News review – October 2019

While there were further developments later in the month on preparations for the UK’s withdrawal from the European Union (see news), September began with a series of warnings of the impact of a no-deal Brexit. The British Medical Association claimed the NHS faced ‘being ravaged’ by a double-whammy of a no-deal Brexit coupled with the expected winter crisis. In A health service on the brink: the dangers of a no-deal Brexit, the BMA said a no-deal exit from the EU on 31 October would leave no area of healthcare unaffected. And the impact of no deal would come as the NHS gears itself up for the busy winter period. The BMA urged the government to answer 40 questions on topics such as access to medicines; reciprocal healthcare arrangements; healthcare in Northern Ireland; and medical research.

Thinktanks came together to warn that health and social care would feel the impact of no-deal Brexit most acutely in four areas. In a letter to MPs returning to Parliament after the summer recess, the Health Foundation, King’s Fund and Nuffield Trust said no deal would risk intensifying staffing shortages. It could increase the cost of medicines and medical devices while new border controls could squeeze supplies. UK emigrants returning from EU countries could increase costs and demand pressures, and all impacts of no deal could put even more financial pressure on the NHS at a time when it is transforming care.

Away from Westminster, an access and finance problem may be brewing for the NHS in England. During the month, the Scottish government announced it had reached a five-year pricing agreement for the supply of medicines that will help people with cystic fibrosis. The agreement – with Vertex Pharmaceuticals, manufacturer of Orkambi and Symkevi – gives NHS Scotland access to the drugs at a discount, which remains confidential. The NHS in England has been unable to reach agreement with Vertex, though talks continue. In a response, NHS England said it was disappointed, alleging Vertex remained ‘an extreme outlier’ in its monopoly pricing.

NHS England published guidance on the strategic direction it is taking to tackle fraud, bribery and corruption, which are collectively known as economic crime. The document said that each year the NHS in England could lose up to £1.3bn as a result of economic crime. The guidance said economic crime is unacceptable, and the NHS must have a culture where fraud is neither ignored nor tolerated. NHS England’s priorities on economic crime are addressing patient exemption and dental contractor fraud, as well as fraud investigations and the development of a proactive work plan.

Only 39% of trust leaders believe the current regulatory regime adopted by NHS England, NHS Improvement and the Care Quality Commission (CQC) is working well, according to NHS Providers. Its report found that only 8% of respondents said the regime was good value for money, while 39% felt NHS England had a good understanding of the pressures trusts faced. NHS Improvement fared better – 74% said it had a good understanding, while the figure was 52% for the CQC. NHS Providers said there was a growing tension between the current organisation focus and the move to system working, with only one in five trusts believing regulators take adequate account for system working in their judgement of providers.

Northern Ireland’s Department of Health announced a boost of almost £27m for local GP services in the current financial year. The £26.76m investment includes more than £18m for the acceleration of transformation schemes. The funding includes money for the development of multidisciplinary teams (£11m) and the delivery of elective care in general practice (£3.5m). Up to £4m has been set aside for investment in GP premises, with the aim of supporting multidisciplinary team working and expanding GP training.

There will be a public inquiry into buildings problems at two hospitals in Scotland. The Scottish government said the decision to hold the public inquiry follows concerns about the new Royal Hospital for Children and Young People (RHCYP) and the Queen Elizabeth University Hospital. The inquiry will focus on issues with ventilation and other key building systems. Health secretary Jeane Freeman also appointed a senior programme director to work with NHS Lothian on the delivery of RHCYP. The move follows the publication of an independent review of governance arrangements and an assessment of building compliance.

Clinicians would be given greater flexibility to choose their pension accrual level under proposals for changes to the NHS pension scheme, currently out for consultation by the government. The proposals respond to concerns that clinicians are limiting their NHS work to avoid breaching annual allowance rules, which can lead to significant tax charges. If implemented, clinicians could choose to pay a percentage of the normal accrual level (in 10% increments) and fine tune pension growth towards the end of a scheme year. The consultation also seeks views on whether this flexibility should be extended beyond the clinical workforce (see Pension equity p10).

Wales health and social services minister Vaughan Gething has announced that doctors working in Wales will receive a 2.5% pay uplift backdated to April. In a written statement to the Welsh Assembly, the minister said his decision was based on affordability, the ambitions set out in the A healthier Wales programme and the need to address challenges of equality, recruitment, retention and productivity in the medical workforce. The value of both the national clinical excellence and commitment awards have been frozen, and Mr Gething has asked the BMA and employers to jointly propose how this money could be used to reward the wider consultant workforce.

Staff ‘passports’, which will help workers move seamlessly between NHS organisations, will enable staff to work more flexibly and cut administration costs, according to NHS England and NHS Improvement. The national bodies said all hospitals in England were being urged to adopt passporting – this will reduce the need for staff to attend an induction (which can last two days) and cut red tape when they move between organisations. The bodies also confirmed there will be a £7m fund to support the nationwide introduction of e-rostering.