their own waiting times and conducted some striking analysis. Leaders are upbeat about the work underway. But again, much like on the national scene, there appears to be great concern about sharing it more widely.

Recovery Watch gently suggests it is well past the time for trying to keep such information back for fear of the scrutiny it might bring, in case people don’t like what they see — if that is the reason — or even because the data may be patchy.

Various conversations in the past week have suggested the spirit and intent is there among many at both national and local levels. People are working towards the same goal after the NHS publicly laid down its marker. However, as with anything, actions and results will be the defining factors.

A depressing read, but consistent with the approach of all talk no action when it comes to our communities.

3. Trust placed in special measures for culture of bullying and racial discrimination

On 15 September 2021 the Health Service Journal also reported that Nottingham University Hospitals Trust had been downgraded from “good” to requires improvement, following a CQC inspection which found amongst other things a culture of bullying and racial discrimination where staff were afraid to speak up.

The article reads:

“The CQC also handed the trust a warning notice urging it to make improvements around leadership, risk management, governance and culture.

The trust has been told “measurable action” must be taken across the organisation to address bullying after concerns were raised that staff were “afraid to speak up” and “are being treated differently due to race”.

What about all the other Trusts CQC?

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