Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern
This week a look at the CQC’s new tone on safe staffing; efforts by NHS Improvement to live up to its name; bursary changes for healthcare students and the junior doctor’s contract dispute is set for a court battle. Something to tell me: Contact me in confidence here.
Shaun Lintern, patient safety correspondent
CQC makes clear its safe staffing position
You have probably noticed the focus on the issue of safe staffing and workforce of late and particularly how trusts can reconcile those pressures with the requirement to meet their financial targets.
This week the Care Quality Commission became the latest national body to want to re-educate providers on what it really means when it says a trusts does not have sufficient staff. I spotted the change in tone in a recent CQC press release, in which deputy chief inspector of hospitals Ted Baker said it was up to Yeovil District Hospital to determine how it tackled a shortage of nurses. It could be through either recruitment or changes to its care model, his statement said.
HSJ spoke to Professor Baker who confirmed the change in tack was intentional and designed to emphasise trust autonomy on safe staffing and that it was not the case that the CQC went around telling trusts to simply recruit more nurses. He said as long as trusts could come up with credible plans the CQC would be happy.
Professor Baker denied there had been any external influence on the CQC, although it is known that NHS Improvement chief executive Jim Mackey has previously said that he has raised the issue with CQC chief executive David Behan.
If a trust decided a care model change was its best option rather than recruitment – but recognised that the service changes would take a significant amount of time – it is difficult to see how the CQC could square this with its legislative requirement on staffing. The law underpinning the CQC process demands that sufficient staff be deployed. It doesn’t have a caveat that this should only be eventually after a care model transformation.
Would the CQC be able to look the other way for 18 months?
Professor Baker told HSJ the regulator would want to see timely changes and that if there was going to be a long delay then “interim measures may be entirely appropriate”.
Presumably these would involve finding additional staff.
NHS Improvement is improving improvement
Spare a thought for NHS Improvement. It hasn’t been an easy few weeks for the regulator. It has had to serve up some messages which are pretty unpalatable for the NHS and has, understandably, suffered a bit of pushback in the wake of the NHS financial reset.
But NHSI has another very important role beyond that of nasty top-down financial regulator. It’s also trying to mould itself into an organisation of support and help. Cue a recent gathering in London on 14 July (summary video here) and a new page on its website sharing what different providers are doing. This isn’t a bad start.
What appears to be lacking, though, is rigorous data and evaluation summaries of the projects so that those considering doing the same can see what really works. At the moment it seems a touch too happy-clappy and about corporate promotion rather than real grit to make measured improvement.
This sort of national resource could help overcome the age old problem of sharing good practice across the NHS. A real resource centre that has substance. Let’s hope there is some improvement as things develop.
See you in court
If you think the junior doctors’ contract dispute is over, think again. The dispute is heading to the High Court next month for a judicial review to answer the question of whether health secretary Jeremy Hunt has the legal power to impose a contract. The review is being brought by a group of doctors who have formed a company, Justice for Health, and raised £150,000.
If the doctors succeed it will likely be thanks to the legislative quagmire of the Health Act 2012. Many think the government is on solid ground given the accountability and responsibility to Parliament that Mr Hunt has for the NHS – that is to ensure a comprehensive health service is provided. But does this extend specifically to trust by trust employment contracts? A judge will rule.
The Justice for Health group have decided not to proceed with their grounds that a single imposed contract is against competition law. Given the Pandora’s box that could open, not just for the NHS but the entire public sector, with employers competing with each other for staff all on variable terms, it was probably a sensible move.
Should the doctors win, Mr Hunt, and future secretaries of state, could potentially be barred from having any involvement or control of future contract negotiations. It’s possible to imagine that NHS Employers may welcome that, given politicians’ interventions have arguably often been unhelpful.
One thing seems certain, a victory in the High Court next month will not stop the new contract being offered to junior doctors by individual trusts when they rotate jobs. This was always the mechanism for imposition and is a perfectly legal route regardless of how the contract itself was drawn up.
Bursary changes go through
The government has pressed ahead with plans to change education funding by controversially scrapping the NHS bursary for nurses and other healthcare students who will move to student loans.
Ministers say this removes the artificial cap on university places which are constrained by what the NHS can afford. There is truth to that. However the suggestion it will deliver 10,000 extra places could be proved to be wishful thinking.
Equally the predictions of an apocalyptic crash in students being prepared to take out loans also seems somewhat unsupported by evidence from the university sector. Neither side really knows, which is concerning in itself.
The government has made some welcome concessions and offered additional support for childcare costs, those taking second degrees and doing postgraduate studies. Close attention will have to be paid to the impact of the changes not just on nursing numbers but on allied health professionals and important groups like health visitors, practice nurses and therapists.