News / News review: December 2015

November health news was dominated by two stories – the spending review (see p10) and junior doctors. Juniors – any doctor in training – in England were balloted on industrial action over government plans for a new employment contract that it hopes will support the introduction of the seven-day NHS. In an increasingly rancorous dispute, both sides have issued claim and counter-claim over safe working hours and how much pay juniors may gain or lose.

The junior doctors, represented by union the British Medical Association, walked out of talks earlier this year, alleging the government had threatened to impose a contract if agreement was not reached. The subsequent ballot on industrial action showed overwhelming support for action, planned to include emergency cover only for 24 hours on 1 December and two full walkouts later in the month. The BMA said 76% of trainees voted in the ballot, with 99.4% of juniors in favour of action short of a strike and 98% supporting industrial action including strikes.

Announcing the ballot result on 19 November, the BMA offered to take the dispute to the conciliation service, ACAS. Health secretary Jeremy Hunt initially said no, preferring direct talks, but on 25 November he agreed to ACAS talks. On the eve of the first planned action, a breakthrough was made and the government withdrew its intention to impose a contract. The BMA suspended industrial action until January, but hospitals across England had already cancelled thousands of elective operations, leaving many patients unhappy. As Healthcare Finance went to press, negotiations were continuing.

Pay will remain a hot topic with the 2016 pay round fast approaching. In November, the Department of Health wrote to the NHS pay review bodies setting out their remit for the 2016/17 pay round. Both letters confirm the government pledge to fund average pay rises of 1% over the next four years and ask the independent bodies to consider recommending targeted rises to urge recruitment and retention.

NHS Clinical Commissioners set out potential changes to the ambulance service and the barriers it must overcome to meet the challenges of the emergency and urgent care review. A discussion paper said changes could include a new payment system that supports the shift of fixed and semi-fixed costs, as well as variable costs, from the secondary sector to community and primary care. This would require a period of transition. The group said a new payment mechanism would support changes in services, including non-conveyance of patients and treatment closer to home.

The centre continued to keep an eye on costs. Final guidance on the caps trusts can pay per hour for agency staff was published by Monitor and the NHS Trust Development Authority in November. The caps came into effect at noon on 23 November and apply to all staff groups, except substantive/permanent or bank staff, as well as those employed by ambulance trusts. The final guidance includes changes to earlier proposals, including the exclusion of bank rates from the cap, NHS Employers said. Monitor also gave greater detail on the £515m spent on agency staff by foundation trusts in the first quarter of this financial year. Medical and dental agency staff cost almost £205m, while temporary nursing and health visitor cover cost £168m. Other agency staff cost just over £142m.

Deterioration of finances at the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Liverpool Women’s NHS Foundation Trust led Monitor to open investigations. The regulator said that although it has concerns over waiting times at the Royal Bournemouth, the investigation would focus on the trust finances – it has forecast a year-end deficit of more than £10m. While Liverpool Women’s had taken steps to address its financial challenges, the regulator had stepped in to see what additional support it could offer. The trust has forecast a deficit of £7m this financial year.

The King’s Fund called on the NHS to move away from a fortress mentality to place-based systems of care. NHS bodies would collaborate with other health service organisations to improve the local population health. However, this would require the support of national bodies and policy makers, as well as fundamental changes in NHS commissioning.

Clear and well-resourced local scrutiny and accountability measures will be critical in the devolution of health spending, the Commons Public Accounts Committee said. In a report on the government programme of devolution to cities, the committee recommended the Department for Communities and Local Government should share learning and best practice with public bodies potentially involved in devolution, such as NHS England and the Department of Health.

Devolution is one of the models that could be used to integrate local health and social care from 2020, but the King’s Fund said it raised questions on financial sustainability, provider deficits and accountability. A fund briefing on how city devolution deals will affect the NHS also questions how the differences between local authority and NHS financial regimes can be resolved. It concludes that devolution holds potential benefits, but it was not a silver bullet. Savings are likely to take time to deliver and will probably require upfront investment.

The government has decided to amend legislation to provide a route for NHS England, clinical commissioning groups and local authorities to use a pooled fund to jointly commission additional primary medical services. The decision follows a consultation earlier this year and will bring primary medical services into pooled arrangements. It will not impose a requirement to use the new flexibility and commissioners will only be allowed to use it where it would improve services.

The Scottish government announced that work is under way to establish six elective treatment centres. It has announced a £200m investment to create the centres to help the local NHS cope with a forecast growth of almost 40% in the most common procedures by 2025.

Waiting times are under continued pressure and unlikely to improve in the near future, analysis by the Nuffield Trust and Health Foundation said. In Closer to critical? they said conditions did not appear to be in place for maintaining care quality and improving services while meeting the financial challenge. The Nuffield Trust also said the OECD Health at a glance 2015 report highlighted the UK’s ‘somewhat mediocre’ performance across the board, from relatively low staffing levels to high rates of avoidable admissions for asthma and lung disease.