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
After a bit of a prolonged summer break, the Risk Register is back with the latest round up of important news this week. I am really keen to hear thoughts on what people want discussed, so do feel free to contact me in confidence here.
Shaun Lintern, patient safety correspondent
Latest Ombudsman failures exposed
Dame Julie Mellor’s many mistakes during her relatively short tenure at the Parliamentary and Health Service Ombudsman should hasten her departure but despite handing in her resignation in July and more revelations this week, she appears to be going nowhere fast.
The PHSO has now published the long awaited report by Sir Alex Allan into what action Dame Julie Mellor took when she was warned in 2015 that her then deputy, Mick Martin, had been involved in covering up the sexual harassment of an NHS HR director. The 19 page report by Sir Alex reveals Dame Julie had two chances to learn of Mr Martin’s involvement in the cover-up at Derbyshire Healthcare Foundation Trust – having been sent a copy of a tribunal judgement in July 2015, followed in August by a letter from Monitor warning that Mr Martin had been named and criticised.
However, she did not read the tribunal judgement until HSJ made the link between Mr Martin and events at Derbyshire Healthcare earlier this year. Dame Julie accepted what she had been told by Mr Martin and only realised after she read the judgement that immediate action was needed.
This scandal at the top of the PHSO is the latest in a long list, which has seen the ombudsman stagger from one crisis to another. Consider for example the repeated financial failures and a National Audit Office report into the management of contracts awarded by the PHSO – including a former business partner of Dame Julie’s. The health secretary has criticised the PHSO, which has also had rows with Morecambe Bay inquiry chair Bill Kirkup – not to mention criticism by its own staff over the way the organisation was run under Dame Julie and Mr Martin. There is more if you care to go looking.
She has done the right thing in announcing her resignation. But because the ombudsman exists as a “corporation sole”, there must be a replacement person to take on the powers and responsibilities. On this and the other failings of the PHSO, the government and MPs have been silent – and there have been suggestions Dame Julie could remain in post until March.
Such a long goodbye is wholly unsatisfactory and will leave the PHSO under a dark cloud and affect public confidence. The Cabinet Office and members of the Commons public administration and constitutional affairs committee should take action now to halt the declining fortunes of the PHSO.
The BMA’s last gasp of protest
There was relief across the NHS as news broke on Saturday that the British Medical Association had stepped back from the brink and cancelled its plans for monthly five-day strikes by doctors.
Since HSJ published the leaked WhatsApp messages in May, the BMA has been losing the battle with the government over the junior doctors’ contract. It did the correct thing and managed to bring the government back to the table and secure concessions for its membership – which was always going to be the end game.
But when former junior doctor committee chairs Kitty Mohan and Andrew Collier led the BMA’s surprise walkout from talks (announced on Twitter) in October 2014, it was inevitable the union would end up following rather than leading its membership. The government helped achieve this scenario with its unnecessary inflammatory language around seven day services – something the contract reforms were never really about.
And so it was that 58 per cent of doctors rejected the compromise deal – causing a mess within the BMA leadership that some have been predicting would happen for the past 18 months. They snatched defeat from the jaws of victory.
But if anyone at Richmond House or in the NHS thinks the dispute is over they should think again. The BMA is likely to continue to oppose imposition of the contract and has yet to say whether this will include some form of action short of strike. But beyond the union, the NHS now faces a situation where a key workforce group feels under attack and has no trust or loyalty towards employers. These issues need addressing as a matter of urgency.
Hoping for the best, not planning for the worst
At a recent “Chatham House rule” event, a senior NHS figure told a room of leaders that he “hoped” NHS trusts would not make cuts to staffing levels that affected patient care.
This followed a question regarding NHS Improvement and NHS England’s financial “reset” dossier, and in particular the identification of 63 trusts which had increased their pay bills above inflation during the last two years. This basic methodology – which ignored local issues, historical understaffing and other sensible analysis – was very quickly attacked by providers and Jim Mackey said it was only intended to start a conversation.
Since the publication of the list a number of organisations that apparently overspent on staffing have been told they are understaffed. The latest is Aintree University Hospitals Foundation Trust, where Care Quality Commission inspectors found wards with below safe staffing levels. A clinical director told the regulator at least one ward was unsafe.
But according to the list of 63, Aintree had a potential pay bill savings opportunity of £12.5m.
I hope we never hear reference to NHS Improvement’s list again.
- AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST
- British Medical Association (BMA)
- Care Quality Commission (CQC)
- Department of Health and Social Care (DHSC)
- DERBYSHIRE HEALTHCARE FT
- Government/DH policy
- Jeremy Hunt
- Jim Mackey
- NHS Improvement
- Parliamentary and Health Service Ombudsman
- Patient safety
- Seven day working