Contract negotiations between the British Medical Association and NHS Employers have suddenly collapsed, plus the rest of today’s news and comment

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5.00pm East of England Ambulance Service Trust has launched an investigation after paramedics allegedly left a body next to bins outside a station.

The body of James Harrison, 32, is believed to been left by bins overnight outside Ely Ambulance Station rather than taking him directly to the mortuary at Addenbrookes Hospital, Cambridge, a whistleblower told The Ely Standard.

It is alleged that the crew involved were due to finish a night shift when the incident occurred.

The body is believed to have been discovered more than an hour later by paramedics arriving for a new shift.

A trust spokeswoman said: ““We are very sorry for what happened and have launched a thorough investigation.  

“This involves working with the family and everyone who responded to the patient.”

3.38pm The BBC reports on renewed calls for there to be public enquiry into the NHS in Wales, after spot checks found problems in at least 20 hospitals.

2.30pm Charities and patient groups have welcomed a mental health trust boss’s decision to withdraw from an expert panel examining patient centred care, arguing she was an inappropriate choice for the role.

1.48pm Balancing the quality of patient care and an organisation’s cost effectiveness is a challenge for trust chief executives.

In the final HSJ Top Chief Executives roundtable, the panel discusses the ways to inspire staff to improve the patient experience

1.29pm With 1 million patients every 36 hours, and continual pressure from national targets, are NHS staff given enough support to deliver high quality patient care?

Julia Ball, assistant director of nursing at University Hospitals of Leicester Trust, explains how IT can lead to better patient outcomes.

12.58pm Cancer surgery performed across a number of specialist hospitals in Merseyside could be relocated to the Royal Liverpool University Hospital, under ambitious proposals being developed to reshape the city’s health services.

The prospect of further centralising cancer services at the Royal is outlined in a “prospectus” for the Healthy Liverpool programme, approved this week by Liverpool Clinical Commissioning Group.

It sets out the programme’s support for concentrating Cheshire and Merseyside’s major trauma services, which are currently split between the Royal Liverpool site and that of Aintree University Hospital, on to a single site.

12.43pm Senior members of the BMA’s junior doctor committee have hit out at NHS Employers for breaking their confidentiality agreement over contract negotiations.

Deputy chair Tim Yates tweeted:

Co-chair Andrew Collier tweeted:


12.22pm The Department of Health has expressed its disappointment with the BMA over its breakdown in contract negotiations with NHS Employers.

A spokesman said: “We are disappointed by the response of the BMA. We want to create an NHS fit for the 21st Century in which doctors get better training and patients can get the best, safest treatment seven days a week.”

11.55am England’s new patient safety drive to halve avoidable harm will be “brave” and not follow the usual “paternal” NHS approach to driving improvements, the director of the Sign up Safety campaign has told HSJ.

Health secretary Jeremy Hunt formally launched the 15 patient safety collaboratives that will support the Sign up to Safety campaign this week.

He confirmed that the collaboratives will be hosted by the country’s 15 academic science health networks and receive £12m a year for the next five years.

11.42am The Care Quality Commission will have to adopt a “learn by doing” approach when enforcing the fit and proper test of healthcare leaders, its chief executive has admitted.

Just over a month before the new requirements comes into force, David Behan told the CQC board meeting this week that they would not be “straightforward” to implement, especially in “difficult cases”.

While the watchdog’s main role is to check providers have sound procedures for appointing competent directors, it could become drawn into decisions, leading to directors removal from post, papers presented to the board indicate.

11.25am NHS Employers has said it is ” disappointed by BMA abandonment of contract talks”.

The organisation’s director of employment relations and reward Gill Bellord said: “This is a hugely disappointing way to conclude a year and a half of serious discussions.

“All our talks with the BMA have been aimed at ensuring safer working hours for doctors in training, as well as providing them with stability of pay and agreed work schedules that take account of educational needs. Underpinning all of this is the essential need to deliver safe care for patients.

“Our work with the BMA over the past 18 months had reached the stage of detailed discussion on contract changes that are fully justifiable because they would enable employers to organise clinical services so that patients can access high quality services every day of the week.

“Throughout all of these negotiations, we have been offering safeguards to protect the wellbeing of individual doctors, so it is a source of personal and professional disappointment that the BMA team feel able to throw our joint progress so far out of the window, and to walk away from what is currently on the table.”

A spokesman for NHS Employers said the organisation expects that as a consequence of the BMA’s actions, the Department of Health is likely to want to consider what steps the government can and should take to move forward, and that local employers are also expected to consider whether they need to make changes to both contracts by other means. NHS Employers will make a formal report to health ministers in the coming weeks.

11.16am In other news, North Bristol Trust will refuse new referrals for spinal surgery after identifying scores of patients were waiting more than a year for procedures.

The restriction will be introduced through changes to the trust’s GP referral criteria.

10.58am NHS Employers has issued a second statement this morning, outlining what it states are the specific commitments it has offered to consultants and junior doctors.

