Welsh Government Response to the Report of the National Assembly for Wales Public Accounts Committee on the Consultant Contract in Wales: Progress with Securing the Intended Benefits
We welcome the findings of the report and offer the following response to the nine recommendations contained within it that fall to the Welsh Government.
Recommendation 1:
We recommend that the Welsh Government publishes a timetable of its actions to provide strategic leadership on job planning arrangements in Wales, including the development of all-Wales guidance and how it intends to hold Local Health Boards to account for its implementation.
Response: Accepted.
Welsh Government officials have already established a Task and Finish group, jointly led by the Welsh Government and NHS Employer Unit. This was established in May, and comprises Medical Directors, Workforce Director, NHS Employers Unit, representatives from the British Medical Association (BMA) Wales, and officials from Welsh Government.
The terms of reference for this group were developed and agreed in May 2013. They focus, in particular, on the actions to be taken forward in response to the Wales Audit Office report (2013). The group will review and revise the All Wales job planning guidance and documentation, ensuring that it supports the delivery of service improvement and modernisation.
The first meeting of the Task and Finish group was held on 4th September and the second meeting took place on 2nd October. The group will formally report progress in the near future with the updated All Wales guidance being presented to BMA Wales for agreement at the Joint Welsh Consultant Contract Committee (JWCCC) on 24th January 2014.
In February 2014, the Welsh Government will launch the revised All Wales guidance, which will be accompanied by robust training for all Clinical Directors and Workforce Directors.
Health Boards will be required to collect job planning data and be asked to provide a structured report on progress to the Chief Medical Officer on an annual basis. The information will then be included in the Welsh Government’s Quality Management arrangements and exceptions will be escalated to the Performance and Delivery Framework.
The above sets out key milestones and timeframe for action. The Task and Finish group will publish a more detailed timetable of future actions by 31st October 2013 which will be shared with the Public Accounts Committee and Wales Audit Office.
Recommendation 2:
We recommend that the Welsh Government coordinates and facilitates the development of a coherent all-Wales information framework on desired consultant outcomes. This should incorporate working with a range of NHS organisations, including Health Boards, the British Medical Association and General Medical Council.
Response: Accepted
Welsh Government supports this recommendation and will work through the Task and Finish Group to coordinate and facilitate this by end March 2014.
An information framework must describe how information should be used in a balanced way to measure patient experience, safety and quality, productivity and outcomes that a consultant must deliver. We agree this work must be undertaken with partners as described
Recommendation 3:
We recommend that the Welsh Government continues to engage with stakeholders to improve the job planning process, including the development of appropriate training for Clinical Directors.
Response: Accepted.
BMA Wales, NHS Employers Unit and Medical Directors are participating in the Task and Finish group, which is reviewing the job planning process, including relevant training materials. The delivery of such training will be reviewed by this group in readiness for the launch of the revised All Wales guidance in February 2014 which will be mandatory training for Clinical Directors.
Recommendation 4:
We recommend that the Welsh Government works with NHS organisations to develop national guidance on consultant’ working hours, and actions that Health Bodies can take to reduce the need for excessive working hours.
Response: Accepted.
The Welsh Government will ensure that this requirement is delivered through joint working in the Task and Finish group. This recommendation will be met by relevant sections in the All Wales job planning guidance.
Recommendation 5:
We recommend that the Welsh Government engages with NHS organisations to develop options for gathering management information on the total number of hours worked by consultants per week (including work outside the NHS).
Response: Accepted
This recommendation will be met for NHS care by effective oversight of the work described in an agreed job plan. There should be no difference between the job plan and the work delivered and management information should confirm this or demonstrate exceptions.
There is no provision within the consultant contract to enable working hours outside the NHS to be measured so this information will need to be provided on a voluntary basis. The contract makes clear there must be no adverse impact of other work on NHS care and appropriate clinical governance and management arrangements should ensure this to be the case. Moreover, the revalidation process requires all Consultants to be appraised holistically on all aspects of their medical practice, including private practice, providing greater assurance around the safety of NHS patient care.
The requirement that Welsh Government engages with NHS organisations to develop options for gathering management information on total hours worked will be met by joint work with the Task and Finish Group and relevant Directors of NHS organisations (Medical and Workforce and OD).
Recommendation 6:
Given the lack of clarify on this issue, we recommend that the Auditor General for Wales conducts a value for money investigation into Local Health Boards’ processes and procedures for patients moving between private and NHS practices.
Response: This is a matter for the Auditor General for Wales.
Recommendation 7:
We recommend that the Welsh Government publishes an indicative timeline for its work to develop All-Wales definitions and guidance related to the objectives of Supporting Professional Activities (SPAs). This should enable greater clarity on the types of SPAs needed, and enable their value to be measured and demonstrated.
Response: Accepted.
This recommendation will be met by the published timetable outlined in the response to recommendation 1 above. The Welsh Government will ensure that the All Wales guidance provides sufficient paragraphs on objectives relating to SPA s and the measurement of their value. SPAs may typically include activities relating to ; Continuing Professional Development, Audit, teaching/training within specific programmes and acting as Appraiser with an agreed number of appraisals.
Recommendation 8:
We recommend that the Welsh Government ensures that its refreshment of All-Wales training material on job planning includes emphasising the importance of using job planning as an opportunity to discuss the service modernisation, and improve clinical practice and patient care.
Response: Accepted.
The Welsh Government accepts that All Wales training material and guidance on job planning should facilitate the discussions on service modernisation and improvements to clinical practice.
This specific point would be included in the revised All Wales, job planning guidance and documentation, currently being reviewed by the Task and Finish group.
Recommendation 9:
We recommend that the Welsh Government provides us with annual updates on its work with health boards and the deanery to develop and implement specific strategies for recruiting specialist consultants to address workforce and expertise shortages.
Response: Accepted.
Welsh Government accepts the recommendation and will provide an annual update at the end of each financial year.
The Local Health Boards and Trusts are responsible for recruiting consultants, we will hold the LHBs and Trusts to account through their future workforce plans and facilitate where possible workforce planning across the LHBs and Trusts individually and collectively to fill shortages.
We will work with the Deanery to ensure a strategic approach to the allocation of specialty training posts to ensure that the training plans align to the workforce recruitment requirements of LHBs and Trusts. The ‘Shape of Training’ review to be published by Professor David Greenaway at the end of October will also inform this strategic approach.
Annual updates will include reference to work undertaken by the Deanery to develop the wider reputation and attractiveness of Wales as a place for doctors to work, recognising they are not directly involved in the recruitment of specialist consultants.