Daily Insight: A damaging row

Perhaps it’s surprising that it’s taken so long for a row of this nature to flare up so publicly, but a nasty disagreement between a trust and the British Medical Association over strike derogations has far wider significance, as distrust intensifies in both camps.

The dispute between the BMA and University Hospitals Bristol and Weston Foundation Trust, as we reported yesterday, began with the union announcing it had reached an agreement with the trust for junior doctors to work during the strike to ensure safety staffing ratios at Weston General Hospital accident and emergency. 

But the union then announced under 24 hours later that it was revoking the agreement because, it claimed, the trust had “misled” the union about the staffing levels it had and “abused” strike agreements.

Not so, said the trust, which claimed it had acted in “good faith” at an earlier stage as a precaution because of safety concerns.

It said that during planning, it appeared rotas may need derogations on particular days to ensure safe staffing levels, but that ultimately, so far it had not required them, because more junior doctors had attended work than expected.

It had therefore “not needed to draw down on any of the derogations”, it said, but believed it was right to ensure it had the option to if needed.

The row comes amid concerns an A&E could face closure this week, although none have shut so far. Calling junior doctors in off picket lines will be infinitely preferable to closing EDs, but strike derogations will be hard to agree if trust between managers and the BMA further deteriorates. 

Fantasy finance league

Nineteenth century German chancellor Otto von Bismarck may not have been familiar with the NHS but his views about the making of laws and sausages being a messy business could easily apply to the annual health service planning round.

The latest iteration of the process has thrown up a £3bn deficit, which has been rejected by NHS England. Now plans that were supposed to be final are being redrafted until they get to numbers that can be signed off by head office.

The danger is that trusts get to a balanced figure on paper by submitting “fantasy” efficiency rates, as one ICS leader put it, adding: “This isn’t planning, it’s just making figures up.”

A chief financial officer elsewhere said the kind of savings being proposed “are not doable by just efficiency” and would see services cut.

The scale of the deficit represents a headache for NHSE, less than six months after a funding settlement that Amanda Pritchard welcomed as “sufficient… for the NHS to fulfil its key priorities”.

More optimistic CEOs are hopeful of extra cash for inflation, as happened last year. But in reality any spare cash held by NHSE is more likely to be earmarked for meeting unfunded pay awards.