foi request number 93 2016 - nsft.nhs.uk · the final position means that if a trainee works one...

Compliance Team – Health Records Kestrel House

Hellesdon Hospital Drayton High Road

Norwich Norfolk

NR6 5BE

Tel: 01603 421687 Fax: 01603 421411

FOI REQUEST NUMBER 93 2016

Request and Response:

Please provide all emails sent or received by your Chief Executive on the subject of the new Junior Doctors contract. This should be from 1/2/16 to date. I enclose a copy of the emails sent or received by our Chief Executive on the subject on the new Junior Doctors Contracts for the period 1st February 2016 to 1st April 2016.

The Trust provides a complaints procedure to deal with complaints about the Trust's handling of requests for information. If you feel you need to make a complaint, in the first instance, you should contact a Non-Executive Director via the Chair of the Trust. If you feel you have exhausted our internal complaints procedure, you also have the right and may feel you wish to write to the Information Commissioner who can be contacted on telephone number 01625 545740 or at www.ico.gov.uk.

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Thorley Debbie (NSFT)

From: Scott Michael C (NSFT)Sent: 23 March 2016 08:29To: Johnson June (NSFT); Solomka Bohdan (NSFT)Subject: FW: Face-to-face engagement events on the junior doctors’ contract

For action please Best Wishes Michael Chief Executive NSFT

From: Daniel Mortimer [mailto:[email protected]] Sent: 22 March 2016 17:15 To: Scott Michael C (NSFT) Subject: Face-to-face engagement events on the junior doctors’ contract Dear Colleague

Yesterday in Newcastle my colleagues and I completed the last of the five face-to-face engagement events to discuss the junior doctors’ contract implementation.

Across all the events I had the opportunity to speak to close to 400 HR professionals and medicalworkforce leaders. I would encourage you to continue to support these colleagues to ensure thatthe finalised junior doctors’ contract is implemented from August 2016.

To assist you, please find below a link to the Powerpoint slide deck that was used during the courseof the day (this includes the slides from both the morning and afternoon session). This pack wasadapted during the course of the events to take on board feedback from Trusts and FTs, and maybe slightly different to the version that was shared with you at the event.

You will note from the slides that the details of the contract are being finalised, and I hope to be able to share the final contract with you shortly.

Powerpoint slide pack

You will be able to download the Powerpoint slide deck here. The link will open a Wetransfer page in your web browser, and a download arrow and button will appear, click download to retrieve the slide pack. Please note: This download is only available for the next seven days. If you need to accessthis document after the seven days please email the relevant contact from our nationalengagement service.

North Jane Raven [email protected]

Midlands & East Amanda Rose [email protected]

London Bernadette El-Hadidy

[email protected]

South Liz Gambrell [email protected]

Freedom of Information Request 93 2016 Page 1 of 50

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Webinars

Although the face-to-face engagement events have now come to an end, we are continuing to hostwebinars for HR and medical directors. The next webinar will take place on Thursday 24 March,you can book your place now.

We will also be scheduling webinars for your medical staffing leads once the details of the contact are shared with you. If you have any comments, or there are any additional resources that would support you, please email me at [email protected] Yours sincerely

Daniel Mortimer

Chief Executive, NHS Employers


2 Brewery Wharf

Kendell Street Leeds LS10 1JR

Tel 0113 306 3000 Fax 0113 306 3001

[email protected]

www.nhsemployers.org

11 February 2016 Dear Colleague, I want to explain and provide you with context to the position on the junior doctors’ contract. I have enclosed a copy of the letter I sent to Mark Porter and Johann Malawana on 9 February. This outlines the much improved offer that was made at a meeting at Tavistock House earlier in that day which was also attended by Clare Panniker and Danny Mortimer. Before making this offer, Clare and I consulted with the senior reference group who have been assisting us since early January and also a wider group of senior leaders in the NHS in England: all of whom agree it needed to be fair and reasonable for doctors in training and for the service. The offer provided an improved position on the substantive issues that had not been agreed when talks under the auspices of ACAS concluded on the evening of 29 January. These are summarised below. Unsocial Hours In my 16 January letter to Dr Malawana, I described revisions to the hours designated as 'plain-time': Monday to Friday, 0700 to 2100 and Saturday 0700 to 1700. I confirmed to the BMA that NHS Employers would move significantly further than the current offer and that all junior doctors who work 1:4 weekends or more would receive premium pay for all the Saturdays they work. This would mean, based upon our assessment, of a representative sample of Trusts, that about half of trainees who work Saturdays would get paid a premium rate. This was a substantial improvement on the 1:3 current offer where we assessed that c.15% would have received premium pay. The final position means that if a trainee works one Saturday a month they will be paid the premium rate and a trainee that works a less frequent ‘unsocial hours’ shift pattern will not. I believe this is a fair final positon. Non-Resident On Call Our current offer proposed to pay a top-rate availability supplement to junior doctors working non-resident on call of 10% for a 1:4 rota and 5% for those on less than a 1:4 rota. I confirmed to the BMA that our improved position would pay a higher rate to ST1 and ST2 doctors based on applying these percentages to the ST3-ST7 nodal point, and making these higher sums available to ST1 and ST2 doctors. We assessed this would provide an increase, above the current offer, of over £1000 to ST1 and ST2s, who work a 1:4 rota, and over £500 for those who work less than a 1:4 on call rota. The final position means effectively introducing flat rate payments so that trainees experiencing a higher frequency of on-call will get paid more and those earning less will get proportionately higher payment. I believe this is a fair final position.

Letter to all NHS Chief Executives


Fines and Pay for Work Done Where a doctor breaches their hours protection under the EWTD (ie 48 hours) or works greater than 72 hours in a week, our current offer would have provided a pay rate of time and a half (150%). I confirmed to the BMA our willingness to make an improved offer for the doctor to receive a double time excess hours’ payment. Implementation I also confirmed that the terms of the contract would be introduced by employers in a phased manner over 12 months from August 2016, with the anticipation that implementation would be completed in 12 months. The Guardian role would be introduced in every employer in August 2016, and I proposed that the BMA and NHS Employers would jointly monitor this implementation. This phasing satisfies the concerns of the BMA that we would be ‘rushing’ into implementation and I believe this is a fair and reasonable final position. Review into Improving the Welfare and Morale of Doctors in Training It is also very clear that no matter what the content of a final contract, no contract will make a bad employer a good one, or a disinterested supervising consultant one who takes a greater interest in the training support and welfare of a trainee. It has seemed to me that much of the dispute is not solely, or even significantly, about the terms of the contract, but are an expression of more profound issues which go far beyond any contractual changes. Throughout the discussions between NHS Employers and the BMA, both parties have maintained that a settlement should protect the safety and welfare of doctors in training and enable a safe and effective service for the NHS. Both parties have acknowledged that there are underlying issues which, over a number of years, have created the conditions for doctors in training to feel a high level of discontent. I have reconfirmed my strong recommendation that an urgent review of these long standing concerns should be established which can make meaningful recommendations to improve the welfare and morale of trainees. The conduct of this independent review, to be commissioned by the Academy of Medical Royal Colleges, Health Education England and NHS Employers, must also ensure that the voices of junior doctors are directly and personally heard. A Safe and Fair Contract Much has been said about how the proposed contract supports safe working practices and safe patient care. I confirmed that the proposed contract would provide further enhanced safeguards for protecting trainees from excessive hours worked and consecutive long shift patterns, for example:

No doctor will ever be rostered consecutive weekends; The maximum number of consecutive nights will be reduced from 7 to 4; The maximum number of consecutive long days will be reduced from 7 to 5; The maximum number of consecutive days will be reduced from 12 to 8; There will be a 48 hour limit of 48 hours per week, worked on average over 26

weeks, and an absolute contractual limit of 56 hours where a trainee has opted out of working time Directive; and

A new role of ‘Guardian’ within every Trust, who will provide safeguards against excessive working hours in every workplace and the Guardian will have the authority to impose fines on an employer for breaches to agreements in the contract.


These go further than the arrangements within the current contract and are in the interests of safe working practices of trainees. There have also been many statements in the media regarding the extent to which the contract supports the NHS commitment to provide safe and reliable care across the 7 days of the week. NHS Employers are committed to deliver the agreed Clinical Standards which focus on the care to be provided (timely assessment, effective clinical decision making and proper handover) for patients requiring emergency and urgent care, and also those in-patients who require regular review. Doctors in training already provide a significant level of service across all hours of the day and it is likely that the additional service which will be required of them will be comparatively smaller than that required from other staff. Nevertheless, as the workforce grows then increased numbers will enable supplementary deployment. I can confirm that the contract makes no requirement for existing trainees to work additional weekends and it is not designed to dilute the numbers of staff working over Monday to Friday. The contract is designed to future proof the NHS so that the costs of deploying additionally employed staff are not prohibitive to achieving the agreed NHS Clinical Standards of safe and reliable care every day of the week. Conclusion Intermittent negotiations have been ongoing since 2012. There has been substantial progress since the end of last year and all significant issues associated with safety and training had largely been addressed before Christmas. Despite the most recent progress and substantial agreement on many elements of the contract, the BMA has refused to compromise on its insistence that the whole of Saturday must be paid at a premium rate. In contrast Employers position has moved several times, on each occasion offering more hours attracting premium pay. Regardless of these changes no agreement has been possible. It became clear that the only way to move forward was to make a 'best and final' proposal in the hope that this would lead to settlement. At the meeting on Tuesday I stressed that this significantly improved offer was the best and final position on the substantive issues which remained outstanding. We discussed the importance of ensuring that BMA members had the opportunity to understand the final offer and I confirmed, at their invitation, that I would be happy to present the offer to the Junior Doctors Committee (JDC) on 20 February 2016. I asked the BMA to confirm to me in writing that they would publicly recommend the best and final offer with respect to these substantive issues, to the JDC and recommend that the committee endorse it as the proposition to be put to their members. I further confirmed that I would need to know by 3pm yesterday at the very latest, whether the BMA Council Chair and the Chair of the Junior Doctors' Committee were both prepared to back the proposals and recommend their acceptance to the JDC. I made it clear that if they could not provide this confirmation then I would be left with no other conclusion than there being no realistic prospect of a negotiated agreement. Following consultation with Chief Executives and other leaders in the service, I am clear that the NHS needs certainty on this contract and that a continuation of a dispute, with a stalemate and without any clear ending, would be harmful to service continuity, with adverse consequences to patients. I received confirmation that this positon is supported by both the NHS Confederation and NHS Providers, together with support from Chief Executives across the country.


