HSJ Live 03.03.2015: Unions divided over government pay offer

There’s been plenty of breaking news on our site today, including the findings of the Kirkup inquiry into maternal and neonatal deaths at University Hospitals of Morecambe Bay.  

Here’s the latest:

• NHS reorganisations are a ‘contributory factor’ in poor patient care, the chair of the independent inquiry into failings at University Hospitals of Morecambe Bay Foundation Trust has said.
• The health secretary has backed the establishment of an independent patient safety investigation unit similar to the Air Accidents Investigations Branch of the Department of Transport.
• The independent inquiry into events at University Hospitals of Morecambe Bay Foundation Trust has found ‘failures at almost every level of the NHS’ combined to create a ‘lethal mix’ which caused the avoidable deaths of at least 11 babies and one mother.
• The Kirkup inquiry into care failures in Morecambe Bay has called for a new duty to be placed on NHS trust boards requiring them to publish the findings of any external investigations into their clinical services, governance or operations.
• A significant number of providers are still yet to decide whether to accept NHS England and Monitor’s offer of a ‘voluntary’ tariff for 2015-16, with just a day to go until the offer expires, HSJ has been told.
• Activity in general practice has risen in the last three complete financial years, but most of this has been for medical professionals other than GPs, research by a leading health think thank suggests.
• Richard Douglas, the Department of Health’s highly influential director general for finance and the NHS, will retire at the end of May.

Jeremy Hunt made the call this afternoon in response to the Kirkup investigation into maternity care failings at Furness General Hospital, which he dubbed “a second Mid Staffs”.

Speaking in the Commons today following the Kirkup report’s publication, Mr Hunt said: “There is no greater pain than for a parent to lose a child, and to do so knowing it was because of mistakes that we now know were covered up makes the agony even worse.

Mr Hunt said he would immediately ask NHS England’s national director of patient safety Mike Durkin to look into the possibility of creating an independent patient safety investigation unit along similar lines to the air accidents branch - a part of the Department of Transport.

3.32pm UNISON members have accepted the government’s pay offer for NHS workers.

67 per cent of the union’s NHS members voted in favour of the pay offer in a ballot that closed today. 32 per cent voted to reject it and take further action.

By contrast, Managers in Partnership today announced it had rejected the government’s offer.

UNISON’s head of health Christina McAnea, said: “Our members have voted to accept this offer. Although it does not go far enough, it is an improvement and it will make a difference particularly to over 250,000 of the lowest-paid in the NHS.

“By ignoring the recommendations of the NHS Pay Review Body for England, the government forced health workers to take strike action over pay for the first time in 34 years.

“I’m proud of the fact our members were prepared to take strike action without compromising patient care. Their industrial action has forced the government to negotiate with us and sent a warning that NHS workers will not sit back and do nothing when their standard of living is attacked. 

“We are calling on any government elected in May to develop a pay strategy that rewards health workers fairly for the demanding jobs they do, and ensures the NHS can continue to recruit and retain a high quality workforce.

“The current state of pay in the NHS means many workers rely on unsocial hours payments to make ends meet. We know this government wants to cut these.

“The industrial action over the last six months should be a warning to ministers that our members will not accept further cuts.”

3.31pm The NHS Confederation has also responded to the report.

Chief executive Rob Webstersaid: “This is a truly harrowing report and our thoughts go out to all of the families affected. We owe it to them to ensure that every failing at every level is addressed, and that every lesson is learned.

“The responsibility for quality lies with everyone who works in the health service, from staff delivering direct care to trust boards and commissioners, regulators and national bodies.

“Two things need to be in place. Firstly, to continually improve care and prevent failures, we need to value and engage staff, patients and their families fully. Vital to this is establishing cultures where people feel safe to report and learn from mistakes. We need to look to clinicians and managers to set priorities and use data and patient feedback well.

