Bad news from the agency spending front line

No one could accuse Monitor/NHS Improvement of being too open about how the war on agency costs is going.

What has been grudgingly eked into public view is the scale of the problem. As HSJ reported from the House of Commons Public Accounts Committee last week, Simon Stevens and Jim Mackey now expect this year’s agency bill to be £4bn.

This is a 50 per cent increase on the total for 2013-14. “The Francis effect”, AKA “hire more nurses to be safe”, was in full swing then so no one should have been surprised.

In this context, HSJ’s story today, that more than a quarter of trusts asked Monitor for permission to breach their agency spending cap last year, is an indication of just how tough/unrealistic the cap on trust agency spending has been. 

With more than a quarter of all the trusts in England applying to raise the “ceiling total” NHS Improvement had set for them and nearly a quarter succeeding, it shows the scale of the problem. 

Does this mean Mackey and Stevens are reconciled to the 2015-16 figures being terrible before they genuinely “disrupt the market” next year? They won’t admit as such. But either way if 2015-16 isn’t the peak year for agency spending then heads will most likely roll. 

Urgent care, urgent questions

Jeremy Hunt has indicated NHS urgent care – including 111 and GP out of hours services – will be simplified in a forthcoming review by NHS England’s medical director Sir Bruce Keogh.

His comments came in response to an urgent question this afternoon about the safety of NHS 111 services following death of a one year old child rom sepsis.

William Mead, from Cornwall, died in December 2014 following repeated contacts with GPs, out of hours and NHS 111 services. 

Mr Hunt told the Commons it was necessary to simplify the urgent care system, which he said was currently confusing to families because it offered too many choices, including out of hours, 111 and A&E services.

And he specifically criticised 111 for subjecting callers to a “barrage” of seemingly meaningless questions, and said it should be able to put families in touch with a doctor more quickly if necessary.

All this will change, he suggested, when Sir Bruce publishes his review of urgent and emergency care.

Mr Hunt was subjected to repeated questioning from opposition MPs on whether NHS 111, where calls are initially handled by non-clinical call handlers, should have more doctors on hand to give advice.

Demoralised Labour MPs will be momentarily cheered by Mr Hunt’s eventual concession, to look into the clinical cover available.