Both parties, NHS Employers and the BMA, knew that I had hoped for a resolution by the end of January and had stated that we needed certainty by the middle of February at the latest. The remaining substantive issues are not new, and I had hoped that my last effort in making the improved offer would resolve these. As I did not receive the confirmation which I requested from the BMA, I regrettably concluded that we must now have reached the end of the road in relation to the likelihood of achieving a negotiated settlement. I communicated this position in the attached letter to the Secretary of State and let him know that the ball was in his court to take the action which he deemed necessary to introduce a new contract which reflected the best and final offer put to the BMA on 9 February. This is a deeply disappointing position and I remain perplexed why the BMA negotiators have not been able to see that agreement is always found between two points of view. I have huge personal regret that my contribution has not been able to secure the settlement so longed for by everyone. I very much hope that the service can rapidly find ways to engage with and support the Review I have recommended, in the hope we can build a new basis for improved morale and teamwork. Finally, I would like to pay tribute to Danny Mortimer and his team from NHS Employers and associated DH staff, for their outstanding support to me and Clare during the last 5 weeks. Yours sincerely

Sir David Dalton Chief Executive Salford Royal NHS Foundation Trust


2 Brewery Wharf

Kendell Street Leeds LS10 1JR

Tel 0113 306 3000 Fax 0113 306 3001

[email protected]

www.nhsemployers.org

9 February 2016 Dear Mark and Johann I really appreciated the opportunity to meet today to consider whether we could make any further progress on the substantive outstanding issues of the junior doctors' contract. As you know we have reached substantial agreement on the issues of safety and training and have been discussing these and the components of our best and final proposition on the contract, with ACAS support, over recent weeks. Today was the opportunity to place an improved offer to you on those substantive outstanding issues. Thank you for your consideration of these issues which I outline below: Unsocial Hours In my letter of 16th January 2016 I described revisions to the hours designated as 'plain-time' (Monday to Friday, 0700 to 2100 and Saturday 0700 to 1700). Following our discussions I can now confirm that the NHS would move significantly further than the current offer and that we would also pay premium rates to all junior doctors who worked 1 in 4 weekends or more for all Saturdays they worked. This would mean, based upon our assessment, that the majority of trainees who work Saturdays would get paid a premium rate for working Saturdays. This is a substantial improvement on the current offer where we assessed that c. 15% would have received premium pay. Non-Resident On Call Our current offer proposes to pay a top-rate availability supplement to junior doctors working Non Resident On Call of 10% (for a one in four on call rota) and 5% for those on a less than one in four. I can confirm today our improved position to pay a higher rate to ST 1 to 2 doctors based on applying these percentages to the ST3 to 7 nodal point and making these sums available to ST1 and ST2 doctors, we assess this would provide an increase of over £1000 to ST1 and ST2's Fines and Pay for Work Done Where a doctor breaches their hours protection under the EWTD (ie 48 hours) or works greater than 72 hours in a week, our current offer would provide a pay rate of 150%. I can confirm an improved offer for the doctor to receive an excess hours payment of double (200%) of the prevailing hourly rate, and the same amount would be levied as a fine held by the Guardian. Implementation As discussed the terms of the contract will be introduced by employers in a phased manner over 12 months from August 2016. It is expected that implementation would be completed in 12 months. The Guardian role would be introduced in every employer in August 2016, and we agree that the BMA and NHS Employers would jointly monitor implementation.

Dr Mark Porter and Dr Johann Malawana British Medical Association BMA House Tavistock Square London WC1H 9JP


Throughout our discussions we have both agreed that a settlement should protect the safety and welfare of doctors in training and enable an effective service for the NHS. I am pleased that we continue to share this position. We have both acknowledged that there are underlying issues which have created the conditions for doctors in training to feel a high level of discontent. I repeat my assurance that I will strongly recommend that a Review of the long standing concerns should be established which can make recommendations to improve the welfare and morale of trainees. The conduct of this review, in addition to including the Academy of Medical Royal Colleges, Health Education England and NHS Employers should also ensure that the voice of junior doctors is heard in partnership with the BMA. I must stress that this significantly improved offer is the best and final position on the substantive issues which are outstanding. Since the start of my involvement I have always been clear that I wanted to achieve a position which was 'fair and reasonable' and which would carry the support of the Service. Following involvement of a senior reference group and a more wider involvement of other senior leaders in the NHS, I can confirm that this improved offer is judged as having achieved this objective. We discussed the importance of ensuring that your members had the opportunity to understand the final offer and I am happy to present, at your suggested invitation, to the JDC on 20 February 2016. Furthermore, I can confirm that NHS Employers are happy to work with you, as suggested, to prepare the full package of offer materials to be presented to your membership in any referendum. NHS Employers also confirm that they are happy, as requested, to share the rota data with you. As you will know from my previous letter, I have gone on record in saying that the service needs certainty on the contract by the middle of February at the very latest. The issues under discussion are not new, and it is absolutely vital that the service has resolution and clarity of these issues as soon as possible. I therefore believe that it is crucial that I have a clearer understanding of the endorsement you will give to this final offer if I am to be able to recommend to government that it proceeds in the way that you have suggested. I ask you to confirm to me in writing that you would publicly recommend this best and final offer with respect to these substantive issues, to the JDC and recommend that they endorse it as the proposition to be put to your members. I therefore ask you to let me know, by 3pm tomorrow at the very latest, whether you are both prepared to back the proposals and recommend their acceptance to your JDC. It is not possible to offer an extension to this deadline. If you are not able to give me the assurance, I ask for in this letter, I need to be absolutely clear that I will assume that there is no realistic prospect of a negotiated agreement. In that circumstance I will advise the Secretary of State that we would have reached the end of the road in relation to the likelihood of reaching a negotiated agreement. Yours sincerely

Sir David Dalton Chief Executive Salford Royal NHS Foundation Trust cc: Danny Mortimer, CE, NHS Employers


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From: Scott Michael C (NSFT)Sent: 11 February 2016 10:29To: Ball Sarah (NSFT); Solomka Bohdan (NSFT)Cc: Howlett Leigh (NSFT); Julie Cave ([email protected])Subject: FW: Letter to chief executives on the junior doctors' contractAttachments: Letter to CEOs re JDs 11 Feb.pdf; J Malawana and M Porter BMA 09 02 16.pdf

Hi Thought this may be of interest to you all Carol From: David Dalton [mailto:[email protected]] Sent: 11 February 2016 10:25 To: Scott Michael C (NSFT) Subject: Letter to chief executives on the junior doctors' contract

Dear colleague

Please find attached a letter outlining the latest position on the junior doctors' contract and a letter I sent to the BDM JDC on 09 February.

Kind regards

Sir David Dalton

The NHS Confederation Registered Address: Floor 4 50 Broadway London SW1H 0DB Registered Company No: 05256894 Registered Charity No: 1090329 Confidentiality notice This communication contains information which is confidential and may also be privileged. It is for the exclusive use of the intended recipient(s). If you are not the intended recipient(s), please note that any distribution, copying or use of this communication or the information in it is strictly prohibited. If you have received this communication in error, please notify the sender immediately, delete the message from the computer and destroy any copies of it.


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From: Scott Michael C (NSFT)Sent: 16 February 2016 17:13To: Solomka Bohdan (NSFT); Ball Sarah (NSFT); Johnson June (NSFT)Subject: FW: Next steps and support on junior doctors contract

Fyi Best Wishes Michael Chief Executive NSFT From: Rob Webster [mailto:[email protected]] Sent: 16 February 2016 16:51 To: Scott Michael C (NSFT) Subject: Next steps and support on junior doctors contract

Dear Michael,

Following the Secretary of State’s announcement to the House last Thursday, I wanted to share some insights into the current state of play and to let you know how we will be assisting our members with the introduction of the new junior doctors contract.

The introduction of the contract is contentious. We fully supported constructive discussions throughout the four years of negotiations and it is of real regret that, having made so much progress on the contract in so many areas, full consensus could not be reached. We believe that the offer rejected by the BMA, without due consideration or discussion, was fair and reasonable. We also believe that the failure of the BMA to negotiate following a series of concessions by the Government is a significant contributor to the Secretary of State’s decision to introduce the new contract. The NHS Confederation's priority now is to support our members through what we know will be a difficult and contentious process of implementation. Our focus will be to improve relations with doctors and to give you direct support. Junior doctors are a critical part of our workforce and the issues that affect them go beyond the contract and into training, rota design, senior attitudes and change. We welcome the work Dame Sue Bailey has been asked to do in reviewing measures outside the contract that can be taken to improve the morale of junior doctors and will provide support for this work in any way we can. In terms of practical support, it is clear there is an expectation from National Bodies that CEOs and their teams will be able to engage with junior doctors and their representatives to explain and introduce the new arrangements. NHS Employers has produced a number of resources to help in the immediate term, including:

A new at-a-glance factsheet setting out the key points of the contract which senior teams can share in discussions with junior doctors and consultants.

A board presentation pack, summary booklet and FAQs available on the website. An online enquiry form that allows you to submit questions on behalf of your junior doctors.

NHS Employers will use these questions to update the existing FAQs.


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Regular webinars for HR and medical staffing teams covering more detailed technical questions about the contract and its implementation. Joining details will be available on the NHS Employers events web page shortly.

A series of regional face-to-face briefings for your HR and medical staffing teams. These will also be on the events section of the NHS Employers website shortly.

Further resources will include an updated online pay system demonstrator and more guidance on the details of the contract. We know implementation of this new contract will be a test for everyone. We must get this right for benefit of the people we all serve - patients, their families and carers, NHS staff and the wider public. We will do everything we can to support you. Rob Rob Webster Chief Executive NHS Confederation


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From: Scott Michael C (NSFT)Sent: 15 February 2016 12:34To: Armstrong Alison (NSFT); Cave Julie (NSFT); Howlett Leigh (NSFT); Nesbitt Robert

(NSFT); Sayer Jane (NSFT); Solomka Bohdan (NSFT); White Deborah (NSFT)Subject: FW: NHS Confederation Friday note

Best Wishes Michael Chief Executive NSFT From: David Hare [mailto:[email protected]] Sent: 12 February 2016 14:23 To: Scott Michael C (NSFT) Subject: NHS Confederation Friday note

Dear Michael,

Welcome to the Friday note,

I’m standing in for Rob today, bringing you a summary of what the Confed group has been up to during another eventful week for health and care.

Following industrial action earlier in the week, the junior doctors’ contract negotiations came to an impasse on Thursday with Jeremy Hunt taking the decision to implement a contract without agreement from the BMA. There has been some confusion over David Dalton’s letter to Jeremy Hunt. As Sir David Dalton made clear, the statement that chief executives, NHS Confederation and NHS Providers agreed to was confirming that the best and final position was considered fair and reasonable, and that they believed the NHS needed certainty and not continuation of the stalemate. Our priority now is for NHS Employers to work with trusts to ensure that they have the support they need to help introduce the new contract.

