HSJ’s roundup of the day’s must read stories and debate

Chain reaction

It’s been a tricky few days for Sir David Dalton, what with all the shenanigans around his now infamous letter to the government over the junior doctors’ contract.

But amid all the controversy, the white knight of NHS transformation appears to have scored a quieter, but still highly significant victory.

Sir David’s Salford Royal Foundation Trust and Wrightington, Wigan and Leigh FT are in the process of forging an “acute care collaboration” under the new care models vanguard programme, as HSJ revealed last year.

Bolton FT was previously reluctant to join the project, but HSJ understands that the trust’s board is now considering being involved.

The group will look to develop a standardised operating system, which would initially cover aspects such as back office, strategy and planning functions, and over time could apply to care and treatment pathways.

Trusts are expected to retain their separate boards but could be run by a joint executive team.

Getting three successful foundation trusts round the table to discuss plans that could result in top level job losses is no mean feat, and the outcome of this work could have a significant impact on how the NHS is run in future.

Epilogue to imposition-gate

Last Friday night, after Jeremy Hunt, Sir David Dalton, the BMA and the chief executives who did/didn’t support imposition of the junior doctors’ contract had spoken, Jim Mackey provided a cool epilogue to a week of high emotion.

The NHS Improvement chief executive acknowledged that junior doctors and others have strong views on the contract, but appealed for “calm and cooperation”, people to “move forward”, refrain from personal attacks and move into “more positive dialogue”.

The reaction on Twitter so far suggests Mr Mackey was optimistic in hoping the debate on social media would now become more nuanced and civil.

Increase in deaths is biggest for several decades

Mortality numbers are always difficult – lots of deaths happen every day, in a lot of ways, but the figures are nearly always still eye catching and emotive.

Trends in deaths and death rate in the population are fiendishly complicated – there are a lot of fluctuations and the reasons for changes are often very uncertain. It might be easy to get concerned about something that doesn’t actually reflect a major problem.

However, they are also a fundamental indicator to be monitored in public health.

Last year saw the biggest increase in the number of deaths in England and Wales for several decades, and also in the crude death rate (ie: not adjusted for potential year to year changes in the age of the population).

To see this in context for yourself, look at the charts in our analysis.

The potential causes are many and complex. In 2014 there was a year on year fall in the number of deaths. During 2012 and 2013 there were also unusual increases, which drove a fall in life expectancy at older ages, and appear to be linked to an increase in the rate of potential life years lost to theoretically avoidable death.

Several experts have said there should be further investigation of what’s going on. The very unusual size of the increase seems to justify some comprehensive, open minded consideration.