9th October 2015

• Hunt writes to BMA proposing way forward on junior doctors' contract
• RCS attends the first Conservative party conference since the unexpected general election victory
• Welsh government introduces new commissioning policy for orthopaedic services
• NHS regulators report large trust deficits with call for 'radical change' in FTs
• Monthly statistics show most surgical specialties continue to miss targets
• New NHS Improvement Chief Executive announced

Hunt writes to BMA proposing way forward on junior doctors’ contract

Jeremy Hunt MP has written a letter to the Chair of the BMA Junior Doctors’ Committee, Dr Johann Malawana, following their meeting to discuss the proposed new junior doctors’ contract. The Health Secretary emphasised the shared aim of improving patient safety and quality of care, and his aim of introducing a contract that would better support the implementation of seven-day services.

Mr Hunt gave assurances that the new contract is ‘not a cost cutting exercise’, and also outlined areas that could still be negotiated. The Health Secretary stated that he would be prepared to discuss the extent of the proposals to extend plain time working on Saturdays, and that he intends to include a flexible pay premia to encourage recruitment into shortage specialties such as emergency medicine and general practice.

In the letter, Mr Hunt also discussed a commitment to work with Health Education England (HEE) and royal colleges, along with the BMA and NHS Employers, to improve the training experience for junior doctors. The BMA have initially said the letter is ‘encouraging’ but said they are ‘urgently seeking clarification on the points raised in the letter'.

Following a meeting of our Council, the RCS has today released a statement on issues relating to the junior doctors’ contract, including a commitment to do more to support trainees. The statement is supported by The Association of Surgeons in Training (ASiT) and the British Orthopaedic Trainees Association (BOTA). 

RCS attends the first Conservative party conference since the unexpected general election victory

The first conference for the Conservatives as the single governing party since 1996 took place in Manchester this week amidst angry protestors. The key theme of the conference was stability, security and opportunity, with the message that the country is safe in their hands. However with David Cameron already declaring that he does not intend to serve a third team, speculation was rife as to who might be the next Conservative leader. There was also much debate about the EU referendum, especially in the fringe events.

The Health Secretary Jeremy Hunt MP used his conference speech to reinforce the push for a seven day NHS and the drive for more transparency and openness. The Five Year Forward View remains the Government’s key health policy and it was clear that there will be no further investment in the NHS than the extra £10 billion already promised. Instead Ministers are keen to improve efficiency and productivity in the NHS by making better use of existing resources.

The RCS hosted a roundtable event jointly with NHS Providers to discuss practical solutions to the challenges facing the NHS in relation to the themes of integration, and urgent and emergency care. This was attended by Ben Gummer MP, Care Quality Minister and Nick Seddon, Special Adviser to the Prime Minister, along with senior representatives from other health and care organisations. During the conference the RCS President Clare Marx and Vice-President Stephen Cannon also met a number of key figures in the health sector, including members of the Health Select Committee, the BMA and its junior doctors’ committee, and leaders from the NHS Confederation and other royal colleges.

Welsh government introduces new commissioning policy for orthopaedic services

As part of the Welsh government’s Planned Care Programme, which targets a number of clinical specialties to improve patient experience and establish sustainable services, the government published the plan for orthopaedic services this week. The National Orthopaedic Implementation Plan sets out measures to manage capacity and demand for orthopaedic services aiming to develop greater sustainability for the specialty.

Commissioning of orthopaedic services will come under a new policy which states that all patients who smoke or have a body mass index of 35 or above, who are being considered for referral to orthopaedic treatment, should undertake a smoking cessation or weight management programme before orthopaedic surgery. Patient reported outcome measures (PROMs) will also be developed for orthopaedics under the plan, to enable health boards to report on postoperative patient outcomes.

Deputy Health Minister, Vaughan Gething AM, said: “A recent report by the Wales Audit Office concluded that the orthopaedic services in Wales have become more efficient in the past decade but we want to go further to meet future demands. … This plan sets out what NHS Wales needs to do to develop sustainable services so we offer the very best services to patients. It also sets out what people can do themselves to manage their own health”.

In a statement, Miss Clare Marx, President of the Royal College of Surgeons, commented: “It is absolutely right for the Welsh Government to look at ways to encourage patients to lose weight or stop smoking before surgery.  … Today’s announcement indicates that this is a voluntary scheme. This is the best approach as in some cases it might be difficult for patients to lose weight without surgery or they might require urgent treatment. We would not support this scheme if it became a mandatory requirement for all patients before surgery.”

