Cowper’s Cut 300: 3% pay offer sends junior doctors back to striking

The leadership of the BMA junior doctors committee caught many by surprise this week, when they briefed The Times that they were withdrawing from the pay talks with new Health But Social Care Secretary Victoria Atkins, after having been offered 3%.

Junior doctors plan longest strike in NHS history

Walkouts set for three days in December and six days in January

The TimesKat Lay, Health Editor | Chris Smyth, Whitehall editor

Their ‘full pay restoration’ campaign had been asking for 35%, but as the Times article states, “while junior doctors came down from an initial demand of 35 per cent, they are holding out for a rise said to be in the “high teens”. After gradual progress in recent weeks, ministers had been looking for ways to bridge the gap, possibly through measures such as easing student debt, and insist they had not made a final offer.”

Even if the 8.8% they were offered earlier this year were deducted, the gap between the ask of the ‘high teens’ and the offer of another 3% was a credibility challenge too far.

So they will be striking for three consecutive days just before Christmas (20-22), and then six consecutive days in January (3-8). This is designed to cause significant inconvenience over the period when hospitals are usually trying to get everyone out in anticipation of the post-festive ‘I’ll go in the New Year’ rush.

Cue a flurry of distinctly sub-Talleyrand ‘I wonder what he meant by that?’ analysis pieces from The Guardian and BBC News. It isn’t complicated. They want more money, and they think that more strikes will help them get it.

Nursing a grievance

The RCN’s renewed grumpiness over the consultants’ pay offer covered last week is another key variable now back in play.

Covid-19: Agency nurses cost NHS £3bn during pandemic

The figures cover the period of the Covid pandemic when the NHS was under huge additional pressure.

BBC NewsTim Dodd and PA MediaBBC England

In entirely related news, we learned this week that locum nurse costs went off the scale during the pandemic. The RCN obtained figures for spending on agency nurses and nursing staff between 2020 and 2022 at 182 NHS trusts which show that NHS trusts in England spent £3.2 billion in total, with the London region spending the most at almost £630.5 million.

The Government spent most of last week cosplaying ‘tough on asylum’, which may well affect immigrants coming to work in the NHS and social care. This was served up with hearty emphasis on what Home Secretary James Cleverely has termed their “batshit-crazy” Rwanda asylum policy, which made Dame Ruth May’s intervention at this week’s NHS England board meeting all the more telling.

She was talking about the Government’s ‘six months’ early success’ of hitting its target of 50,000 more nurses in the NHS in England.

Almost all promised ‘50,000 more nurses’ are international recruits

Ninety-three per cent of the 51,245 nurses who have joined the NHS in the last four years have been recruited from overseas, NHS England’s chief nursing officer revealed yesterday.

Health Service JournalJames Illman

Dame Ruth pointed out that “93 per cent of that target was achieved by international recruitment. It does show the need to have the long-term [workforce] plan, so we can rebalance domestic and international supply”, as Health Service Journal reported.

Amanda Pritchard in ‘makes a silly comment’ shock

NHS England’s chief executive Amanda Pritchard undistinguished herself at the boards meeting by saying that “we absolutely cannot have not her winter like last year: I think that was the worst of my NHS career … and strikes will make that even harder”.

Ahem.

There are some more staff this year, but most are relatively inexperienced: experienced staff make the big difference.

There are some extra ‘ beds’ in ‘virtual wards’, but this is not Hospital At Home and the monitoring staff are thinly spread.

Take-up of flu and Covid-19 vaccines is slow.

New ambulances are late.

And there are already lots of ‘busy A&E’ alerts.

All of these things were and are happening regardless of the next industrial action. For NHS England’s chief executive to be going on about it smacks strongly of attempted misdirection.

There is not substantially more NHS capacity this winter. It is therefore likely to be about as bad as last winter, and could certainly be worse. Appalling NHS service has been normalised over many years.

Another week, another Alan Milburn tribute act from Labour’s Wes Streeting

Here we go again: the latest performance from Labour’s shadow health secretary Wes Streeting.

Last week, we had his Boris Johnson Fanzine Alan Milburn tribute act. This week, it’s the same show, but in the Sunday Times.

Wes Streeting: NHS uses every winter crisis as an excuse for cash

Britain’s medical chiefs must accept that money is tight, says the shadow health secretary, and they can learn lessons from Singapore’s high-tech hospitals

The Sunday TimesShaun Lintern, Health Editor

As I wrote last week, Streeting is not stupid. He makes some strong points in the piece, but his revealed preference ‘epater les bourgeois’ (ou quand-meme, les bien-pensants’) is really not doing him favours.

Much of the reasoning he presents is not good. Among the things ignored by his arguments that the NHS wastes money; begs for cash every winter; and should be more like Singapore’s health system are:

