Written evidence from the Department of Health


Please find attached notes relating to the Emergency Admissions to hospital: Managing the Demand, hearing requested by the Committee along with the corrected transcript.

The notes are provided in Annex A along with the corrected transcript in Annex B.

I trust the information provided is of help to the Committee.

15 January 2014

Annex A



NHS England publishes monthly data on delayed transfers of care, and this has been done continually (formerly by the Department of Health) since August 2010. The figures can be found on this weblink:


The data use definitions in place since 2003, when re-imbursement was introduced.

NHS England also tries to cross validate these data with the winter data to spot any inconsistencies in reporting.

The data collected are:

(a) Number of patients delayed on last Thursday of calendar month.

(b) Number of delayed days during the month for all patients delayed (not just those delayed in end month snapshot).

These are split by:

¾ Acute/Non acute.

¾ Agency responsible for delay (NHS/Social Care/Both).

¾ Reason for delay.

NHS organisations submit the data split by local authority, so the figures are presented by trust and by local authority responsible.


Emergency Medicine Workforce Implementation Group (EMWIG)

Since April 2013 the Department has tasked Health Education England (HEE) to joint chair an Emergency Medicine Workforce Implementation Group (EMWIG) with the College of Emergency Medicine (CEM). The group’s remit is to address workforce and training issues and is constituted of experts in emergency care and medical education and training.

In order to address shortages in the consultant workforce the group has undertaken programmes of work that will:

¾ Develop training routes into EM training (including alternative routes).

¾ Explore the recognition of transferable competences of trainees currently in other specialties to increase the pool of trainees eligible to apply for EM training.

¾ Support Associate Specialist and Staff Grade Doctors (Specialty Doctors) in their roles to ensure retention and increase work satisfaction.

¾ Expand training of multi-professional workforce and define their roles in the emergency department.

HEE through EMWIG will continue its work on the emergency medicine workforce and look to its LETBs to support the recommended workforce interventions in order to alleviate the current problems in emergency departments across England.

In October 2013, the Government mandated NHS Employers to enter into formal negotiations with the British Medical Association (BMA) to deliver joint proposals for consultant contract reform. We are keen to see proposals for a renegotiated consultant contract that makes the best use of the medical pay bill, but offers flexibility in the reward mechanisms ie terms and conditions, increased leave and recognising the intensity of work etc, so that specialty-specific issues can be addressed when needed.


How many social workers are employed by the NHS now?

Using data from October 2013 it is estimated that between 1700 and 1900 Social Workers were employed directly by NHS organisations. The uncertainty associated with this range is because we are not able to definitively identify those in Social Work roles.

The Electronic Staff Record (ESR) Data Warehouse is a monthly snap shot of the live ESR system. This is the HR and payroll system that covers all NHS employees other than those working in General Practice, two NHS Foundation Trusts that have chosen not to use the system, and organisations to which functions have been transferred, such as local authorities. ESR was fully rolled out across the NHS in April 2008. The ESR fields used for this question have not been centrally validated and so reliability is subject to local coding practice.

This estimate has been derived in conjunction with the "Job Role Verifier" Tool produced by the Health and Social Care Information Centre (HSCIC). The Tool was developed to aid local organisations with Data Quality and shows compatible combinations of Job Role and Occupation Code. More information about the Tool can be found at: http://www.hscic.gov.uk/media/12940/Occupation-Code-and-Job-Role-Data-Verifier/pdf/4_Occupation_and_Job_Role_Data_Verifier_Presentation.pdf.

This method has been selected as while the fields are not subject to external validation they reflect combinations of Job Role and Occupation Code that could be reasonably expected of Social Workers or Approved Social Workers.

A number of individuals also appeared under the "Social Worker" or "Approved Social Worker" but with Occupation Codes not in line with the HSCIC Tool. These individuals emphasise the fact that the estimate is not a definitive figure and may be either an under or overestimate depending on how individuals have been coded at the local level.


Consultants Contract Reform

In October 2013, the Government mandated NHS Employers to enter into formal negotiations with the British Medical Association (BMA) to deliver joint proposals for consultant contract reform, on the basis of Heads of Terms (HoTs) agreed by both parties. The HoTs set out key areas where the parties believe there is scope for reaching an agreement, including the facilitation of seven-day services. The HoTs sets out a commitment from both parties to creating a pay system that attracts, retains and motivates the right number and the right mix of medical staff to do all that is required for high quality patient care. The parties will aim to produce a national contract that is responsive to patients’ needs and delivers sustainable improvement in the quality of care, consistently, across the NHS.

The target date for implementation of new contractual arrangements is from 2015, allowing for a negotiating period of 12 months, with a phased period of implementation.


Long term conditions year of care funding model

The long-term conditions Year of Care (LTC YoC) funding model programme will develop a new payment system, based on a Year of Care currency and a capitated budget for patients with multi-morbidity (anticipated to focus on around the top 10% of high-intensity health and social care users in a population). The key features of this payment system are that it is:

¾ person-centred, rather than using the episodic currencies that current exist;

¾ cross-service (acute, community, mental health, social care and primary care), a currency for the whole patient pathway irrespective of the provider; and

¾ need-based, rather than a currency for a specific disease or service.

This four-year programme has seen eight Early Implementer teams work towards "shadow-testing" the LTC YoC currency in 2014–15 (Year 3) and, subject to satisfactory testing, national implementation (non-mandatory) in 2015–16.

NHS England plans to share thinking on future plans regarding year of care payments in more detail in spring/summer of 2014. Any proposed new payment models must be tested properly before roll-out, and there are opportunities to build on the work already underway with the "integration pioneers" and the seven-day services demonstration sites. We hope to be able to start the process of implementation of new payment models in 2015–16.

Prepared 3rd March 2014