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
New safe staffing research planned after government U-turn. NHS Improvement pushes on with seven day services despite political dramas. And the mask slips from the British Medical Association.
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Shaun Lintern, patient safety correspondent
There is ample evidence that the numbers of nurses working on a hospital ward have a direct impact on the outcomes for patients. Many senior leaders in the NHS continue to belittle this wealth of global research but now researchers may be about to embark on a study that could talk their language by putting the issue of safe staffing on an economic footing.
Experts from the University of Southampton are preparing a study at 155 trusts in England on the implementation, impact and costs of safe staffing policies for nursing in acute settings.
The study will be led by Jane Ball and Professor Peter Griffiths at the University of Southampton, with Professor Jo Rycroft-Malone and pro vice chancellor and Professor Christopher Burton from Bangor University.
They say the study, funded by the Department of Health policy research programme, will identify the costs and consequences of implementing safe staffing policies.
The study is apparently part of a programme to examine the effectiveness of policies implemented after the Francis inquiry.
Jeremy Hunt has long argued that safe care costs less, so this will be a useful test of that hypothesis. Ironically, the government U-turned on plans to implement Sir Robert Francis’ recommendations on the subject when it scrapped the work on National Institute for Health and Care Excellence safe staffing guidance. It will be interesting to see the results of this study, which could well help identify those sites which have improved and what the associated costs and savings were.
Meanwhile, the NHS is still waiting for NHS Improvement to unveil its post-NICE safe staffing fudge.
Seven day reconfiguration
A letter sent last week by NHS England medical director Kathy McLean on implementing seven day services has again made clear that the focus is urgent and emergency care. The note reiterates the importance of the 10 clinical standards published in December 2013 and the four must-do priority standards by 2020. Simon Stevens made the same points to the Commons health select committee last month.
It makes clear “patient demand for most planned care, such as surgery and investigations and some outpatient clinics, over weekends is currently low” but also emphasises the need to focus on diagnostic services and some cancer treatment and day case procedures to “maximise patient choice.”
Crucially, the letter sets out a vision of how the NHS will need to work differently and where necessary reconfigure services. This will include hospitals working in networks to support the delivery of the 10 clinical standards, as well as systems sharing information and creating financial incentives to support the delivery of those standards.
It also says the NHS will need to develop “innovative workforce approaches to consider new and extended roles for clinical and non-clinical staff” to tackle short staffing.
Beyond the distracting arguments and political punch-ups between the DH and BMA over weekend mortality, anyone with knowledge of the existing system knows there is scope for the quality of weekend care in the NHS for those who survive their admissions to be vastly improved.
Jeremy Hunt’s commitment to a version of “seven day services” – which has enabled him to inaccurately frame the junior doctors’ contract dispute – should not be allowed to derail the quiet revolution of improving weekend services. This letter from NHS Improvement delivers a glimpse of some of the very difficult choices that are going to have to be made.
The true face of the BMA?
A cache of leaked messages to HSJ and two resignation letters last week from junior doctors revealed the true face of the British Medical Association’s junior doctors’ leaders. And it wasn’t a pretty one.
The leaked messages revealed that junior doctors’ committee chair Johann Malawana dismissed the chance of genuine talks at the start of the year and hugely miscalculated the BMA’s chances of defeating the government. While some doctors have tried to downplay the significance of the messages, others have expressed their anger at being led to the picket line on what now looks like a false manifesto. The messages show members of the JDC executive warning they were taking a gamble and that “they had nothing to talk about” with the government at the same time as the BMA was publicly calling for talks.
Of course the BMA is not the first organisation ever to have different public and private positions, and HSJ would love to see Mr Hunt’s private musings. But the fact is the BMA got caught and was exposed for having a private position that even the majority of its own members were unaware of.
More worryingly the resignation letters from two members of the executive show they felt their leaders’ approach was undemocratic, with one even accusing Dr Malawana of leading doctors in England on a campaign she described as a “dishonest” political game.
Dr Malawana and the remaining members of the executive committee should take some time to reflect on how they arrived at a position where their own union members are leaking against them.
The new terms and conditions for the proposed new contract were published on Friday. I’m analysing them now.
Bizarrely, some people who have contacted me seem to think HSJ published this story to provoke a “no” vote in the forthcoming BMA referendum so the dispute can rage on. But the leaks clearly show a deal could have been done sooner than this. If the leaks affect the vote at all, it should swing it to a “yes” vote. A “no” would simply mean more of the same and doctors should have the insight to see that won’t work in their favour – or anyone else’s.
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- Academy of Medical Royal Colleges
- Board Talk/governance/assurance
- British Medical Association (BMA)
- Care Quality Commission (CQC)
- Department of Health and Social Care (DHSC)
- Health Education England
- National Institute for Health and Care Excellence (NICE)
- NHS England (Commissioning Board)
- NHS Improvement
- Patient safety
- Quality and performance
- Seven day working
- Simon Stevens