A number of barometers showing how the NHS is performing under considerable pressure and increased demand were published this week. The Nuffield Trust and Health Foundation published a report on winter pressures reinforcing what you are already telling us, that it’s winter all year round. Equally the latest performance figures show the increasing pressure on elective treatments, with the 18 week target being breached for the first time in seven years. We continue to strongly highlight that these ongoing pressures are symptomatic of wider demands across health and social care and that all parts of the service must work together in the best interests of patients to turn the position around. I believe that the independent sector has a crucial yet currently under-utilised role to play here across elective care, diagnostics, clinical home healthcare and primary and community services and expect the fledgling public/private partnerships already observed across the service to develop considerably in the months and years ahead.

Today the OECD have published a report on quality in healthcare in the United Kingdom. The report confirms the findings of previous research that have sought to compare performance between the four health systems, concluding that no consistent picture emerges of one performing better than another. What it does show is that there is significant scope for more collaboration between the four nations to learn from one another. This is where the Confed can really help with Welsh and Northern Ireland members as part of the Confed group.


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The NHS Confederation is all about partnership working and this week we were delighted to have a strong presence at the Association of Ambulance Chief Executives Ambulance Leadership Forum. Ambulance services have an important role to play in helping deliver the new models of care and this was a great opportunity to learn more about the innovative work already being done.

Two important documents were published this week. Monitor have published the tariff consultation for 2016/17. There is nothing unexpected in this. Our focus is to help improve engagement and ensure the whole sector has the opportunity to shape how prices are set and to voice concerns where necessary. We need to learn from the mistakes of the past where the sector wasn’t properly engaged in the process and are working closely with all partners to improve engagement ahead of 2017/18.

NHS Improvement’s implementing the Forward View: Supporting providers was also launched at a conference in London. The document sheds more light on NHS Improvement’s strategy for working with providers to develop an effective improvement offer alongside their legal duties as the economic regulator of the service. The report makes a number of welcome commitments including supporting ongoing and important work which is emerging between public and independent sector organisations and stressing the need to strengthen national and local collective system leadership to succeed.

The NHS Confederation is busy working with Jim and his new team to further strengthen our relationship and our Director of Policy, Johnny Marshall, is hosting a roundtable with senior colleagues from NHS Improvement and members from across the group on Tuesday 23 February. The roundtable will explore how NHS Improvement’s role will be different from that of its predecessor organisations, and what it can do, working together with NHS England, to enable local organisations from the statutory and non-statutory sectors to work together more closely. Places are still available so please do get in touch by emailing [email protected] if you would like to join the discussion.

We continue to work with all the national bodies to make sure you are well represented. We met with many of you and the CQC on Tuesday to discuss the key proposals in the regulator's 2016-21 strategy and help inform our formal consultation to the response. Thank you to everyone who attended and if you would like to feed in any further comments please email [email protected]

On Tuesday NHSCC Chief Executive Julie Wood gave evidence at the Health Select Committee’s inquiry into public health. The Committee were interested in a wide range of topics including devolution, funding, data and health and wellbeing boards. Also on Tuesday an Independent Commission led by Nigel Crisp published its report on adult acute mental health care. As David Dalton highlighted in his response to the report, this is not just about beds but is about understanding why people are admitted and why it can be difficult to discharge some people. The report rightly recognises this. The real answer is to ensure people can get care when and where they need it most. You can also read NHSCCs response to the report on their website.

Finally some weekend reading with two great blogs on NHS Voices on the themes of supporting an older population. Lord Filkin writes on the importance of fostering healthy ageing while Elisabetta provides insights from Italy on managing the chronic conditions of an aging population.

Have a great weekend

David

David Hare Chief Executive


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NHS Partners Network


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From: Scott Michael C (NSFT)Sent: 02 February 2016 12:23To: Armstrong Alison (NSFT); Cave Julie (NSFT); Howlett Leigh (NSFT); Nesbitt Robert


Best Wishes Michael Chief Executive NSFT From: Rob Webster [mailto:[email protected]] Sent: 29 January 2016 14:50 To: Scott Michael C (NSFT) Subject: NHS Confederation Friday note

Dear Michael,


In this fragmented and conflicted system we now work in, who do you trust and where do you find out what is really going on? Mixed messages from ALBs, political spin and media leaks of draft documents parading as official guidance mean it has never been harder to discern the important from the inconsequential and the meaning from the mire. One of the key roles we fulfil is to help to do this as a trusted voice on the issues that matter.

We can do this because we do the hard yards behind the scenes with politicians, ALB chiefs and the most influential in health and care – as well as spending time with each of you. This week has been no different with productive time spent with people like Ben Gummer, Simon Stevens, Jim Mackay, Sarah Wollaston and Ian Cumming representing your views and influencing their actions; and a great visit to Weston Hospital and a regional chair and chief executive dinner in the South West exposing the brilliant work that goes on in the midst of the pressures we face each day.

And we lead on issue that make the biggest difference, building movement to drive momentum for change. Published on Thursday The Commission on Improving Urgent care report really demonstrates how the NHS Confederation can bring all parts of the system together to find solutions to problems, showcase some the excellent work already happening and disseminate best practice across the service. With the help of Dr Mark Newbold as chair, the commission didn’t look at the issue of older people’s care as an ‘acute problem’ or a ‘social care problem’ or a ‘primary care problem’, instead it brought key players together to understand what we could all do differently and learn from organisations who have got this right. We’ve had a fantastic response to the report and it received widespread media coverage as well as a mention in a Commons debate by Sarah Wollaston.

One of my aims is for the Confed to go beyond the papers and into practice, and the next phase of the commission is to focus on implementation. Over the coming months we will be working to embed the principles of the report and make positive improvements to how we deliver care for older people. Because the best practice examples save lives and money. They are backed by the Royal Colleges, patient groups and the managerial representative organisations.


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Take a look and ask how they can be implemented in your system and contribute to your Sustainability and Transformation Plan.

We are working with the ALBs to speed up the planning guidance. Drafts are in circulation and we are making sure they are fit for purpose. We will continue to press for more frequent communication and better engagement. Because you need to know and they need to understand the fantastic work that goes on in the service.

Three great examples:

Monday saw the launch of Care City, an innovative health ageing centre in North East London. This ground-breaking collaboration between North East London NHS Foundation Trust (NELFT) and the London Borough of Barking and Dagenham aims to improve the health of the local community and also act as a catalyst for regeneration in the area. You can read more about the project from two of the collaborators, John Brouder, CEO of NELFT and Anne Bristow from London Borough of Barking and Dagenham who have blogged for us on NHS Voices.

On Wednesday NHSCC shared further best practice in clinical commissioning with a series of case studies on diagnosis and prevention. The case studies demonstrate how CCGs are taking the lead in preventing illness and the causes of ill health – and working to keep people out of hospital.

I’ve been out and about seeing some best practice in action at Weston Area Health NHS Trust, which is definitely open for business under the leadership of James Rimmer. Weston is a brilliant example of how award winning services – like the excellent EdibleEddie programme on tissue viability – sit alongside new innovations driven by staff in an organisation that has faced structural uncertainty and financial stress. James’ team showed how backing staff and building an engaged model of leadership can start to change culture and care.

Sometimes we must go further afield – and the Confed took 27 representatives from some of the vanguard and pioneer sites to Almelo in Holland this week to see first-hand the innovative way care is being delivered to people in their own homes. The Buurtzorg concept is very simple – the patient is at the centre of their care, they choose and help co-design the care they receive and it is all carried out by a team of self-managed nurses who have complete autonomy over the decisions they make. This has resulted in better outcomes for patients, economic savings and a better overall experience for patients, their families and importantly also for staff. Thank you to the European Office for organising this trip.

And when the rhetoric is damaging, or plans are flawed, we say so. The Welsh NHS Confederation have worked with Health and social care organisations to outline ten actions they would like the political parties to commit to in order to improve health, social care and wellbeing in Wales. The political rhetoric in Wales is set to “stun” and on Thursday there was the usual wrangling over whether England has a better health system than Wales. This tit for tat squabbling is unhelpful when we know the incredible pressure the health service across the UK is under and that the focus needs to be on transforming care for patients.

The CQC have now published their draft strategy consultation which supports a shift in focus, moving away from solely regulating individual organisations and towards health and care services in local areas and for local populations. We believe this would better reflect the impact that healthcare providers can have on each other and support them to work together to offer more joined-up care for patients. We will be canvassing your views on the strategy at a roundtable in February and you can also send your views to [email protected]

So who can you trust when the noise becomes a cacophony? This is a massive question when it comes to the Junior Doctors contract. NHS Employers, with the support of Sir David


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Dalton, are continuing negations to find a resolution to the junior doctors’ contract. You will have now received a special Chair and CEO briefing via TDA/Monitor on progress to date and are encouraged to read this and share with your boards. We will continue to keep you informed, with significant detail from NHS Employers going regularly to your HRDs.

That’s what I think but am I right? Thank you to everyone who has completed our membership survey. If you’ve not done so already there is still time to have your say. Look out for an email reminder in your inbox. For those who read our regular publication The Insider we are also keen toget your thoughts on how we can improve it. Take our quick survey and be in with a chance to win a free place at our annual conference in June.


Rob

Rob Webster Chief Executive NHS Confederation


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From: Scott Michael C (NSFT)Sent: 21 March 2016 16:52To: Armstrong Alison (NSFT); Cave Julie (NSFT); Howlett Leigh (NSFT); Nesbitt Robert


Best Wishes Michael Chief Executive NSFT

From: Rob Webster [mailto:[email protected]] Sent: 18 March 2016 17:50 To: Scott Michael C (NSFT) Subject: NHS Confederation Friday note

Dear Michael,

Welcome to the Friday note

The language we use can connect us, it can divide us and it can define us. In the NHS we have our own array of acronyms and terms that often feel like another language. The popularity of our Acronym Buster shows how opaque our language can be and the #Hellomynameis campaign was born out of a desire for patients to be treated with respect as equals rather than be labelled as “the tumour in bed 7”.

As a senior civil servant, I became quite skilled at “finding ever more elegant ways of not saying what I really meant”. This came in handy with certain ministers and in difficult public situations where neutrality had to be maintained. Fortunately I am no longer a civil servant and can be clearer about what I mean – which was apparent at our event with the Nuffield Trust on #Daringtoask about whether the NHS was on the brink of disaster or serious transformation. My summary was that we cannot collude with anyone who states we have a clear plan on how to deliver the 5YFV.

The PAC published a scathing report on acute hospital finances on Tuesday that seemed to agree – they certainly have no qualms about saying what they mean either. The report suggested there was no credible plan for turning around the NHS finances and that national bodies were acting too late. What is clear is that there is an urgent and pressing need to reform the financial system of reward and risk in the NHS. Too often the incentives work against whole person care. We also need support from politicians and regulators to change services, change finances, and change a culture looking at performance based on individual hospitals, into one that measures and supports the whole system.

