Ministers have taken the first step towards imposing a contract deal on medical consultants and junior doctors, plus the rest of today’s news and comment

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5.37pm In the Nuffield Trust blog, senior policy fellow Rebecca Rosen proposes there are three key factors for making the NHS five year forward view a success of the frontline.

Dr Rosen, who also practices as a GP in Greenwich, argues the first key factor is time. The development of the new models of care outlined in the forward view “cannot be based on discretionary effort,” she writes. “People will need time out of their day jobs to understand new models of care, to influence their design and to develop a commitment to success.”

She also suggests there will need to be “realistic expectations” about the performance level of these organisations during the period of transitions.

Finally, she argues there need to be “substantial support for local leaders”.

5.00pm A review of mental health services in Cumbria will examine an apparent trend of patient suicides in connection to the local mental health trust, HSJ has learned.

The independent review, due to be published next month, is examining the issue after a coroner called for Cumbria Partnership Foundation Trust to be “assessed independently” after the deaths of a number of patients who had been treated by the trust.

3.22pm You can now read our full story on ministers taking the first steps to imposing contract deal on doctors on

In response to the move, Mark Porter, chair of the BMA council, said: “After more than a year of negotiations the government has failed to produce any credible evidence on how it will staff and resource a massive expansion of services over seven days in a safe and sustainable way.

“They have also failed to demonstrate how they will protect junior doctors from unsafe and gruelling working patterns that put patient care at risk.

“It comes as no surprise that they have now chosen to refer this issue to the review body.

“It is vital if we are to have a contract that is good for patients, fair for doctors and good for the NHS that the review body listens to the doctors who already care for patients at nights and weekends, about how to make that care better and more consistent.”

“They have also failed to demonstrate how they will protect junior doctors from unsafe and gruelling working patterns that put patient care at risk.

“It comes as no surprise that they have now chosen to refer this issue to the review body.”

“It is vital if we are to have a contract that is good for patients, fair for doctors and good for the NHS that the review body listens to the doctors who already care for patients at nights and weekends, about how to make that care better and more consistent.”

3.00pm More from our breaking story that ministers have taken the first step towards imposing a contract deal on medical consultants and junior doctors:

In a letter to the Doctors’ and Dentists’ Review Body, health minister Dan Poulter said he wanted the body to “make observations” on contractual reform to deliver seven day services as well as examining possible changes to the Clinical Excellence Award Scheme.

It will also investigate proposals for pay progression linked to responsibility and performance and arrangements in other sectors where seven day services are provided.

For junior doctors the DDRB has been asked to make recommendations on new contractual arrangements including a new pay system ending “time-served incremental progression,” working patterns and how the current pay envelope could be used to increase basic pay, while providing reward for additional work and supporting services and training over seven days.

Dr Poulter said: “The government is disappointed these negotiations have not resulted in agreements acceptable to all parties.

“I am therefore now asking the DDRB to make observations and recommendations that take into account the work undertaken during the negotiations.

“Patients should be placed right at the heart of everything we do, and the way the NHS organises and manages the workforce should be built around patients and their needs.”

He added that seven day services had the “potential to reduce mortality in the evenings and at weekends, speed up diagnosis and discharge times and reduce the amount of time patients spend in hospital overall.”

2.32pm A member of University Hospitals Birmingham Foundation Trust’s senior leadership team has taken a permanent post at Medway Foundation Trust in one of several changes to the troubled trust’s management.

Morag Jackson, previously director of projects at UHB, will take on the role of chief operating officer at Medway on a permanent basis from November.

The move follows a three month project where UHB offered support to Medway.

2.28pm In our sister title Nursing Times, Halloween costumes can become a “dangerous” culture that brands the mentally ill as “psychos or schizos or freaks”, a government minister will warn.

Liberal Democrat care and support minister Norman Lamb will give a speech urging retailers not to “demonise” people with mental health problems by selling trick-or-treat and party outfits that mock psychiatric patients.

His address to the national child and adult services conference in Manchester comes after several joke outfits depicting dangerously violent mental patients in chains and wearing masks made headlines after going on sale online.

