News / News review November 2015

In England at least, October saw the government and junior doctors on a collision course over plans for a new contract to support the planned implementation of seven-day NHS services. As Healthcare Finance went to press, the British Medical Association was planning to ballot its junior doctor members over industrial action on 5 November. A decision is due shortly after the poll closes on 18 November.

Before the BMA announced the ballot, health secretary Jeremy Hunt had assured juniors that the proposed new contract was not a cost-cutting exercise. And, as Healthcare Finance went to press, there appeared to be a significant development, with Mr Hunt giving the BMA a firm guarantee that no junior would see their pay cut compared with their current contract. He added that no junior doctor would be required to work more than 48 hours each week, with a new legal limit of 72 hours (rather than the current 90 hours maximum). The BMA reacted positively, saying it was a ‘significant shift’. However, it added that it would not negotiate until the Department met a number of conditions, including withdrawing the pledge to impose a new contract if one could not be agreed.

Despite the issues with junior doctors, the prime minister continued to push for seven-day services. David Cameron said all patients in England would have access to seven-day GP and hospital services by 2020. A voluntary contract would be offered to GPs who wished to provide seven-day services at their surgeries. And he said by 2017 a quarter of the population who need urgent or emergency hospital care would have access to the same level of consultant and diagnostic tests across all days of the week. The NHS should achieve 50% coverage by 2018 and full coverage of the population by 2020.

The use of agency staff continued to hit the headlines, with NHS England chief executive Simon Stevens (pictured) questioning why ballet dancers were recognised as a shortage occupation for immigration purposes, but not nurses. In a speech to the Institute of Directors, he said it was time to ‘join up the dots’ on immigration policy and the NHS. He also highlighted the impact of the proposal to deport immigrants who were not earning more than £35,000 after six years.

Later in the month, the Department of Health announced that nurses had been temporarily added to the government list of shortage occupations. Visa applications from nurses from outside the European Economic Area will be prioritised. The move is pending a review by the independent Migration Advisory Committee, which will present its report to the government by February 2016. The Department said the move was designed to help the NHS at a time when cost controls on agency staffing were being introduced (see news analysis, page 8).

NHS deficits remained a concern and there was no shortage of advice on how the service could become more efficient. Lord Carter broke down the £5bn of savings he believes the NHS can make by specialty. The potential savings include £381m in general medicine and £362m in obstetrics and gynaecology. The Department said hospital activity in each specialty was reviewed and showed huge variations in clinical costs, infection rates, readmission rates, litigation payments and device and procedure selection. Lord Carter has sent letters to 137 non-specialist trusts in England detailing how they can improve patient care and become more efficient.

According to Monitor, a series of practical steps could save trusts between 13% and 20% of the cost of elective ophthalmology and orthopaedic services. A report on increasing productivity in elective care said the moves would improve patient care and reduce lengths of stay. Meanwhile, a report from the NHS Alliance and the Primary Care Foundation said up to a quarter of GP appointments could be avoided if there was greater co-ordination between hospitals and primary care. Making time in general practice said a significant amount of GP time could be saved if they did not have to rearrange hospital appointments and chase test results. These accounted for 4.5% of appointments – an estimated 15 million appointments a year if repeated across England.

While these reports focused on efficiencies, others feared cuts in services. A number of organisations, including the NHS Confederation, the Academy of Medical Royal Colleges and local authority and public health bodies, wrote to Mr Hunt calling for an end to public health cuts in the forthcoming spending review. A decision to cut £200m from this year’s public health grant to local authorities could have a knock-on cost to the NHS of more than £1bn, the letter said.

The Care Quality Commission (CQC) highlighted significant variation in quality and concern about safety in its first national assessment since the introduction of a new ratings system. While it rated the majority of health and social care services as good, the CQC said strong leadership and collaboration were more crucial than ever to delivering good care. While 80% of GP practices were either good or outstanding, 38% of the 150 trusts inspected recorded the top two ratings.

Two experienced managers were brought in to lead Heart of England NHS Foundation Trust after Monitor found the trust to be in breach of its licence. The regulator opened an investigation into the trust at the beginning of October after it recorded a £29.5m deficit in five months. It also agreed with the Care Quality Commission that Sherwood Forest Hospitals NHS Foundation Trust needed a long-term partner to deliver improvements for patients. Monitor removed Burton Hospitals NHS Foundation Trust from special measures in recognition of improvements made for patients. However, Monitor said that while the trust has made significant progress in improving its services, further improvement is needed over its finances and the way it is run.

The National Audit Office said progress has been made in reducing the extra risk of death for people with diabetes, but an estimated 22,000 die from related causes that could be avoided. The National Audit Office said the estimated cost of diabetes in England in 2010/11 was £5.6bn, 69% of which was due to complications.

Northumbria Healthcare NHS Foundation Trust chief executive Jim Mackey has been appointed chief executive of NHS Improvement, the new body that will bring together Monitor and the NHS Trust Development Authority.