News in brief
Doctors accuse Tories of deception over “extra £10bn for NHS” claim: Doctors’ leaders have accused the Conservatives of deceiving the public by giving the NHS less than half the extra £10bn ministers regularly cite as proof of their support for the service. The government has used a series of accounting tricks to wrongly give the impression of generous backing when in reality it is leaving patient care underfunded and refusing to face up to the NHS’s deepening financial crisis, a report from the British Medical Association claims. “This continued and repeated misuse of figures is nothing more than a political deception that is damaging to the long-term future of the NHS,” Dr Mark Porter, the BMA’s chair of council, told The Guardian. Its report seeks to expose what it calls a worrying “mismatch between the cosy political rhetoric and the practical reality of an NHS facing an unprecedented funding crisis”. Porter warned that quality of care could suffer because of disguised underfunding, and added: “The government’s promise to inject an extra £10bn into the health service will actually see less than half of that amount reach frontline services, with the rest diverted into what the chancellor describes as ‘Whitehall budgets’, such as the National Institute for health and Care Excellence (Nice). A Department of Health spokesman rejected the BMA’s report as “misleading”. He said: “We are committed to the NHS and absolutely clear the £10bn we’ve promised is being made available to NHS England for frontline patient care, not ‘Whitehall budgets’. This is much more than the funding the NHS called for in its own plan for the future.”
Junior doctors’ strike: BMA plans first full walkout in the history of the NHS: Junior doctors have been condemned as “desperate and irresponsible” after announcing plans for the first full walkout in the history of the NHS, reported The Telegraph. The British Medical Association (BMA) said planned industrial action due to take place next month over a new contract will now instead be an “all out strike”. This means junior doctors will not provide emergency care, as they have in previous strikes. The Department of Health said patients would inevitably be placed at risk. Health charities have pleaded with both sides to return to the negotiating table. However, health secretary Jeremy Hunt said last night “the matter is closed” and that there was no point in negotiating because of the stance taken by the union. A planned 48-hour emergency care only action due to start at 8am on Wednesday 6 April and end at 8am on Friday 8 April will still go ahead as planned. Further industrial action scheduled for 26 April will change from 48-hour emergency care only to a full withdrawal of labour by junior doctors between the hours of 8am and 5pm on Tuesday 26 and Wednesday 27 April. This means consultants and other hospital staff will attempt to take on emergency care duties normally performed by more than 40,000 doctors. Dr Johann Malawana, BMA junior doctor committee chairman, said: “No junior doctor wants to take this action but the government has left us with no choice. In refusing to lift imposition and listen to junior doctors’ outstanding concerns, the government will bear direct responsibility for the first full walkout of doctors in this country.”
Minister casts doubt on whether government can fulfil 5,000 new GP pledge: A health minister has admitted that there is a ‘risk’ around whether the government will achieve its commitment to find 10,000 new GP or GP equivalents, according to Pulse. The website reported on concerns from Lord Prior that failure to achieve the target would make it “difficult to deliver our ambitions”. Lord Prior – who was chair of the CQC before becoming minister for NHS productivity last year – has cast doubt on health secretary Jeremy Hunt’s commitments on GP numbers, which included increasing the workforce by 5,000 GPs by 2020. The minister said that the government has increased the number of training places to 3,500 from this year. But Pulse has revealed that there has been a 5% decrease in applications this year, which would lead to only 2,630 places being filled based on last year’s 2,769 filled posts. In the debate on GP access in the House of Lords last week, Lord Prior said: “The workforce is a serious issue. We are committed to finding 10,000 new GPs or GP equivalents in general practice by 2020 and we have increased the number of training places by 3,500 from this year and going forwards. To be honest, there is a risk whether we will be able to get that number of people into general practice. However, without that kind of workforce commitment it will be difficult to deliver our ambitions.”
CQC continues to miss performance targets: The Care Quality Commission (CQC) performance targets for hospital inspections and registrations are still being missed, according to the inspection body’s latest figures, reported National Health Executive. A report to be considered at the CQC board meeting this week shows that in January 2016 it carried out 1,039 inspections of adult social care, compared to a performance target of 1,247, an 83.3% success rate. In January, it completed 390 out of a planned 600 (65%) inspections of primary medical services. The CQC has consistently fallen short of both performance targets since April 2015, when it dramatically increased the number of inspections required from 733 to 907 for adult social care and from 189 to 299 for primary medical services. It warned last September that its performance may be “unrecoverable” if it continues to miss performance targets. It also only completed 73.1% of registration processes and 73% of cancellation processes within 50 days, compared to a 90% target. The CQC said this could be due to a backlog from 2014 and the complexity of some cases. It was also called ineffective in a recent Public Accounts Committee (PAC) report. Despite this, the Department of Health confirmed recently that it will recommend to Parliament that the CQC be allowed to increase fees from mid-sized NHS and foundation trusts.
