5th February 2016

• Second junior doctors' strike to go ahead
• Carter review sets out £5bn savings opportunities
• MPs call for action on child dental health
• NAO report questions management of the supply of NHS clinical staff
• One in five consultants see patient safety problem in trainee rota gaps
• Prime Minister sets out EU renegotiation deal

Second junior doctors’ strike to go ahead

Continued talks between the BMA Junior Doctors’ Committee (JDC), NHS Employers and the Department of Health (DH), facilitated by the Advisory, Conciliation and Arbitration Service (Acas), broke down this week over the proposed new contract. The BMA announced that a second day of strike action will go ahead, but contrary to the original plan, emergency care will be covered by junior doctors. All other junior doctor labour will be withdrawn between 8am on Wednesday 10th February and 8am on Thursday 11th February.

Sir David Dalton, Chief Executive of Salford Royal Hospital who was leading negotiations on behalf of the Government, wrote to the Health Secretary explaining the outcome of talks. He said that both sides had agreed on the ‘majority of hours protections, including rest periods’ and reductions in maximum consecutive numbers of days and nights with no consecutive weekends. He explained that agreement had been reached on ‘new terms which support the training of medical trainees’, as well as the BMA’s proposal for a new pay structure based on ‘progression linked to increased responsibility’. He warned that ‘if effective implementation is to be assured for junior doctors then agreement is required by no later than mid-February’. Sir David also wrote to junior doctors with an update. The outstanding issues are ‘about pay, and the most significant of these is pay linked to unsocial hours … in the evenings and on Saturday’.

Dr Mark Porter, BMA Council Chair, wrote to the Health Secretary, explaining that industrial action will go ahead due to talks so far failing to reach agreement on ‘the issue of unsocial hours’, and that ‘we have been consistently clear that we want to see a fair and affordable system of pay that would recognise the impact of weekend working’. Further detail on these issues has been published on the BMA website. Health Secretary, Jeremy Hunt MP, responded that ‘the Government and NHS Employers made a significant offer on the extent of plain time and stood ready to discuss matters and it is very disappointing that the BMA felt unable to negotiate’.

Carter review sets out £5bn savings opportunities

Lord Carter has published the review on hospitals’ operational productivity and performance in England, a final report concluding the work he has done on NHS efficiencies on behalf of the Government. The report concludes that there is ‘significant unwarranted variation across all the main resource areas’, which is estimated to be worth £5 billion in potential efficiency savings. The review involved taking evidence from 32 non-specialist acute trusts, who agreed that savings of between £3 billion and £5 billion could be made by 2020 through the report’s recommendations, with trusts reporting that they typically already had plans to deliver around a third of the possible efficiency savings.  
    
Recommendations around workforce include better use of e-rostering, a new metric for nurses and healthcare assistants which would measure care hours per patient day (CHPPD), and for NHS Improvement to develop a national people strategy. A single integrated performance framework centred around customers, workforce and finances should be adopted by every organisation to avoid institutions using data in differing ways. NHS Improvement is recommended to take the role of incentivising trusts to fully use their existing digital systems and possibly invest in new technologies.

Two system issues widely cited by consulted trusts in the review were delayed transfers of care, and barriers to greater collaboration and cooperation to create economies of scale. The review highlights an ambition to create a ‘model hospital’, to be created by NHS Improvement, from data on treatment costs and activity to build the picture of what a best practice hospital looks like, in an accessible format for trusts to access. Other recommendations include introducing hospital pharmacy transformation programmes, challenging underused or unoccupied hospital space, and reforming pathology services. 

Lord Carter will continue to engage with trusts over the coming months, and NHS Improvement will undertake work around the recommendations, with Lord Carter becoming a non-executive director from April, when the new organisation becomes operational.

Responding to the review, Health Secretary, Jeremy Hunt MP, said: “This groundbreaking review will help hospitals care for patients, making sure every penny possible is spent on frontline patient care and bureaucracy is slashed so doctors and nurses can concentrate on caring. I’m grateful to Lord Carter, his team and those trusts involved in identifying the recommendations and urge all trusts to implement them immediately”.

MPs call for action on child dental health

On Wednesday the House of Commons held a debate on child dental health. The debate was tabled by Sir Paul Beresford MP, a former dentist who the Faculty of Dental Surgery (FDS) Dean, Professor Nigel Hunt, met recently. The FDS sent written briefings to Sir Paul and the Health Minister, Alistair Burt MP, in advance of the debate.

