Daily Insight: Jeremy's 'last big job'

Junior doctors make history

Despite the heated debate in the Commons the previous day and dire warnings about the impact on patient care of the BMA’s “dangerous escalation”, the first full walkout of junior doctors in NHS history appears to have passed relatively quietly.

At the time of writing, shortly after the Tuesday 5pm cutoff point for the withdrawal of emergency cover, HSJ – after making enquiries of dozens of trusts, senior managers and clinicians around the country – has heard of no examples of doctors being called back to work in A&E, diverts from struggling departments, or unplanned service closures.

As many people expected, more patients stayed away from A&E and consultants covering for their junior colleagues have coped with demand.

The more interesting stories have been taking place away from the picket line and emergency wards.

In an exclusive report, HSJ revealed that a number of medical and workforce directors have serious worries about the impact of the new junior doctors’ contract at the heart of the dispute. Their concerns include the impact on finances of higher pension costs and pay protection concessions; that trusts will need more doctors to maintain training; and that services at small DGHs could become unviable.

Meanwhile, as the strike kicked off, Jeremy Hunt told Radio 4 that health secretary was “likely to be my last big job in politics”. HSJ editor Alastair McLellan tweeted that the interview was “very, very important” and indicated that Mr Hunt was happy to be reshuffled. A government source then told us this was not Mr Hunt’s intention and he wanted to remain in post for a long time.

And while the strike restarts at 8am on Wednesday, the first steps towards contract imposition have already been made. Trusts have begun recruiting for the “guardians of safe working”, who will have to make sure junior doctors don’t work too many hours under the new deal. The role was created as a concession made by the government to the BMA – back when they were still talking to each other.

The cap fits a bit

Meanwhile, in other workforce crisis news, NHS Improvement has for the first time put a figure on the savings it thinks are accruing from the caps on agency pay.

The regulator estimates that the cap saved NHS providers around £290m between October 2015 and February 2016, sharply curbing growth in agency spending over the winter months.

NHSI has also published figures for that period showing how many times a week trusts needed to breach the cap to protect patient safety. These began at around 35,000 a week last November, and shot up to 45,000 when the caps were tightened on 1 February.

Numbers are not yet available for breaches after the caps were further screwed down on 1 April. NHS Improvement expects that they will have risen again, but will then reduce steadily as the market “adjusts”.

Of course, it’s hard to evaluate the breaches data without corresponding weekly figures for activity, unfilled shifts, untoward incidents and other data that would help establish whether the caps were affecting patient safety.

We should also probably wait for that data before we decide whether to call the £290m a “saving”.