8th January 2016
- BMA announces renewed junior doctor strike plans
- RCS backs cross-party calls for a commission on the NHS
- NHS Shared Planning Guidance focuses on sustainability and transformation for 2016/17
- EU Court of Justice finds Greece flouting EWTD
- Government recommends new alcohol intake guidance
- NHS England reveals action plan to tackle sepsis
- New GMC power granted to appeal tribunal decisions
- CQC appoints first national whistleblowing guardian
BMA announces renewed junior doctor strike plans
Following further conciliatory talks this week between the Government, NHS Employers, and the BMA Junior Doctors’ Committee (JDC) conducted through the Advisory, Conciliation and Arbitration Service (Acas), the BMA has announced plans for junior doctors to conduct three days of industrial action. The first planned strike will implement emergency care only for 24 hours between 8am on Tuesday 12th January and 8am on Wednesday 13th January, the second is 48-hour emergency care only action between 8am on Tuesday 26th January and 8am on Thursday 28th January, and all junior doctor labour will be withdrawn between 8am and 5pm on Wednesday 10th February. The British Dental Association (BDA) has also announced that its member junior NHS hospital dentists will join doctors in the strike.
Dr Mark Porter, BMA Council Chair, commented: “After weeks of further negotiations, it is clear that the Government is still not taking junior doctors’ concerns seriously. Furthermore, the Government has repeatedly dragged its feet throughout this process, initially rejecting our offer of talks and failing to make significant movement during negotiations. We sincerely regret the disruption that industrial action will cause, but junior doctors have been left with no option”.
In response to the announced strike action, the Health Secretary, Jeremy Hunt, wrote to Dr Porter, saying: “I believe we made good progress in the negotiations and given the many areas of common ground it cannot be appropriate to put patient safety at risk with a series of potentially damaging strikes without seeing these negotiations in full”.
Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust, has been appointed to lead negotiations on behalf of the Government and the NHS in new talks with the BMA, which began today. He wrote to all chairs, chief executives, human resources and medical directors in the NHS explaining his role. At his request, Dr Mike Durkin, National Director for Patient Safety, Professor Ian Cumming, Chief Executive of Health Education England, and Danny Mortimer, Chief Executive of NHS Employers, wrote to all junior doctors setting out details of the latest contract offer, addressing concerns over patient safety, training and pay.
Together with the other surgical Royal Colleges, we have published advice to surgeons on the forthcoming industrial action.
RCS backs cross-party calls for a commission on the NHS
The RCS has voiced its support for calls from three former Health Ministers to establish a health and social care commission to look at the future of the NHS. Liberal Democrat MP Norman Lamb, who was a Health Minister in the last Coalition Government, along with former Conservative Health Secretary and Chair of the Health Select Committee Stephen Dorrell, and former Labour Health Secretary Alan Milburn, have called on the Government to establish a commission to examine the future of the NHS and social care system, with a particular focus on financial sustainability.
Mr Lamb tabled a Ten Minute Rule Motion to the House of Commons this week as a way of introducing a Bill to Parliament that would legislate for the establishment of the health and social care commission. The Bill will receive Second Reading on 11th March.
Miss Clare Marx, President of the RCS, commented: “The NHS and the social care systems are currently living on a knife edge. We strongly support calls to establish a cross-party commission on health and social care. … An independent cross-party commission would allow these issues to be scrutinised and solutions aired. For the sake of patients this long overdue debate with the public has to happen now”.
NHS Shared Planning Guidance focuses on sustainability and transformation for 2016/17
NHS England, NHS Improvement (comprising Monitor and the NHS Trust Development Authority), the Care Quality Commission (CQC), Public Health England (PHE), Health Education England (HEE), and the National Institute for Health and Care Excellence (NICE) jointly published the NHS Shared Planning Guidance for 2016/17. The guidance focuses on longer-term sustainability and transformation and is supported by £560 billion of NHS funding, including a new Sustainability and Transformation Fund, as well as providing guidance on immediate priorities for 2016/17.
All NHS organisations are asked to produce two plans:
- A five-year local health and care system sustainability and transformation plan (STP), which is place based and drives the Five Year Forward View, covering October 2016-March 2021
- A one-year operational plan for 2016/17, which is organisation based and reflects the emerging STP
Each local health system is also being given nine ‘must dos’ for 2016/17, including producing the STPs, returning to aggregate financial balance, achieving key targets such as on A&E waiting times and referral to treatment times, publishing avoidable mortality rates, addressing the sustainability of general practice, and achieving new targets for mental health waiting times.
The STPs will act as the application and approval process for health systems being accepted onto programmes with transformational funding for 2017/18 onwards, and will have to be submitted by June 2016. £1.8 billion from the 2016/17 Sustainability and Transformation Fund will replace direct Department of Health (DH) funding, and will be distributed on a trust-by-trust basis. The quarterly release of sustainability and transformation funding to trusts and FTs will depend on achieving recovery milestones for deficit reduction, access standards, and progress on transformation. From April 2017, assessment for local funding will be based on the quality of STPs, the reach and quality of the local process, and the strength and unity of system leadership.