Prevention and social care are both contributing factors to a successful future. It was disappointing that underfunding of social care was not addressed in the Budget – especially as a 32% increase in people stuck in hospitals due to the unavailability of social care contributed to January showing the worst NHS performance results in recent history. The proposed sugar tax is expected to raise £500m which is a drop in the ocean compared to the funding gap in public health spending. Business rates are also due to be cut which again will not help local government raise vital funds for social care.


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We must hope that the STP process is given the space and the support to succeed. The 44 geographic areas that will bring together local health and care systems to transform care, as mandated by the NHS planning guidance, were revealed on Tuesday, alongside a small number of the senior leaders who will coordinate them. Old thinking suggests that these “leaders” are now “in charge”. This isn’t the case statutorily, legitimately or practically.

My take on this is that these networks of organisations now have lead CEOs who should be supported to deliver changes to their local services, with good relationships and respect at their core. This means a robust package for all 44 patches. You’ve told us that in order to transform services, you need a joined-up approach from the national bodies. This must improve as 86 per cent of you feel the national bodies work in a contradictory way, and the majority feel that their policies do not support local transformation. We must avoid excessive control from the centre, which is in danger of stifling local ambitions to transform local services.

All parts of the service have a role to play, including the independent sector. Our NHS Partners Network have produced a guide on how this support could be realised in three specific areas, capital, capacity and capability – each of which are essential ingredients. You will note the language here and the fact we have used alliteration but avoided the usual word associated with this sector : “Competition”. “Collaboration” is more appropriate now. You can download the guide on our website and if you’d like to find out more please contact [email protected].

More guidance, support and evidence is being made available on a regular basis. We have also produced an interactive timeline for transformation with all the key dates and useful links. We will continue to support the development of new arrangements and our director of policy, Johnny Marshall wrote to you all this week, sharing the work we are doing with NHS England and NHS Improvement on your experiences so far. NHSCC has also written in similar terms.

Place based regulation is part of the future and we have submitted our response to the CQC strategy consultation on how this might happen. Thank you to all of you who provided feedback. Our submission shows support for the proposed direction of travel. We have however raised a number of significant challenges and concerns. A summary and the full consultation response is available on our website. We are also expecting a decision on the CQC fees consultation imminently.

Our people continue to be front and centre of the NHS story. Also announced in the Budget were changes to pensions which will impact on the NHS in 2020. There are no accurate figures on what the impact will be at present because pensions figures will need to be updated with 2018 data and mined by the actuaries. Our own estimate, based on current pro-rata division of public sector liabilities, is around £600m. For full details on all the issues in the budget relevant to employers and the NHS workforce see the NHS Employers website.

Danny Mortimer and his team have been touring the country explaining how introduction of the new junior doctors contract will be delivered. These have been very well attended. The contract was subject to a great deal of conversation and some interesting language at the Presidents’ Dinner for Royal Colleges and Partners at the BMA. We continue to work hard behind the scenes to understand and act in any way we can in these febrile times.

I spent time with graduate trainees today, talking about leadership and their future. Variability, uncertainty, complexity and ambiguity will be a big part of their lives – as will a need for clarity of purpose and clarity of values. Other staff new to careers in the NHS include apprentices and NHS Employers has produced a briefing to provide an overview of key policy changes around apprenticeships, including the apprenticeship levy and public sector apprenticeship targets. The briefing suggests key actions that boards may wish to take to obtain the maximum benefit from these policy changes, and a set of key questions to consider. We will be following up with chief executives next month to build a picture of confidence levels in these areas and to shape our national offer of support for employers.


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It’s been a big week politically in Wales and on Tuesday the Welsh Confederation held a health hustings. The event saw around 80 people from across NHS Wales, independent, third and voluntary sectors, pose questions around the pledges and priorities of five political parties ahead of the National Assembly Elections in May. With health a key issue in the elections, the themes that emerged during the debate included the recruitment and retention of the workforce, integration, finance and addressing public health challenges.

Finally a few leadership changes here: welcome to Louise Scull and Julia Hickey, Chairs of Nottingham University Hospitals NHS Trust and Gateshead Health NHS FT who have joined as trustees. Congratulations to Jim Easton who has been appointed as chair of the NHS Partners Network, Bev Humphrey who has been elected Chair of the Mental Health Network and Graham Jackson who has been elected co-chair of NHSCC.


Rob



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From: Scott Michael C (NSFT)Sent: 01 April 2016 17:18To: Armstrong Alison (NSFT); Cave Julie (NSFT); Howlett Leigh (NSFT); Nesbitt Robert


Best Wishes Michael Chief Executive NSFT

From: Rob Webster [mailto:[email protected]] Sent: 01 April 2016 13:16 To: Scott Michael C (NSFT) Subject: NHS Confederation Friday note

Dear Michael,


It’s April Fool’s Day and HSJ came up with a reasonable effort this year. In the current political world of #Brexit it is often difficult to separate reality from the risible so it must have been tougher this year.

What’s no joke is the number of changes that come into force on 1 April. Our indispensable guide to all of the changes is available here and covers everything across all sectors. One for all company secretaries and Chairs to enjoy cross checking against local governance and delivery mechanisms.

This week saw the publication of NHS England’s Business Plan and the creation of NHS Improvement. These changes signal another move towards a different approach to delivery of the 5YFV. This is often a place based focus and one where organisations are expected to collaborate to be sustainable. We look forward to these behaviours being modelled by the national bodies.

This won’t be easy for them or us. This week we received the news that CQC will be pressing on with a substantial increase in fees, aiming to cover all costs from inspected organisations within two years. This will leave a sour taste in the mouths of many for two reasons. Firstly, consultations must be genuine and this one feels like a four year recovery was a distant possibility. Secondly, the CQC must demonstrate better value for money if it is to maintain the respect and goodwill of an NHS and care sector on the efficiency rack. I mentioned last week our member survey results which reflect little confidence in the regulator’s ability to support transformation or provide value for money. The senior leadership of CQC have seen the detail. We will continue to press on this.

Notably, this week we saw a group of leaders step forward as NHS England announced the full list of STP area leaders. We’ve been clear about the support, freedom and flexibility these leaders will need from the national bodies and will be working to ensure that this is the case.


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As one of these leaders in West Yorkshire, I will be working with local CEOs and Council leaders, building on partnerships and strong relationships across the system. STPs should be ours not a bureaucratic exercise to appease HMT or anyone else. I am looking forward to the challenge, and I am determined to show that the best way to enable transformation is to resist the pressure from the centre to revert to the old style of leadership. Any FT leader will tell you that their freedoms have already been eroded. CCGs are too often prescribed courses of action by NHS England - you may have seen the story in the Guardian about the £600m hospital fines being levied on providers over patient targets. What the story could perhaps have made clearer is that commissioners are now mandated to impose fines and are prohibited from reinvesting this money in the local system. NHSCC issued a response and rightly say this policy hampers local efforts for organisations to work in partnership and drive improvements to care.

The only answer to the issues that face us is to embrace the laws of subsidiarity and plan as close to the problem as possible. That will require working on most issues at a local level and some issues on bigger footprints - and this must be a local choice. Speaking to many of you and senior figures in the system, I know this will be no easy task.

After some detailed work, NHS Employers published the full terms and conditions of service for junior doctors, now available on NHS Employers website. Along with the contract there are a number of supporting resources including a model contract, a communications toolkit, an A-Z reference guide for the terms and conditions and details on the new guardian role. The resources are aimed at supporting employers through the implementation phase. Danny wrote to all of you this week and NHS Employers continues to work hard to ensure you have as much material as possible to help the transition to the 2016 junior doctors’ contract. If you have any questions regarding the new junior doctor contract our team are available to help. Please contact: [email protected]

The contract includes the equality impact assessment which will be the focus of a judicial review by the BMA of the DH and their decision to introduce the contract. This is part of the ongoing opposition by the BMA to the contract, which also includes industrial action with more details and support here.

In these tough times, the resilience of our collective and individual leadership will continue to be tested. Congratulations to Sue Sjuve & Paula Head at Sussex Community NHS Foundation Trust and Tom Storrow & Tracy Taylor at Birmingham Community Healthcare NHS Foundation Trust for getting over the very high bar that is now set for FTs. Your leadership and resilience is a credit to you, your teams and the NHS.

The NHS Confederation will only succeed if we are driven by what our members, leaders in the NHS, tell us they need. Our board of trustees is vital to this and we were delighted to see two new NHS leaders joining the team - Julia Hickey, Chair, Gateshead Health NHS Foundation Trust and Louise Scull, Chair Nottingham University Hospitals NHS Trust. Both bring a wealth of talent and experience with them and will no doubt help to ensure the Confederation continues to be led by its members.

Throughout my career I have always believed that having the protection and support of the NHS Confederation is essential. In these times where the system and individual sector voice is so important, the role of the NHS Confederation and its Networks has never been more vital. When I leave here on 6 May to join South West Yorkshire Partnership NHS Foundation Trust, I will be glad that we are members of the Mental Health Network and the NHS Confederation.

Finally, I wanted to take the opportunity to again thank you for your support. You should have received our member renewal pack by now and I wanted to highlight the impact report we have produced which outlines our activity over the last year. There are some real achievements and none of this would be possible without your continued backing. Value for money is also a key issue for us and we have worked hard to ensure we can keep our fees flat for the ninth year running (plus a decrease of 4% in 2012/13) and - unlike CQC - our fees are not increasing!


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Have a great weekend,

Rob



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(NSFT); Sayer Jane (NSFT); Solomka Bohdan (NSFT); White Deborah (NSFT)Subject: FW: NHS Confederation Thursday note

Good focus on community capital here Best Wishes Michael Chief Executive NSFT

From: Rob Webster [mailto:[email protected]] Sent: 24 March 2016 16:51 To: Scott Michael C (NSFT) Subject: NHS Confederation Thursday note

Dear Michael,

Welcome to the Thursday note,

Easter is a time of extra pressure in parts of the service and sometimes a chance to take a break and reflect. We will spend time at work and with our families and relatives in the communities we live or serve.

The idea of seeing communities as assets has long been a passion of mine and is an agenda which is gaining in pace across the service. This week I chaired a dinner sponsored by the Social Action team in the Cabinet office with a group of members to explore the role of social action in health and care services. This is part of a broader programme of work being led by our associate director, Joan Saddler, and is always a source of great stories. Cliff Richards from Halton CCG spoke eloquently about the power of Halton Community Wellbeing practices that sit alongside GP practices. A couple – let’s call them Harry and Rita - experiencing mental health problems approached Dr Cliff for medication and were sent to the Wellbeing practice. It became apparent that Harry was suffering from early dementia and was no longer able to cycle as he became confused and lost. This affected his mental health and Rita was stressed and isolated. The Wellbeing practice arranged for the local cycling club to pick Harry up and drop him off as part of their regular rides and put him in the peloton. He regained his self-worth, Rita got respite and the club carried on giving back to the community.

