The must-read stories and debate in health policy and leadership.

Written equivalent of a shoulder shrug

The rules surrounding NHS pensions can be pretty prescriptive, with contribution rates, tax relief allowances and administration levies all out of trusts’ hands.

Which is perhaps why the Department of Health and Social Care’s written equivalent of a shoulder shrug on what to do with unused employers’ pension contributions if a doctor chooses to reduce the amount they are contributing to their pension – one of the proposals in its recently published consultation – has been described to HSJ as “significant”

The document read: “Employers have the discretion to pay to the member unused employer contributions in these circumstances, although this would be a decision for individual employers.”

But, although the ball may be in their court, trusts which choose to hang onto unused pension contributions face potential backlash from their workforce, especially if a neighbouring trust is choosing to use them to sweeten clinicians’ pay packets. 

When approached by HSJ, DHSC explained the proposals were aimed at putting an end to the so-called hokey-cokey tactic – where staff opt in and out of the pension scheme throughout the year – and added: “Given the design of the flexible accrual facility it is considered that, if employers decide to add the value of unused employer contributions to staff pay, they would pay the balance as a non-recurrent lump sum at the end of the year.”

An uncomfortable pre-winter lesson

Ten to 15 years ago, the NHS viewed MRSA as the main hospital-acquired infection to tackle and put considerable resources and effort into reducing the harm to patients from it. 

As a result, the number of MRSA infections, as well as those from C difficile, tumbled. But Medway Foundation Trust has shown how things can slip if you take your eye off them for too long.

The trust had eight cases of hospital-acquired MRSA in 2018-19. Clearly less than impressed with this, the retiring director of infection prevention and control Rella Workman used her final annual report to the board to point out that these were avoidable and “occurred as a result of disjointed consultant ownership, multiple ward moves and suboptimal nursing practice or procedures”.

She also claimed infection control was “not driven from the centre of the organisation” and highlighted the lack of engagement from managers, and the medical and nursing establishment.

In response, Medway FT said it has changed leadership and governance around infection control and has a comprehensive improvement plan. It believes it has tackled the issues behind the dip in performance.

That may be true, but that the dip happened at all shows how healthcare-acquired infections never really go away – and, at times of stress, can start to creep up again. That’s an uncomfortable lesson for all trusts as we enter the period of winter pressures.