HSJ’s roundup of a crucial day for the NHS

The imposition inquisition

It all seemed quite straightforward this morning.

Jeremy Hunt went into the House of Commons just before Thursday lunchtime to say the government would impose a new contract on junior doctors, believing he had the backing of 20 high profile trust chief executives and the national system leaders.

This morning a letter from Sir David Dalton, who was involved in negotiations between the government and the BMA, said an agreement was not possible and the government “should do whatever it deems necessary to end uncertainty for the service”.

The details of the contract then almost became an afterthought as PR around the announcement unravelled.

(In brief, the details of the contract to be imposed are: a 13.5 per cent basic pay rise for junior doctors; additional pay premiums for doctors who work one in four weekends or more; mean pay for night shifts covering 9pm-7am; restrictions on working consecutive days and nights.)

Just a few hours later, nearly half the chief executives named on the letter had made it clear to HSJ they do not in fact support contract imposition.

Their words contradicted the health secretary’s apparent suggestion to Parliament that he had their backing for an imposed contract.

Central North West London’s chief executive Claire Murdoch was the first to dissent, saying early in the afternoon that she was “unhappy” to be included on the list and at being perceived to be supporting the government’s plan to impose a contract on junior doctors.

She was followed over the course of the afternoon by seven others who said they did not support imposition.

The day ended with shadow health secretary Heidi Alexander citing HSJ’s work as she raised a point of order in the Commons to say Mr Hunt may have “inadvertently misled” the House by suggesting 20 chief executives supported contract imposition.

At the time of submitting this briefing email, this extraordinary undoing hadn’t stopped… Log on to hsj.co.uk to see where it got to.

Meet the new boss, same as the old boss

The first thing many people will notice about the line-up of NHS Improvement’s first executive directors – revealed by HSJ on Thursday morning – is their familiarity.

All of its national board executive posts have been appointed directly from its predecessors, Monitor and the NHS Trust Development Authority.

The aspirational name given to the new regulator, and some of the rhetoric about NHS Improvement (Jeremy Hunt said “safety and quality will be at the heart of the new organisation’s remit”), had led some to believe its top team would feature more new faces.

Most of those shaping the new organisation would like it to develop a day to day approach that supports improvement in the NHS, leaving behind regulators’ more traditional interventionist and punitive methods. They believe the job can theoretically be done better, and in a different way, than it has been in recent years.

There are some early indications of a potential shift in style: in particular, NHS Improvement appears to be talking and listening more to NHS providers instead of only handing out orders.

Despite the will for change it won’t abandon the normal business of regulation and performance management overnight. The familiarity of its execs reflects this continuity, as well as the fact it is covered by the law on employment transfers.

NHS Improvement has a massive financial mess to address in the NHS provider sector, and is under huge political pressure to make this situation look a lot better and quickly. This might mean more use of some of the old ways of financial management – not less – at least until the immediate crisis subsides.