A number of key messages from FDS reports were highlighted during the debate. Sir Paul called for investment in a national oral health programme, similar to Childsmile in Scotland, to target areas with poor oral health; and for healthcare professionals, such as midwives, health visitors and pharmacists, to promote oral health. MPs also discussed the need to reduce children’s sugar consumption and increase exposure to fluoride.

In response, the Minister made a commitment that his officials “would work with NHS England, Public Health England and local authorities to identify ways to reach those children most in need, and to ensure that they are able and encouraged to access high-quality preventive advice and treatment”. He also noted the work the FDS has been doing to incorporate dental content in the personal child health record (also known as the ‘red book’) given to new mothers. Finally he pointed to the measures recommended by Public Health England to reduce sugar consumption, and work to reform the dental contract to allow dentists to focus on prevention and treatment where appropriate.

The FDS Dean is continuing to urge the government to take firm action on sugar consumption and poor oral health in the upcoming childhood obesity strategy through a tax on sugary drinks, restrictions on price promotions and advertising, product reformulation and support for ‘sugar free schools’.

NAO report questions management of the supply of NHS clinical staff

The National Audit Office (NAO) report on managing the supply of NHS clinical staff in England has found the system to be ‘fragmented’ and not good value for money. The NAO judges that Health Education England (HEE) should be more proactive in addressing national workforce variations, and cited figures from 2014 showing a shortfall of around 50,000 NHS clinical staff in England. 

Despite measures brought in by the Government to cap spending on temporary agency staff, the NAO concludes that these are unlikely to address the underlying causes of increased demand for temporary staffing. Given the large cost of employing staff in the NHS, the NAO estimates that efficiencies could be made for the NHS as a whole through a more coordinated and proactive approach to managing the supply of staff. 

The RCS contributed to the review undertaken by the NAO. The House of Commons Public Accounts Committee (PAC) has announced an inquiry based on the NAO report, and will hold an evidence session on Thursday 25th February.

One in five consultants see patient safety problem in trainee rota gaps

A survey of consultant physicians conducted annually by the Royal College of Physicians (RCP) has reported consultant physicians’ views on workforce numbers, working hours, and workload. The survey found that 21% of respondents think that trainee rota gaps ‘are such that they cause significant problems for patient safety’. This was reported most frequently for acute or general medicine. A further 48% of consultants responded that trainee rota gaps happened ‘often’, but without compromising patient safety as a solution could usually be found. 

Other findings include that 64% of consultant physicians would support a 12-hour 7-day acute medical service, and the support was greater among those in acute medicine than those in specialty medicine, however this varies among specialties. The RCP also notes that 78% of respondents said that they would rather have time off in lieu for working weekends than increased pay. A rise in the number of physician associates in the workforce was reported, noting that they have been reported to be working with over 400 acute physicians, which is four-times the number of any other specialty. Figures show a rise in the number of female physicians, now making up 34% of consultant physicians, and 52% of trainees.

Prime Minister sets out EU renegotiation deal

At the outset of talks between the Prime Minister, David Cameron MP, and the President of the European Council, Donald Tusk, around renegotiating terms of Britain’s continued membership of the EU, President Tusk has written to European Council members, each member state government, on resulting proposals. 

Proposals include draft decisions on economic governance, competitiveness, sovereignty, and social benefits and free movement of people. Perhaps the most widely publicised proposal is around migration, which addresses concerns from the UK through promising stronger enforcement of the rules on free movement, and sets out that the European Commission will propose changes to EU laws on exporting child benefits ‘to respond to exceptional situations of inflow of workers from other member states’. In order to facilitate further integration within the Eurozone, while ‘safeguarding the rights and competences of non-participating member states’, the proposal includes establishing a mechanism that cannot constitute a veto from non-eurozone member states on economic governance. Further proposals are set out on giving more consideration to individual member states’ objections to EU laws on grounds of national sovereignty, as well as increasing competitiveness and simplifying bureaucracy.

Negotiations between Mr Cameron and President Tusk will continue for a further two weeks, and final agreement is expected to be reached by a summit from 18-19 February. Mr Cameron has reportedly said that there remains “detail to be worked on”, but that the draft deal is “worth fighting for”. The Prime Minister has received criticism from politicians, including within his own party, that the deal does not go as far as he had promised in renegotiating returning powers to the UK. Speculation around the date of a referendum on UK membership of the EU includes the possibility of a vote as early as June 2016.