Lintern's Risk Register: Planning for the Five Year Forward View’s Retirement

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Nursing associate role fears

A new sub-graduate nursing role in the NHS, designed to bridge the gap between healthcare assistants and nurses, must not be used as a substitute for registered staff, the Royal College of Nursing has warned this week. The college is right to be concerned as there is evidence that substituting non-qualified nursing staff for nurses increases poor outcomes for patients and leads to a rise in mortality.

Supporters of the nursing associate role will say that this evidence is limited and shows only an association, not causation. They are right. But at least there is some peer-reviewed evidence to start with – I am unaware of any peer reviewed evidence showing the nursing associate role will improve care.

With an NHS under increasing financial pressure and a UK wide nursing shortage it is worrying that the creation of this new role is continuing full-steam ahead with little mention of safeguards to prevent poor decisions by under-pressure boards. The advent of Lord Carter’s average care hours metric makes the risks all the more real.

Are consultants about to bite the bullet?

Junior doctors are set to walk out again for 48-hours on 6 April. While many consultants have expressed support for their younger colleagues, the senior doctors might by then be in the midst of their own contract dispute… or they might have agreed their new contract, depending on which consultant you speak to.

Negotiations on the consultants contract had concluded before Christmas after the Department of Health insisted on a “guillotine” deadline for the talks. However, as Mr Hunt pressed the button on his nuclear option with junior doctors the DH re-opened talks with consultants ahead of a final offer expected within the next few weeks.

I understand senior figures at the BMA are attempting to take a pragmatic approach and are resigned to seeing the loss of their weekend opt-out for non-emergency work, as well as being acutely aware of the government’s willingness to impose a solution if necessary. But they are also aware of a growing anger towards the government among the membership which may mean any deal will be rejected.

The offer is likely to try to split the voting membership depending on where the doctors are in their careers. It’s too close to call which way they will go at this point.

Embedding safety in education

With less fanfare than it deserved, the Commission on Education and Training for Patient Safety, chaired by Professor Sir Norman Williams, has published its first report on how to embed safety in training. You can download a PDF of the report here. It sets out the future of education and training for patient safety in the NHS over the next 10 years, with 12 recommendations to Health Education England.

It is sensible stuff – in fact, the surprise is that much of what the commission recommends is not already the case. A focus on human factors and simulation as well as multi-disciplinary training will all be welcome changes if applied consistently across the NHS.

Particularly notable for me was the emphasis on NHS leaders needing safety training so they have the skills needed to improve services. A lot of this is easy to say but as I’ve mentioned before magical thinking in the NHS is a problem and better knowledge of how to actually deliver is welcome.

Planning for the Five Year Forward View’s Retirement

The Chancellor George Osborne delivered a spot of bad news for the NHS hidden in the detail of the Treasury documents this week. While winning plaudits for his tax on sugary drinks the Chancellor quietly dropped a pension bombshell which will see NHS employers forced to increase their contribution to the NHS Pension Scheme from 2019. The Treasury documents are here.

The changes will save the Treasury around £2bn a year off the cost of unfunded public sector pension funds but according to figures obtained by the Lib Dems this will mean a £650m increased cost for NHS providers in 2019. This tallies with the estimate HSJ published on budget day. And in case you forgot that is the same year that the NHS is due to receive real-terms funding growth of just £700m. The shine of the Five Year Forward View will have long faded by then, no doubt.

And while we’re on pensions, this innovative and controversial approach to solving a nursing shortage by Oxleas Foundation Trust has raised a few eyebrows. One to watch, for sure.