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

Unpopular choice

The government’s announcement this week that it was considering a 50:50 pensions option for senior clinicians in a bid to stop them being landed with large tax bills didn’t go down particularly well.

What went down even worse was the realisation that managers wouldn’t be included as there was insufficient evidence the current rules were causing retention problems, although the Department of Health and Social Care acknowledged senior managers may have to contend with high tax bills.

Managers in Partnership chief executive Jon Restell said this decision undermines the “new, positive focus on the NHS workforce”.

Mr Restell questioned where the evidence was that the way pensions are currently taxed doesn’t affect recruitment and retention of managers. He stressed that board vacancy rates in trusts in need of permanent leaders was “well documented” and a “threat to patient care”.

An HSJ reader made the point that it’s difficult, if not impossible, for senior managers to go part-time and stop discretionary work.

Another questioned the fairness of this decision and warned this could incentivise managers to leave the NHS too.

MiP said it will be pressing for an equalities impact assessment on the proposals but, as of yet, it’s not totally clear what government is planning, with the consultation yet to be written.

A systemic problem

For the second time this year, St Andrew’s Healthcare has had one of its inpatient mental health hospitals placed in special measures. In February, the provider had a hospital in Nottinghamshire for men rated “inadequate” by the Care Quality Commission. This week, its hospital for children and adolescents in Northamptonshire was given the same rating.

A running theme in the CQC’s concerns about both hospitals was the use of seclusions and restrictive practices. Its report on the Northamptonshire unit found patients in seclusion were left to sit or lie on the floor with no chair, bed, pillow, mattress or blanket.

But reports like these don’t exist in isolation. They are just two in the long line of recent news stories which have exposed the national systemic problem with mental health services’ approach to restraint and seclusion. Such headlines are becoming the norm not the exception. 

These approaches towards vulnerable people with complex mental health needs reflect both a cultural problem and a need for better training for staff. This is an issue which, thankfully, is now getting national attention, but it is not one which will be easily solved.