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NAPC News 26 March 2012

Doctors Signing Off Abortions For Women They Have Never Met

Doctors routinely sign consent forms for women having abortions without ever meeting them, the former medical director of one of Britain’s biggest abortion providers said at the weekend.

Vincent Argent, the former medical director of the British Pregnancy Advisory Service, said that doctors had a ‘lax’ approach to completing paperwork so that women could have abortions.  He said: ‘We used to pre-sign forms, we used to sign forms after the operation, we used to ask the anaesthetist to do it... it was bad practice.’

Dr Argent said the practice was common at an NHS hospital where he used to work and a colleague ‘used to presign a batch of forms before she went away so there was on signature already on the form, without the patient’s name.  Then when I saw the patient, or someone else saw the patient, they could add their signature.’

His comments were made as Andrew Lansley, the Health Secretary, warned that abortion providers will have their licenses withdrawn if they were found to be breaking the law.  The statement was made as the health watchdog made a series of unannounced inspections to all abortion providers.

It is understood that hundreds of private and NHS clinics have been inspected by the Care Quality Commission and more than 50 were not in compliance with the law or regulations.

Three police forces are investigating abortion clinics – Greater Manchester, West Midland, and the Metropolitan Police.  The General Medical Council and the Nursing and Midwifery Council are also carrying out investigations.

Pay Freeze Fails To Prevent Trust Wage Overspend

The NHS pay freeze has failed to prevent acute hospitals from running up and estimated £330m year to date overspend on wage bills, according to the health service press.

Figures also show that although the number of pay increments withheld from staff has doubled in 2011/12 compared with 2010/11, the vast majority of employees are automatically being handed incremental rises worth on average 2.8 per cent a year.

An analysis of board papers of 96 trusts show they had already a combined £176.3m year to date overspend on their 2011/12 bills, based mainly on January figures.  This suggests there is a £300m plus overspend if extrapolated across all 165 acute and specialist trust in England.

NHS Chief Executive, Sir David Nicholson, said last October that 40 per cent of the £20bn efficiency savings target would come from national action such as pay freeze, which affects all NHS staff earning over £21,000 until April 2013.

Many trusts claim activity levels are preventing them from cutting their workforces as planned, as well as forcing them to rely on agency staff.

A Freedom of Information inquiry drew responses from 98 trusts with a combined £14.2bn year to date pay budget.  This showed that so far this year just 18 had held back increments form 1,219 staff in total.  The biggest proportion of withheld pay increments were due to performance issues identified through appraisals, but a third were due to poor attendance and a fifth were for other reasons, including not attending mandatory training.

At 81 trusts, however, not a single increment had been withheld for the past two years.
The figures emerged as public sector pay is being heavily scrutinised by the government.

Leaders May Shun New National  Bodies

National bodies being set up as part of the government’s NHS reforms risk being unable to attract good leaders due to declining pay, terms and conditions, experts have warned.

The fears have been highlighted by government advisory group, the Senior Salaries Review Body and come as details of new pay rules for ‘very senior managers’ in the NHS emerging.

Very senior managers include chief executives and the board directors they line manage – other than medical directors- in primary care trusts, strategic health authorities, special health authorities and ambulance trusts.  From next year, they are expected to include senior leaders in new arm’s length bodies such as the NHS Commissioning Board, Health Education England and the NHS Trust Development Authority.

The Review Body’s latest report published recently said very senior managers’ average take-home pay had dropped by 12 per cent since 2009/10 from £55,843 to £48,860, due to inflation, tax changes and the pay freeze, which started a year earlier than for the rest of the NHS.

The Department of Health commissioned PricewaterhouseCoopers in March 2010 to devise a job evaluation system for very senior managers to address fears of a widening boardroom pay gap between PCTs and foundation trusts, which have the freedom to offer more attractive salaries.

The new system awaits ministerial sign-off.  But, ahead of its publication, the review body said: ‘We have learned that the DH intends to control closely the pay of the very senior managers covered by us and in that respect the framework may remain fairly rigid..... Therefore we question whether NHS arm’s length bodies will be able to compete with foundation trusts to recruit and retain suitably able and qualified managers.’

Regional Gaps In NHS Salaries

New evidence has been obtained of salary disparities within and between regions as the government prepares to introduce local pay rates.

Chancellor George Osborne has announced local pay will be introduced to parts of the public sector to better reflect cost of living and private sector rates.
There have also been reports that pay in cheaper regions would be frozen for a number of years.  However, unpublished provisional NHS Information Centre figures for July to September 2011 demonstrate the extent to which NHS pay for clinical and non-clinical staff already varies between regions.

Among small acute trusts, London dominates the top end of the pay table while four trusts paying the lowest average salaries are all in the North West.  The current system provides supplements of up to 20 per cent extra in and around London.
In other areas, there is no obvious relationship between pay and living costs.  For example, nurses working at North Bristol Trust are paid £33,800 on average, £200 less than at Royal Cornwall Hospitals Trust.

Managers at Cambridge University Hospitals Trusts get £54,800 on average, compared with £60,600 at Norfolk and Norwich University Hospitals.  The figures take no account of differences in skill mix. 

Hay Group public sector practice director, Peter Smith, said there were similarly ‘mad’ patterns nationwide.

Reform Row Will Continue

Healthcare leaders predict that the high profile row over the government’s NHS reforms will persist despite its Health Bill finally completing its stages through Parliament.
The government is likely to want to move away from discussing structural reforms and health secretary, Andrew Lansley, is expected to focus publicly on separate issues, for example the development of an alcohol abuse strategy.

However, senior figures consider the dispute will continue to rumble on.  A stream of subordinate legislation in the form of regulation and guidance still need to be published to support the implementation of the legislation.

This includes details of licensing and failure regimes for providers and the authorisation and performance management of clinical commissioning groups by the NHS Commissioning Board.

A Department of Health source said it was expected that much of the detail would be uncontroversial, but some, particularly in relation to Monitor’s competition regulation, would spark further debate.

NHS Confederation’s chief executive, Mike Farrar, called for the post-bill guidance to simplify implementation and aid service redesign, which he said could be hampered by the legislation.  He said CCGs should have the ‘ability to act and freedom to be bold’ and Monitor’s guidance and payment rules should encourage providers to work together.

Top Job Goes To NHS North’s Nursing Director

The NHS Commissioning Board has appointed Jane Cummings as its chief nursing officer (CNO).  Ms Cummings is currently the nursing director for NHS North of England, and previously for NHS North West.

The Commissioning Board CNO is expected to become the lead nurse figure for the English NHS.  It is one of the two new senior nursing roles created under the government’s reform plans.

Ms Cummings had led work in the north and nationally to develop indicators, which highlight the quality and efficiency of nursing care.

A Commissioning Board statement said the ‘core role’ of the CNO would be to drive quality improvements in patient safety and patient experience.  The post was advertised with an indicative base salary of £165,000.