EU Court of Justice finds Greece flouting EWTD
The EU Court of Justice has ruled on a case between the European Commission and Greece over implementation of the European Working Time Directive (EWTD) for the country’s doctors. Ten Greek medical associations took the case to the Commission, claiming that under Greek national legislation, doctors were obliged to work on average between 60 and 93 hours per week, and to work regularly for up to 32 consecutive hours without minimum daily and weekly rest periods.
The Commission brought an action for failure to fulfil obligations of member states establishing an upper limit of 48 hours for the average weekly working time, including overtime. The Court subsequently found in favour of the Commission and judged that Greek legislation was incompatible with EU law on the WTD.
Government recommends new alcohol intake guidance
New guidelines for recommended levels of alcohol consumption have been introduced by the Department of Health (DH) today, which represent the first revised recommendations since 1995, supported by a new scientific review from the Committee on Carcinogenicity (CoC) on alcohol and cancer risk. Recommended weekly maximum intake of alcohol is now 14 units for both men and women, which demonstrates a significant shift from previous guidance that recommended a weekly limit of 21 units for men and 14 for women. New evidence shows that the increased risk from cancer and other alcohol-associated diseases arise from any level of regular drinking, and the new recommendations aim to keep the risk of illnesses such as cancer and liver disease ‘low’ for people who regularly drink alcohol.
Dame Sally Davies, Chief Medical Officer (CMO) for England, explained on the Today programme (2:10) on BBC Radio 4, that the risk from alcohol consumption varies by type of cancer. For instance, evidence from the CoC review concludes that at low levels of alcohol intake, below 10.5 units per week, there is an increased risk of mouth and throat, gullet, and breast cancer in women. At alcohol intake above 10.5 units per week, there is an increased risk of larynx and colorectum cancer.
High levels of alcohol intake, above 42 units per week, there is an increased risk of liver and pancreas cancer. The review also concluded that there is no justification for drinking for health reasons, and that the benefits of alcohol for heart health only apply for women aged 55 and over, with the greatest benefit seen when women drink up to 5 units per week.
NHS England reveals action plan to tackle sepsis
NHS England has published an action plan to help support healthcare professionals to recognise and treat sepsis promptly. An estimated 37,000 deaths in England are associated with sepsis per year, and the number of recorded cases is rising. Evidence suggests that only a third of patients with sepsis receive good quality care, and that better prevention or early accurate diagnosis and effective treatment could lead to 10,000 fewer deaths each year.
NHS England has worked with Royal Colleges (including RCS), the UK Sepsis Trust to advise on how best to improve the recognition and treatment of sepsis. The resulting action plan focuses on five areas:
- Preventing avoidable cases of sepsis – particularly focusing on at-risk groups such as older people, children, pregnant women and the immunosuppressed, and looking at best practice in care settings around UTIs and sepsis
- Increasing awareness – UK Sepsis Trust are developing sepsis savvy microteaching sessions for lay people, and PHE will run a public awareness campaign
- Improving identification and treatment – the CQC will look at how trusts can use NICE guidance to better identify and treat sepsis along the whole care pathway
- Improving consistency of standards and reporting – NICE will publish clinical guidelines in 2016 and a quality standard in 2017, and HSCIC will produce SNOMED code sets for sepsis identification
- Ensuring appropriate antibiotic prescribing – organisations will look to update guidance on antimicrobial resistance and antibiotic use as new evidence emerges
New GMC power granted to appeal tribunal decisions
The General Medical Council (GMC) has been granted a new power to challenge decisions of tribunals that hear cases against doctors who are alleged to have breached GMC standards. Appeals can be made to the High Court of Justice in England and Wales, the Court of Session in Scotland, and the High Court of Justice in Northern Ireland, if the GMC considers that the tribunal has not adequately protected patients.
This change to the Medical Act also introduces other legal changes, including that the Medical Practitioners Tribunal Service (MPTS), which was set up in 2012 and runs hearings on breaches of GMC standards, be put on a statutory footing; cutting the length of hearings; giving the MPTS the ability to award costs if the GMC or doctor fails to comply with directions; and requiring the introduction of a legally-qualified chair in all hearings.
Niall Dickson, Chief Executive of the GMC, commented: “The new right of appeal and the establishment of the Medical Practitioners Tribunal Service as a statutory body are huge strides in UK professional regulation. This will help us to make sure doctors receive the support they require and patients receive high quality care. The new law underlines the separation of our investigations from the tribunal service and thereby strengthen our role as a patient safety organisation. These changes will also make investigations and hearings more proportionate, faster and more efficient”.
CQC appoints first national whistleblowing guardian
Dame Eileen Sills DBE, Chief Nurse at Guy’s and St Thomas’ NHS Foundation Trust, has been appointed as the first national guardian for speaking up safely in the NHS by the Care Quality Commission (CQC). The new role will aim to lead a cultural change, initially within NHS trusts and Foundation Trusts (FTs), for healthcare staff to feel confident and supported when raising concerns about patient care. She will support and advise a network of local freedom to speak up guardians who will be based in NHS trusts, and be responsible for developing a trust-level culture of openness, as well as sharing good practice, reporting on common national themes, and identifying barriers to a safe and open culture in the NHS.
Dame Eileen has been a nurse for over 30 years, has held posts in general management and senior nursing leadership, and has served as Chief Nurse at Guy’s and St Thomas’ since 2005. In 2003 she was awarded a CBE, and a DBE in January 2015 for services to nursing.