Doctors call for “safe staffing levels” in Scottish NHS: Doctors are calling for “safe staffing levels” in NHS Scotland to be a priority for the new Scottish Government following the May election, reported The Scotsman. The Royal College of Physicians of Edinburgh (RCPE) wants improved workforce planning to address challenges in recruiting and retaining employees, and warns the size and structure of the medical workforce must be reassessed to account for the needs of an ageing population and deal with vacancies, rota challenges and trainee attrition rates. Successful integration of health and social care to enable patients to be treated in the community is also a priority. RCPE president Professor Derek Bell said: “Developing and implementing safe staffing levels across all professions in the NHS in Scotland must be a policy priority and will be an essential part of ensuring we can deliver high-quality weekend and out-of-hours care. It is also important that we learn from previous failings in care to minimise the risk of recurrence. Part of this will be acknowledging and valuing the contribution of the healthcare workforce at all levels.” Health secretary Shona Robison said: “The NHS workforce in Scotland is at a record high having increased by more than 10,000 whole time equivalent employees under this government, including around 25% more doctors and around 2,300 more nurses and midwives. We are determined to attract and retain the best in the healthcare profession.”
NHS Easter “meltdown” feared as pressures mount: The number of distressed patients turning to a national helpline for help has more than doubled amid fears that NHS pressures will force hospitals into “meltdown” over the Easter weekend, reported The Telegraph. The Patients Association said its helplines were receiving “soaring” numbers of calls from patients and relatives who had suffered poor care or NHS blunders. The charity’s chief executive, Katherine Murphy, said she was fearful about mounting pressures on hospitals as the four-day bank holiday weekend approaches. She added its helpline was now struggling to cope with more than a doubling in calls in recent months from patients and relatives who felt they had “nowhere else to turn”. Traditionally, GPs and dentists close on Maundy Thursday, re-opening on the Tuesday morning. As a result, A&E departments fall under extra pressure, at a time when more staff are on holiday leave. But A&E doctors say the service is already struggling to cope with “unprecedented” levels of pressure and overcrowding, and with growing staff shortages. Mrs Murphy said “a bank holiday weekend always puts great pressure on the NHS – but our concern is that this week we are starting from a vulnerable point, in terms of the levels of strain the service is already under; the fear is this weekend could throw the service into meltdown.” Health officials today urged the public to “play their part” and turn to pharmacies for help.
NHS England sets core digital targets: NHS England has set out 10 core digital targets local areas must be able to “demonstrate substantive delivery” on by March 2018, reported Health Service Journal (subscription required). The targets are included in long awaited draft guidance, setting out the criteria for local digital roadmaps. The guidance has been sent to clinical commissioning groups and those in charge of the 85 local digital roadmap “footprints”, the groupings of local organisations, including providers, commissioners and non-NHS bodies, which will develop the local blueprints. The document sets out 10 “universal capabilities” local areas must “demonstrate substantive delivery [on] by end-March 2018”. These largely address areas the centre has long being focusing on. They include patient access to their GP records, GPs referring electronically to acute care, and emergency care professionals being able to access patients’ GP records. The draft guidance says: “Over the next five years, funding of £1.3bn is to be distributed across local health and care systems to achieve the ambition of paper-free at the point of care. This is made up of £900m capital and £400m revenue.”
Health and Social Care Board to be abolished by NI minister: The health minister is to abolish Northern Ireland’s Health and Social Care Board. All commissioning powers are to be transferred to the Department of Health, while a new group will be established to hold the five health trusts to account. This is a radical plan and one which many critics argue should have happened a decade ago. Ultimately, it means all decisions will be made within the department. Last November, health minister Simon Hamilton hinted strongly that he wanted to restructure the health service. It followed recommendations from the Donaldson report which highlighted a system burdened with bureaucracy. In 2014, England’s former chief medical officer, Sir Liam Donaldson, was asked to review the performance of Northern Ireland’s Department of Health and the health trusts. In a tough report that pulled no punches, he recommended that the health service be stripped of bureaucratic structures, with one person taking control. Off the back of that report, Hamilton launched a consultation. The BBC understands the outcome is that the health board is to be scrapped with the department taking the lead on the day-to-day running of health and social care services, including planning and monitoring services. That means the health minister would be ultimately responsible for everything that happens within the health and social care service. A new, department-led group is to be established to ensure trusts meet targets. The BBC understands that group – the performance directorate – will closely monitor the trusts on targets such as waiting times.