2.04pm BREAKING: Ministers have taken the first step towards imposing a contract deal on medical consultants and junior doctors, HSJ has learned.

The government has asked the independent Doctors’ and Dentists’ Review Body to consider making recommendations on changes to the medical contracts to “better facilitate the delivery of services seven days a week, in a financially sustainable way.”

This could result in a substantial proposals from the DDRB to amend the medical contract terms and conditions which could then be unilaterally imposed on the medical workforce

Negotiations between the British Medical Association and NHS Employers collapsed after 18 months of talks after the BMA accused the government of offering no safeguards for doctors despite NHS Employers claiming such safeguards were under discussion.

More to follow soon.

1.55pm A cash strapped clinical commissioning group plans to limit access to routine surgery for obese patients and suspend funding for some non-urgent procedures in a drastic bid to find £26m of in year savings.

1.38pm The NHS has a “responsibility” to help councils cope with their “tough financial settlement”, the health secretary has said

Jeremy Hunt made the comments in a speech at the national children and adult services conference in Manchester yesterday, according to HSJ’s sister title Local Government Chronicle.

“We prioritised the NHS by protecting its budget, which meant tougher settlements for other departments including local government,” he said.

“But the interconnected relationship between the services we both offer to vulnerable people means that we in the NHS have a responsibility, as we move to fully integrated services, to help you [in local government] deal with a tough financial settlement.

“If we operate in financial silos, the costs will be higher for both of us.”

12.21pm More from The Telegraph, survival rates for some cancers are stalling and some have gone into reverse, figures from the Office of National Statistics reveal.

12.13am The Daily Telegraph reports that people drink consume 400 fewer calories during a night at the pub when their drinks have calorie labels on them, according to trials conducted by The Royal Society of Public Health,

The body’s chief executive Shirley Cramer said: “Calorie labelling has been successfully introduced for a wide range of food products and there is now a clear public appetite for this information to be extended to alcohol to help individuals make informed choices.”

She suggested the move “could make a major difference to waistlines of the nation,” pointing out that adults who drink get about 10 per cent of their calories from alcohol.

11.56am Homeopaths have offered their services to prevent and treat Ebola in west Africa, The Guardian reports.

“Homeopaths worldwide have been mobilising their efforts toward gaining entrance in those countries affected”, the National Center for Homeopathy in the US said on its website.

The organisations claims that homeopathic remedies have been used successfully in other disease epidemics in the past, naming cholera, diphtheria and hepatitis among others.

Scientists say there is no evidence that homeopathic remedies have any effect on the body, with the substances so heavily diluted that they are effectively water.

11.51am The Guardian reports that the new head of the civil service, John Manzoni, will leave his second job as a non-executive director of a major alcoholic drinks company next summer after coming under fire from more than 70 leading medical professionals and charities.

The Cabinet Office had initially said Manzoni could keep his second job as they saw no conflict of interest, they then said he could do it on an unpaid basis. However, signatories to a letter to Sir Jeremy Heywood argued it was incompatible with public health goals.

11.38am Also in The Times, the NHS needs an aviation style independent safety investigation agency to make sure it learns from its mistakes, experts have said.

11.27am In today’s papers, The Times reports that patients should be able to opt out of the NHS in exchange for a tax rebate to buy private cover, a free market think tank has urged.

The Institute of Economic Affairs said this would drive up standards by encouraging competition and would let patients unhappy with the NHS take their custom elsewhere.

11.01am As much as a quarter of ambulance callouts are for falls, but a new web tool is helping to reduce the cost to the NHS, explains Karen Middleton, chief executive of the Chartered Society of Physiotherapy, in a comment piece for HSJ.

10.51am NHS England has today launched a national public awareness campaign in a bid to persuade people to seek early advice from their local pharmacist if they are beginning to cut down well.

The campaign, named ‘feeling under the weather’, will run for six weeks.

A press release issued by NHS England stated the campaign has been launched “to encourage people, particularly older people and those with existing respiratory conditions, to nip health problems in the bud”.