Here is the statement in full:

We were informed via social media late last night (Thursday 16 Oct) by the BMA that they had decided to cease negotiating with us on both the consultant and junior doctors’ contracts.

Earlier that evening we had agreed with the BMA team leading on the consultants’ contract that we would exchange further detailed safeguards on working hours with them in a few days’ time, so it came as a complete surprise to find that they had withdrawn from the discussion unilaterally, without notice, an hour later.

This was quickly followed by an announcement on Twitter that the BMA junior doctors committee was withdrawing from the discussions without notice. It is a disappointing way to conclude 18 months of serious discussions that were intended to ensure safer working hours for doctors in training, as well as providing them with stability of pay and agreed work schedules that take account of educational needs. Underpinning all of which is the need to deliver safe care for patients.

We believe that we have been discussing in detail fully justifiable contractual changes to enable employers to organise their services so that patients can access high-quality services every day of the week. Throughout all of these negotiations, we have been offering safeguards to protect the wellbeing of individual doctors. 

Specifically for the consultants we have offered:

• to maintain a negotiated national framework and the BMA’s role in collective bargaining
• a maximum 40-hour contract, unless extended by mutual agreement. No requirement for the majority of consultants to be contracted for more hours than they are currently contracted for
• maintain the current lifetime earnings potential
• accelerated access to higher pay - consultants will be able to access higher levels of pay earlier in their career than is possible under the current pay scales, as long as they meet all necessary access criteria
• introduce a fairer way to reward consultants who work frequent and intense shift patterns
• continued access to a national clinical excellence award (CEA) scheme, by competitive application
• transitional arrangements that provide protection to existing pensionable pay
• local clinical excellence awards to be incorporated into the consultants’ contract as part of revised performance payments structure. As this will be a contractual entitlement all consultants will be considered for a pay award against jointly agreed access criteria
• jointly agreed safeguards (set out in the contract and supported by jointly agreed guidance), to ensure consultants are provided appropriate protections where service changes are necessary to deliver seven-day services
• a commitment to move towards consultant-led services which will require a growth in the consultant workforce
• greater emphasis on clinical engagement when determining service delivery priorities with a duty to consult being placed on employers
• strengthen the job planning process and put it at the heart of the process for determining the appropriate clinical activity to support local service delivery
• limit the number of weekends that consultants will need to be available for work, without mutual agreement
• maintain an environment where education, training, innovation and research by both NHS and academics can flourish
• no changes to any of the core contractual entitlements – redundancy, maternity, sick pay, leave entitlements, requests for flexible working etc.

Specifically for junior doctors we have offered:

• an hours-based model of pay, with pay relating to work done
• increased basic pay
• pay progression linked to accepting a post at a higher level
• pay protection during transition
• a basic full-time working week of 40 hours
• maximum hours of 48 per week on average, and a cap of 56 hours per week on average for doctors who opt out of WTR
• an extension of plain-time working, with a higher rate for nights - the degree of extension and the rate for unsocial hours had not been decided and was still under discussion
• an on-call availability allowance
• a maximum of 72 hours in any seven consecutive days (lower than the limit suggested by the BMA)
• no more than four consecutive night shifts
• no more than five consecutive long-day shifts
• a work schedule for each post, mapped to the curriculum and setting out both training opportunities and service commitments. This would be personalised to the job holder and reviewed regularly and also on request
• a system for reporting exceptions (eg work overruns) which would trigger a work schedule review
• a system for resolving work schedule issues, including appeals process
• business travel expenses in line with Agenda for Change, but also retaining the provisions on relocation and removal expenses for trainees
• removal of the current four-month eligibility period for sick pay
• a joint commitment to press for better information for trainees ahead of their placements. This cannot technically be done via the contract but is a priority for employers as well as trainees.

Next steps

As a result of this lack of agreement, we expect that the Department of Health will want to consider what steps are necessary at government level and we will be reporting formally to the Minister on 28 October. We also expect that local employers will now consider whether they need to make changes to both contracts by other means.

10.51am Here are a few more tweets from HSJ correspondent Shaun Lintern this morning on the contract negotiation breakdown:

10.27am You can now read HSJ’s full story on the sudden collapse of contract negotiations between the BMA and NHS Employers.

Follow HSJ Live throughout the day for further updates.

10.20am Here is the full response from NHS Employers, issued last night:

Gill Bellord, director of employment relations and reward at the NHS Employers organisation, said: “We are surprised to hear that the BMA junior doctors committee appear to have withdrawn from the discussions without notice and are communicating by Twitter.

“It is a disappointing way to conclude 18 months of serious discussions which were intended to ensure safer working hours for doctors in training, as well as providing them with stability of pay and agreed work schedules that take account of educational needs.

“Underpinning all of which is the need to deliver safe care for patients. And we are amazed to leave consultant negotiations, having agreed further urgent work in next few days by both parties, only to learn by Twitter that the BMA has withdrawn without notice from serious discussions like these.”

