The recommendations will now go to the Secretary of State, and the rest of today’s news and comment
5.37pm The findings and ideas in the latest report on staff wellbeing should be be taken seriously by all who work in the NHS, says Steve Boorman in our Comment section.
4.39pm The BBC’s Adam Brimelow writes that one year on the pressure is growing for new health organisations, such as CCGs, to deliver.
The recommendations include having a midwife-led unit and retaining the reduced accident and emergency opening hours, between 8am to 10pm.
Monitor chief executive Dr David Bennett said: “Making changes to local health care services is never easy, or necessarily popular with the general public. Neither does change in a complicated system like the NHS come cheap. Nevertheless it is absolutely essential that patients are able to access safe services today, tomorrow and well into the future.”
Here is an article outlining the trust special administrator’s proposals in more detail.
1.32pm Our story on the increase in NHS productivity is collecting some interesting reader comments:
“The significant thing about this report is that as well as measuring what we count and spend, they have linked it to quality and outcomes. So it’s not just we are generating more activity for less cost, we are are also giving effective treatment. Who’d have thought it from the state sector. I look forward to widespread coverage in the Mail and Telegraph.”
“Hmmm. Yes to more effective treatment. But actually we’re generating more activity for more more cost, not less cost. What these data actually show is that it took the NHS 13 years to get the growth in outputs to match the growth in inputs. Or, to put it another way, for 12 years the taxpayer paid over the odds for output growth. That NHS productivity in 11/12 is only fractionally better than it was in 98/99 is not a success story! But perhaps when weighed against the qualitative benefits achieved, the cost of the growth in output has been a price worth paying. Who’s to say?”
12.44pm Our editor-in-chief comments on the findings of a rise in NHS productivity.
He writes that the new data “exposes the lie that the huge increase in funding over the last decade knocked NHS productivity off course”.
12.41pm Andrew Street, the professor at the Centre for Health Economics at York University who led the NHS productivity study, discusses his team’s findings and the data they used to come to their conclusion.
Eight months after procurement regulations came into force, their effects are already being felt across England, with two-thirds of those responding to the survey witnessing changes in commissioning behaviour.
The survey received 93 completed responses. Of these, 38 per cent of providers felt their organisations might challenge a procurement process in the next six months.
HSJ will be hosting a free webinar on this very subject at 12.30pm on 5 February. Register here to join in.
NHS Arden, Greater East Midlands, North Yorkshire and Humber, West and South Yorkshire and Bassetlaw Commissioning Support Units have come to an agreement.
However, they confirmed to HSJ: “This is not a merger. Our Memorandum of Understanding specifies that individual organisational sovereignty will be retained.”
In a joint statement the CSUs said: “The alliance will deliver market-leading, cost-effective services that meet the needs of our customers.”
11.17am There has been a sharp increase in the number of applications to use deprivation of liberty safeguards for people over the age of 75, it has emerged.
The Care Quality Commission’s annual report on DoLS found overall applications increased in 2012-13, although the increase was smaller than for each of the previous three years.
DoLSs were introduced in 2009 as part of the Mental Capacity Act 2005. They are intended to ensure a care home or hospital only deprives someone lacking mental capacity of their liberty when it is in their best interests, and in a safe and correct way.
11.09am Also in The Times, an inquest heard that a daughter who helped her elderly parents to carry out a suicide pact was “genuinely motivated by compassion”.
Georgina Roberts prepared a lethal drug for her parents, David Arnold, 82, a retired GP, and Elizabeth, 85, who decided to commit suicide after he became bed-ridden and she was diagnosed with dementia.
11.08am The Times reports that more than a million people in Britain have gout, but only a third of patients get sufficient treatment, due to lack of knowledge among GPs and people being too embarrassed to seek medical help.
There has been a rise in gout cases in the last decade, which experts have blamed on alcohol, red meat, junk food and obesity.
The High Court action is being seen as potentially an important test case, involving a man kept alive medically after a devastating series of heart attacks who could die at any time.
