The story of how chief executives signing up to support Sir David Dalton’s proposals for the junior doctors’ contract became a debacle, and the rest of the week’s important NHS news.

The junior docs debacle

NHS chief executives were given just four hours to agree whether or not their name was included in Sir David Dalton’s letter sent to health secretary Jeremy Hunt on the junior doctors’ contract negotiations, it emerged on Friday. The bosses, who had earlier had phone conversations with The Centre about the contract, were told that if they did not actively “opt out” their names would be included.

In the 24 hours since the letter was made public, a majority of the 20 chief executives named as co-signatories have distanced themselves from the health secretary’s subsequent decision to impose a contract.

As we pressed publish on this Executive Summary, 14 chief executives have said – with varying degrees of forcefulness – that they had not given their backing to contract imposition.

Of those, one has asked her name to be removed from the letter altogether, and another has suggested that, had he been shown the full letter, he would never had signed.

Click here to read the full account of the events leading up to the letter’s publication.

In the letter, sent on Thursday morning, Sir David urged the government to do “all it deemed necessary” to bring an end to the junior doctors’ contract dispute.

Health secretary Jeremy Hunt, in his statement to Parliament later that morning announcing his intention to impose the a new contract, appeared to suggest that all 20 chief execs backed this decision. This became the key point of contention.

Meanwhile, on the meat of the negotiations, Sir David told HSJ he believed the British Medical Association was not serious about reaching a final negotiated settlement, adding that the union had not “moved an inch” on the issue of plain time working at weekends.

Rolling in to action, NHS Employers has stated that the new contract will be phased in from August. In a letter to junior doctors, it said the new arrangements will be phased in over 12 months “and it is expected that implementation would be completed by August 2017”.

He said trusts would appoint ‘guardians’ at each trust to “provide safeguards against excessive working hours” from August 2016.

The whistleblowing finance director

Recent actions by regulators to reduce the provider sector deficit have proved a step too far for one trust executive, who has taken the highly unusual step of whistleblowing to a parliamentary committee.

The anonymous finance director has raised a number of concerns in evidence submitted to the Commons public accounts committee, including a warning that trusts are under pressure to “cook the books”.

He said regulators have pressured providers to “potentially mislead the public and government departments” over their finances, and the measures being dictated by Monitor and the NHS Trust Development Authority threaten finance directors’ responsibility for “objectivity, integrity, professional competence and due care”.

HSJ has asked several other trust finance directors if they agreed with the views expressed, and received a mixed reaction.

It seems that for many who have worked in the NHS for many years, some of the “wheezes” being employed, such as local capital-to-revenue transfers, are not much to worry about.

But HSJ readers were far less accepting, and all seem in agreement that while the measures might help the Department of Health stick to its revenue limits this year, they do nothing to resolve the underlying financial crisis.

One who commented on the piece stated: “We need people to stand up and tell it as it is. Truth and honesty. If the result is that the government feels putting up taxes is worse than a failing NHS then we need to be honest with the public about what the NHS will no longer do (or do for free). The choice is there but it needs truth and honesty both of which are seriously lacking.”

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