NHS regulators report large trust deficits with call for 'radical change' in FTs

Monitor and the NHS Trust Development Authority (TDA) published financial reports on the performance of NHS Foundation Trusts (FTs) and NHS Trusts today. Monitor reports an FT sector deficit of £445 million for the period April – June 2015, which is £90 million more than planned for the first quarter of this year. 78% of FTs (118) have recorded a deficit for the period, and the sector’s wages bill was £59 million higher than planned.

The Monitor report also finds that trusts had made £64 million less in cost savings than was planned. NHS TDA has reported a £485 million deficit for the NHS Trust sector, which is £73 million more than expected. Higher pay costs, with an overreliance on agency staff, have been identified by FTs and NHS Trusts as the biggest cause of the deficits.

The FT sector as a whole failed to meet A&E waiting time targets; waiting lists for routine operations rose to 1.9 million, with an increase of 169,100 from the same period in 2014; and 10,800 patients waited longer than 6 weeks for diagnostic tests. FTs did, however, meet targets on treating non-emergency patients within 18 weeks, and on ambulance response times for the most critical incidents.

Commenting on the figures, Richard Murray, Director of Policy at the King’s Fund, said: “The reported overspend of £930 million at the end of the first quarter is more than the deficit of the whole of last year. … Unless emergency funding is announced in the forthcoming Spending Review, a rapid and serious decline in patient care is inevitable.”

Monitor revealed that the regulator has intervened at 37 FTs (25% of the total) where trusts were identified to have operational or financial concerns. Chief Executive of Monitor, Dr David Bennett, commented on the report, saying: “today’s figures reiterate that the sector is under massive pressure and must change to counter it. The NHS simply can no longer afford operationally and financially to operate in the way it has been and must act now to deliver the substantial efficiency gains required to ensure patients get the services they need.” 

Monthly statistics show most surgical specialties continue to miss targets

Statistics on key care areas for August 2015 have been released by NHS England. They illustrate a long-term trend of increasing volumes of both urgent and emergency care and elective activity, and show that most surgical specialties are missing referral to treatment targets.

The number of A&E attendances for August 2015 was 2.5 per cent higher than that for August 2014, and over the last 12 months the number of attendances has increased by 1.2 per cent, with emergency admissions up by 2.5 per cent. A&E waiting time targets were missed, with 94.3 per cent of patients admitted, transferred or discharged from A&E within four hours.

The number of patients starting consultant-led treatment over the last 12 months was 4.7 per cent greater than in the preceding 12 months. Standards for referral to consultant-led treatment within 18 weeks were met, with 92.6 per cent of patients on the waiting list at the end of August waiting less than 18 weeks (the target is 92 per cent). However, the majority of surgical specialties missed this target, with the exception of ENT (92.0 per cent). Figures for the other specialties ranged between 89.8 and 91.6 per cent. The percentage of patients seen within 18 weeks was 89.8 for cardiothoracic surgery, 89.9 for neurosurgery, 90.2 for general surgery, 90.4 for plastic surgery, 90.8 for trauma and orthopaedics, 91.0 for urology, and 91.6 for oral surgery.

Six of the eight cancer standards were met, but only 82.7 per cent of patients were treated within 62 days of urgent GP referral (the target is 85 per cent). Delayed transfers of care were up 5.4 per cent compared to August 2014, with 145,000 delayed days during August 2015.

New NHS Improvement Chief Executive announced

The new health service regulator, NHS Improvement, announced earlier this year, has appointed Jim Mackey as its first Chief Executive. Mr Mackey will join the regulator from Northumbria Healthcare NHS Foundation Trust, where he has been Chief Executive since 2005, having previously held the post from 2003-04, and leading the Trust through its transition to Foundation status in 2006. A qualified accountant, he has also served as the Trust’s Deputy Chief Executive, and Chief Operating Officer, Director of Finance at North Tyneside Healthcare NHS Trust, and a Regional Director of Finance in the NHS.

Commenting on his appointment, Mr Mackey said: “The gap between the quality of care provided within the NHS must be reduced, and our grip on managing our business and finance must be improved. This will be my priority and focus for the coming years ahead and I look forward to working with health partners across the NHS and social care to support a more sustainable and integrated service for patients.”

The new Chief Executive will start his work with NHS Improvement in November 2015.