Your essential update on health for the week.

HSJ Catch Up

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

Domestic medics upended

Some interesting data was released as part of the General Medical Council’s first workforce focused report today, which revealed more non-UK medical graduates are joining the register than British-trained.

Its chief executive Charlie Massey told HSJ the regulator expects out of 19,000 medical graduates, 10,000 would be international, 2,000 from Europe and 7,500 from UK medical schools. And this trend is expected to continue.

However, despite the UK’s increasing reliance on international doctors, Mr Massey warned they are facing many more challenges in terms of “landing well” in the health service and said we are “inconsistent” in the way these doctors are supported.

A skill-mix remix

Our outgoing quality and safety correspondent, Shaun Lintern, has done a major analysis of the patterns in fill rates of nursing and care assistant shifts in acute hospitals all the way back to 2014.

It is not terribly pretty – with the share of daytime nursing shifts going unfilled broadly increasing over the years. There’s been a slight improvement between June 2018 and June 2019 – perhaps a reason for hope, perhaps a blip.

Raw numbers of the actually staffed daytime registered nursing shifts stayed broadly stable over the five years; while unregistered healthcare assistant shifts saw a gradual but significant change in the skill mix in acute hospitals.

Capital conversations

While MPs and the media worked themselves into a frenzy about the latest Brexit vote in the Commons, Daily Insight’s eyes were fixed on events in another part of the Palace of Westminster.

Over in Committee Room 8 a rather sparse Commons health and social care committee took evidence on NHS capital from Simon Stevens and Matt Hancock, as well as a smattering of health policy experts.

The session’s most eyebrow-raising comment came from Mr Stevens, who admitted the recent capital process for the NHS effectively amounted to “implicit rationing”. He is spot on, though Daily Insight feels it would have had more impact had he acknowledged that publicly a few years ago.

Mr Stevens stressed the need to take “delays” out of the capital process, and he appeared confident the measures outlined in the Health Infrastructure Plan would assist with this.

How many warning signs are needed for a commissioner to properly scrutinise a service? So asks Rebecca Thomas in this week’s Mental Health Matters column.

She writes: “HSJ reported how repeated concerns over the safety of children’s autism services across South Staffordshire, over several years, were given “minimal” attention due to the small size of the contract.

“While minimal attention would have been justifiable if the service was performing well, local leaders had been sent serious complaints by families since at least 2013 — essentially saying children in crisis were not getting specialist help and were repeatedly passed between different services.”

New digital department NHSX was forced to remove a job advert for a senior IT role last week after it faced criticism for excluding people from black and minority ethnic backgrounds.

NHSX officials confirmed the application process for the chief nursing information officer role has been paused, so the criteria in the advert could be amended “to ensure they fit with NHSX values”.

The advert attracted criticism for stating hopeful candidates must have “proven and significant experience at director level”. By putting this in as an “essential” criteria significantly limited the number of BME candidates eligible to apply for the role as “very few BME people have reached director level”.

An interesting industry

Patient transport is an industry which people shake their heads about.

One of the least glamourous parts of the health system, it seems to have no small amount of dysfunction in its commissioning and provision. Leaving aside the actual inconvenience to patients of a poorly-functioning service, this also has a significant effect on the functioning of hospitals.

Being unable to discharge someone from a bed because there is no way for them to get home has an obvious effect on flow through a hospital – all important, especially in winter.

The NHS England commissioned report into the sector will make interesting reading.

Legislation for the new Health Services Safety Investigation Body — which was previously the Healthcare Safety Investigation Branch — does not include any plans to extend the current maternity investigations, which it took out of the NHS’ hands in 2018. The Department of Health and Social Care has subsequently confirmed HSIB will no longer do these from 2021.

Former health secretary Jeremy Hunt said he was concerned HSIB has not been asked to carry on with this work, given the scale of failure by the NHS to do these investigations well over many years.