Your essential update on the week in health

HSJ Catch Up

This new weekly email gives HSJ subscribers a vital update on the biggest stories from the last week in health. If you have been out of the office or otherwise too busy too busy to keep up, HSJ Catch Up will ensure you are still in the know.

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Leak reveals plan to ‘drag out’ contract dispute

On a busy day of NHS news, there was one story that got HSJ readers and the national media talking more than any other.

In a huge leak of more than 1,000 pages of private messages, HSJ revealed the strategy adopted by junior doctors’ leaders in their historic contract dispute with the government.

The revelations include:

  • The leadership of the British Medical Association’s junior doctors’ committee wanted to “draw this [dispute] right out” with “punctuated [industrial action] for a prolonged period” and tie “the DH up in knots for the next 16-18 months”.
  • JDC chair Johann Malawana told the group in December that the “best solution” might include playing out the dispute for so long that it would “force” the government “to impose [the contract] against our support”.
  • The strategy contrasts with public statements made by BMA leaders throughout the dispute asserting that it could be resolved if the government was willing to negotiate. For example, on 23 February Dr Malawana said: “The government can avert this [strike] action by re-entering talks with the BMA and addressing rather than simply ignoring the outstanding issues and concerns junior doctors have.”
  • Despite protestations that the dispute was about “safety, not pay”, the issue of weekend pay was described late last year by a JDC executive member as “the only real red line” for junior doctors. This point was only finally conceded by the JDC on 7 May when it decided to re-enter negotiations.
  • Dr Malawana discussed conceding the weekend pay issue if the government increased the medical pay bill by £500m-£700m.
  • Although the BMA stated throughout the dispute it wanted to negotiate with the government, the leak reveals the JDC executive believed it “had nothing to talk about” as it was not willing to discuss weekend pay. This position only changed this month.


Salford ICO ready to launch

This week we reported Salford Royal Foundation Trust’s involvement in some genuinely innovative projects could reshape how health and social care services are delivered.

By July, more than 400 council staff are set to transfer to the FT to become part of a new “integrated care organisation” with a budget of £213m.

Subject to final signoff by NHS Improvement, the Salford ICO will be among the first new care models supported by the national vanguard programme to be formally up and running.

Although Salford Royal will be the “prime provider” by delivering and subcontracting acute, community, mental health and social care services, much of the hard work has been done by Salford Clinical Commissioning Group and Salford City Council.

The CQC’s four year plan

The CQC published its new strategy on Tuesday, outlining what health and social care regulation will look like over the next four years.

While trusts will have to submit an annual description of their own quality on the CQC’s five questions, language around provider “self-assessment” and “co-regulation”, which the CQC used when it kicked off its consultation last October, are conspicuously absent from the strategy.

In an exclusive interview with HSJ, the CQC’s chair and chief executive confirmed the regulator was going to review how the fit and proper person test is working.

CEO David Behan also told us that he might have to make job cuts to cope with a budget which will decrease year on year until 2019-20.

The new investigators

The new Healthcare Safety Investigation Branch will be up and running from this autumn. It’ll have a budget of £3.6m to carry out approximately 30 investigations a year.

HSIB is designed to deliver a revolution in incident investigation in the NHS on a par with the Air Accidents Investigation Branch in aviation. Its emphasis will be on learning, and it will operate in a legal “safe space” to encourage openness with those it is investigating.

HSJ reported on Wednesday that Jeremy Hunt rejected the advice of his own expert advisers, brought in to help inform the government on how best to establish the new regulator.

A&E’s four hour warning

When all but a few trusts have missed the four hour A&E target, and the national target has been breached, you might conclude it was a macro issue. It’s true that attendances are up, but on the type one A&E figures (the meatier indicator) the increase is milder in percentage terms.

Similar to last year, 20 trusts have driven more than half the national performance decline.

NHS Improvement hasn’t been as quick as it might have been to support trusts on A&E, but the good news is it has now invested significantly in the intensive support team for emergency care.

The four-hour wait has been around long time, it’s not the motivator it was, and why not have patient experience and something more clinical in there as well?

Inquiry into the invisible army

On Monday, the HSJ/Serco Inquiry on Maximising the Contribution of NHS Non-Clinical Staff published its interim report. Its headline conclusions so far include that Lord Carter’s efficiency agenda will not succeed if the NHS fails to engage with non-clinical staff, and that there needs to be greater engagement and co-design with non-clinical staff on local STPs.