The Ward Round: The toughest week since peak covid

It is a nightmare situation. The long Easter bank holiday followed by four full days of junior doctor strikes. Of course, the point is to cause maximum disruption, and this will be achieved in spades. The number of elective cancellations will surely easily surpass the 175,000 reported last time (and this was almost certainly an underestimate).

NHS leaders have again reiterated how desperately worried they are about patient safety. Chiefs across the service talk about, at best, hoping to provide safe urgent and emergency care, and how the already “incredibly fragile” state of the service could quickly deteriorate further if more juniors strike than last time, or if there is any sort of spike in sickness absence.

The consultant workforce is tired and morale is low, with many extremely disgruntled, not least those who had planned to take extended annual leave around Easter, but are now being asked to work. Although the consultants’ strike vote has been pushed back by the British Medical Association from April until May, it is still a dangerous time to further anger this staff group.

NHS Providers chief executive Julian Hartley echoed these sentiments, stating the view among trust leaders was that the NHS was in “unchartered territory”.

He called for the government and the doctors’ unions to “recognise the gravity of the situation and step back from the brink”.

“We need a solution to prevent further strikes, and we need it now,” Mr Hartley said.

Barking Havering and Redbridge University Hospital Trust chief executive Matthew Trainer added: “We need to see proper negotiations between the government and unions on junior doctor pay and a suspension of strike action.”

He said he supported the “right to strike” and stressed not enough was being done to encourage doctors to stay in the NHS. But he was also clear about the impact the strikes will have on the public, describing how the mass cancellations of last month’s industrial action affected “thousands of patients”.

And then there is the on-going BMA rate card issue. My colleague James Illman reported last month how consultant strike cover was costing several thousand of pounds per shift, with hospital bosses describing the BMA as “acting like football agents” to try and inflate pay.

This time round, the tricky pay negotiations have continued, with a 2.3 per cent increase in the rate card, brought in from early April, for trusts to contend with.

Providers find themselves stuck between BMA local negotiating committees, who want them to meet the cap, and from NHSE to keep well below it.

NHSE response fiercely criticised (again)

The response of NHSE and ministers to last month’s strikes was fiercely criticised by trust leaders, but it doesn’t appear lessons have been learnt.

Chief execs have again expressed frustration at the lack of comms from the centre for the public to avoid hospitals unless there is real, genuine need. And the letter sent from chief operating officer David Sloman and national medical director Steve Powis was lambasted by HSJ readers as “absurd” and lacking in empathy for patients, in response to its request for “rolling day-to-day cancellations”.

In terms of pay talks, there’s been no update from the doctors’ union since last week, when the BMA posted a letter on Twitter inviting Steve Barclay to meet on Wednesday and Thursday this week. However, insiders have suggested it’s much more likely any talks with the heath secretary will take place after next week’s strikes.

Meanwhile, there is a strong argument next week could be the worst – and potentially the most dangerous – since the covid pandemic, with leaders and other staff putting in a huge amount of effort for little positive outcome.

More work for the CQC

Last week it was confirmed via a surprise ministerial statement by Maria Caulfield that the Healthcare Safety Investigation Branch’s maternity programme would be hosted later this year by the Care Quality Commission, which she said would provide the “most appropriate and streamlined mechanism”.

This differs from what was promised last year – when then health and social care secretary Sajid Javid told the commons a “new special health authority” would be established to run the maternity investigation programme – but it has been expected maternity investigations would be passed back to the NHS for a number of years.

However, the CQC’s involvement was a surprise for HSIB staff, who were only informed of this decision five minutes after the statement was published. It also seems strange the CQC held a board meeting just the day before the announcement and this major developed was not discussed.

Also, questions remain about why ministers would want to place the maternity programme within the CQC, an organisation in the middle of a major transformation programme and due to start inspecting integrated care systems, which is a huge undertaking. Will it have the resources to give to a new department? This was a serious problem for HSIB, which struggled to accommodate the maternity investigations, the new staff and the corporate processes it required.

And of course, much has been written about the cultural, governance and leadership problems within HSIB, and within its maternity team - it is understood an unpublished review was carried out into concerns around bullying and conflict of interest in the division and an employment tribunal is slated involving HSIB in a couple of weeks.

The CQC has been handed a huge responsibility. But will it be up to the task?