NHS leaders struggling to implement Five Year Forward View: NHS leaders are struggling to implement the Five Year Forward View (FYFV) and keep their organisations financially sustainable, according to a new survey, reported National Health Executive. The survey from Grant Thornton UK LLP found that three-fifths of respondents say the FYFV has had little or no impact on their local health economy and 46% believe they do not have a shared strategy to implement the FYFV. Grant Thornton said that NHS organisations could be struggling with the FYFV for reasons including pressures on staff meaning they lack the time to take on leadership roles and unclear leadership roles due to silos across different NHS bodies. The report also found serious financial concerns among NHS organisations, with 59% of trusts failing to deliver their 2014-15 cost improvement programme and 77% reliant on non-recurrent savings, and 74% of organisations feeling it is definite or likely that their organisation will post a deficit by 2020. Mark Stocks, partner from public sector assurance at Grant Thornton, said: “Many NHS leaders have witnessed resistance to significant and sustainable change due to the unique and cherished nature of the NHS. Our research shows that changing the culture of health and social care needs to be a planned and iterative process. It requires local health economy partners to unlock formal and informal cultural values and behaviours and to find commonality on health and social care outcomes.”
Patient record access: March target likely to be met: IT system suppliers have said that GPs will be able to offer patients online access to their “detailed coded record” (DCR) by the end of the month, reported DigitalHealth.net. The GP contract for 2015-16 says all practices must be able to offer patients online access to their DCR before the end of March 2016. The website has confirmed that each of the four principal primary care suppliers expect to have the functionality enabled for all practices by then. However, the British Medical Association’s GP IT lead Dr Paul Cundy said the vast majority of patients are “completely uninterested in access to detailed coded records”. More than 95% of GPs are already offering patients access to a summary of their record.
Wales to get infection alert system: Health boards in Wales are to get an IT system designed to provide alerts of infections springing from healthcare sites, following a Welsh Government decision to invest £1.9m from its Efficiency through Technology Fund. Named ICNet, the system is expected to be in place by the middle of next year, reported UKAuthority. It will provide surveillance and case management functions with the aim of reducing the risk of infections spreading to other patients, either in hospitals or buildings providing healthcare in the community. Announcing the move, the Welsh Government said ICNet will be able to connect and interact with other national IT systems, including those for patient administration, laboratory reporting and surgery databases. It will enable staff to monitor confirmed cases of infections such as MRSA that are known to spread in hospitals, and provide a national picture of infection control across the country. Public Health Wales, the Welsh Government and health boards will all have access to the data. Deputy health minister Vaughan Gething said: “The new national ICNet system will allow the Welsh NHS to track, prevent, control and manage healthcare-associated infections in real time. This will help improve patient safety by reducing preventable infection outbreaks in our hospitals.” The system has been trialled across North Wales where it is claimed to have reduced the number of avoidable infections.
Welsh A&E targets missed with departments ‘busier than ever’: Targets for accident and emergency waiting times were missed in February, with ministers saying departments have been “busier than ever” this winter, reported the BBC. Its target states 95% of patients should spend less than four hours in A&E before being transferred or discharged. But it achieved 77.2%, which was down from the 78.5% figure for January. An average of 2,689 people attended Wales’ emergency departments each day in February – 112 cases per hour. The Welsh Government said this was the highest number of attendances at A&E departments in February since records began in 2006. The figures were significantly lower compared to last February, when 83.7% of cases spent less than four hours in A&E. A spokesman for the Welsh NHS Confederation said: “There is no doubt that emergency healthcare services across Wales have been extremely busy in recent weeks. Staff are continuing to work hard to meet this demand and it is important that we recognise these efforts. It is also important that we do not look at A&E in isolation. The pressures on emergency services are indicative of pressures across the whole of the NHS and social care.”