The woman “AB”, who cannot be named, says her partner “P” would have given his written consent had he known “he would be in his current state”.
The NHS Support Federation, which opposes a competitive market in the NHS, says changes to the NHS have allowed increased competition between providers which bid to provide a range of services, including the clinical care of patients.
The group examined 57 contracts for clinical services awarded between April and December 2013 and discovered 39 of them went to private firms.
In response, the NHS Confederation’s NHS Partners Network pointed out that the sample of contracts was very small and it claimed there had only been a small increase in the proportion of clinical care provided by the independent sector since 2010.
10.52am There have been two consecutive years of productivity growth in the NHS for the first time since the late 1990s, according to research shared exclusively with HSJ.
A study by the Centre for Health Economics at York University found NHS productivity increased by 2.1 per cent from 2010-11 to 2011-12. This is on top of its 3.2 per cent growth the previous year.
The centre uses 12,000 categories of data, including hospital episode statistics and reference cost returns, to measure growth in the amount of healthcare provided for patients and the level of resources, for instance staff and equipment, used to produce it.
10.51am Here’s some of our previous coverage on the Competition Commission’s proposals.
10.49am Nuffield Health has responded to the Competition Commission’s proposed measures.
Nuffield Health Group chief executive David Mobbs said: “The proposed measures announced today by theCompetition Commission will go a long way to improve the competitiveness of the private hospitals market for the benefit of the health consumer. The recommendations for the divestiture of two hospitals In London will significantly reduce the harmful dominance of the Hospital Corporation of America, and is a breakthrough not just for health consumers in London, but could have a far reaching benefit for private healthcare across the UK.
“Whilst these proposed measures also address some of the competitive concerns in separate local markets across the UK, they fall short in addressing the national market power of BMI and Spire in negotiations with Private Medical Insurers outside of the London market, which has led to patients paying inflated prices.
“Although the Competition Commission has proposed a complementary package of remedies that should introduce choice for patients and drive competition in a limited number of local markets, they have stepped back from introducing a solution to prevent the ‘tying and bundling’ tactic used by some hospital operators in negotiations with Private Medical Insurers that drives higher prices. At the same time, the Commission appears to have diluted the measures for divestiture outside of London which has weakened the complementary impact of the remedies that would have reduced national market power.
“As the Competition Commission emphasise, the detriment to the health consumer and to the employers that fund most of the private healthcare in the UK, is caused by market power held by the Hospital Corporation of America, BMI and Spire across the UK. This is not just a factor for separate local markets but is also about the scale of market power on a national basis. This issue still remains to be resolved.
“The industry should strongly welcome the removal of consultant incentives, the improvements in patient information, and the transparency of consultant fees. These remedies will not only improve the competitive environment but will also restore integrity and consumer confidence to the market. As an organisation Nuffield Health has long been committed to providing transparent and easily accessible data for patients on price and quality and have already begun to implement initiatives to address this.
“Nuffield Health will be looking with interest at the opportunities arising from divestments in all of the geographical areas, including London, from which we have previously been excluded, to see whether we can bring Nuffield Health’s unique offering of joined-up health, from prevention to cure to a wider group of patients.”
10.43am The Competition Commission has outlined its proposed measures to increase competition in the private healthcare market.
The measures are based on the CC’s provisional report in its private healthcare investigation, which was published in August last year and found that many private hospitals face little competition in local areas across the UK and that there were high barriers to entry.
The CC also pinpointed incentive schemes, which encourage clinicians including consultants to refer their patients for treatment or tests to particular providers and a lack of available information on the performance of hospitals and consultants and on consultant fees as further competition problems.
The CC will now consult further on these measures (as well as continuing to assess responses to the provisional decision itself) before it publishes its final report at the end of March. The CC has not, at this stage, made a final decision regarding the existence and form of any competition problems.