There are many stories like this and this approach needs hard wiring into the way we do business. It’s clear there is much good work going on in the service around how we use of volunteers and people in our communities to lead innovative developments in the NHS. Equally there is much more we can do. It is clear that the Cabinet Office are prioritising health in their £40m social action programme and we will work with them to share this work across the system. We are organising an event next month in Sheffield looking at patients as partners. You can find out more here.

Social action is part of the 5YFV transformation and in our recent member survey nearly 70% of you said you were part of a pilot scheme for new models of care. The vanguards are


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important, although of course not the whole picture. Along with NHS Providers, the LGA and NHSCC, we are working to create greater understanding, involvement and ownership of the vanguard vision, showcasing new ways health and care economies can help establish a sustainable health service. We're running a series of site visits to localities involved in the vanguard programme which aim to help share the learning of developing new models of care across localities. If you are interested in attending one of these visits, you can find more information here. I’d also encourage you to listen to the latest podcast about the vanguards. This one is an interview with the ever engaging Sir Sam Everington, from Tower Hamlets CCG – who knows about social action very well.

In recent months we’ve seen a welcome focus on “places” rather than individual institutions, with devo deals and combined authorities as one manifestation of this. This week we published a slide deck aiming to make sense of devolution following an event we ran with the LGA and NHSCC earlier this month. A key part of this agenda is the huge potential for the NHS to contribute to efforts to foster greater local growth in many places. This is why we appointed Michael Wood as our local growth advisor earlier this year. This agenda will lead to opportunities for new sources of funding for the NHS and we are running a series of workshops to help NHS organisations take advantage of this.

CQC will regulate places in future. We expect an announcement at time of writing about the CQC fee increase for next year. This will not be good news and piles further pressure on finances. It’s something I reiterated when I met with David Behan earlier today. Our member survey was crystal clear on the need for the CQC to make progress in a number of areas before the service can be confident CQC’s regulation will support transformation and offer trusts genuine value for money. David was receptive to these messages and keen to work with us in future to get this right.

Sadly, service and financial pressure remain a theme in the modern health and care system. There was some good news with the publication of Monitor and NHS England’s 2016/17 National Tariff Payment System. This confirmed a 2% efficiency factor which will help strained budgets, and follows continued lobbying from the NHS Confederation. We have helped in ensuring there is genuine engagement with the sector around the tariff so we avoid last year’s debacle. It’s only a sticking plaster solution – what we need is long term redesign of the payment system. We’ll continue to press on this.

Workforce issues remain front and centre. Following sustained lobbying, we have seen moregood news with the MAC continue to put nurses on the shortage profession list for overseas recruitment. NHS Employers have responded.

The dispute around junior doctors’ contracts rumbles on, with news this week that the BMA has voted to intensify industrial action, planning to withdraw emergency cover duringupcoming the strikes. NHS Employers continues to provide support for trusts in meeting thischallenge. NHS Employers has developed a helpful slide deck on this subject, based on 5 recentevents which I’d encourage you to share with your team. You will be able to download thePowerpoint slide deck here. We are continuing to host webinars for HR and medical directors. The next webinar will take place on Thursday 24 March, you can book your place now.

There is a saying that “you never saw your hometown until you went around the world”. I hosted a Dutch delegation this week and gave them an outline of where we are as a service. Providing a view to outsiders focuses the mind. There are a number of serious challenges faced and some degree of hope too. This will require good leadership, a genuine local vision and ambition for the places we serve and new ways of working.

I have been clear on this in debates about the STPs. We know there is a lot of positive intent and hope linked to these – and a lot of unhappiness. I know as the putative lead for the STP in West Yorkshire that there is a lot to do to if we are to develop a network approach to STPs that engages all parties and includes everyone. I made these points to Simon Stevens and Jim


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Mackey this week, as well as developing a shared approach with the LGA that we will take forward nationally. Meeting with LGA CEO, Mark Lloyd this week, it is clear that the Confed and LGA share much common cause.

Leadership will be needed at all levels to drive this agenda. This will be a theme at our annual conference, which is always a unique opportunity to take stock of the big issues we face every day. Conference this year will focus on transforming care for patients. Our trustees, including Sir Andrew Cash, have been speaking about the many benefits of conference and why it is important to bring all the different parts of the system together. See what they said in our latest conference video. To book your place visit www.nhsconfed.org/conference

Speaking of leadership, we are out for a new CEO of the Confed. I expect a very strong field for a great job. There will be a gap between me leaving on 6 May and my successor. I have asked the excellent MHN CEO Stephen Dalton to act as CEO during the interregnum. As an experienced front line CEO and a national figure he is ideally suited to take temporary charge for a while after 6 May.

Have a fantastic long weekend,

Rob



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(NSFT); Sayer Jane (NSFT); Solomka Bohdan (NSFT); White Deborah (NSFT)Subject: FW: Update on the junior doctors’ contract position

To note Best Wishes Michael Chief Executive NSFT

From: Daniel Mortimer [mailto:[email protected]] Sent: 15 March 2016 14:45 To: Scott Michael C (NSFT) Subject: Update on the junior doctors’ contract position Subject: Update on the junior doctors’ contract position

Dear Colleague

Last week saw the first in the latest series of planned industrial action by junior doctors. During this 48-hour period, although no major incidents were reported, there was considerable pressure on services on the second day and it is hugely regrettable that so many patients were inconvenienced. It is frustrating that the NHS is in this position, as I believe we made significant progress in addressing the concerns regarding the new junior doctors' contract, especially around safe working. As David Dalton has previously stressed, the contract we are offering junior doctors from August 2016 is both safe and fair. The next planned industrial action is due to take place from 8am on Wednesday 6 April until 8am on Friday 8 April. Once again, we will do everything we can to support you and will be updating our industrial action web page with latest information. I know there are additional concerns during this period due to the changeover of doctors on many rotations, and we will update our advice accordingly. If there are any additional resources you would find useful during this period, please contact me at [email protected]. Engagement events I had the opportunity to speak to a number of you recently at our face-to-face engagement events in London, Manchester and Birmingham, and look forward to meeting colleagues at the upcoming events in Exeter and Newcastle. I greatly valued the opportunity to speak candidly with colleagues and listen to the questions you have regarding the implementation of the contract. The full contractis being finalised and will be published by the end of the month. I have been struck by the commitment of those who have attended to ensuring that the new contract is properly implemented. We will of course all need to work closely together to ensure that is the case.


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To support you with any local engagement, I have included the powerpoint slide pack that I’ve been using at the engagement events. If there are any additional resources that would support you, please email me at [email protected] Understanding the facts On 4 March, Dr Johann Malawana, chair of the BMA junior doctors committee, wrote to all NHS trust chief executives in England expressing his concerns over the introduction of the new contract. Much of what he wrote to you surprised me, as it appeared to minimise all that had been achieved between the end of November 2015 and mid-February 2016. I wanted to take this opportunity to give you some information that may help in responding to the points raised in his letter both directly if you so choose, or in discussion with your doctors. The slide pack attached will also be useful with such a response.

Seven-day working – We want a new junior doctors’ contract that is safe and fair, and supports effective working across the week. Under the proposals, plain time has been extended as part of moving from highly variable pay to more predictable earnings, while still ensuring that those working the most unsocial hours (nights, Saturday evenings and Sundays) will continue to receive premium pay for those hours. The contract does not in itself compel doctors to work more frequently at weekends, and you will of course be aware of whatever priority actions you have identified locally to deliver the clinical standards expected by NHS England. These may be worth sharing with your junior doctor workforce.

Concerns over training and supervision – the current new deal contract makes no reference to training and there are no mechanisms to rapidly address circumstances where training opportunities are missed because of service pressures. There is too much reliance on fixed leave and insufficient notice of training placements, so as part of determining the final contract position we agreed with the BMA a number of new measures to tackle the issues of training, including:

o ensuring proper notice of forthcoming rotational placements o a review of access to flexible training o developing national procurement of essential clinical courses o implementing tax-efficient ways of paying professional and examination fees.

These actions will be supplemented by any that might be recommended by Dame Sue Bailey in her review.

Non-resident, on-call availability proposals - The on-call arrangements set out in the proposals are similar to those that are currently used for speciality doctors and consultants, though the availability supplement for juniors is more generous at 10 per cent and 5 per cent. Employers are therefore already skilled in planning anticipated workloads during on-call periods and most already do for this for junior doctors to roster on-call and rest periods under the current contract. We were not able to accept the BMA position that being available for on call should be paid at 20 per cent of contract earnings, when weekend shift duties receive 30 per cent pay uplift.

Plain time and unsocial hours – We agree that it is important that the junior doctors have a work/life balance, and the new contract reflects this by paying doctors who work the most Saturdays. In addition, junior doctors cannot be rostered for consecutive Saturdays without agreement. Junior doctors will be paid for actual work done, with an increase in basic pensionable pay; additional pay for additional rostered hours; enhanced rates for unsocial


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hours; on-call availability supplements, and (where appropriate) flexible pay premia.

Locum restrictions - The proposed contract sets a clear limit on weekly average hours of work in any setting at 56 hours, where a doctor has opted out of the Working Time Regulations. Doctors have a responsibility to ensure that when working any additional hours outside their work schedule, those hours are safe and in line with the contractual limits that are binding for both the employer and the doctor. I accept that some doctors may find unwelcome the requirement that they offer 'first refusal' on any time they intend to work as locums compared to at present, particularly as there will be a set national rate. These new requirements will however be balanced against a set of rules that require the first refusal to be deployed within a reasonable timeframe, and which ensure a similarly reasonable approach in terms of 'acting down' to cover shifts of more junior colleagues.

Pay and pay protection - The Secretary of State made a commitment to doctors in training that during the transition to the new contract, there will be 'no doctor earning less that she or he does today.' This will apply to all doctors in training, save those who receive Band 3 payments. Those doctors at the later stages of their training will continue to receive pay and banding, as if they were still working on the present contract.

The guardian role – Trusts will be supported in setting up the guardian role, and we had always expected that you should seek to involve junior doctors within your organisation in its appointment and functioning. Johann was concerned in our negotiations to ensure the role of the regional and national BMA apparatus in oversight of the role, whilst we emphasised the local accountability to your board and junior doctors. We will shortly be producing a package of materials for employers on the role, including a job description and a role specification.

Night shifts - The current contract introduced in 2000 does not provide all the safeguards we would want for trainee doctors. For example, it does not allow for short rest periods after night work or late ('twilight') shifts. Working with the BMA, we reached agreement on a package of measures to protect doctors in training against working unsafe hours, including night work. These go beyond the European Working Time Directive and the current new deal contract. Further, we have in the 2016 contract prioritised payment of work at nights over other periods, whereas the BMA’s view was that work during the weekend daytime hours was equivalent in pay terms to work at night.

