GOOD AFTERNOON and welcome back to reality with my patient safety update after a week of high drama in Westminster. Whatever obsesses SW1 the pressures in the frontline are real and continuing, so this week we look at the Sajid Javid select committee session as well as the RCN staff survey and key announcements on leadership, innovative medicines and HSIB. 

THE SAJ IS BACK Yesterday the Select Committee took evidence from Sajid Javid, Amanda Pritchard, Professor Sir Stephen Powis as part of our inquiry into NHS workforce. Although Westminster attention was focused elsewhere, it was a useful session. Saj confirmed - disappointingly - that the much-vaunted Framework 15 workforce plan would not contain any actual numbers for how many more staff are going to be trained. But he promised those numbers would be in the ‘workforce strategy’ - due by the end of the year. Honestly - but depressingly - he said the publishing the ‘gap’ between what we needed and what we are actually getting was ‘subject to cross-government approval’ e.g. he wants to publish it but the Treasury may still block him. It has taken a ridiculously long time to get proper workforce analysis done and to hear that even then the numbers may be treated as ‘secret’ shows just how scared the government are to reveal what everyone knows to be the case, namely that we are simply not training enough doctors and nurses for the future. Better news was that even though we are struggling to get the 6k more GPs promised by 2024 we do have 1672 more than in 2019. He also promised to tell us when we would get the new midwives and obstetricians recommended by Ockenden.

ROYAL COLLEGE WORKFORCE SURVEY A worrying survey reveals just how bad staffing shortages are with 8 out of 10 nurses saying there weren’t enough staff on their last shift to meet all patient needs safely. Just a quarter of shifts had the planned number of registered nurses and less than 1 in 5 said they had enough time to provide the level of care they’d like. We are constantly told we are on track for 50,000 more nurses (and of course welcome increases in the workforce) but as I have said before ‘more’ does not equal ‘enough.’ Another consequence of staff shortages is this horrific story highlighting how too many women are still not being offered pain relief for hysteroscopies.

MESSENGER REVIEW The review into NHS and social care leadership by General Sir Gordon Messenger has been published today. I met Sir Gordon twice and was very impressed by his openness and willingness to engage. His seven recommendations are pretty sensible and include consistent management standards delivered through accredited training, standardised mid-career training and incentives to attract top management into challenging parts of the system. But the elephant in the room is surely targets: how can we free up managers to be leaders if they are micromanaged by more targets than any other healthcare system in the world? There is an interesting book called Zero written by a certain former Health Secretary which you may have heard makes the same point.

CQC TO HSIB Dr Rosie Benneyworth, CQC's respected Chief Inspector of Primary Medical Services and Integrated Care is set to join HSIB as their new Interim Chief Investigator. HSIB state that she will help guide them as they transition to the Health Services Safety Investigations Body and Special Health Authority for maternity investigations. This is a crucial time for the development of independent investigatory functions and so I wish her well. It also leaves a big gap at the CQC as Rosie was due to be the Chief Inspector of the new ICBs.

INNOVATIVE MEDICINES FUND Modelled on the Cancer Drugs Fund this new £340m fund will give patients early access to life saving treatments. The most promising medicines will be fast tracked and offered to patients whilst waiting a final decision from NICE. The Cancer Drugs Fund was very popular but exploited by drugs companies to charge higher prices than they would otherwise have been able so I hope this fund avoids that trap.

HOSPITAL PROGRAMME DELAYS Sajid Javid insisted the programme to build 40 new hospitals was on track but the Sunday Times and NHS Providers think differently. This was a key pledge so it is vital it gets back on track.

COVID LATEST. The latest ONS figures show a continued fall in cases as 1 in 70 people in England in the community had the virus in the week ending 27th May compared to 1 in 60 for the previous week. The dashboard also sees cases (2.2%) and deaths (28.4%) both dropping but a slight increase in hospitalisations (4%). There are now just over 4,000 people in hospital with the virus but that is actually an increase from the low of 3,800 at the start of the month. Is this being driven by the increase in cases more recent data shows as highlighted by Alistair McLellan? Let’s hope not but it does show we need to stay alert.

THE PLUG Why not forward this email to a friend and get them to sign up here? We are not quite at all 1.4 million NHS employees yet but pretty much all of them are interested in patient safety…

Jeremy Hunt