Classification: Official
Publication reference: PRN00599

To:

• Integrated care boards (ICBs):
  • chief executives
  • chief operating officers
  • chairs London
  • chief people officers/HR directors
• Trusts:
  • chief executives
  • chief operating officers
  • chief people officers/HR directors
• Commissioning support unit (CSU) managing directors

cc.

• Regional:
  • directors
  • directors of nursing
  • heads of EPRR

Dear Colleagues,

Industrial Action – Junior doctors and dental trainees (13 – 18 July 2023); BMA Consultants (20 – 22 July 2023): Pre-action self-assessment, rescheduled activity, and workforce data collections

This letter provides information regarding NHS England’s approach to pre-action self-assessment and situational reporting of workforce and rescheduled activity impacts of the industrial action announced by the British Medical Association (BMA), Hospital Consultants and Specialists Association (HCSA) junior doctors, and British Dental Association (BDA) dental trainees from 07:00 on Thursday 13 July – 07:00 Tuesday 18 July. It also sets out the approach for action by consultant members of the BMA from 0700 on Thursday 20 July – 0700 Saturday 22 July 2023.

We are again asking Trusts to avoid block rescheduling of elective cases. Rescheduling of appointments should only happen when absolutely necessary and be undertaken in consultation with your Integrated Care Board and your regional Performance Director.

It will be important for systems and Trusts to plan for the entirety of the cumulative period of disruption (both strikes and days in between and either side). Where appropriate, urgent elective surgery (P1 and P2), cancer care (particularly for patients who have already been waiting over 62 days, or who are likely to pass day 62 if their appointment needs to be rescheduled), and long waiters should be the final cohorts to be rescheduled.

There will be complex planning required across different services within each Trust (for example surgical and ITU teams) to ensure adequate staffing through the entirety of urgent care pathways.

Early and systematic discussion between specialties and service areas is key to ensure a shared understanding of expected staffing levels – as is dialogue between staff, management, and the local negotiating committee.

Where elective surgery continues, there must be adequate and aligned levels of staffing in other services (e.g. Pathology, Diagnostics, ITU) which support the elective pathway.

Pre-action self-assessment – ICB requirement

Ahead of industrial action, NHS England is requesting ICBs to report confidence in their service provision in their area. A single Excel self-assessment template sets out questions to capture the likely impact of action by HSCA and BMA junior doctors, and BDA dental trainees from 13-18 July and BMA Consultants from 20-22 July 2023.

In line with the NHS operating model and ICBs’ responsibilities as Category 1 responders and system leaders, we are asking for returns to be completed by ICBs only.

Our expectation is that returns are co-ordinated by ICB EPRR leads, informed by decision-making and operational planning led by Medical Directors and Workforce/People directors.

The self-assessment return should be informed by dialogue with Trusts, understanding of plans at Trust and place levels, as well as ICB- and network-level preparations.

We will use your information to identify risk areas for escalation or further guidance, to guide our conversations with Trade Unions and the Government, and to focus our support for systems. The template is enclosed with this letter.

Pre-action self-assessment – planning assumptions and limitations

For junior doctors’ industrial action, ICBs are asked to complete the template on the basis that no derogations are agreed (beyond the stated commitments to recall staff in the event of mass casualty incidents).

For BMA consultant action, ICBs are asked to plan and complete the template based on local intelligence on staff intent and reflecting your area’s ability to ensure minimum sufficient consultant cover to manage anticipated demand.

Conversations are ongoing with BMA regarding the BMA’s definition of Christmas Day service levels of staffing and staff recall arrangements for unexpected major incidents during the consultants strike period. Further detail will be provided if/when this is available.

We expect that an ICB’s first template return on 7 July will provide an initial assessment of readiness for junior doctors’ industrial action, whilst highlighting key areas of risk in relation to the consultants’ industrial action. We appreciate that detail will improve as planning progresses and that initial assessments will be updated. The second return on 11 July should therefore confirm each ICB’s readiness ahead of Junior Doctors’ action and provide greater detail on preparedness for consultant action.

For both sets of questions, ICB’s should therefore complete the template based on realistic local planning assumptions for the level of clinical cover to be available on the strike days, based on their Trusts’ assessment of likely staffing levels on the day and progress of discussions with Trade Unions and staff.

Pre-action self-assessment – timings and deadlines

ICBs will be informed of the regional submission date and time by their NHS England regional office. This timing will be aligned to ensure the region has time for review returns ahead of submission to the National Operations Centre (NOC). The submissions to regions will therefore be ahead of national submissions, due on Friday 7 July and Tuesday 11 July.