I would again stress that whatever feeling there is about the implementation of the contract withoutagreement, the contract itself is a fair one that has benefited from the discussions between the BMA and the NHS from late November until mid-February. Naturally, we all share the sentiment that Dr Malawana expresses regarding agreement to a way forward being a clear preference. In my experience, such agreements involve a degree of compromise and I am very aware that the employers side agreed to steps in the negotiations - the new guardian role and the application of financial penalties - about which many trusts and FTs have real concerns, but which were supported to ensure a deal could be agreed. I had very much hoped that a similar compromise could be reached by Dr Malawana's committee regarding payment for Saturdays. Implementing the contract

I wanted to clarify the issue regarding the implementation of the new contract by foundation trusts, as questions have been raised at some of the recent face-to-face events. Ian Cumming, chief


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executive of Health Education England, wrote to trust chief executives on 15 February stressing the importance of consistent implementation of the new junior doctor contract across the service.

In his letter he said: “A single national approach is essential to safeguard the organisation and delivery of postgraduate medical training to ensure all doctors can secure the professional development they require to complete their training programmes. They are not prepared to see a system where a competition based on a local employer’s ability to offer different terms is part of the recruitment process. The recruitment process should be based on patient and service need and quality of training, as it always has been.”

We have raised, on your behalf, the need for HEE and NHS Improvement to ensure the proper tracking of the differential impact of the new contract, in terms of costs and savings in different organisations, during 2016/17.

I hope that you have found this update useful and if you have any queries or comments then please do not hesitate to drop me a line at [email protected]

Yours sincerely

Daniel Mortimer



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From: Scott Michael C (NSFT)Sent: 05 February 2016 19:21To: Cave Julie (NSFT); Nesbitt Robert (NSFT); Sayer Jane (NSFT); Solomka Bohdan

(NSFT); Howlett Leigh (NSFT); Armstrong Alison (NSFT); White Deborah (NSFT)Subject: Fwd: NHS Confederation Friday note

Sent from my iPhone Begin forwarded message:

From: Rob Webster <[email protected]> Date: 5 February 2016 17:02:04 GMT To: Michael Scott <[email protected]> Subject: NHS Confederation Friday note

Dear Michael,


“Everything we see is perspective not the truth” said Marcus Aurelius around 2,000 years ago. “We must have a single version of the truth” said Lord Carter today. Both in a way are right. The Carter Review was published today, an important document in both the way it was produced – with the service, with good engagement, using evidence and analysis - and for what it says. You can read a summary on our website and understand what the 15 recommendations mean for your organisation.

The review has strong messages for the Government and the ALBs. It is good to see that the work we have done to contribute to the review is reflected in the requirements for a people strategy; a single framework for reporting that reduces the burden on the service; and a single approach to support for improvement. This clearly is about sharing perspectives in pursuit of a single agreement on the truth and what needs to be done.

Carter also suggests a move to system based solutions to patient flow. This captured a lot of media interest and, as I said on BBC News, when you cut social care, the NHS bleeds. Carter claims £900m could be saved by improving support in communities – when social care DTOCs are up 31% in a year, he has a point. Our Independent Commission on Improving Urgent and Emergency Care for Older People covered this too.

Clearly this requires leadership within and across systems, which is our focus as the collective voice of all parts of the NHS. This is an area we're keen to explore further as we support the implementation of the Carter programme with a project of our own that brings leaders together to share learning on delivering better value. If you would like to be involved in this work, please contact [email protected].

A good example of system working is through the Streamlining Programme, a collaboration between NHS Employers, HR for London and Skills for Health looking at reducing excessive time and bureaucracy involved in transfers between


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trusts. Working with staff to engage in efficiency savings needs to be seen in the light of the whole health and care sector and not just in hospitals so that rostering, and management of staff are based on the care needs of local people, and determined by an integrated health and care system.

Government could do with role modelling here, seeking to learn lessons from different parts of the UK, instead of bitter politicking over the differences between us.

Clearly by investing in social care and integration, the Welsh position on DTOC and demand is improving in a way not seen in England. This was clear at the Welsh NHS Confederation annual conference which championed values, leadership, resilience and ambition. It was a very well attended event with high profile speakers including the First Minister for Wales, Rt Hon Carwyn Jones AM. New research by the Welsh NHS Confederation launched at the conference shows that the public do understand the breadth and scale of the challenges faced by the NHS. The survey reinforces the messages in The 2016 Challenge: A Vision for NHS Wales.

It is not always about flow, we also need to do what is in our gift within our organisations, as evidenced by the brilliant work on “crowding” coming out of the Bristol Royal Infirmary. The excellent Dr Emma Redfern shared work on National Early Warning Scores and the development of an ED checklist that is saving lives and improving services. The work is spreading across the South West, under the Patient Safety Collaborative supported by the West of England AHSN.

The AHSNs are currently collating their top three innovations for a compendium – after half a day at the brilliant WEAHSN, they will struggle to get it down to only three each. There are some days when you feel you are stealing a living and this was one of them. From the PreCePT work on preventing Cereberal Palsy in preterm babies to risk factors in Atrial Fibrillation in general practice, the work is clinically led, evidence based and having impact. Lives are being saved, clinicians enthused and the public informed. Check out things like dontwaittoanticoagulate.com and www.openprescribing.net for examples of what they do. Thanks to Deborah Evans and her team at West of England AHSN for reinforcing the power of AHSNs. It was timely as Sir Hugh Taylor and I met this week to discuss how AHSNs play into the final recommendations of the Accelerated Access Review.

Speaking of local collaboration, the Communities and Local Government Committee have published their report on devolution this week. I gave evidence to this committee back in November. It was good to see the committee’s final report reflecting our view that devolution is not the silver bullet to the funding problems facing social care. Equally the committee recognises that devolution might not be right for all areas and that we need a locally driven approach to designing services.

Devolved areas need community focused solutions and on Thursday our community health services forum held an event to talk about the future of the community workforce. Delegates discussed the barriers and enablers to ensuring a sustainable community-based workforce. New models of care usher in more flexible ways of delivering services based around local population needs and not organisational structures.

NHS Partners Network produced an important report this week on the sharp rise in the use of block contracts for elective care. The increase in the use of block contracts gives a clear indication of how much of a priority CCGs are putting


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on support for the balance sheets of trusts. This balance between block contracts being financially tempting, and whether patients should be allowed choice is one of the daily challenge for NHS leaders. I despair that the HSJ continue the joke comparison with the PM’s salary and won’t validate it by claiming we are worthy of being paid more than the Prime Minister! Until you all get two houses on expenses, clothing allowance, your own personal staff, a plane and a pension after 10 years, it is a ludicrous claim.

Thanks to Rod Barnes at Yorkshire Ambulance Service for our meeting today on ambulance services, innovation and place based planning. The innovation in YAS is noteworthy – from the 111 predictive planning, to new specialist paramedic roles and shared developments with the Fire Service. It was a mouth-watering precursor to the AACE conference next week, which I am looking forward to. These meetings are so important to me and my team in being able to understand the challenges you face and find out more about the work you are doing. Check out our interactive map of recent and up and coming visits and do get in touch if you’d like us to come and see you. YAS is also dealing with industrial relations. Something that continues to be an issue across the NHS.

The BMA have refused to negotiate on plain time for Saturdays and patients will suffer. It is extremely disappointing that more industrial action will take place next week when progress has already been made and significant offers have been made to the BMA to address the concerns raised by junior doctors. Daniel Mortimer wrote to you earlier this week outlining progress to date and sharing David Dalton’s letter to junior doctors. I would encourage you to work with your medical directors to ensure all your junior doctors are aware of and understand the details of this letter.

I have seen perspectives on the NHS from London, Cardiff, Bristol, Leeds and Wakefield this week. What is true is that you remain an inspiration and an asset to the country in these tough times.


Rob



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From: Scott Michael C (NSFT)Sent: 19 February 2016 16:35To: Cave Julie (NSFT); Nesbitt Robert (NSFT); Sayer Jane (NSFT); Solomka Bohdan

(NSFT); Howlett Leigh (NSFT); Armstrong Alison (NSFT); White Deborah (NSFT)Subject: Fwd: NHS Confederation Friday note

Sent from my iPhone Begin forwarded message:

From: Rob Webster <[email protected]> Date: 19 February 2016 16:10:41 GMT To: Michael Scott <[email protected]> Subject: NHS Confederation Friday note

Dear Michael,


When numbers get really big, they become difficult to grasp. The much anticipated Mental Health Task Force report, published on Monday contains some very big numbers. It suggests 600,000 people need to be assessed for depression & anxiety and 350,000 should complete treatment. Around 30,000 women should get access to MH support in the perinatal period. At least 70,000 children need access to high quality care when they need it. Around 280,000 people with severe MH problems should get access to services that improve their physical health. I could go on.

Big numbers are made up of units of one – each a collection of single adult patients, new mums and children. Think of it that way and the suffering we are overseeing in our system becomes an urgent issue in need of a collective fix. Read a summary of the report that MHN have produced and read NHSCCs response on their website.

The report meets one of the tasks we set the new Government when it came in – to set out plans to make Mental Health as accessible as physical health. It’s a good report founded on input from over 20,000 people. It sets out a vision for improving the mental health of children, young people, working-age adults and older people. The Confed had good representation on the taskforce with Stephen Dalton from the Mental Health Network and Dr Phil Moore from NHSCC’s mental health commissioners network.

The report will be widely supported - by mental health service providers and commissioners but the finances are questionable. Mental health trusts have been straining to provide care with shrinking resources in complex environments. The promise of a billion pounds of extra investment by 2020 is welcome – on top of previous announcements for CAMHs. The issue is leverage, and whether this can be found by a system under pressure and when it is a sum included in the growth announced in the SR settlement.


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As the financial year draws to a close, there has been much pessimistic rhetoric about the financial position of NHS trusts with the King’s Fund describing the NHS as nearing ‘make or break’. As our senior policy advisor Paul Healy said in the Guardian on Thursday we know the status quo isn’t sustainable and are working hard to join up across the health and care system, so as to be more efficient, deliver better value and offer a more individual service for the public. This takes time and we need the space to be able to do this.

Supporting local leaders to deliver sustainable health and care is another of our asks of Government – and sustainability and transformation plans (STPs) have featured heavily this week. After weeks of drafting, a letter from the ALBs arrived providing more detail on process and content. We have tried hard to influence this communication, being involved in multiple drafts, while stressing the requirement for the pace and scale of engagement to pick up. I would also urge you to keep at the forefront of your mind that the STP footprint is not an organisation or an administrative boundary for all occasions. It is not the new structure of the NHS – it is simply a footprint within which a network of organisations can operate services that make sense.

