News review – March 2020

At Westminster, the new Parliament began to move into gear. Aside from the resignation of chancellor Sajid Javid – who was replaced by his deputy, Rishi Sunak – just weeks before the 11 March Budget, a familiar face came back into health politics. Former health secretary Jeremy Hunt was confirmed as the new chair of the Commons Health and Social Care committee. Meanwhile, Meg Hillier was re-elected chair of the Commons Public Accounts Committee.

Getting health and social care staffing levels right will be crucial to the delivery of the NHS long-term plan, and NHS England and NHS Improvement will outline their strategy in the NHS People Plan, due in March or April. However, the government’s announcement of its plans for a new points-based immigration system in February caused consternation. Although the system will make special allowances for the recruitment of NHS staff, there is no provision for social care workers. According to the Health Foundation, 17% of adult social care staff are non-British nationals, while in London the figure is closer to 40%. The King’s Fund praised the recognition of the need for overseas workers in the NHS, but added there are more than 120,000 vacancies in social care. Many people were struggling to access the support needed to live independently and avoid long stays in hospital.

The NHS in England needs the biggest rebuilding programme since The Beatles were in their pomp, according to NHS Providers. While recent capital funding announcements are welcome, they fall well short of what is required. In a new report, Rebuilding our NHS: why it’s time to invest, the providers body said that in a survey of NHS leaders, 97% were worried that their organisation’s capital needs would not be met. The last, and only, major national hospital building programme was in the 1960s, which delivered 95 schemes in its first three years. The government has, so far, announced 40 projects – showing more modest ambition than previous initiatives, NHS Providers said.

A two-year delay in breaking ground on a building project can add 36% to the cost, according to health and care property development company Prime. In its report, Ending change paralysis in NHS estates: how to forge ahead in uncertain times, the company said a three-year delay can increase costs to ‘an incredible, often insurmountable, 49%’. It argued that NHS organisations must create their own momentum to deliver projects sooner, or risk their plans being derailed as costs rise.

The Institute for Public Policy Research (IPPR) urged the government to invest in the primary care estate by allocating £500m a year for a decade to build 1,300 new primary care hubs. The IPPR report, Realising the neighbourhood NHS: delivering a new deal for primary care, also called for the traditional GP partnership model to be phased out. Rather than being independent contractors, GPs should be salaried. This would allow them to focus on patients, rather than managing a business – improving quality and access to care, and addressing workforce shortages.

With some commissioners forecasting an underspend on additional roles funding in 2019/20, NHS England encouraged primary care networks (PCNs) to recruit now to any of the 10 roles included in the scheme from April. Funding for the new roles is included in the new GP contract, agreed between the government and the British Medical Association. There will also be funding for recruitment and retention schemes to deliver 6,000 extra GPs; a renewed focus on improving access; moves to improve vaccination coverage; and an investment and impact fund to reward PCNs that deliver their objectives. The investment fund will be worth £40.5m in 2020/21, rising to £150m in 2021/22, £225m in 2022/23 and £300m in 2023/24.

According to NHS Resolution, a total of 117 trusts achieved all 10 safety actions in the second year of the maternity incentive scheme. The scheme was set up at the end of 2017 to incentivise improved maternity safety. Trusts that achieve all 10 actions recover their contribution to the maternity incentive fund (an additional 10% of the Clinical Negligence Scheme for Trusts maternity premium) and share in any unallocated funds. Maternity claims account for 60% of the annual £9bn cost of harm under the CNST. Details of year three of the scheme have also been published.

NHS Employers has not included specific recommendations in its evidence to the Doctors’ and Dentists’ Pay Review Body (DDRB) for 2020/21. The organisation said junior doctors have a multi-year deal, while any pay increase for specialist and associate specialist (SAS) doctors is likely to be linked to contract reform. Employing bodies have told NHS Employers that they are not in favour of targeting pay at specific specialties or localities.

The NHS invested more than 50% of the apprenticeship levy (£200m) back into apprenticeships in 2019/20, representing a significant improvement on the previous year. NHS England and NHS Improvement urged every trust to aim for 100% in 2020/21. NHS employers were asked recently to review workforce plans to ensure that they make full use of the apprenticeship levy. Chief nursing officer Ruth May insisted that the NHS must increase its nurse apprenticeships if it is to deliver the ambitions of the NHS long-term plan. Almost 1,800 nurse apprentices started their courses over the last two years, but the NHS requires thousands more. Boosting apprenticeships is part of the government’s plan to increase recruitment and retention.