HSJ’s roundup of the week’s top stories and debate

Doctors on the streets

Thousands of junior doctors were expected to protest in central London on Saturday against the government’s controversial plan to change their terms and conditions. They hope it will further ramp up pressure on the Department of Health and health secretary Jeremy Hunt.

The British Medical Association claims the draft contract proposals are unfair and unsafe, and will damage patient safety. It is planning to ballot members over plans to take industrial action if the contract is imposed. However, Mr Hunt has written to the BMA offering guarantees that doctors will not see widespread cuts in pay or longer working hours, urging them to return to negotiations.

You can swot up on the facts of the debate in a summary by HSJ workforce correspondent Shaun Lintern, who has looked at key facts and areas of contention.

Simon’s nascent health systems

A speech by Simon Stevens at the King’s Fund was described as his most important since returning to the UK last year.

The NHS England chief executive delivered a volley of major policy assertions and hints, sending a clear message that he remains in charge of national decisions and will reshape and reinterpret the rules as necessary.

Mr Stevens also revealed his intention to use the fast approaching national planning round to accelerate his comprehensive replumbing of the health service. He said organisations would have to agree joint plans, and may be punished financially if they fail to do so.

His comments ramped up interest and energy ahead of the process, but also raise important questions. Our senior bureau chief Dave West has examined the issues.

Getting the ‘balance’

A directive from regulators aimed to clarify “contradictory” messages around financial performance and staffing levels – but appeared to leave many recipients scratching their head.

Five national bodies have told trusts they must “get the balance right by neither understaffing nor overspending”, and that nurse to patient ratios “should not be unthinkingly adhered to”.

It felt to some like a veiled suggestion that trusts should ignore the guidance altogether, but there was no guarantee that they won’t be hammered by the Care Quality Commission if they did so.

Life should be made slightly easier by the home secretary’s move on Thursday to immediately relax controversial immigration controls on nurses working in the UK. The U-turn should increase supply and help control cost.

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

No, minister

Transparency on quality is a key part of the Hunt vision, and in July he hired the King’s Fund to advise him on new measures for health systems and the Health Foundation on to do the same on GPs.

Reports by both were published this week and were direct about the flaws in the health secretary’s ideas, ruling out single “aggregate” ratings based on metrics or arbitrary “population groups”.

However, Mr Hunt can be expected to rescue some policy direction from their reviews. Both were in favour of identifying a small set of national measures that resonate with the public to focus attention – which the King’s Fund said would give us a “single definition of success”.

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