This is very apparent in Cumbria, West Yorkshire and North West Surrey where I have had the pleasure of spending time with members in the last week. Each was different. Cumbria Partnership NHS Foundation Trust is an organisation that has a vanguard in the South and a success regime in the North with a need to meet the requirements of both. West Yorkshire encompasses a mental health led urgent care vanguard, integration pioneers and one of the biggest tertiary hospitals in Europe. North West Surrey is delivering a whole system programme of transformation that includes a potential acute trust merger, one of the longest standing private sector community and radical reform of community services and social care. Through effective partnerships, driven by excellent leaders, organisations are developing credible plans for the future of services. Thanks to Mike Taylor, Suzanne Rankin and Linda Pollard for the invitations to spend time in their systems. Thanks also to Ann Taylor, taking time out from her 15th anniversary at Penrith hospitals, to show me around and talk through the issues she faces as a clinical manager in services today. They each now need support from a set of ALBs that will help deliver not cut across some excellent work.

This is writ large in our member survey which is a humdinger for the ALBs, including CQC. The survey paints a picture of conflicting, duplicative and burdensome arrangements that must change. Thanks to all of you who completed the survey. Look out for news on this next week and rest assured we will be having private conversations with ALB CEOs using the data to get extra leverage over their impact on you. Judging from the conversations at our NW regional dinner on Tuesday, it is long overdue.

NW leaders also debated the junior doctors situation and risks – and NHS Employers have been cutting through the noise and providing as much factual information as possible for junior doctors on the new contract. There is a summary guide, factsheet and pay calculator to help explain what the new contract offers. NHS Employers will also be running a series of roadshows to provide further information and enable junior doctors to raise any questions they have. The Junior Doctors Committee meet on Saturday to decide whether to ballot for further industrial action. It is time for them to take positive action towards reconciliation. Given their approach to date, I am not convinced that this will happen.

In other news, the GP Committee of the BMA and NHS Employers have reached agreement on changes to the GP Contract. Effective, collective


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bargaining done between committed and professional negotiators out of the public spotlight has worked well. Details are available on the NHS Employers website.

We need to rebuild the social contract with doctors – and other staff – and Sue Bailey’s work on this will help in time. In the meantime, a consistent approach to contract implementation is helpful and multiple approaches to building momentum on the NHS as a good employer are required. NHS Employers through #Thinkfuture have launched a series of toolkits to support HR professionals, managers and comms managers in helping to bring more young people into the NHS workforce. Please do share these with your teams.

David Cameron is in Brussels today hammering out a deal, as are senior colleagues from Confed members, NHS Blood and Transplant. In parallel negotiations, they will meet with EU decision-makers to discuss EU legislation and policy on blood, tissues, cells and organs. The visit aims to strategically position NHS Blood and Transplant to pro-actively influence EU policy which has a direct impact on their work.

Space prevents me from reflecting on other system issues like how the independent sector have a role to play in helping to manage demand and reduce waiting times. As David Hare wrote to Jeremy Hunt last week, covered in the FT on Monday, less than one percent of the extra capacity offered by the independent sector is being used.

Finally, it’s all change at the Confed. Firstly congratulations to Dr Graham Jackson who has been appointed as the new co-chair of NHSCC. Secondly thank you for all your kind messages of congratulations following my announcement that I am leaving the Confederation to take up a new role at CEO at South West Yorkshire Partnership FT. My start date is likely to be in May and there will be plenty of time for us to catch up before then. There is always annual conference, the place for networking with peers. Bookings for the event in Manchester in June have now opened and I have already booked my place and hope to see many you there.

Have a good weekend

Rob



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From: Scott Michael C (NSFT)Sent: 03 February 2016 20:00To: Collins Dawn M (NSFT); Howlett Leigh (NSFT); Hills Ryan (NSFT); Cave Julie (NSFT);

White Deborah (NSFT); Bakshi Kapil (NSFT); Johnson June (NSFT); Solomka Bohdan (NSFT); Sayer Jane (NSFT); Ball Sarah (NSFT); Armstrong Alison (NSFT)

Subject: Fwd: Sir David Dalton’s letter to junior doctors

Game on Sent from my iPhone Begin forwarded message:

From: Daniel Mortimer <[email protected]> Date: 3 February 2016 18:10:23 GMT To: Michael Scott <[email protected]> Subject: Sir David Dalton’s letter to junior doctors

Dear colleague

I just wanted to let you know that Sir David Dalton has today written to all doctors in training across England to provide them with a clear outline on the current position of the negotiations and to highlight the ongoing areas of disagreement with the BMA. A copy of this letter can be found on our junior doctors web page and it has also been shared with your chief executives and medical directors. I would encourage you to work with your medical directors to ensure all your junior doctors are aware of and understand the details of this letter.

As ever, I will continue to keep you updated on progress.

Industrial action planning for 10 February

I also wanted to let you know that NHS England has confirmed that they will be issuing two sit-reps during the course of the industrial action next week. These will be at 9am with a return by 10:30am and second one at 8pm for a return by 9:30pm. If you have any queries about these then please contact your local NHS England office. Yesterday’s email provided you with useful contact details to support you during this period of industrial action, but should you require any additional support and resources do not hesitate to contact me [email protected] Yours sincerely

Daniel Mortimer



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From: Scott Michael C (NSFT)Sent: 23 March 2016 08:55To: Johnson June (NSFT)Subject: RE: Face-to-face engagement events on the junior doctors’ contract

I should have guessed – thanks June ! Best Wishes Michael Chief Executive NSFT

From: Johnson June (NSFT) Sent: 23 March 2016 08:40 To: Scott Michael C (NSFT); Solomka Bohdan (NSFT) Subject: RE: Face-to-face engagement events on the junior doctors’ contract All in hand, I attended the face to face session and also doing all the webinars. Regards June Johnson Medical staffing Manager Norfolk and Suffolk Foundation NHS Trust telephone: 01473 266379 email: [email protected] Human Resources Department, Purple floor 2, Endeavour House, Russell Road, Ipswich IP1 2BX

From: Scott Michael C (NSFT) Sent: 23 March 2016 08:29 To: Johnson June (NSFT); Solomka Bohdan (NSFT) Subject: FW: Face-to-face engagement events on the junior doctors’ contract For action please Best Wishes Michael Chief Executive NSFT


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From: Daniel Mortimer [mailto:[email protected]] Sent: 22 March 2016 17:15 To: Scott Michael C (NSFT) Subject: Face-to-face engagement events on the junior doctors’ contract Dear Colleague

Yesterday in Newcastle my colleagues and I completed the last of the five face-to-face engagement events to discuss the junior doctors’ contract implementation.

Across all the events I had the opportunity to speak to close to 400 HR professionals and medicalworkforce leaders. I would encourage you to continue to support these colleagues to ensure thatthe finalised junior doctors’ contract is implemented from August 2016.

To assist you, please find below a link to the Powerpoint slide deck that was used during the courseof the day (this includes the slides from both the morning and afternoon session). This pack was adapted during the course of the events to take on board feedback from Trusts and FTs, and maybe slightly different to the version that was shared with you at the event.

You will note from the slides that the details of the contract are being finalised, and I hope to be ableto share the final contract with you shortly.

Powerpoint slide pack

You will be able to download the Powerpoint slide deck here. The link will open a Wetransfer page in your web browser, and a download arrow and button will appear, click download to retrieve the slide pack. Please note: This download is only available for the next seven days. If you need to accessthis document after the seven days please email the relevant contact from our nationalengagement service.

North Jane Raven [email protected]

Midlands & East

Amanda Rose

[email protected]

London Bernadette El-Hadidy

[email protected]

South Liz Gambrell [email protected]

Webinars

Although the face-to-face engagement events have now come to an end, we are continuing to hostwebinars for HR and medical directors. The next webinar will take place on Thursday 24 March,you can book your place now.

We will also be scheduling webinars for your medical staffing leads once the details of the contact are shared with you. If you have any comments, or there are any additional resources that would support you, please email me at [email protected] Yours sincerely

Daniel Mortimer


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Chief Executive, NHS Employers Freedom of Information Request 93 2016 Page 40 of 50

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From: Scott Michael C (NSFT)Sent: 15 February 2016 13:20To: Mckay Fraser (NSFT); Solomka Bohdan (NSFT)Cc: Ball Sarah (NSFT); Mungham-Gray Lisa (NSFT); Armstrong Alison (NSFT)Subject: RE: MEDIA ENQUIRY: Junior Doctors contract enquiry - draft statement

Looks good to me Best Wishes Michael Chief Executive NSFT

From: Mckay Fraser (NSFT) Sent: 15 February 2016 13:20 To: Solomka Bohdan (NSFT) Cc: Ball Sarah (NSFT); Mungham-Gray Lisa (NSFT); Armstrong Alison (NSFT); Scott Michael C (NSFT) Subject: RE: MEDIA ENQUIRY: Junior Doctors contract enquiry - draft statement Importance: High Hello, please find below suggested statement with regards to any change to the junior doctors’ contracts. Please feel free to amend or add anything – the deadline is today.

Bohdan Solomka, Medical Director at Norfolk and Suffolk NHS Foundation Trust, said: “We would consider very carefully, in close consultation with our junior doctors, any proposed changes to their existing contracts.” Thank you Fraser

Fraser McKay | Communications Officer

Norfolk and Suffolk NHS Foundation Trust

Hellesdon Hospital | Drayton High Road | Norwich | Norfolk | NR6 5BE

Tel: 01603 421484 | Switchboard: 01603 421421 | Mobile: 07771 877983 www.nsft.nhs.uk | @NSFTtweets |

www.facebook.com/NSFTrust

From: Scott Michael C (NSFT) Sent: 15 February 2016 12:58 To: NSFT Communications; Solomka Bohdan (NSFT)


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Cc: Ball Sarah (NSFT); Mungham-Gray Lisa (NSFT); Armstrong Alison (NSFT) Subject: RE: MEDIA ENQUIRY: Junior Doctors contract enquiry Given the deadline we might want to say we are still considering the position – un less anyone’s made a decision in my absence Best Wishes Michael Chief Executive NSFT

From: NSFT Communications Sent: 15 February 2016 12:46 To: Solomka Bohdan (NSFT) Cc: Ball Sarah (NSFT); Mungham-Gray Lisa (NSFT); Scott Michael C (NSFT); Armstrong Alison (NSFT) Subject: MEDIA ENQUIRY: Junior Doctors contract enquiry Importance: High Hello, could you please confirm whether our Trust would be implementing the new government‐suggested contract on junior doctors? The EDP would like a response explaining the reasons either way? Thank you Fraser






From: Lodge, Will [mailto:[email protected]] Sent: 15 February 2016 07:34 Subject: Junior Doctors contract enquiry Hello, Following on from an article in the national press at the weekend suggesting foundation trusts do not have to impose the new contract on junior doctors – and that many would not, with concerns over losing and alienating staff, I would like to ask if your trust plans to implement the new government-suggested contract on junior doctors. Could I also please get a statement explaining the reasons either way? I would need a response today, preferably by 2pm. For reference: http://www.theguardian.com/society/2016/feb/12/hospitals-jeremy-hunt-junior-doctors-contract Many thanks


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Will

Will Lodge Essex Chief Reporter East Anglian Daily Times --- M: 07785 616283 E: [email protected] Twitter: @essexwill www.eadt.co.uk

This email and any attachments to it are confidential and intended solely for the individual or organisation to whom they are addressed. You must not copy or retransmit this e-mail or its attachments in whole or in part to anyone else without our permission. The views expressed in them are those of the individual author and do not necessarily represent the views of this Company. Whilst we would never knowingly transmit anything containing a virus we cannot guarantee that this e-mail is virus-free and you should take all steps that you can to protect your systems against viruses. Archant Community Media Limited, is registered in England under Company Registration Number 19300, and the Registered Office is Prospect House, Rouen Road, Norwich NR1 1RE. Please Note: If you have sent through a Contribution (e.g. written, audio, visual, video or audiovisual material) Archant Community Media Ltd’s use of that content will be subject to its Rights Holder Charter at http://www.archant.co.uk/articles/archant-community-media-limited-rights-holder-char/. Please ensure that you have read and understand this Charter. If you have any questions with regards to this Charter please contact us as soon as possible. If we do not hear from you will be deemed to have accepted the Charter terms.


