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

Around a quarter of acute trusts paid consultants premium rates to provide strike cover during the first two junior doctors’ walkouts, broadly matching the pay levels demanded by the British Medical Association’s “rate card”, HSJ research has found.

The research also confirms the number of trusts paying the rate card prices – of more than £260 per hour for overnight shifts and around £160 for weekday shifts – rose further in subsequent strikes.

Our research also reveals average night rates, and the wide variation of pay levels for extra shifts, including how trusts in the North West swiftly paid BMA rates while London trusts initially held out for the first two strikes. 

We found 26 per cent of acute trusts were offering premium rates or payments very close to this level, of those providers which responded to freedom of information requests during the first two junior doctor walkouts in March and April. Responses were received from 108 of England’s 124 acute trusts.

NHS Employers has long raised concerns over the rate card because trusts have never collectively agreed to them, and the increased rates are driving up costs. But the BMA said the new rates were “entirely appropriate”.  

See our full interactive map for what every trust paid here.

Keep it close but not too cosy

Integrated care systems can end up being dysfunctional if the partners involved get along a little too well, according to NHS England’s national director of intermediate care and rehabilitation.

Jenny Keane was speaking at a roundtable organised by HSJ and the National Care Forum to discuss social care’s contribution to NHS winter planning. She said that ICSs “where everybody’s getting on well” tend to avoid tackling “uncomfortable” – but critical – issues.

Ms Keane leads the national “frontrunner” programme to explore and spread effective hospital discharge methods. She said the programme had identified the “key” importance of system partners holding each other to account.

The NHSE director told the roundtable she had become suspicious of “cosy” systems where “everybody’s getting on really well and they tell you that they’re all really good friends”.

She added systems need the “edge” that high-quality and transparent data provided if they were to tackle the “really, really difficult” challenge of working through the shared responsibility of dealing with delays in discharges.

Also on today

In North by North West, Lawrence Dunhill wonders if Lancashire and South Cumbria has missed a trick in not implementing a group model and a single CEO who oversees multiple organisations. And in Comment, Dan Hayes examines winter preparedness, challenges in communication and data exchange with health systems, and the need for long-term funding to deliver sustainable care services for older people.