Labour expects trusts to pay ‘time and a half’ to staff delivering ‘40,000 extra appointments’

In an hour-long interview with HSJ, Mr Streeting also said:

• NHS staff had told him they wanted more thorough CQC inspections;
• Some trust CEOs were more concerned about their reputations than being candid about risks to patient safety; and
• NHS England’s encouragement of trusts to cut their pay bills, in order to reduce deficits and increase productivity, would be one of the “burning issues” to be addressed the “moment” Labour took power.

He also covered a range of strategic issues, including pledging to increase the proportion of NHS funding given to primary and community care, and said he had “total confidence” in the NHSE CEO Amanda Pritchard.

The Labour candidate for Ilford North said he was expecting trusts to pay “time and a half” to staff for the additional work to deliver the extra 2 million appointments each year which the party has promised, although he said the rates would ultimately be agreed locally.

The extra slots are mostly expected to be at evenings and weekends, and the higher non-contractual rates for medical consultants are expected to represent a significant cost.

The rates already vary locally, but Mr Streeting’s suggested “time and a half” figure would undercut what many trusts have been asked for — and paid — in recent years. 

He also warned that trusts which could not meet the levels of activity required by a new Labour government within their share of the extra £1.1bn pledged to “deliver an extra 2 million NHS operations, scans, and appointments every year” would not receive extra funding.

He said: “If we win the election [we’ll try] to give trusts and integrated care boards the freedom and flexibility to work out how best to deliver those appointments at a local level, because it will look different in different places.

“[But] what we’re not prepared to do is throw good money after bad. People [trust leaders] will get the money in order to deliver the appointments. [If] they [trust leaders] say they can’t deliver those appointments, then they won’t have the money.”

The future of the CQC

Mr Streeting said re-establishing the credibility of the Care Quality Commission, which last week admitted it was losing the confidence of ministers and the NHS, would be a “first order priority” for a Labour government.

He said he would await the review of the troubled care regulator by North West London ICB chair Penny Dash before making any decisions. Mr Streeting added he had “a lot of confidence in” the former McKinsey & Company consultant.

Asked whether he supported the idea of a quality regulator for the NHS, he said during his lengthy career in education and as shadow schools minister, “I never, ever found teachers in any context or setting ever say, ‘what I want is a longer and more thorough Ofsted inspections’.

“[However] I have been blown away by the number of times I’ve had [NHS] staff, and it’s usually nurses, saying the CQC isn’t thorough enough. They say ‘[inspectors] don’t talk to people like us. And we can tell you where the problems in patient safety are, and what they’re missing’.”

The shadow health and social care secretary said he welcomed “the CQC’s admission and humility, that it isn’t getting it right”, adding: “That actually gives me far more confidence in the CQC than if they had done as the government has been doing, pretending everything is fine.”

The honesty of CEOs

Mr Streeting also accused the NHS of having a culture in which some CEOs were more concerned about protecting their reputation, and that of their trusts, than they were about being honest about safety risks.

He said: “The NHS has…had political leaders that cannot admit the scale of the challenge in the NHS…

“But then that rot seeps right through the culture of the system, and leads to a situation where chief execs are more concerned with protecting their own reputation, and the reputation of their trusts and avoiding negative headlines, than being candid about the real risks to patient safety as a result of failures within the system, or even failures in public policy.

“So, the first thing we’ve got to do is set people free to be completely upfront about the problems, the risks, and then establish a culture where we can work together to try and address those.”

NHS deficits

Asked his view on the pressure being put on NHS trusts to cut posts to reduce financial deficits, Mr Streeting said: “We shouldn’t be in a position where trusts are having to cut back on clinical posts that are going to be needed to speed up waiting times.” However, he admitted a Labour government wouldn’t be able to “fix all those problems overnight”.

Asked whether he would review NHSE’s demands for trusts to cut their pay bills, Mr Streeting said: “This is one of a number of burning deck issues that [we would be] confronting at the moment we walk in, if we win the election. Other issues in this category include “junior doctors industrial action” — which Mr Streeting has said he’d seek to resolve quickly — and ”pay review body recommendations” for staff salary uplifts for 2024-25, which are overdue.

Mr Streeting recently confirmed to HSJ a Labour government would pledge to hit the four-hour accident and emergency target by the end of its first term.

Asked what led him to believe this was possible when many in the service did not, he said: “Because I’m an avid reader of the HSJ, I read the rather excellent piece by [columnist and analyst] Steve Black about the four-hour target, and how achievable it is, and why this is not a big money challenge, but actually a system design and performance challenge… Before we get to the argument about additional resources, the starting point has surely got to be, how do we make sure existing budgets are better spent?”