Surveys by the Confed and the RCN discuss causes and solutions to A&E pressures, NHS failings on sepsis, tips for better public sector leadership and the rest of today’s news and comment

Live logo

5.28pm NHS Employers have come up with a natty new infographic showing average earnings in a range of NHS roles. It’s downloadable from their website.

5.18pm Former Labour health minister Lord Hunt tweets “If only the money would make its way to A&E!” in response to today’s HSJ story about the new RCGP leader condemning Cameron’s A&E plan. @LordPhilofBrum

4.28pm Still going strong. The most popular story on our website remains Dave West’s exclusive that outgoing Royal College of GPs chair Clare Gerada has been appointed to lead a project to overhaul primary care across London.

3.06pm The number of vacancies in the healthcare sector rose further during August, according to the Recruitment and Employment Confederation and KPMG.

Their Report on Jobs, published today, indicated strong rates of growth in demand for both permanent and temporary workers.

For short-term staff, the healthcare sector was in second place in the demand for staff “league table” during the latest survey period, behind Engineering. At 67.9, the index measuring demand for temporary healthcare workers was little-changed from 68.4 in July.

For permanent staff, healthcare dipped to seventh place during August. But an index reading of 60.4, up marginally from 60.0 in the previous month, still signalled a robust pace of expansion in vacancies, the analysts said.

2.29pm While on the topic of NHS England, last thing on Friday it announced it was seeking chairs for its Clinical Priorities Advisory Group (CPAG) and its Rare Diseases Advisory Group (RDAG).

2.15pm NHS England has today published its response to Monitor’s Fair Playing Field Review recommendations. It said it supported most of the recommendations but identified concerns with four of them.

Among NHS England said it was concerned about was recommendation seven, which called for the development and publication of performance metrics for all providers of commissioning support. It also noted concerns with recommendations 15,16 and 19.

1.50pm For the arty types among HSJ readers. Patients at an East London GP surgery are the subject of a new photography exhibition, being held at the RCGP’s headquarters at 30 Euston Square.

The 24 photographs, taken by Swiss photographer Michael von Graffenried, explore the backgrounds of patients at Shoreditch Park Surgery that have shaped their lives and, in some cases, their medical problems.

Access is by appointment only and can be arranged by via

1.30pm Top neurosurgeon Mary Murphy has joined Highgate Private Hospital, where she will lead its neurology team.

1.10pm The Centre for Public Scrutiny has published a short briefing on how it thinks council scrutiny can support improvements in quality and patient experience and help the local NHS put patients first.

Almost inevitably the document is a response to recommendations made by the Francis report in February.

CfPS has suggested the following first steps for scrutiny to consider in responding and improving scrutiny practice and outcomes in relation to holding the NHS to account:

  1. Involve people who use services, their families and the public
  2. Use information that is available: media reports, public Board papers, complaints data and published statistics about health and care outcomes
  3. Collaborate to avoid duplication and complement the work of others
  4. Training and knowledge will lead to improved performance

12.45pm Cumbria County Council has announced that it is to invest £85,000 in recruiting more school nurses.

The additional investment means three extra school nurses will be recruited by Cumbria Partnership NHS Foundation Trust.

12.15pm Mid Staffs downgrade set to lead to court battle. A bid to downgrade services at Mid Staffordshire Foundation Trust could end in court, it has emerged.

Both Stafford Council and local campaigners said they are prepared to take legal action against the trust special administrators if the proposals to downgrade the hospital are implemented.

This would be the first legal challenge of the government’s failure regime for foundation trusts under legislation in the Health and Social Care Act. It’s a Mid Staffs story so that means @ShaunLintern is the author.

12.11pm Exclusive: College plans back to work scheme to ease GP shortage. The Royal College of GPs is proposing to set up a back to work scheme to create a “short term surge” in GP numbers and help fill what it says is an urgent shortage.

The RCGP is also calling for government action to increase the proportion of doctors becoming GPs in the medium and long term. Recent months have seen particular concern about unsafe staffing levels for out of hours’ primary care and a lack of access to urgent primary care appointments.

The chair elect of the college Maureen Baker told HSJ’s @Davewwest the situation was sufficiently urgent that she wanted the college to help fill the gap in the short term by encouraging GPs who were not working to do so, and others to increase their hours.

11.32am The Health and Social Care Information Centre (HSCIC) is undertaking a collaborative audit of data collection in acute trusts, as part of the “busting bureaucracy” challenge set by Jeremy Hunt at this year’s NHS Confederation annual conference.

Up to 50 trusts, of differing size, complexity, regional location and with a range of maturity of electronic information systems are needed to participate during September and October. The audit will concentrate initially on frontline care in three areas: A&E, maternity and stroke services.

Trusts interested in helping the HSCIC should contact the Busting Bureaucracy Challenge on 0845 3006016 or email:

11.24am A hundred MPs across England have signed up to a British Medical Association scheme to see first hand the day-to-day workings of a GP practice.

Launched in June 2013, 100 MPs from across the political spectrum have signed up to the BMA’s GP practice visit scheme that allows them to see the pressures facing general practice.

Among those who have arranged a visit is former Conservative health secretary Andrew Lansley and former Labour health minister Ben Bradshaw. No serving members of the coalition’s health team have so far taken part.

Dr Chaand Nagpaul, chair of the BMA’s GP committee, said: “It is vital that politicians get a real understanding not just of the pressures that many practices are facing, but how greater support from government would help general practice deliver even better care to patients.”

11.15am Health minister Lord Howe was due to speak this morning at a conference on reducing bureaucracy around pharmacy.

11.03am Sticking with the emergency pressures theme: In an interview with HSJ’s @Davewwest, the new RCGP leader has condemned the PM’s A&E plans.

