News from Nowhere 70 Sept. 12th 2018

A question of numbers

In an interview with the Sunday Telegraph on September 9th 2018 Professor Ian Cumming, the chief executive of Health Education England, said the NHS must get to grips with artificial intelligence or face increasing its workforce by 50% by 2028. AI should be able to
help by examining X-rays, MRI and CAT scans.
News from Nowhere’s moles nearly choked on their muesli when they read this. Another half million workers needed to read X-rays and scans sounded wrong. And it was, for what Prof Cumming actually said was that around 30% more staff will be needed within a decade to
cope with Britain’s ageing population. The NHS would need to increase its workforce by around 50% in a decade (including the 30%) unless successful action was also taken to stem the impact of ‘lifestyle’ diseases caused (at least in part) by dietary excess and alcohol
overuse. In his view technology would also have an important role in the prevention of such illnesses.
This is what the NHS calls a “challenging” perspective, given the inability of HEE to find the formula for retaining nurses once they are trained. Roll on the robots?

Filling the rotas
Financial and workforce services provider to the NHS, Liaison, has released the results of its annual ‘Taking the Temperature’ report which analyses anonymised temporary staffing data from around a quarter of UK NHS trusts. Taking the Temperature figures show that NHS spending on temporary agency (non-contract) staff in England decreased from £3.1bn in 2016/17 to £2.4bn in 2017/18.
The main reasons for engaging temporary staff in the NHS were driven by the need to fill substantive vacancies – 79% of hours booked in 2017/18, a reduction from the 86% reported in 2016/17. Clash or a gap in rota accounted for 8.3% of bookings during the year, up from
6.3% in 2016/17, whilst service pressure accounted for 4.5%. This is likely to have had a negative effect on average rates booked during the year, as trusts struggle with increasing demand and limited resources.
Just over 70% of NHS temporary staff are still being booked from ten agencies. Between the most and least expensive agency there is a difference of £30.30 p/h in total pay and commission for the agency – the equivalent of an additional £242 per eight hour shift – despite the fact they are supplying the same grade of staff. The average total Consultant hourly agency rate was £143 p/h, 43% more than the average Bank rate of £99. If Consultant hours had been booked at the average Bank rate, the annual saving to the NHS on this staff group could be in excess of £10m.
In 2016/17 there was an increase in medical staff Banks, with the number almost doubling across England to 67%. This trend is continuing and at the end of 17/18, an estimated four in
every five trusts now have a medical Bank up and running. The growth in staff Banks provides a platform for greater trust collaboration across regions, STPs or even specialties.
By working collaboratively, trusts are in a better position to share temporary resources, particularly where specialties are in short supply.
To download the latest Taking the Temperature report from Liaison visit:

No More WoCs!

After more than a year of campaigning we are winning the argument about NHS Trust’s forming Wholly Owned Companies (WoCs) to avoid tax. Trade union action has ensuredseveral will not now go ahead. For example, Unite staff at East Kent Hospitals University Foundation Trust will take industrial action from 24 to 28 September, just before 250 staff transfer into a WoC called “2together Support Solutions”. (Alison Moore, Staff to strike over transfer to subsidiary company HSJ 12/09/18). Even the Regulators appear to have woken up and are starting to impose conditions that will stop the trend… if they are actually applied.
Setting up these WoCs always involves taking low paid staff out of the NHS and offering new staff inferior terms and conditions. Aside from that they are just a tax scam which allows financially challenged NHS Trusts a chance to balance their accounts. It does nothing for patients. The scam has been nodded through by the impotent and Nelson-eyed regulator NHS Improvement, which is now focused on rearranging its own deckchairs as it is being reconfigured. Ineffective and supine Trust Boards simply nod through changes based on assurances, and with fingers crossed.
Evidence compiled for UNISON has shown that these schemes rely on the tax changes for 85 – 90% of the benefits they claim. Actually the tax changes are the only benefit that has any evidence to support the claims. This is tax avoidance.
Work continues on challenging the arguments being peddled by the Trade Body NHS
Providers that WoCs are really all about better services and more staff flexibilities. That work is hampered by the refusal of Trust to provide information –which they claim is commercially confidential – despite the fact that some of the more honest Trusts have published everything! The business cases are not being released mainly because this would show how shallow the WoC argument is without tax avoidance. From what information has been released it is clear no business cases are being produced to allow proper scrutiny.
This is an indefensible position under the Freedom of Information Act and eventually will be successfully challenged because commercial confidentiality in a public body is hard to justify.
Anyway, the murky world of WoCs drives all the hype about the openness and transparency of the NHS out the window. We may have slowed the WoC rush but we need pressure to ensure every scheme that has already gone through is subjected to proper independent
scrutiny –which is likely to expose the dishonesty that underpins this whole saga.

ACO Regulations
It’s a while since the Five Year Forward View came out to a mixed reception. The development of the rather strange and ill- defined 44 Strategic Transformation Plans followed and these are morphing somehow into Accountable Care Organisations.
It is hard to find anyone who understands what is actually happening or even why. It is also clear that almost nobody wants to form an ACO when there is so much that can be done by simply improving relationships and systems without the false promise of organisational
Some suggest that this is all part of a conspiracy to Americanise the NHS. Just about everyone agrees that the launch of STPs was a communications disaster and almost all failed to be have any kind of engagement or consultation even with the “partners” whosupposedly signed up to the Plans. The few vaguely sensible Plans were not credible without increased funding and the removal of the constraints set by the legal architecturearound competition and markets. Still they stumble along.
At the end of last year somebody finally accepted that the stretching of the legislation (which is being ignored in many places) could only go so far. GPs are joined to the NHS by legal contracts so they are effectively private providers in that sense. To allow GPs to take part in some of the new structures and organisations like an Accountable Care Organisation required some modest legal changes. How this would be done has been published, mostly as technical changes to Regulations. This triggered legal (Judicial Review) challenges which have had some success so far and which are also ongoing.
Behind all this is the total incoherence of the NHS legal and organisational structures.
Everyone knows the Lansley Health and Social Care Act has been a disaster but the current government will not repeal it even though they turn a blind eye to its provisions being ignored. We should all oppose the proposed changes to Regulations as they are another step in the wrong direction. The NHS is not a market; patients are not customers; NHS bodies are not businesses competing with others. That is madness and so too are long term legally binding contracts to deliver services. This legal contracting rubbish has led to the farce of one public body taking another to Court and one Trust paying compensation to another. More of this we do not need.

All change for private practice?
Pressure on health insurance premiums, a decline in Private Medical Insurance subscriptions, demands for increased transparency about private practice pricing and hospital and consultant outcomes, all seem likely to affect private practice.
The Private Practice Masterclass at the King’s Fund on September 18th features contributions from two organisations that have had a significant influence on private practice… Bupa and the Private Healthcare Information Network (PHIN). The Masterclass is
open to consultants, their practice staff, private hospital and clinic owners and managers.
The Private Practice Masterclass series is run by LaingBuisson, the publishers of consumer portals such as Private Healthcare UK and LaingBuisson has been serving clients for over 30 years with insights, data and analysis of market structures, policy
and strategy across healthcare and social care and is the chosen provider of independent sector healthcare market data to the UK Government’s Office for National Statistics.
The Masterclass is free for existing clients of LaingBuisson (one ticket per client organisation). There is a charge of £25 (plus VAT) for other attendees (refundable, if you ubsequently become a LaingBuisson client).
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