1. The big difference between correlation and causation. The NHS is not in crisis every winter because it isn’t getting enough money: it is in crisis every winter because there is no spare capacity. This is not complicated, and if he actually doesn’t know this, he should dismiss all his advisors.
2. We hear A Lot about Singapore. A Lot!
   The piece says of the UK’s ageing population that “Singapore is facing similar challenges. The island nation has a population of just under six million and it is ageing fast.”
   Ahem.
   Setting aside the pertinent question of how a population would age slowly, health policy tourism is often unhelpful, and it certainly is here. The population of Greater London is twice bigger than the population of Singapore.
   And England is very unlike Singapore indeed: culturally, economically and politically.
   This is the 2023 equivalent of the early 2000s’ “the NHS should just be Kaiser Permanente” era, and it’s going to have just as permanente (boom-tish!) an impact.
3. “Streeting’s ambition is to mimic the use of apps in Singapore where the island’s HealthHub app allows users to access medical records and link up hospital and GP services.” The current state of NHS IT is very, very far away from making this possible. It’s a great ambition, but one which will take time, money and public trust: none of these can be taken as read.
4. There is some sensible stuff towards the end: “He says Labour, unlike past new governments, will not embark on a reorganisation of the NHS … At the end of his Singapore tour, Streeting was struck by how often officials he met praised the NHS for its streamlined single organisation structure. “We’re not realising any of those advantages,” he says, adding: “Consultants and nurses often feel the dead weight of management bureaucracy holds them back. We do need to adopt a culture of innovation”.”
   Mmmmmmm.
   There’s a lot there. The reforms that led to the internal market and New Public Management approach to the NHS were huge steps away from the ‘NHS as monolithic single organisation’ era (which it’s never been).
   The use value of competition / internal markets in the NHS is debated. Cooper, Van Reenen and Popper all published in its favour. If you have NHS provider organisations acting as competing bodies, you may be more likely to get the cultures of innovation for which Streeting calls.
   There is a chunk more thinking to be done here. There will be a paradox once Streeting becomes SOS: he will need to grip because the NHS is going to be in a really significant crisis; and he also wants to decentralise and encourage innovation.
5. He really needs to not keep using the “the NHS is a service, not a shrine” line. It suggests that he is much better at critique than coagulating good and workable ideas for reform. When he becomes Health Secretary, there will be no time to waste: 2024 (or 2025) is not 1997.

Victoria’s vision

Lucky us: we now have the new Secretary Of State For Health But Social Care Victoria Atkins’ hallucinations for the system.

Oh, sorry: her priorities.

Health and Social Care Secretary sets out priorities for system

Secretary of State aims to make health and social care system faster, simpler and fairer for patients

GOV.UKDepartment of Health and Social Care

This is truly bad. She talks about “doctors, nurses, GPs, pharmacists and other health workers(’) … frustrations where they feel they are not able to deliver the best possible care or where prevention or early intervention could have made a real difference.

“That is why I am committed to making health and social care services faster, simpler and fairer”.

Sounds lovely: not clear how. Atkins talks of a “difficult winter ahead. And though our early winter planning is seeing some results we know there is much more to do”.

Ahem. See my earlier points about Amanda Pritchard’s attempted overclaim.

The Health and Social Care Secretary claims to have “committed to making health and social care services:

• faster for patients, by making it easier to get treatment locally, improving A&E performance and cutting waiting lists
• simpler for patients, with joined-up, integrated care, and simpler for staff, by reducing bureaucracy and giving them the latest technology to free up their time to care for patients
• fairer, ensuring that:
  • children are protected from health harms
  • health outcomes are not determined by where you live
  • government supports older people to maintain their independence for longer
  • government delivers a more productive NHS that is fairer for taxpayers.”

OK. We’ll see how this plays out in The Real World.

Monewatch

Michelle Mone has comprehensively stolen the title of the health policy universe’s ‘Everybody’s Favourite Noble Baroness’ from its former champion jockey, Dido Harding.

Baroness Mone: The PPE scandal made me ashamed to be a Tory – I am purely a scapegoat

Entrepreneur launches fightback over PPE equipment investigations with startling counter-allegations

The TelegraphGordon Rayner,

The new Tory peer of our hearts has launched a fight back to clear her name in - where else? - the Boris Johnson Fanzine.

The BJF’s brown-tongued write-up is a masterpiece of bathos, which puts Alan’s entire career (and indeed life) into the shade. “For more than two years, Baroness Mone has lived a reclusive life as she has endured repeated death threats over accusations her family illegally profited by selling unusable PPE equipment during the Covid pandemic.

“The Ultimo bra entrepreneur and her husband Doug Barrowman have maintained their silence after coming under criminal investigation by the National Crime Agency (NCA), with a separate civil case launched by the Department of Health and Social Care (DHSC).

“Now, however, the couple say they have decided enough is enough. They are beginning a public fightback in which they insist they are entirely innocent and make a series of startling counter-claims against the DHSC and its representatives.”

Everybody’s New Favourite Noble Baroness claims that she “believes it (the Government) is now using her as a scapegoat for its own failings in the multi-billion PPE procurement scandal”.

‘Believes’. Goodness me. Did ENFNB forget so quickly her own imprecation “don’t believe everything you read … or everything you think”?

Wrenchingly, ENFNB also tells the BJF, “I am ashamed of being a Conservative peer given what this Government has done to us.” One must have a heart of stone not to laugh.

Recommended and required reading

HSJ reports further consolidation in the primary care ownership market, as Centene sells its Operose/AT Medics practices to HCRG Care Group (formerly Virgin Care).

The Health Foundation gives the FT an exclusive on its analysis that inflation has eroded NHS England budget by £3.5 billion.

HSJ also reports that the amount spent by NHS trusts on outsourcing activity to other providers has doubled since the period before Covid19.

Excellent House of Commons Library piece on NHS waiting times.

A pair of balanced and sensible articles on the Federated Data Platform and contract winners Palantir (with my usual COI declaration attached: I’m paid for my attendance at Palantir’s health advisory panel).

BJF piece about how private sector employers are watering down private healthcare perks after premiums rose by 60% due to NHS delays: firms are removing dependent cover from policies; asking staff to ‘co-pay’ on claims; and in some cases restricting cancer support to reduce the cost of delivering the workplace benefit. The private sector, eh?

The NHS still hasn’t got better at whistleblowers.