The must read stories and talking points from Friday

Redundancy pay clampdown

Clearly the government, fresh from its “victory” over junior doctors in the High Court, hasn’t had enough of being at loggerheads with staff unions.

Enter the Treasury and its proposals to substantially cut the level of redundancy pay and exit payments for all NHS staff.

The changes will include a £95,000 cap on public sector exit payments and a route to “claw back” money if senior managers return to working in the public sector.

HMT is applying the changes across Whitehall and has asked every department to draw up proposals in three months and have them implemented within nine months.

This will mean reducing significantly the redundancy pay available to all NHS staff including senior managers and doctors – at a time when the government needs to implement the junior doctors’ contract, secure a significant win on the consultant contract reforms and press on with changes to Agenda for Change.

The Treasury’s timetable is likely to be significantly optimistic.

NHS England hasn’t had a great record with legal challenges this year.

In June, a High Court judge criticised the national commissioner for refusing a drug for a teenager with narcolepsy.

A couple of months later it lost a judicial review on whether it has the power to commission the preventative HIV drug, PrEP (more on this later).

But it was a different story on Friday. NHS England successfully rebuffed the Hepatitis C Trust’s legal challenge over the commissioner’s decision to cap access to new drugs for the disease.

NHS England said capping the treatments through a “monthly run rate” was the only way to roll out access to the groundbreaking new drugs without spectacularly blowing its specialised commissioning budget, and swamping out a lot of other worthy treatments.

The charity argued that capping a therapy approved by NICE as cost effective was against the rules, but Mr Justice Blake was unconvinced.

The High Court judge concluded that use of a run rate “is not an arbitrary cap but a legitimate way of giving effect to the guidance that the treatments must be available as an option for patients with qualifying conditions ‘to prioritise treatment for people with the highest unmet clinical need’”.

To rub further salt into the Hepatitis C Trust’s wounds, its request for its liability to pay NHS England’s costs to be capped were rejected by the judge, who pointed to “uncertainties” about the charity’s “financial relationship” with the three drugs companies who were interested parties in the legal action.

The judgment is significant. If NHS England had lost then it would have had significant implications for future drug access policy, and would have left the organisation with a hefty bill to foot.

Instead, NHS England will feel it has the High Court’s blessing to determine “the overall balance of clinical need, efficiency of expenditure and balance between competing health considerations”. A joint NHS England and NICE consultation is expected in a few weeks, which could make significant proposals to change the process by which high cost treatments are authorised for use in the health service. Watch this space.

Which brings us back to another legal dispute with big implications for specialised commissioning.

The outcome of NHS England’s appeal of the PrEP judicial review is expected imminently – will its recent legal success carry through to that decision?

NHS Improvement clinical staffing article

We have been made aware that at an Imperial College healthcare improvement event on Wednesday, the NHS Improvement chief executive told an audience he had been misquoted by HSJ in an interview piece on clinical staffing.

We want to clarify, and NHS Improvement has acknowledged, that Jim Mackey was quoted accurately in the piece. Following the piece NHS Improvement published a letter which clarified its view on the issue, as HSJ has covered.