“We cannot rely on national standards and targets alone to secure consistently high-quality, compassionate care. We need transparency in the NHS so every opportunity to learn lessons is taken.

“Secondly, we need to organise care in ways that are safe and evidence-based. This requires the right clinical leadership, good provision and effective commissioning.

“We fully support the recommendations in this review. When a mirror is held up to the NHS, we must look long and hard if we are to see the issues we truly face.”

3.29pm The Nursing and Midwifery Council has said it welcomes Dr Kirkup’s report into maternity and neonatal services at University Hospitals Morecambe Bay Foundation Trust.

NMC chief executive and registrar Jackie Smith, said: “We recognise that it has taken too long to deal with individual complaints and we are sorry that the delay has caused distress to the families affected. We have speeded up the time it takes us to deal with complaints, but we know we need to do more.

“Today’s report makes very significant recommendations which we will consider carefully. Every midwife and nurse has a responsibility to speak up when things go wrong and the work we are doing with the GMC on the Duty of Candour will reinforce that duty to speak up. 

“We are pleased that the Inquiry and the Department of Health have acknowledged the need to remove supervision from our legislation. With the necessary and long overdue changes to our legislation, we can make further improvements.

“What happened to the families at Morecambe Bay was awful and we have a duty, when things go wrong, to act swiftly.”

3.05pm Managers in Partnership members have rejected the government’s pay offer by 92 per cent on a turnout of 31 per cent of those polled.

MiP members also reported that they work long unpaid hours,

93 per cent of those polled also said they work over  37.5 hours a week on average, with 29 per cent working more than 48 hours, the limit set by the working time regulations.

MiP chief executive Jon Restell said: “The government’s failure to value managers for their hard work, skill and dedication has led to this strong vote to reject the pay offer.

“Managers are people, not machines: our members say the proposed pay deal is divisive, demotivating and demoralising and will see a loss of goodwill and exacerbate recruitment and retention problems.’

“Managers deserve respect from the government. Our members keep the show on the road for staff and patients, working long hours for no extra reward. They are critical to delivering dignified, safe health services, making every penny count and supporting the clinicians who care for patients in a complex and demanding walk of life – and many are clinicians themselves.’

“The government could have shown respect for managers’ hard work by honouring the Pay Review Body’s recommendation. Instead they have cynically made the improved offer for lower paid staff dependent on taking away from those on higher bands, putting the unions representing lower paid staff in a very difficult position.

“Our members support the weighting of any increase towards the lower paid to ensure they finally receive the Living Wage, but this should not be at the expense of those on the higher bands.’

“We call on the government to value managers and amend its offer at this late stage to pay clinical and other managers fairly and consistently with other NHS staff. ’

“Our hours survey shows the NHS is under intense pressure with managers working very long hours in response. Employers should be worrying about the wellbeing of senior staff working long hours and whether jobs are properly designed with enough resources going into these critical roles within the healthcare team.’

‘If the offer is accepted and implemented nationally, MiP will ask local employers to make up the difference.’

‘We call on all parties to the national agreement to sign up to the principle of paying managers and other senior staff fairly and consistently with other staff groups. We all believe in the NHS and we all work hard for our colleagues and our patients.’

3.03pm In response to the report of the Morecambe Bay investigation, NHS Providers director of policy and strategy Saffron Cordery said: “Our deepest sympathy is with the patients and families who were affected by the tragic failures of care within the maternity unit at Furness General Hospital.

“Today’s findings offer significant learning for all NHS providers as well as regulator, national bodies and the wider NHS. 

“While it is important to reassure patients and the public that tragic incidents such as this are rare, the report rightly reiterates the central importance of ensuring an absolute focus on quality of care, robust governance and continuous learning by NHS provider boards, their clinicians and staff and the system within which they operate.

“Much has changed at Morecambe Bay since the terrible events under investigation from January 2004 to June 2013.

“The new leadership team is fully focused on developing a culture of transparency and learning with a core focus on delivering consistently high quality care, listening to patients and families and supporting their staff to develop and learn.