10.18am Here is the full statement released by the BMA last night, announcing its breakdown in contract negotiations with NHS Employers:

Negotiations on new contracts for consultants and junior doctors1 have stalled after the Government refused to agree necessary safeguards to protect doctors from working dangerously long hours, compromising patient safety and doctors’ wellbeing.

After more than a year of negotiations with consultants, the Government failed to produce any credible evidence on how to staff and resource the delivery of more seven-day services in a safe and sustainable way. They also failed to offer sufficient guarantees on safe working hours which are vital to protect patient safety, ensure that the quality of patient care isn’t compromised and to prevent burnout amongst consultants.

Similarly, after more than a year of talks with junior doctors, and despite 82 per cent of junior doctors struggling with long hours2, the Government wants to remove vital safeguards3 designed to prevent junior doctors from working dangerously long hours, without replacing them with any alternatives.

Throughout both sets of negotiations the BMA’s aim was to reach agreement on improving safeguards which protect patient safety and doctors’ wellbeing. For a Government that claims to champion patient safety, its failure to agree safeguards, and in the case of junior doctors its desire to remove existing protections in order to save money, shows how they have failed to recognise the damaging impact that unsafe and gruelling working patterns have on patients, doctors and the quality of care in the NHS.

The BMA is not prepared to agree changes to contracts that would risk patient safety and doctors’ well-being, and we urge the Government to work with us to address these key issues.

Commenting, Dr Paul Flynn, chair of the BMA’s consultants committee, said: “The BMA has been clear in its support for more services being available over seven days. We believe the Government must make urgent and emergency care the priority for investment to ensure patients have access to the same quality of care seven days a week, and that this needs to happen before elective – or planned – care can be extended.

“Consultants already work across seven days providing emergency care 24/7, with almost nine in 10 working evenings and weekends on top of their normal working hours4. But delivering more services across seven days will also require more nurses, diagnostic and support staff5, as well as community services to be in place, all at a time when the NHS is facing huge financial pressures.

 “So far the Government has failed to produce any detail on how it will staff and resource a massive expansion of services in a safe and sustainable way. Without this detail, consultants are not prepared to sign up in the dark to proposals that could put patients at risk by forcing existing doctors to work dangerously long hours, or lead to weekday services being cut because there simply aren’t enough doctors to staff them.

“The Government recently announced plans to dramatically increase the services offered by GPs while ignoring the reality on the ground. By trying to rip up the consultant contract for the sake of nothing more than a few more headlines, they are at risk of repeating the same mistake.” 

Dr Kitty Mohan, co-chair of the BMA’s junior doctors committee, added: “The reality is many junior doctors are still working 90-hour weeks, leaving them exhausted and burnt out. By refusing to ensure that protections on safe working hours are in place, the Government has failed to protect patients and junior doctors from unsafe and gruelling working patterns.

“We have been clear throughout this process that we want to make improvements to the junior doctor contract. We are happy that this would be at no extra cost to the NHS, but not at the expense of patient care. The Government’s decision to remove key safeguards designed to prevent doctors working dangerously long hours has been done for no reason other than to save money, regardless of the consequences.

“Junior doctors are asking for the same basic guarantees on safe working hours, training, fair pay and respect for the right to a life outside of work, which should be the bare minimum for any employee.

“If the Government is serious about increasing the number of people coming into medicine and if it wants to stem the flow of young doctors leaving the NHS to work abroad, it needs to urgently address these issues.”

10.15am HSJ correspondent Shaun Lintern was following the action last night as the breakdown in contract negotiations between the BMA and NHS Employers unfolded.

Here are a selection of his tweets:


9.55am Good morning and welcome to HSJ Live.

We start the day with news that contract negotiations between the British Medical Association and NHS Employers suddenly collapsed late last night.

The BMA issued a press release on social media website Twitter at 9.15pm in which it announced the talks had ended claiming: “the Government refused to agree necessary safeguards to protect doctors from working dangerously long hours, compromising patient safety and doctors’ wellbeing.”

NHS Employers appeared to have been caught by surprise issuing a statement last night that it was “amazed” at the decisions of the BMA having agreed with consultants to do more work on achieving a deal in the next few days. It is understood an email from the junior doctors committee was sent to NHS Employers moments before the announcement.

The 18-month talks had centred on removing consultants ability to refuse to work weekends and evenings for non-urgent work and changes to their pay structure as well as reform of the Clinical Execellence Award scheme.

The BMA claimed last night that whilst it was willing to discuss changes NHS Employers refused to provide necessary safeguards beyond what it called “broad statements of intent.”

The failure of negotiations comes as the NHS is seeking to develop more seven day services, a key Government and NHS England ambition. Changes to pay structures follow similar agreement with Agenda for Change unions last year to better link pay to performance although there were also moves to try and secure a lower starting salary for new consultants.

More to follow.