“Every year the NHS sees a huge increase in numbers of emergency admissions to hospital over the colder months,” the statement continues.

“Those with existing respiratory conditions, such as asthma or bronchitis are particularly vulnerable, and for frailer and older people, even the common cold can become more serious.”

Professor Keith Willett, NHS England’s clinical director for acute care, said: “As a doctor who has spent some 30 years working in A&E, I know we have to do better at helping people stay well, not just picking up the pieces when they fall seriously ill.  The NHS has not spent enough time broadcasting that message in the past.

“Every winter, doctors and nurses see a big increase in the number of older and frail people who are admitted to hospital because of respiratory or other chronic conditions usually worsened by immobility, the cold and viral illnesses.

“People often don’t seek advice for wheezes, coughs and sneezes because they don’t think it’s serious enough, or they don’t want to waste their pharmacist’s time.  But no problem is too small for your local pharmacist, who is a highly trained and trusted source of health advice.”

Building on the success of last winter’s campaign and the evidence base for the urgent and emergency care review, ‘feeling under the weather’ aims to relieve pressure on A&E departments by promoting earlier access to health advice and self-care information from community pharmacy services or NHS Choices.

NHS winter planning started earlier than ever before this year, with hospitals, GPs, social services and other health professionals coming together to identify local pressures and respond in every area of the country.   The NHS is determined to protect the good standards of service that patients deserve, despite the very considerable pressures we anticipate over the winter months.

Bruce Warner, the body’s deputy chief pharmaceutical Officer, said: “Pharmacists and their teams are well trained and well placed to be able to offer advice to people seeking help. They can provide medicines advice and support for minor ailments, advise you about how to manage a long term condition and tell you if something needs more urgent medical attention from your GP, or even your local hospital.

“You don’t need an appointment and many have consultation areas so your local pharmacy  is a good place to start when you’re feeling unwell.

“We would encourage people to seek help from their pharmacist when they first feel unwell rather than waiting until it becomes more serious.”

10.39am Our 2014 HSJ Innovators were announced last night at an event in London.

The NHS Five Year Forward View last week set out system leaders’ vision for how the health service can meet public demand and remain affordable over the next five years.

In the second HSJ Innovators, we put the spotlight on 50 people in healthcare who are already showing the creativity and imagination necessary to transform the health service for the 21st century, by introducing new ways of working, policies and technology at their workplaces and beyond.

10.28am The Care Quality Commission has today published its first inspection reports in adult social care services, with the majority of providers being rated good.

Out of the 31 reported published this morning, 21 providers have been rated ‘good’ overall, seven were rated as ‘requires improvement’ and three were rated as ‘inadequate’.
The CQC rolled out a new inspection regime for social care providers at the start of October, when it also introduced a ratings system.

Andrea Sutcliffe, the CQC’s chief inspector of adult social care, said: “Our new approach to inspecting and rating adult social care services is intended to shine a spotlight on care, to celebrate the good and tackle the bad. I am pleased that our first ratings do just that and are highlighting the good services we know exist.

“This is of course a very early picture with the publication of our first 31 reports. There is a long way to go before we inspect and rate every one of the 25,000 adult social care services across England by March 2016.

“But what is very heartening is that of these first reports, 21 have been rated as good. I pay tribute to the managers and staff whose sheer hard work and determination is obviously making a difference for the people using these services.
“I am determined that we see improvement in under-performing services to ensure every person has the same opportunity to receive care that is safe, caring, effective, responsive and well-led. In that way we can realise our ambition for adult social care to provide services we would be happy for any of our loved ones to use.”

10.00am NHS staff should be awarded a pay rise in line with inflation next year, according to HSJ’s poll of HR managers that found strong support for an end to pay restraint in 2015-16.

7.00am Good morning and welcome to HSJ Live. We begin the day with the news that most NHS senior human resources directors would support the imposition of national employment contracts on medical staff, an HSJ survey has found.

Almost three quarters, 74 per cent, of 130 HR directors polled in HSJ’s survey, carried out in association with NHS Employers, said they would support the government recommending a national contract framework that trusts must apply.