The Primer provides a rapid guide to the most interesting comment and analysis on the English health and care sector that has not (usually) appeared in HSJ.

The health and care bill is supposed to get the two sectors working more in partnership, but it’s design and development has been heavily led by the NHS.

Particularly in the north of the country, which has much larger integrated care systems, many councils see the bill as a power grab by the health service.

The Local Government Chronicle says moves to exclude councillors from the budget-holding integrated care boards have provoked suspicions the NHS “will seek to claw back public health powers and seize more funding for acute services”.

LGC quotes Sunderland City Council leader, Graeme Miller, denouncing the NHS for an “attempt at political castration” in the bid to exclude politicians from ICBs, which would mean “scrutiny is effectively ignored at a local level”.

Cllr Miller added: “It does need some grown-ups in the room who understand about local service delivery, and what residents really want. From the way… they see the boards progressing, the acutes will absolutely gain power and money. That’s what it’s all about.

“Quite how having an ICS that runs from the Scottish border down to the south of Yorkshire is going to deliver place-based service delivery to residents in Castle ward in Sunderland… Christ knows.

“This is a car crash coming, but the NHS will force it through. What we’ve got to try and do is get them to see sense, and hopefully listen to us and understand that the local authority structure is a very good partner for them. But they’ve got to then treat us like grown-ups. We’re not there as a tick-box exercise.”

Meanwhile, John Merry, the deputy mayor at Salford City Council, said the new structure feels like a “step backwards” for his council because Greater Manchester “already [has] a fully integrated budget with the NHS, and co-decision making”.

He said there was a “very real worry” that the ICS structure “is not going to necessarily reflect that”, and that the “integrated budget we’ve carefully developed in places like Salford is going to be taken away from us”.

The postponement of the transition to ICSs indicated that “this isn’t as smooth as people thought it was going to be,” said Cllr Merry, who predicted “some fairly choppy waters as we try and work out the precise relationship between the NHS and local government”.

Private healthcare insurance

Labour’s new health secretary Wes Streeting has spoken of the need to use private sector capacity to treat more NHS funded patients.

But writing in Conservative Home, Tory Harry Phibbs suggests the mammoth waiting lists require a more radical approach, to encourage more patients to pay for their care privately as well, by providing tax relief for private insurance.

He wrote: “Those who spend money on the health of themselves and their families should be allowed to make that spending tax deductible.

“That change would make the option affordable for far more people. There should also be the security that, regardless of income, for certain treatments, if the NHS fails to provide care within a specific deadline, then the alternative of private provision can be undertaken with the cost fully met by the taxpayer.

“Politically this approach would have some attractions for the government. It would probably be popular with most voters. If Streeting supported it I suspect that would prompt a split in the Labour Party – with many keen not to compromise their ideological purity. But such policies would also have the merit of being right.”

It would be a path not previously trod by the Conservatives since their unsuccessful opposition years in the early 2000s, and since thought to have represented an unwise abandoment of the NHS.

Major liabilities

Also writing for Conservative Home, junior doctor Rob Sutton says the disruption caused by the pandemic has made some of the government’s headline pledges on the NHS workforce (50,000 more nurses, for example) look a “major liability”.

He says Sajid Javid could commit to a new pledge that’s achievable in time for the next election, namely to increase the number of junior doctors going on to complete specialty training.

The number of trainees doing specialty training has collapsed over the last decade, with many put off by the costly examinations, limited geographic choice, fixed timetables, and the major professional commitments - instead preferring to do locum work or keeping their options open.

Dr Sutton adds: “It is also a system which perpetuates itself indefinitely. A doctor leaving training creates new demand for a locum to take their place. But we can’t build the NHS on locum work. Doctors need to have a stake in a place and a sense of ownership in the work they do. Without this, there is little incentive to engage in long-term quality improvement projects through audit, research, medical education, and trials.

“The health secretary is fortunate that he has the power to tackle this problem immediately [in the health and care bill]. Locum rates should be capped nationally. Entry points to training should be increased throughout the year.

“Completion of at least one examination during the foundation programme for specialty entry should become the default. We need to normalise a smooth passage through training and move away from the hand-to-mouth provision of healthcare provided by a system increasingly built on locum work.”

Mandatory vaccination deadline looms

The government is being urged to delay the deadline for mandatory covid vaccinations to be imposed on healthcare workers, with some staffing unions saying the controversial policy amounts to “self-sabotage”.

The warning from the Royal College of Nursing and Royal College of Midwives, reported by the Guardian, comes as NHS trusts in England prepare to start sending out dismissal letters from 4 February to any member of staff who has not had their first dose of a vaccine.

The unions fear this is likely to trigger a mass loss of staff, and make it even harder for providers to maintain normal care.

The Guardian says the government’s own risk assessment of mandatory jabs - published last November - estimated that it could lead to the loss of 73,000 staff in a service that in England already has 93,000 vacancies.

It quotes Pat Cullen, the RCN’s general secretary, saying: “We are calling on the government to recognise this risk and delay a move, which by its own calculations looks set to backfire… To dismiss valued nursing staff during this crisis would be an act of self-sabotage.”

Meanwhile, an anonymous doctor writing for the website Unherd, said the mandatory vaccination policy should be seen through a prism of an underlying misogyny which has been present throughout the pandemic.

The author, given the alias Amy Jones, writes: “Reports of menstrual irregularities following the jabs were downplayed for months, despite tens of thousands of women reporting changes.

“Rather than being listed as a side effect or investigated promptly, such concerns were often belittled and diminished. For many women, the only available information they had on the menstrual side effects was via social media — hardly a comforting (or reliable) source of information.

“It is only now, more than a year after the vaccine rollout began, that researchers have begun looking at the extent and cause of the link. It is likely that the changes to menstrual cycles are benign; a number of possible causes have been suggested, with some also occurring with other vaccinations.

“But this comes as scant consolation for the women who’ve experienced unexpected side effects and have, yet again, had to fight to be heard.

“Distrust can be infectious, and many women have been left feeling understandably uncertain about the ability and willingness of healthcare providers to listen to their concerns and to research the effects of the vaccine on their bodies. Is it any wonder that young women remain one of the cohorts most likely to refuse the jab?”