15th January 2016

• Junior doctors strike across England
• Peers raise concerns on children's oral health
• Government pledges extra emergency cash for hospital deficits
• Delayed transfer days remained over 150,000 in November
• Healthier Together judicial review rules against campaigners
• New DH Permanent Secretary announced

Junior doctors strike across England

Junior doctors across England took part in 24 hours of strike action this week, withdrawing from all but emergency care between 8am on Tuesday 12th and 8am on Wednesday 13th January. NHS England reported that 1,279 inpatient and 2,175 day case elective procedures had been cancelled ahead of the strike. National Incident Director at NHS England, Anne Rainsberry, commented: “It’s a tough day but the NHS is pulling out all the stops, with senior doctors and nurses often stepping in to provide cover”.

Following the announcement of the strike plans, Health Secretary, Jeremy Hunt MP, appointed Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust, to lead the next round of negotiations on behalf of the Government and the NHS with the BMA. Talks through the Advisory, Conciliation and Arbitration Service (Acas), resumed on Thursday 14th January.

Commenting on the conciliatory talks on the BBC Radio 4 Today programme (1.38), Mr Hunt said: “I really hope we can make progress, because we all want the same thing. Every doctor wants high quality care every day of the week, and I think that the BMA also want that. And so I think that this is something that we should be sorting out by sitting round the table, and I think that if we do it in the right spirit, we can solve this.” On the possibility of the imposition of a new contract on junior doctors, Mr Hunt said that it was a legal possibility, but that he would ‘rather not’ impose a new contract, though this could happen as a ‘last resort’, if agreement isn’t reached with the BMA.

The Department of Health (DH) today published evidence submitted to the Doctors’ and Dentists’ Remuneration Body (DDRB) on the 2016/17 pay round. The report sets out details on the Government’s contract reforms for junior doctors, consultants, GPs, and dentists, in the context of moving to seven-day NHS services, implementing the Five Year Forward View, and the financial pressures on NHS organisations. 

Peers raise concerns on children’s oral health

There were a number of calls to tackle children’s oral health in the House of Lords this week. Following briefing from the Faculty of Dental Surgery, former dentist Lord Colwyn called for better preventive oral health care during a debate on sustainability in the NHS. He highlighted the Faculty’s report, Report on the State of Children's Oral Health, stating it "reveals how much further we need to go in our fight against tooth decay".

During a debate about the merits of a tax on fizzy drinks, former RCS President Lord Ribeiro reminded the government that without action, the impact of poor oral health on the NHS and children would be harmful. In a separate debate on childhood obesity, children’s campaigner and former TV star Baroness Benjamin asked the government how they were going to address the factors causing unnecessary hospital admissions for children suffering from tooth decay.

The Dean of the Faculty of Dental Surgery, Professor Nigel Hunt, is continuing to urge the government to take firm action on sugar consumption and poor oral health in the upcoming childhood obesity strategy.

Government pledges extra emergency cash for hospital deficits 

The Government announced today emergency funding for hospitals to tackle their deficits next year. The Health Secretary, Jeremy Hunt MP, has highlighted key concerns, which have arisen from Lord Carter’s efficiency review, over varying costs being paid by hospitals for procuring the same clinical products, and the need to eliminate waste in the NHS. The Government plans to collect the money hospitals are spending on products, and help them ‘bear down’ on agency staffing costs through a further cap on the rates that hospitals can pay for agency staff will be introduced.

Speaking on the BBC Radio 4 Today programme (1.30), Mr Hunt commented: “There is extra money available, £1.8 billion of taxpayers’ money available to hospitals next year. They are not necessarily going to clear all their debts next year. … To access that money, there has to be financial discipline. … There is a way through the issue of deficits if you show financial discipline, if you do the things we all know need to be done, we’re putting extra money in. But we want that to go towards improved patient care, improved services. … Lord Carter has written to me today confirming that he thinks there’s actually about £5 billion of savings that can be made every year, and that we can get there by the end of this Parliament.”

Delayed transfer days remained over 150,000 in November

NHS England has released statistics on key care areas for November 2015, which show a slight decrease in delayed transfers of care since October, when the figure peaked at 160,000 delayed days. But the figure for November was still the second highest since records began, at 153,000 delayed days, reflecting an 8.7 per cent increase on the previous November. The number of patients delayed on the last Thursday of November was 5,583, the highest since data collection began in 2010.

The statistics continue to illustrate a long-term trend of increasing volumes of both urgent and emergency care and elective activity. The number of patients starting consultant-led treatment over the last 12 months was 4.1 per cent greater than in the preceding 12 months. Standards for referral to consultant-led treatment within 18 weeks were met, with 92.4 per cent of patients on the waiting list at the end of November waiting less than 18 weeks (the target is 92 per cent). However, nearly all of the surgical specialties missed this target, with one exception, oral surgery. The percentage of patients seen within 18 weeks was 92.1 for oral surgery, 91.9 for urology, 91.6 for ENT, 90.1 for trauma and orthopaedics, 89.9 for cardiothoracic surgery, 89.7 for general surgery, 88.6 for neurosurgery, and 88.0 for plastic surgery.

Seven of the eight cancer standards were met, but only 83.5 per cent of patients were treated within 62 days of urgent GP referral (the target is 85 per cent). The number of A&E attendances for November 2015 was 1.1 per cent higher than that for November 2014, and over the last 12 months the number of attendances has increased by 0.3 per cent, with emergency admissions up by 1.9 per cent. A&E waiting time targets were missed, with 91.4 per cent of patients admitted, transferred or discharged from A&E within four hours.

Healthier Together judicial review rules against campaigners

Campaigners for Wythenshawe hospital lost their legal battle with the Healthier Together programme following its decision against designating the hospital as one of four specialist sites in Greater Manchester under reconfiguration plans.

Four of Greater Manchester’s ten hospitals will be specialist sites for emergency and high risk general surgery, with the others being local general hospitals. It had been decided that three of the sites would be Manchester Royal Infirmary, Royal Oldham Hospital, and Salford Royal Hospital, but the decision over the fourth hospital, between Wythenshawe and Stepping Hill was met with criticism from clinicians.

The campaign group, Keep Wythenshawe Special, argued that the consultation process had been legally flawed, placing too great an emphasis on the travel and access standard of an emergency journey for a patient to the hospital taking 45 minutes or less. It was argued that part of the evidence favouring Stepping Hill considered patients who lived outside of Greater Manchester, and could therefore use a hospital out of the area and closer to home, and the widening of the catchment area should have triggered a re-consultation on the plans.

The High Court judge ruled that the consultation process contained no legal error, and the decision to designate Stepping Hill as the fourth specialist site for emergency and high risk general surgery was deemed to be reasonable. The judge did however note that the implementation process of the reconfiguration plans should remain under close consideration.

New DH Permanent Secretary announced

Following the recent announcement that Dame Una O’Brien plans to step down from her role as Permanent Secretary for the Department of Health (DH), Chris Wormald has been named as her replacement.

Mr Wormald is currently Permanent Secretary at the Department for Education (DfE), a position he has held since 2012. He has previously served as Director General in the Deputy Prime Minister’s Office, Head of Economics and Domestic Secretariat in the Cabinet Office, Director General for Local Government and Regeneration at the Department for Communities and Local Government (DCLG), and Principle Private Secretary to Estelle Morris MP and Charles Clarke MP during their times as Education Secretary.