31 January 2023

Businesses would not tolerate variation seen in health service – Barclay

31 January 2023

Commercial businesses “would not tolerate” the level of variation seen within the NHS, the Health Secretary has said.

Steve Barclay said more must be done to “compare and contrast” performance between local care bodies.

He said that more than half of ambulance handover delays across England occur at just 15 NHS trusts and not all hospitals were achieving the highest level of “theatre utilisation”.

He told the House of Common’s Health and Social Care Committee that hospitals should not be patient “magnets”.

“We need to look differently than simply having hospitals as magnets for more and more activity,” Mr Barclay said.

If one looks commercially, I don’t think most businesses would accept the level of variation that we tolerate, or is tolerated, within the NHS

“What we have to do is more work upstream … particularly around the frail elderly rather than them having to come to the emergency department.

“We need to do more work the other end in terms of patients being able to go home sooner, which is what most patients want.”

He was also probed about variation in care across the health service.

Following questions about resolving issues in maternity care, Mr Barclay was asked whether he thought there was a culture in the NHS that needs to change, to which he replied: “I think there is variation within the NHS and what you see is some areas that are extremely good and others where there has been persistent concerns.

“The question is the speed at which those are identified and how quickly measures are taken to intervene.”

He said patient safety incidents and how they are reported, as well as how whistleblower concerns are being addressed, should be looked into in maternity care.

Mr Barclay added: “I think if one looks commercially, I don’t think most businesses would accept the level of variation that we tolerate, or is tolerated, within the NHS.

“One of the opportunities moving forward is to compare and contrast the performance of ICBs (Integrated Care Boards) – and that’s not to say everyone should be similar to others, but to look at cohorts within those 42 (ICBs) where there are comparisons that can be drawn, and look at how they’re managing the devolved powers and how we compare and contrast between them.

“We should have greater transparency on the data so we can particularly target variation in performance.

“So, 15 trusts were responsible for more than half of ambulance delays, for example, in the summer.

“We also have massive variation in theatre utilisation – so we should be aiming for 85%, we don’t have that. Quite often theatres take too long to get going or finish, so those are the sorts of things that we will be looking push on.”

Meanwhile, Mr Barclay insisted that cancer has not been “downgraded” as a result of its inclusion in a new major conditions strategy.

He announced last week that the Department of Health and Social Care will combine existing Government commitments on mental health, cancer, dementia and health disparities into a “single, powerful strategy”.

The move was met with criticism by charities, with one cancer charity calling it a “downgrade”, but Mr Barclay told the Committee: “I can absolutely reassure you that that isn’t the case.

“What we have tended to have is a medical system which has seen greater specialisation but more siloed operating. I think we need to look more holistically about how we treat the whole rather than treat single conditions.”

He added: “When I was in the cabinet office I had responsibility for science at one stage and discovered we had over 60 strategies across government for science and technology.

“I think there’s sometimes a danger for people to confuse a strategy with necessarily the delivery on the ground … I think it would be a mistake to think having a plethora of strategies is necessarily the best way to deliver.”

Meanwhile, when asked about gender dysphoria care, Mr Barclay said health providers need to be “cautious” about decisions children make with regard to their gender.

Asked what is being done to improve care for children experiencing gender dysphoria, Mr Barclay said: “We need to be cautious about what decisions very young children are taking and at what stage of life that is.

“Ensuring we empower the patient but reflect the stage of life they are on before decisions are taken from which it is hard to return.”

He went on to say that one of the “concerns” with care at the now closed Tavistock gender identity clinic for children in Belsize Park, north-west London, was “the lack of transparency” in terms of what actions were taken and how people were held to account.

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