1


From: Scott Michael C (NSFT)Sent: 15 February 2016 12:58To: NSFT Communications; Solomka Bohdan (NSFT)Cc: Ball Sarah (NSFT); Mungham-Gray Lisa (NSFT); Armstrong Alison (NSFT)Subject: RE: MEDIA ENQUIRY: Junior Doctors contract enquiry

Given the deadline we might want to say we are still considering the position – un less anyone’s made a decision in my absence Best Wishes Michael Chief Executive NSFT

From: NSFT Communications Sent: 15 February 2016 12:46 To: Solomka Bohdan (NSFT) Cc: Ball Sarah (NSFT); Mungham-Gray Lisa (NSFT); Scott Michael C (NSFT); Armstrong Alison (NSFT) Subject: MEDIA ENQUIRY: Junior Doctors contract enquiry Importance: High Hello, could you please confirm whether our Trust would be implementing the new government‐suggested contract on junior doctors? The EDP would like a response explaining the reasons either way? Thank you Fraser






From: Lodge, Will [mailto:[email protected]] Sent: 15 February 2016 07:34 Subject: Junior Doctors contract enquiry Hello, Following on from an article in the national press at the weekend suggesting foundation trusts do not have to impose the new contract on junior doctors – and that many would not, with concerns over losing and alienating staff, I would like to ask if your trust plans to implement the new government-suggested contract on junior doctors.


2

Could I also please get a statement explaining the reasons either way? I would need a response today, preferably by 2pm. For reference: http://www.theguardian.com/society/2016/feb/12/hospitals-jeremy-hunt-junior-doctors-contract Many thanks Will

Will Lodge Essex Chief Reporter East Anglian Daily Times --- M: 07785 616283 E: [email protected] Twitter: @essexwill www.eadt.co.uk

This email and any attachments to it are confidential and intended solely for the individual or organisation to whom they are addressed. You must not copy or retransmit this e-mail or its attachments in whole or in part to anyone else without our permission. The views expressed in them are those of the individual author and do not necessarily represent the views of this Company. Whilst we would never knowingly transmit anything containing a virus we cannot guarantee that this e-mail is virus-free and you should take all steps that you can to protect your systems against viruses. Archant Community Media Limited, is registered in England under Company Registration Number 19300, and the Registered Office is Prospect House, Rouen Road, Norwich NR1 1RE. Please Note: If you have sent through a Contribution (e.g. written, audio, visual, video or audiovisual material) Archant Community Media Ltd’s use of that content will be subject to its Rights Holder Charter at http://www.archant.co.uk/articles/archant-community-media-limited-rights-holder-char/. Please ensure that you have read and understand this Charter. If you have any questions with regards to this Charter please contact us as soon as possible. If we do not hear from you will be deemed to have accepted the Charter terms.


1


From: Scott Michael C (NSFT)Sent: 15 February 2016 17:06To: Barlow Lesley (NSFT)Subject: RE: MMMAttachments: MMM_15 02 16.doc

Thanks Lesley – have amended slightly so good to go please Best Wishes Michael Chief Executive NSFT

From: Barlow Lesley (NSFT) Sent: 15 February 2016 16:17 To: Scott Michael C (NSFT) Subject: MMM

Hi Michael Attached is the starter for 10 for your comment. Lesley Barlow Deputy Head of Communications Norfolk and Suffolk NHS FT Hellesdon Hospital | Drayton High Road | Norwich | Norfolk | NR6 5BE Tel: 01603 421563 E: [email protected] www.nsft.nhs.uk | @NSFTtweets | www.facebook.com


15.02.16

Michael’s Monday Message

Today I announced that we have appointed Verita, a specialist agency, to lead an independent review into unexpected deaths. The review will include examining how our Trust investigates deaths and learns lessons.

The review will also examine how the numbers of unexpected deaths compare with national rates, and will help to establish whether we are an outlier in terms of numbers or trends. Most importantly, we can take any learning and implement it, if this prevents even one death it will be worth while

You may remember that I announced that we would commission the review at the January Board meeting and I can confirm that this work will begin later this month, with a clear and detailed scope.

It has been agreed that for the review to be as thorough as possible, it will be held in two parts with a report on phase one ready by the end of May, and the second phase ready in the summer.

Any urgent concerns or emerging issues would, of course, be immediately fed back to the Board and operational leads, and actions put in place immediately.

We don’t take this matter lightly and that is why we are looking into all of the facts. We want people to be assured that we have commissioned this independent review to be as in-depth as possible.

The safety of our service users is paramount. One single avoidable death is one too many – which is why we have commissioned this investigation, to ensure we are fully confident that our services are as safe as they can be.

Verita is a leading independent consultancy. Its work ranges from specialist support and advice on challenging operational and strategic matters, to reviews and investigations of complex, sensitive issues. The company will be supported by Colin Vose, an independent clinical reviewer who has worked on suicide investigation, and who has a long career in the NHS.

During the first phase of the review Verita will look at several key areas, including:

• Comparing NSFT’s rates of unexpected deaths with national trends • Reviewing the Trust’s internal investigation process to examine if it sufficiently

rigorous for lessons to be learned, that there is consistency, sound challenge and families and carers offered opportunity to contribute to the process of investigation

• Identifying potential themes, priorities for action and effective systems for monitoring and sharing learning

This will be followed by phase two, to also incorporate:

• An appraising of NSFT’s suicide prevention strategy


http://www.verita.net/

• An examining of how NSFT has progressed with the national requirements for mortality review

• A review of Trust governance around investigating deaths set against guidance in the new NHS Serious Incidents Framework

We look forward to receiving its report so that we can understand whether there are any issues which we need to address to further improve the safety of our services for the benefit of everyone in Norfolk and Suffolk. I believe that the data show that this is an area where nationally there has been insufficient focus and that our work will become a national exemplar of how to deal with this vital topic.

Junior doctors’ contract

If you had the chance to read the national papers at the weekend you may have seen that one of broadsheets is suggesting that foundation trusts do not have to impose the new contract on junior doctors proposed by the health secretary, Jeremy Hunt from August. We will consider this very carefully and work in close consultation with our junior doctors on any proposed changes to their existing contracts.

Putting People First Awards The shortlisting for the Putting People First Awards is well underway in the lead up to the staff vote and the judging panel taking place next week. The Shortlisting process will whittle down over 150 entries to six to eight nominees in each of the categories and I understand that this is proving to be a really difficult task as the standard is so high. I am really looking forward to reading the entries as I’m sure you are too. Look out for more information about how to cast your vote next week.

The Five Year Forward View for Mental Health

The Chief Executive of Mind and independent Chairman of the Mental Health Taskforce launched its final report today – The Five Year Forward View for Mental Health. It sets out what needs to happen to make sure people get access to the treatment and support they need, when they need it. It makes recommendations for the NHS to achieve the ambition of ‘parity of esteem’ between mental and physical health for children and young people, adults and older people. This includes prevention, early intervention, access to crisis care and better integration of mental and physical health care. The report also includes an important set of recommendations to tackle inequalities at both a local and a national level –and the need for more resources . The Board of our trust has been campaigning for just these issues so it is good to see them being recognized in this report


https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf

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From: Scott Michael C (NSFT)Sent: 04 February 2016 08:53To: Ball Sarah (NSFT)Subject: RE: Sir David Dalton’s letter to junior doctors

Agreed but at least they now have the high moral ground … Best Wishes Michael Chief Executive NSFT

From: Ball Sarah (NSFT) Sent: 04 February 2016 08:51 To: Scott Michael C (NSFT); Howlett Leigh (NSFT) Subject: RE: Sir David Dalton’s letter to junior doctors I think it’s a real shame that they’ve lost their nerve and conceded on making unsocial hours payments. There was a real opportunity here to lead the way for change that could then be followed for other medical staff and those on Agenda for Change if we want to change the culture to proper 7 day services. The ‘Guardian’ role is interesting….!

From: Scott Michael C (NSFT) Sent: 03 February 2016 20:00 To: Collins Dawn M (NSFT); Howlett Leigh (NSFT); Hills Ryan (NSFT); Cave Julie (NSFT); White Deborah (NSFT); Bakshi Kapil (NSFT); Johnson June (NSFT); Solomka Bohdan (NSFT); Sayer Jane (NSFT); Ball Sarah (NSFT); Armstrong Alison (NSFT) Subject: Fwd: Sir David Dalton’s letter to junior doctors Game on Sent from my iPhone Begin forwarded message:

From: Daniel Mortimer <[email protected]> Date: 3 February 2016 18:10:23 GMT To: Michael Scott <[email protected]> Subject: Sir David Dalton’s letter to junior doctors

Dear colleague

I just wanted to let you know that Sir David Dalton has today written to all doctors in training across England to provide them with a clear outline on the current position of the negotiations and to highlight the ongoing areas of disagreement with the BMA. A copy of this letter can be found on our junior doctors web page and it has also been shared with your chief executives and medical directors. I would encourage you to work with your medical directors to ensure all your junior doctors are aware of and understand the details of this letter.

As ever, I will continue to keep you updated on progress.


2

Industrial action planning for 10 February

I also wanted to let you know that NHS England has confirmed that they will be issuing two sit-reps during the course of the industrial action next week. These will be at 9am with a return by 10:30am and second one at 8pm for a return by 9:30pm. If you have any queries about these then please contact your local NHS England office. Yesterday’s email provided you with useful contact details to support you during this period of industrial action, but should you require any additional support and resources do not hesitate to contact me [email protected] Yours sincerely

Daniel Mortimer



foi request number 93 2016 - nsft.nhs.uk · the final position means that if a trainee works one...

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