NHS launches first wave of diabetes prevention programme: Up to 100,000 people in England could benefit from a new government initiative aiming to prevent Type 2 diabetes, reported PharmaTimes. According to the story, around five million people in England are estimated to be at high risk of developing Type 2 diabetes, potentially placing a huge strain on healthcare resources. The majority of these cases could be prevented through lifestyle intervention. Healthier You: The NHS Diabetes Prevention Programme – a joint commitment from NHS England, Public Health England and Diabetes UK – has been launched to single out people at risk and refer them into an evidence-based behavioural intervention to help stave off the disease. The first wave of the scheme will rollout 27 areas covering 26 million people, half of the population, and making up to 20,000 places available. This will roll-out to the whole country by 2020 with an expected 100,000 referrals available each year after. “That people in England identified at high risk of developing Type 2 diabetes will be offered personalised support to help them to eat well, become more active and maintain a healthy weight is therefore a significant step in the right direction,” said Chris Askew, chief executive of Diabetes UK. “This will provide them with the best possible chance of reducing their risk of developing Type 2 diabetes, and living a long, full, healthier life.”
Community trust’s failures compared to Mid Staffordshire: Liverpool Community Health Trust has been heavily criticised for a catalogue of governance and care failings that have been likened to those found at Mid Staffordshire Foundation Trust, reported Health Service Journal (subscription required). A damning report said the trust was pursuing aggressive savings and foundation trust status, which led to a culture of bullying and harassment and substandard patient care. The review, by Capsticks Solicitors, said: “Inappropriate and unsafe care was not addressed, even where that was clearly set out in internal or external reports, and the response to adverse incidents was grossly deficient, with a failure to investigate properly and learn lessons.” The report has prompted Rosie Cooper MP to call for a public inquiry into care failings at the trust.
“iSOFT7” hospitals extend EPR contracts: Six of the “iSOFT7” NHS trusts that retained their iSOFT systems rather than enter the National Programme for IT have extended their contracts with CSC to cover the procurement and implementation of new electronic patient records, reported DigitalHealth.net. Just three of the trusts have already chosen a new provider. Lewisham and Greenwich NHS Trust has switched to Cerner Millennium; King’s College Hospital NHS Foundation Trust will implement Allscripts’ Sunrise; and Salisbury NHS Foundation Trust has chosen to deploy CSC’s Lorenzo. The remaining trusts are either out to procurement for a replacement system, or plan to do so in the near future. The group of seven trusts signed a four-year, £25 million extension to their contracts with CSC in March 2012, which expires this month. All use iSOFT Patient Manager and four also use iSOFT Clinical Manager. CSC and iSOFT first signed a deal in 2006 to cover the ‘out of cluster’ trusts, enabling them stay with their existing systems instead of moving to Cerner Millennium, the strategic EPR for London and the South under NPfIT. Salisbury is the only trust so far that has chosen to stick with CSC long-term by taking its newer Lorenzo EPR. Salisbury picked CSC as its preferred bidder in August 2015 and a trust spokesperson has told Digital Health News that a contract signing with the company is “imminent”.
Healthcare reports & surveys
How precision medicine is radically improving healthcare
Orion Health has released a report “Introducing Precision Medicine” about the practice of enabling personalised health care by capturing and analysing all the information that is relevant to maintaining a consumer’s wellbeing. Details of this report have been published in eHealthNews.eu. “Only 10% of an individual’s health is determined by their medical history, but currently that is all the information a doctor has access to,” said Orion Health CEO Ian McCrae. “More significant is the person’s genetic makeup which determines 30% of his or her health outcome. Information from “exogenous sources”, that is a person’s diet, living and social circumstances determines 60%. In total, 90% of the information required for specific, individual treatment is not being captured today, but that is changing rapidly with the introduction of precision medicine.” Colin Henderson, country manager, Orion Health UK and Ireland commented: “In the UK the shift from a ‘one size fits all’ approach to personalised medicine is already on the way through various initiatives such as Genomics England. We are on the cusp of a medical revolution, which will be underpinned by data. Health information sytems are essential to processing this data to enable this revolution to happen.” To find out more about precision medicine, download a copy of the report here. Colin Henderson will be speaking about precision medicine and how it is enabled by health information systems at the eHealthWeek conference in London on 19th/20th April.
NHS England communications survey
NHS England has launched a communications survey to help it better understand who it communicates with and how it can improve the ways it shares information. To take part in this short survey you can participate here.
