6th November 2016

• BMA ballots junior doctors for industrial action as Hunt sets out new contract offer
• CQC to review work of junior doctors
• NI health minister announces NHS restructure as RCS visits
• UK access to care good, but quality of care and public health worse than other countries
• Annual review of quality of care finds waiting times 'under severe strain'
• Access to Medical Treatments (Innovation) Bill makes progress in Parliament

BMA ballots junior doctors for industrial action as Hunt sets out new contract offer

The Government set out their offer to junior doctors this week, the details of which can be read here. The Government offer includes pay premia for time taken for academic research contributing to NHS training and for shortage specialty training programmes for general practice, emergency medicine, and psychiatry. 

Reacting to the announcement, the Chair of the BMA Junior Doctors’ Committee, Dr Johann Malawana, said that in order to reach a negotiated agreement, the Government “must remove the threat of imposition and provide the concrete assurances junior doctors have asked for”, and that following the latest proposals, “the government have so far failed to provide these reasonable assurances”, and “the BMA will be left with little option but to continue with our plans to ballot members.”

The BMA has now issued ballot papers to their junior doctor members. The BMA ballot poses two questions: on taking industrial action short of a strike – using emergency care models in hospitals and GP practices, and on conducting a full strike – removing junior doctor labour. The BMA is recommending that members vote ‘yes’ for each question. The ballot will close on Wednesday 18th November.

Following the Government’s announcement, the surgical royal colleges issued a joint statement urging all parties to use the opportunity to re-engage in discussion. The General Medical Council have also issued guidance on industrial action for doctors in England.

CQC to review work of junior doctors

The Health Secretary has announced that the CQC will lead a review of the workload, service delivery and overall training experience of junior doctors. Information from the review will be considered within CQC judgements on whether hospitals are delivering safe, effective care. The CQC will also review the mechanisms for junior doctors to report working patterns that risk patient safety.

NI health minister announces NHS restructure as RCS visits

Northern Ireland health minister, Simon Hamilton, has announced a radical restructure of the health service. This will include abolishing the Health and Social Care Board which is currently in charge of commissioning, with the NI health department, Trusts and the Public Health Agency taking over its existing functions. A panel of local experts will also be established to consider the future configuration of services. A similar recommendation had been made in a recent report by Sir Liam Donaldson, commissioned by the NI executive, who said such a panel would help to tackle the high number of hospitals in Northern Ireland. Mr Hamilton said he would also pursue a significant increase in health spending in the next budget. 

The announcement came as members of the College council, including Vice-President Mr Steve Cannon, visited Northern Ireland. There was a packed programme with visits to Queens University Medical School, the South Eastern Trust Quality, Innovation and Improvement Centre, Parliament Buildings, Stormont and the Belfast Health & Social Care Trust.

As part of the visit the College co-hosted a reception and dinner at Parliament Buildings on the Stormont Estate with Jo-Anne Dobson MLA and representatives from the Department of Health, the Trusts, other political parties and several of our regional specialty representatives. The discussions, which focused on challenges in the NI health service including its high waiting times, were positive and fruitful. We look forward to future political engagement.

UK access to care good, but quality of care and public health worse than other countries 

This week the Organisation for Economic Cooperation and Development (OECD) published its 2015 edition of Health at a Glance, which presents comparable data from 2013 on key indicators of health and health systems across the 34 OECD member countries. Read our blog on the report here.

The OECD found that in the UK access to care is good, with unmet care needs, both medical and dental, below the OECD average. In the UK 1.6 per cent of the population have unmet medical care needs (10th lowest of 25 countries) and this figure is 2.9 per cent for dental care needs (8th lowest of 26 countries). The UK carries out more hip replacements (183 per 100,000 population; average of 161) and knee replacements (141 per 100,000 population; average of 121) than the OECD average, and waiting times for elective surgery are below the OECD average. Of 13 countries for which there were data, the average UK waiting time in 2013 was the third lowest for hip replacement (89 days) and knee replacement (95 days). The UK also initiated hip fracture surgery within the recommended two days in 88 per cent of cases, slightly above average. Rates of surgical complications are slightly above average, but this is likely a consequence of increased reporting levels in the UK.

The UK is also ahead of the curve when it comes to day surgery, with 47 per cent of tonsillectomies taking place as day cases. Partly owing to the increase in day surgery, the UK’s average length of stay in hospital in 2013 is 7.1 days, compared to the OECD average of 8.1 days.

However, the quality of care in the UK is uneven and leaves room for improvement. Survival after heart attack or stroke is worse than in many OECD countries, and spend on health is slightly below the OECD average and has not increased since 2009. The UK also does not fare well on risk factors, with rates of smoking, alcohol consumption and obesity all above the OECD average. One in four UK adults is obese, compared to the OECD average of under one in five, and one in five adults smoke. Cancer survival is relatively poor, with the UK in the bottom third of OECD countries in five-year survival for colorectal, breast and cervical cancer.

The UK has 2.8 doctors per 1000 population, below the OECD average of 3.3. The Nuffield Trust has noted that in countries with higher numbers of doctors, doctors tend to earn less, suggesting that this is what allows them to hire more doctors. The number of doctors has been growing in most countries, in particular in the UK, where there were 15 per cent more employed doctors in 2013 than in 2008, owing to the rise in the number of graduates from domestic medical training. Across OECD countries, the proportion of generalists has decreased over the past few decades, as more doctors become specialists. The proportion of generalists in the UK is 29 per cent, the same as the OECD average. Across the OECD, 45 per cent of doctors are female; this proportion is 46 per cent in the UK.

Annual review of quality of care finds waiting times ‘under severe strain’

The Nuffield Trust and Health Foundation QualityWatch annual assessment of care quality, 2015: Closer to Critical?, reports that the number of A&E patients waiting longer than the 4 hour target to be admitted has risen from 3.2% in 2013/14 to 5.5% in 2014/15, and the trend is continuing into 2015/16. In primary care, the number of patients waiting over a week to get a GP appointment rose from 13% in 2011/12 to 18% in 2014/15. 

The statement identifies three main areas of concern: access to services, staff and working environment, and child health. It concludes that time spent in A&E, and delays to planned treatment are continuing a rising trend seen over several years, and that ambulance services are under particular strain. Increasing reports of low staff morale and high vacancy rates with a growing reliance on agency staffing risks reducing the quality of care received by patients. A particular cause for concern highlighted in the report is childhood obesity, where the numbers of children aged 10-11 who are obese are continuing an upward trend. 

Areas of care quality that are improving include reductions in unplanned admissions for children and young people with chronic diseases, high vaccination and screening rates, and prevention of harm to children. However, evidence shows that performance is declining in key areas around deteriorating access to hospital, mental health and social care services, increasing waiting times, and the report expresses concern that services will not be able to hold to today’s level of performance in the future.

Access to Medical Treatments (Innovation) Bill makes progress in Parliament

Conservative MP Chris Heaton-Harris’s Access to Medical Treatments (Innovation) Bill received a money resolution in the House of Commons this week. A money resolution gives Parliamentary approval to any public money costs arising from the legislation. 

The money resolution was voted for by 281 votes to 227, with turnout from the Conservatives indicating that the Bill has strong support from the Government. The RCS continues to oppose the Bill, and Shadow Health Minister, Justin Madders MP, expressed our view during the debate. The Bill is expected to progress to Committee stage later this month.