HSJ’s roundup of Wednesday’s must know stories

Open secret on agencies

As with other savings initiatives announced by NHS chiefs over the last few months, many trusts have regarded the new “ceilings” on agency nurse spending as starting points for negotiation, rather than mandatory targets.

Several trusts have told HSJ they will be unable, or will at least struggle, to cap their spending within the ceilings, and have looked to revise their targets with Monitor or the NHS Trust Development Authority.

This provides further proof, if any were needed, that provider chiefs are becoming more comfortable with challenging the edicts coming down from on high.

It follows the refusal of many trusts to alter their deficit plans after being issued with “stretch targets” by the regulators over the summer.

Regarding the deepening NHS financial crisis, Tameside Hospital Foundation Trust’s chief executive, Karen James, was brave enough to say what many others are thinking.

She told HSJ: “Everyone’s been working towards the [safe staffing] guidance and this has increased demand for agency nurses. This all could have been predicted.”

Safe decision

Talking of safe staffing guidance, internal emails from NICE chief executive Sir Andrew Dillon and obtained by HSJ have revealed the decision to reverse plans to publish NICE’s work on safe nurse staffing levels was made after Sir Andrew spoke with Jeremy Hunt’s principal private secretary Kristen McLeod.

The emails, released under the Freedom of Information Act, show that Sir Andrew and his senior team were intending to publish the work on safe staffing levels in accident and emergency departments, as well as evidence reviews in other areas such as mental health and community nursing on 30 July.

However, after a conversation with Ms McLeod on 28 July, Sir Andrew sent an email to his senior team saying that the information would not now be published and that the Department of Health had told him it would be published at a later date by NHS Improvement.

In her email, Ms McLeod says the two of them agreed that publishing the work would be “confusing for staff and the public”.

NICE has also refused an FOI request to release the safe staffing work, claiming it could “disrupt the effective management of the health service by publishing the evidence reviews at this time”.

It added: “Publication is likely to give rise to further public interest and generate enquiries about the work, which has the potential to delay NHS Improvement’s work. Safe staffing is very much a live issue for the NHS and we believe it’s important that NHS Improvement has safe space to develop and reach its own conclusions as it develops its guidelines.”

HSJ is on the case

With management of the NHS workforce so crucial to its future, HSJ has launched an investigation into the causes and consequences of the NHS’s growing reliance on temporary clinical and medical staff. Recommendations for providers will be unveiled in December.

To inform the investigation we want NHS managers, clinicians, regulators and leaders to submit evidence and proposals. All proposals should address the central question: How can the NHS reduce its reliance on temporary staffing?

Submissions can be made in confidence to workforceinvestigation@emap.com