Appointments
Andy Kinnear new head of BCS Health: The high-profile leader of Bristol’s Connecting Care shared records programme is to become the new head of the British Computer Society’s Health Group. Andy Kinnear, who works for South Central and West Commissioning Support Unit, is a leading member of Digital Health’s Chief Information Officer Network and a passionate advocate of the need to break down boundaries between health and social care organisations. He will succeed the current BCS Health chair, Dr Justin Whatling, on 5 April. Speaking to DigitalHealth.net, Kinnear said: “What we’ve got is a real alignment of the stars. There are some big factors coming into convergence. We’ve got a genuinely mature CCIO (chief clinical information officer) and Health CIO (chief information officer) Network; a high-level review of professionalism in health and social care agenda; and a level of enthusiasm and morale that I’ve not seen in 20 years.” Together, these elements provide a unique opportunity to make a step change in capability and the use of IT across health and social care, he believes. “There are huge opportunities for the BCS to work alongside the CCIO and Health CIO networks, the Health and Social Care Information Centre, NHS England and academia; it’s a heady mix.” Kinnear said that priorities for his first 100 days include ensuring that eHealth Week, in London on 19-20 April, is successful and building partnerships to take forward work on Fed-IP; the initiative to accredit health informatics professionals. “Fed-IP remains a major priority as fragmentation of professional bodies has not served our industry well,” he explained.
Salford Royal NHS boss Sir David Dalton brought in to head up troubled Pennine Acute: The NHS chief who led national negotiations over junior doctors’ pay has been brought in to temporarily head up troubled health trust Pennine Acute, reported Manchester Evening News. Sir David Dalton, chief executive at Salford Royal, is to take the reins after Pennine’s last chief executive left abruptly last month. He is best known nationally for overseeing talks between the government and junior doctors, in a dispute over contracts that still has not been resolved. Meanwhile Salford Royal’s chairman, Jim Potter, is also being drafted in to help oversee the trust after months of speculation over its future. The pair have been appointed temporarily after a stormy few months for Pennine that have seen its chief executive Gillian Fairfield leave suddenly for another trust. There also appears to be potential issues around patient safety arising from the trust’s latest CQC inspection, which has not yet been published.
Awards
EHI Awards 2016 entries open
Entries are now open for the EHI Awards 2016, which recognise the achievements being delivered by healthcare IT teams and companies across the UK. The awards will be presented at a black tie dinner in central London in the autumn. Entries must be in by 5pm on Monday, 2 May, after which there will be a judging process that will end with the awards dinner at the Lancaster Hotel on 29 September. The awards are being run by Informa, whose senior marketing manager Solenne Singer said: “The awards present a valuable opportunity for those involved in UK-based projects to get the recognition they deserve for their exemplary work. The ten categories that trusts and suppliers can enter this year give them the opportunity to demonstrate how they use IT to tackle major issues in healthcare: ranging from patient safety to efficiency and from supporting integrated healthcare to opening up new services to patients.” A full list of the awards categories, and guidance on how to enter, is available here.
As part of this Easter edition of the Highland Marketing Healthcare Roundup we have featured an Easter word search. To get you into the Easter spirit and to entice the chocolate taste buds, the winning entry will receive an indulgent Easter hamper filled with a luxury selection of Easter treats including hot cross buns, bunny shaped biscuits, chocolate eggs and more.
Simply find which word in the list below on the left is not in the grid on the right. Words can go in any direction just to make it a little challenging! Email the correct missing word along with your name and a direct contact telephone number to info@highland-marketing.com.
| APRIL BASKET BONNET BUNNY CARROT CHICKEN CHOCOLATE CHURCH EASTER EGGS FRIDAY HUNT LAMB SUNDAY |
 easterwordsearch |
Opinion
The NHS is in the midst of a financial hurricane
The forecast from the budget shows no let-up in the weather for the struggling health service, but a plan for the future must be put in place this year, says Adam Roberts head of economics at the Health Foundation.
“A hurricane is characterised by severe storms, surrounding an area of relative calm known as the eye of the storm. The NHS is in the midst of a financial hurricane. Costs are rising faster than funding, creating a perfect storm for NHS providers. Next year will be one of relative calm, similar to the eye of a hurricane, with the largest planned funding increase for 2016-17. This is followed by flat or falling real-terms funding per head until 2020-21. The forecast from the budget shows no let-up in the weather; in fact the forecast looks worse for three reasons.
“The first is that the economy is not growing as fast as previously thought, largely due to a fall in the expected rate of productivity growth. This means lower tax revenue for the government and a borrowing requirement in 2018-19 that is four times as large as that planned for in November’s comprehensive spending review. The chancellor has staked his reputation on achieving a surplus in the national budget by 2019-20. To achieve this, public spending will now have to fall by an extra £3.5bn in 2019-20 and £10bn in 2020-21.