“We will work with all of our members to share the considerable learning from the report’s recommendations”.

2.48pm Commenting on Bill Kirkup’s report following his investigation into University Hospitals Morecambe Bay, Care Quality Commission Chief Executive David Behan said: “We welcome today’s report and our sympathies are with the families who have suffered as a result of poor and unacceptable care.

“We hope it gives them answers to the questions they have been asking for many years. We have previously apologised, and today we repeat that apology, for CQC’s regulation of the trust not being as robust as it should have been and for missing opportunities to intervene to prevent poor care.

“We will study this report and consider carefully the recommendations that relate to CQC.

“CQC has radically changed the way we regulate and inspect hospitals in the last 18 months. What happened at University Hospitals Morecambe Bay has contributed to the changes and improvements we have made and continue to make. This progress is noted in today’s report.

“The trust is currently in special measures following a CQC inspection in February 2014 that rated it inadequate. We are due to inspect again in May to check progress on improvements but will go back sooner if we need to respond to concerns.”

2.44pm Commenting on the Medical Innovation Bill, the Academy of Royal Medical Colleges said: “The desire to promote innovation is fully supported by the medical profession and the Academy of Medical Royal Colleges welcomed the opportunity that the Medical Innovation Bill provided for this to be debated.

“However, the view of the Academy and Medical Royal Colleges, reaffirmed at the end of last year, is that we did not believe that the bill would actually achieve this worthwhile intention.

“When it was first presented, Royal Colleges and other professional medical bodies had concerns about potential unintended implications of the bill.

“The amendments made to the Bill certainly addressed a number of these concerns and were welcomed.

“There still, however, remained a danger of the unintended consequences of the bill in diverting efforts away from properly conducted clinical research trials.

“The Academy and Medical Royal Colleges did not believe that the legislation added clarity or value to current arrangements and was not therefore actually necessary.

“We felt that efforts could more helpfully be directed at removing some of the real and practical barriers that can impede innovation in the NHS.

“The Academy therefore believes that the fact that that the bill will apparently not progress in this Parliament should be used as positive opportunity to have a full and constructive debate on promoting innovation in the NHS as has been proposed.

“Medical Royal Colleges would be pleased to discuss with the Bill’s supporters and Government how this could best be achieved.”

2.40pm The decision to devolve and integrate £6bn of health and social care spending in Greater Manchester raises more awkward questions than it answers, writes Micheal White in his weekly HSJ column.

2.31pm The House of Commons debate has now ended.

2.30pm A joint statement in response to the Kirkup inquiry has been issued by Care Quality Commission chief executive David Behan, Monitor chief executive David Bennett, NHS Trust Development Authority chief executive David Flory, the Department of Health’s permanent secretary Una O’Brien and NHS England chief executive Simon Stevens.

It states: “We are deeply saddened by the tragic and inexcusable events described in this report. They should never have happened, and they must never be allowed to happen again.

“Our fundamental purpose is to ensure that every NHS patient is offered safe, honest and compassionate care, but the report is unequivocal that the care provided to some patients in the Morecambe Bay area between 2004 and 2013 fell far short of this.

“This is a terrible personal tragedy for all of the families involved. We apologise unreservedly for all the appalling suffering that they have endured and extend our condolences to every one of them.

“Following the tragic events at Mid Staffordshire NHS Foundation Trust, the NHS is making progress towards becoming safer, more compassionate and more transparent - with patients at the heart of all it does.

!But there is more to do, and we are absolutely committed to learning from the findings of this investigation to prevent future tragedies and suffering.

“We are grateful to Dr Kirkup and his expert panel for this thorough report, and particularly to the families who have played such a crucial role in bringing these events to light and uncovering the truth.

“As outlined in the health secretary’s oral statement, there are some actions that will be implemented immediately.

“We will consider the report’s other recommendations in detail and work together to develop a system-wide response.”