The provisional decision on remedies proposes the following measures:
- divestiture of nine private hospitals—HCA should sell two hospitals in central London (London Bridge and Princess Grace) and BMI should sell seven hospitals in Greater/Outer London, Home Counties and the North-West of England. Buyers will need to get CC approval and to have the appropriate financial resources and expertise;
- the Competition and Markets Authority (see Notes for editors) will review any proposal by a private operator to enter into an agreement to operate a private patient unit (PPU) in an NHS hospitals in a local area where it faces little competition;
- prohibition on or restriction of clinician incentive schemes provided by private hospitals to clinicians that encourage patient referrals to their facilities or for particular treatments or tests; and
- requiring the collection and publication of information on the performance of private hospitals and individual consultants and the provision of consultant fee information to patients.
CC chairman and chairman of the Private Healthcare Inquiry Group, Roger Witcomb said: “We’ve looked hard at how we can meet the challenging task of opening up this market to increased competition. We’re now proposing those measures which we believe will offer practical and effective ways of improving competition and ensuring private patients get a better deal.
“Requiring operators to sell hospitals is a big step and we have focused on those areas where a sale will be effective in increasing competition—where a single operator owns a cluster of hospitals which face little rivalry.
“As well as these measures, we will look to remove ways in which hospital operators can reinforce their position and close the door on potential competition. So we want to prevent incentive schemes that encourage patient referrals to particular hospitals. We will also look to ensure that the option to partner with a NHS PPU is open to potential new entrants in areas which need greater choice.
“We will also provide for greater information on the performance of hospital operators and consultants and for consultants on price as well to allow patients to make informed choices when deciding which hospital and consultant to choose for their treatment.”
The CC is required to publish its final report by 3 April 2014.
10.37am Researchers have suggested that comedians are able to make people laugh because they display characteristics usually found in schizophrenics or those with bipolar disorder, The Guardian reports.
The study is based on 523 comedians from the UK, USA and Australia who filled out a questionnaire describing their own personalities and beliefs. The questionnaire measures psychotic traits in people who do not have mental illness.
The researchers compared the comedians’ results with a group of actors and people from non-creative occupations. They found that comedians scored highest on the four types of psychotic personality traits.
10.30am The Guardian reports that two men with progressive blindness have regained some of their vision after taking part in the first clinical trial of a gene therapy for the condition.
Six patients had the experimental treatment for a rare inherited disorder called choroideremia, which steadily destroys eyesight.
After the therapy the men could read two to four more lines on an optician’s sight chart and this improvement has remained. One of the men was treated more than two years ago.
10.23am The Financial Times reports on the EU’s ratification of new rules on public sector procurement which will open up the £450bn a year market to smaller contractors and allow governments to outsource health and social care services more rapidly.
The changes will streamline the procurement process in a new “light-touch” regime”, and contracts worth less than £626,000 will be excluded from EU laws because they are deemed not to be of cross-border interest. The new rules also allow governments to blacklist companies who have provided substandard services in the past, where this has led to formal sanctions such as termination or damages claims.
Social enterprises and public sector mutual will also be exempted from EU rules so that staff can bid for contracts without private sector competition for an initial three-year period.
9.54am The Daily Telegraph also reports that thousands of elderly patients have been subject to restraint in care homes and hospitals.
Health watchdogs said two-thirds of hospitals and care homes were breaking the law by locking up elderly patients and stopping them from seeing their loved ones.
Figures from the CQC found the number of applications to deprive those over 75 of their liberty has risen by 85 per cent since 2009-10.
9.50am The Daily Telegraph reports that women will be able to have an abortion without a doctor considering their case under draft guidance proposed by ministers.
The proposals state that there will be no legal requirement for a woman to consult a doctor before terminating a foetus. Ministers admitted that fewer than half of women who have abortions now see doctors face-to-face.
The compliance actions relate to a lack of full completion of the World Health Organization surgical checklist, the safety of the accident and emergency department, the recording of care assessments and records management on acute medical wards.
During the inspection in November the team found that the trust’s services were “safe, effective, caring, responsive to patients’ needs and well-led”.
9.30am According to a new survey by Hay Group health sector workers have more pride in their job than other public sector workers.
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