The chair elect of the Royal College of GPs has condemned the prime minister’s £500m accident and emergency bailout plan as “voodoo med-economics” and said it was driven by “political priorities ahead of a forthcoming general election”.

Maureen Baker

Dr Maureen Baker, who will succeed Clare Gerada as RCGP chair in November, criticised the “allocation of £500m to failing A&E departments”, and said the money would make a much bigger difference and improve overall efficiency if invested in primary care. “[£500m] is almost 10 per cent of our entire budget for general practice,” she said.

She also used an interview to express reservations about the government’s proposal to identify named GPs as “accountable clinicians” for patients.

10.57am The Guardian reports Ed Miliband will put forward plans tomorrow to outlaw the exploitative use of zero-hours contracts, as new figures show Britain has suffered the second biggest fall in wages of any G20 country since the coalition took office.

Labour leader Mr Miliband will propose three specific measures to reduce the use of zero-hours contracts:

  • Banning employers from insisting zero hours workers be available even when there is no guarantee of any work
  • Ending zero hours contracts that require workers to work exclusively for one business
  • Ending the misuse of the contracts where employees are, in practice, working regular hours over a sustained period.

10.44am A quarter of doctors and surgeons are bullied into bad behaviour a survey has found reports The Guardian.

Fewer than three out of five health workers would be confident to raise concerns about the quality of patient care to senior management and about 40 per cent were worried their organisation could be at the centre of the next patient care scandal.

The findings are the result of a survey by the Chartered Institute of Personnel and Development (CIPD) released today.

10.37am Ombudsman report set to reveal sepsis failures. The NHS is failing to adequately diagnose and treat patients suffering from the life threatening condition sepsis, the parliamentary health service ombudsman will say in a report later this week, HSJ has been told.

On Friday the ombudsman, Dame Julie Mellor, will highlight the poor care of sepsis patients, a condition which kills 37,000 people a year. It will be the first ever clinical report produced by her office. @ShaunLintern has the story

Julie Mellor


10.28am Overseas doctors could be tested on their English language skills under latest government proposals.

Under current EU rules, the General Medical Council is not able to test doctors for competency in English, but the new plan would enable it to do so if it has concerns about an individual.

10.15am Readers will be pleased to know that the 6 September issue of HSJ is ready to read on the app

10.13am The Society for Acute Medicine responds to the NHS Confederation A&E report, saying it provided a “stark reminder” of the ongoing pressures being faced.

SAM president Dr Chris Roseveare said: “Acute medical units are a key part of the solution to emergency department overcrowding, ensuring that patients who require hospital admission are able to move rapidly into a hospital bed. However this ‘patient flow’ is dependent on a hospital’s ability to maintain spare bed capacity.

“Too many hospitals run at 100% occupancy for too much of the time, despite evidence that suggests that greater efficiency is achieved with occupancy below 85%. Maintaining spare capacity in hospitals, such that every day starts with empty beds in acute admitting areas, would provide a major step forward in achieving the timely admission of patients from the emergency department.” 

Earlier this year, the Society for Acute Medicine, NHS Confederation, Royal College of Physicians and College of Emergency Medicine collaborated to produce a 10-point plan to ease emergency pressures. It is crucial that these are now addressed as quickly as possible.

10am We now have a story up that draws together the surveys from the Confed and RCN, plus the views of shadow health secretary Andy Burnham: A&E departments ‘could reach breaking point’

9.58am The NHS Confederation is calling for a “package of interventions to avert winter meltdown” on the back of a survey of senior members. It found 45.7 per cent said they were likely or very likely to meet the 95 percent four hour waiting target for the next quarter.

The survey - carried out in July - asked 125 chief executives, commissioners, chairs, medical directors and chief nursing officers about the causes of pressures on A&E and how they can best be managed. The findings are contained in report Emergency care: an accident waiting to happen?

Nearly half of respondents said the main cause of pressure on A&E is the rising number of frail older people with multiple long-term conditions, and more than a quarter identified difficulties with patient discharge or transfer.

More than half said giving organisations much earlier notice about funding designed to ease winter pressures would be very helpful in tackling A&E demand.

Other solutions proposed included a public information campaign, more incentives for staff to work in A&E, more senior staff working during the evenings and weekends, and a change in the payment system fro A&E work.

Mike Farrar, chief executive of the NHS Confederation, said: “There needs to be cultural change in order to introduce seven day a week working in the NHS and social care, and a greater shift of our resources to enhance community services.”

  • HSJ will be hosting a Twitter chat together with NHS Confed on Wednesday, 1-2pm, to discuss A&E and urgent care pressures. Hashtags are #HSJchat and #urgentcare

9.55am: Not to be outdone by the Confed, the Royal College of Nursing also released findings on Sunday from a member survey. It suggested that 89 per cent of nursing staff working in acute and emergency care believe current pressures on these services are putting patients in danger.

In the survey, conducted in July with 416 RCN members working in acute and A&E settings, 85 per cent of respondents said patient safety was being compromised due to increased pressure on A&E services, with 19 per cent saying this was the case on every shift.

RCN chief executive and general secretary Peter Carter said: “Our member survey demonstrates the same picture that NHS Confederation leaders are painting - that emergency services, and the staff working within them, are under increasing pressure which is putting patient safety at risk.”

8:56am: There is no shortage of books offering management advice, but what works for business is not always appropriate for the public sector. Good morning, today on HSJ, expert Alexander Stevenson offers four tips to tackle the specific challenges of public sector leadership.

Man reading a book

He writes: “The public sector is often criticised for its red tape but bureaucracy is inevitable given the level of public scrutiny. The managerial challenge is how to deal with it”.