Pre-action self-assessment – Regional role

The deadline for the first return to the NOC is 11:00 Friday 7 July.

A second submission will be requested to highlight any changes given we anticipate a rapidly evolving picture in terms of staffing cover and risk.

The deadline for resubmission of the template to the NOC will be 11:00 on Tuesday 11 July.

Regional Operations Centres are asked to liaise with ICBs to ensure a comprehensive and accurate picture of local preparations and to identify service and geographical areas of concern. Where ICBs indicate there are trusts or services of concern and the return does not provide detailed information, NHSE region should contact the relevant ICB for further detail. Once regions have collated and reviewed ICB returns, regional EPRR teams are asked to complete a regional overview, and to send both this regional overview and the collated ICB returns for their region to the NOC.

An extended IA Working group will take place on the morning of Wednesday 19 July to consider regional teams’ latest assessment of risks and readiness ahead of BMA Consultant action expected on subsequent days and will consider the latest intelligence from region-to-ICB meetings held over the previous days.

Workforce and rescheduled activity situation report (SitRep) data collections

NHS England will conduct two SitRep data collections via the Strategic Data Collection Service (SDCS):

1. Industrial Action workforce SitRep. This will collect numbers of staff taking part in the industrial action, and total numbers of staff due to be at work. The collection will be open for all ICBs and Trusts. All organisations are requested to submit data, even if it is a nil return. The template for this can be found in Annex A.
2. Industrial Action rescheduled activity SitRep. This will collect information on activity that has been rescheduled because of the industrial action. The collection will be open for all acute, community and mental health trusts and will request the figures of rescheduled activity for the 15-day period of 11 – 25 July inclusive. All organisations are requested to submit data, even if it is a nil return. The template for this can be found in Annex B. Guidance for completion is provided as Annex D.

SitRep data collections – dates, timing, and guidance

The rescheduled activity collection will run on four occasions – on Friday 7 and Wednesday 12 July (to provide an initial internal estimates and aid in planning), on Wednesday 19 July (to provide final figures for the junior doctor and dental trainee industrial action) and finally on Monday 24 July (to provide final figures for the impacts of the industrial action by consultants).

Collections prior to the periods of industrial action will be used to understand the anticipated position of each Trust and help NHS England target regional support and follow-up – data will not be published. Highlights of the data collected on 19 and 24 July will be published on NHS England’s website. We acknowledge that data collected on 19 July may be subject to change and highlights of the data collected on 24 July will confirm the final position overall.

The workforce collection will run twice: on Wednesday 19 July (to cover junior doctors’ and dental trainees’ industrial action from 13 – 18 July) and Monday 24 July (to cover BMA consultants’ industrial action from 20 – 22 July). This data is also published and used for both internal and media reporting therefore it is important that an accurate submission is received from every organisation. The window will close at 13:00 on the days of collection and will not be reopened.

Submissions will be made through the SDCS platform. On any day that the collection is running we will open the collection at 09:00 and the deadline for submission will be 13:00 that day. The template will be available to download from SDCS from 09:00 on the first day the collection is running. Missing returns will be highlighted to regional Chief Operating Officers for follow-up.

A schedule highlighting which data will be collected on each date is included at Annex C. More detailed guidance notes will be shared with those registered as submitters in SDCS ahead of the first collection. An extract can be found in Annex D. If you have any questions, please contact your regional team.

Updates on the days of strike action

On the days of industrial action, NHS England, via its regional teams, may request information about the estimated number of staff participating in strike action and number of electives cancelled – in particular how this compares to the expected position set out in Sitrep and self-assessment returns. For NHS England (national) purposes, verbal confirmation of trends will suffice, and no formal data collections are planned. Use of any additional template or SitRep returns ‘on the day’ are for NHSE regional team and ICB agreement, during the planning stage. Many thanks for your continued cooperation and support in providing this information and ensuring a high return rate. And thank you for your continued efforts to provide NHS patients with the best possible care during these challenging periods of industrial action.

Yours sincerely,

Mike Prentice, National Director for Emergency Planning and Incident Response, NHS England.

Annex A – Workforce collection

Collection on 19 July

Collection on 24 July

Annex B – Rescheduled activity SitRep

Annex C – Schedule of data collections and pre-action self-assessment returns

Annex D – Extract from guidance for Industrial Action Sitrep collections – July 2023

Rescheduled activity SitRep

Full guidance will be shared with SDCS submitters ahead of collections.