2.24pm Health committee chair Sarah Wollaston has asked whether independent medical examiners could be brought forward before the course of death before the end of this parliament.

Hunt said at this stage he can only commit to introducing an independent medical examiner as soon as possible.

2.18pm Hunt said one of the issues regarding the failings made by the Parliamentary and Health Service Ombudsman was the lack level of expertise and their confidence in understanding about when a clinical failure has been made.

He said the PHSO needs to ensure that their culture is as fair and transparent as the NHS it oversees.

He was responding to a question by Cumbrian MP Tim Farron about whether the health secretary can do everything he can to make sure the PHSO is not a lapdog for managers.

2.17pm Back to the House of Commons debate, Jeremy Hunt said the most important lesson we need to learn from today’s report is the need for a culture of trust, including for staff to feel safe in reporting mistakes and poor care.

2.16pm Labour has announced a mandatory review of all hospital deaths to improve patient safety in the NHS.

In a statement published this afternoon, Labour said will launch a review on improving the quality and safety of care in the NHS, including introducing a mandatory review of case notes for all deaths in hospital.

Speaking at the House of Commons, shadow health secretary Andy Burnham announced that Nick Black, of the London School of Hygiene and Tropical Medicine and advisor to the government on hospital mortality, has agreed to advise Labour’s review. Professor Black will produce broad policy advice on implementing the new approach before the general election.

The statement said: “Experts have called for greater use of case-note reviews in monitoring and learning from avoidable harm, which they believe will help to foster the promotion of an open learning culture in the NHS.

“The Shadow Health Secretary said the commitment builds on, but goes further than, recent Government announcements on case note reviews. Ministers have pledged to examine a sample of approximately 2,000 case notes of deceased patients each year to produce a new measure of avoidable deaths. Labour supports this but plans to go further by ensuring that every death in hospital is subject to an appropriate level of review as part of a drive to improve patient care in every trust.

“Labour will argue the move builds on reforms of the last Government – such as the introduction of independent regulation of hospitals, and the systematic publication of clinical data – but also builds on the lessons of recent Inquiries.

Mr Burnham said: “Today’s investigation recommends better systems for recording deaths, so that concerns can be better identified and acted upon. It recommends mandatory reporting and investigation as serious incidents of all maternal deaths, still births and unexpected neonatal deaths.

“But we believe there is a case to go further, including looking at how we can move to a mandatory review of case notes for every death in hospital, and also looking at how we can use a standardised system of case-note review to support learning and improvement in every Trust.

“This reform is needed because rather than just looking a sample of deaths to measure avoidable harm, it looks at every single death to learn lessons. It means every single person matters.”

2.11pm Responding to the shadow health secretary, Jeremy Hunt said the CQC is the best body to review ongoing maternity services at the trust at the moment, which has been deemed safe.

Hunt said the government fully supports the policy of death certification and want to implement it sooner.

He said it would be “technically very difficult” to review the case notes of all 250,000 deaths in hospitals, for example in terms of taking up doctors’ time, but he has asked Nick Black to help him look at avoidable deaths across hospitals.

He said the report makes it clear that ministers were advised that they were not able to intervene about the decision to award the trust foundation trust status in 2010.

2.07pm “We need a better system for scrutinising [all] deaths in hospital,” Burnham said.

Burnham has announced a review into this, which hopes will be endorsed by the government.

2.06pm Burnham has said reform for death certification is “well overdue”.

2.05pm Burnham pointed that out the report said there remains confusion about the oversight and regulatory system.

2.04pm Burnham said any further referrals to the GMC and NMC should be made without delay.

He also asked whether the health secretary will take forward the recommendation in the report for a review into care in rural areas.

2.03pm Burnham has asked the health secretary about what steps he has taken to ensure the trust now has the right safety culture.

2.01pm Shadow health secretary Andy Burnham has also apologised to the families affected on behalf of the previous government.

