Daily Insight: Strike plea heeded

An eleventh-hour decision by the Royal College of Nursing to staff more high-risk services during its upcoming strikes has followed a letter from the UK’s four chief nursing officers.

In a letter, leaked to HSJ, the union agreed to further exemptions from strike action – known as national derogations – for all-age mental health, learning disability and autism services “as part of an emergency response”. Community physical services will operate a Christmas Day model.

Previously the only national exemptions were in acute services, including critical care, chemotherapy and dialysis. It followed CNO warnings of patient safety risks and a lack of parity of esteem in a letter leaked to The Times (£).

Meanwhile, HSJ also revealed that ambulance trusts are pressing unions to confirm crews will cover at least some “category two” calls – including suspected heart attacks and strokes – during walkouts next week.

At least one major ambulance union has so far stated all category two calls will not be covered by national derogations and no trusts have so far secured local exemptions, HSJ understands. Negotiations are taking place locally while national agreements only cover the most serious category one calls, including cardiac arrests.

All will be revealed

The year is 2022. The NHS is going through one of its toughest winters to date, a collapse in care standards, a series of debilitating strikes and unknown numbers of excess deaths.

At DHSC headquarters, health secretary Steve Barclay reaches for the NHS’s last hope: The Organogram.

Not content with ordering NHS England, the Department of Health and Social Care and arms-length bodies to publish the documents, Mr Barclay has extended the move to integrated care boards, which have been told to publish breakdowns of staff numbers, grades and costs.

The health secretary is taking aim at what he sees as top-heavy management in ICBs, having previously said the bodies employ more than 30,000 staff.

In one sense Mr Barclay is pushing at an open door: Amanda Pritchard has said ICBs need to “rationalise” roles and some chief executive officers have taken matters into their own hands by planning slimmed-down operations – no doubt aware that NHSE might take a firmer line in future.

Mr Barclay said the organograms should help the “public and those on the frontline understand how money is spent”.

But he forgot to mention another intended audience: journalists, who will likely use the information to fuel what critics say would be “cheap attacks” on NHS management.