“The second reason is that cost pressures are likely to rise more than expected. The budget revealed that the Treasury’s support for public pensions will fall by £2bn in 2019-20. This shortfall will be picked up by public sector employers. The true cost to the health service is not yet known, but the NHS pension accounts for a third of total public pension liability, so this could increase costs for providers by up to £650m. Workforce pressures are already contributing to financial distress among NHS providers, with an over-reliance on agency staff following poor workforce planning.
“The third reason is that there was no announcement of extra funds to help the NHS realise financial stability this year. Most providers have been forced to overspend to protect quality during the storm. Three-quarters of providers are experiencing a deficit, which is expected to reach a total £2.8bn by the end of the year. Without extra funds this year there is a risk that the Department of Health may exceed its allocated budget for the year. One of the key ramifications of this is that it will need to pay back any overspend next year, eating into the funds available during the eye of the storm.
“If we don’t rise to the challenge now, the second half of the storm could hit harder than the first.”
Andrew Lansley: Devolution does not reverse the Health Act
Devolution may have failed in New Labour’s hands but it can and must succeed – we just need a different mindset, writes Andrew Lansley, in Health Service Journal.
“There must be the point at which the government lets go,” says Lord Lansley, the former health secretary.
“When it does, devolution has to rest on three principles: identity, accountability and additionality. The devolved forms of government must be those with which people will identify, structured so that someone can be held to account and capable of adding value and benefit to those it serves.
“When I was at the Department of Health, I applied these principles in health reform. The public expects general practice to be responsible for its care, and I gave GPs the opportunity to bring their clinical skills and leadership, with their understanding of population health management, to add value in commissioning healthcare.
“I left GPs free to structure from the bottom up. I maintained national funding, standards and the adherence to NHS values of a comprehensive, free service. We recognised, however, that accountability and added value would also derive from creating a new partnership between the NHS and local government.
“In particular, the new health and wellbeing boards would bring health, social care and public health responsibilities together in local strategies.
“I have seen it recently argued that “devo Manc” is a reversal of these reforms; that is completely wrong. The reforms enabled this devolution. Clinical commissioning groups now have the statutory freedoms to combine on the geography of their choosing, the flexibility to work with local government, a duty to work to a shared strategy and the ability to pool budgets and create joint commissioning bodies.
“The requirement on the NHS at any level is simply to ensure that quality and outcomes are improved and that clinical standards and NHS values are sustained, and these do not prevent joining in new accountability mechanisms.
“Devolution, in practice, provides an inherent gain in potential effectiveness, giving local people the ability to work together across boundaries to deliver shared solutions. Those boundaries are not just geographical, but organisational and professional. The latter can frustrate integrated services.”
What has the impact been of recent caps on NHS agency staff spend?
Phoebe Dunn, research assistant, Policy at The King’s Fund writes: “Almost four months to the day since the first caps on agency spending were introduced by Monitor and the NHS Trust Development Authority – and with new framework agreements due to come into force next week – what do we know about the impact of these measures so far?
“Unfortunately, not a huge amount. Although NHS providers are submitting weekly data returns to Monitor and the Trust Development Authority, no official figures have yet been published. Without this we are, to some extent, in the dark about the effect of the measures.
“So what do we know about the effects of the caps to date? On the whole, the information points to only patchy success in enforcing even the more ‘generous’ early caps. A recent discussion with one agency suggests that it has largely managed to reduce its rates to below the cap for nurses in London but that it has been more difficult in areas outside the capital, where in the majority of cases rates have been above the 75% cap. In the case of allied health professionals, some areas are operating within the cap but a majority are not, again particularly outside London. For doctors the story is even more marked. Here the agency report that they were not able to meet the first round of caps in the vast majority of instances, with wide variation between grades and specialties.
“The major risk we see is that the solution being pursued by the national bodies fails to address the underlying issue of shortage of supply; in recent years providers have increasingly been forced to rely upon more expensive temporary staff to fill vacancies because they simply cannot recruit sufficient permanent staff.
“This view is echoed in recent reports from the National Audit Office, the NHS Pay Review Body and the Public Accounts Committee, which concluded that ‘the NHS will not solve the problem of reliance on agency staff until it solves its wider workforce planning issues’. The danger then, if more stringent caps are enforced and the shortage of permanent staff not tackled, is that providers will simply not be able to get the staff they need. Controls on agency staff should be part of a wider workforce strategy that ensures the NHS can attract the staff it needs.”