He has paid tribute to all families involved, but particularly to James Titcombe, whose baby son died in 2008 after care failngs at the trust.

1.59pm The most important legacy for the 19 lives lost would be to ensure that these makes are never made again, Hunt said.

1.58pm Hunt said he expects the trust to implement all 18 recommendations for it outlined in the report, and he has asked Monitor to ensure this is done within the necessary timeframe.

1.57pm Hunt said for too long the NMC had the wrong culture and was too slow to act, but he is “encouraged” by the improvements they have made and their apology to patients and their families.

1.56pm Hunt said he has today asked Sir Bruce Keogh to review the professional standards for docotors and nurses, and Sir Bruce will report back to the health secretary later this year.

1.55pm The government received the report yesterday, and will respond to its 44 recomendations in due course, Hunt said.

However, he sais there are some actions that he intends to implement immediately. He said the NHS is too slow to investigate serious incident. He said he today will ask Mike Durkin, director or patient safety at NHS England, to draw up and publish standardised guidelines

1.53pm Hunt said the trust will be reinspected this summer, in which an independent decision will be made about whether to take the trust out of special measures.

1.50pm Hunt has described the failings at Morecambe Bay as a “second Mid Staffs” - both happening over a similar period, whether families faced delay, denial and obfusciation.

He said today’s report with give “serious cause for reflection” who say Mid Staffs was a one-off, local failure.

“The result was not just a tradegy of lives lost” but the “anguish for the lives left behind”, he added.

1.49pm Hunt said what we hear today is not typical of maternity services of in the NHS as a whole.

1.47pm Hunt has apologised to every family who have “suffered as a result of these terrible failures” on behalf of the NHS.

1.46pm Jeremy Hunt has now begun his statement to the House of Commons on the Morecambe Bay Inquiry.

1.40pm The Parliamentary and Health Service Ombudsman’s has also responsed to the Morecombe Bay inquiry.

Managing Director at Parliamentary and Health Service Ombudsman Mick Martin said: “We welcome the report’s recommendations.

“The proposed review of the NHS complaints system to improve the quality of complaint handling at a local level is a step forward and will help patients and their families get answers they deserve when things go wrong. We’ve been calling for changes to midwifery supervision and regulation and expect legislation now.

“We are finalising our memorandum of understanding with the Care Quality Commission to be clear about roles and responsibilities and how we work together in the interests of patient safety.

“As the report states our decision not to investigate was made in good faith and based on evidence at the time. That is not a decision we would make today.

“Since 2009, we’ve been listening and learning from people who use our service and now investigate all complaints concerning allegations of avoidable death.”

1.13pm The TaxPayer’s Alliance has said political point-scoring and ideology “mustn’t get in the way of a proper debate on the NHS”.

Responding to the publication of the report into failings at the University Hospitals of Morecambe Bay Trust, the organisation’s chief executive Jonathan Isaby said: “From Mid-Staffs to Medway to Morecambe, we hear too often of shocking failures of care in the health service.

“Patients deserve far better than the uncritical, childish debate we have in this country about the NHS, which sees political point-scoring and ideology trump improving patient care.

“We can’t keep throwing more taxpayers’ money into a system that doesn’t seem fit for the 21st century, and we have to look to more successful European systems as models for reform.

“The NHS budget has more than doubled since 2000, and it’s during that massive injection of cash that this scandalous care was occurring. The answer isn’t more money, it is fundamental reform of the way the health service operates.”

Representative body NHS Providers said quite a few trusts were holding special board meetings today or tomorrow to decide their response to the latest pricing offer.

The pricing authorities made the offer two weeks ago, after official tariff proposals for next year were scuppered by objections from providers accounting for three quarters of tariff funded services.

Trusts were given a deadline of 4 March to decide whether to accept the deal.

1.00pm BREAKING:Richard Douglas, the Department of Health’s highly influential director general for finance and the NHS, will retire at the end of May.