HSJ Live 16.12.13 Keogh launches seven day working plan

4.55pm The Royal College of Surgeons has put out a briefing on the Care Bill with focus on the ‘single failure regime’, extenidng the powers of trust special administrators and duty of candour.

2.45pm Have your say on how to improve hospital care for the frail elderly through our Commission on Hospital Care for Frail Older People. If you have not already received a link to the dedicated website for the commission, please email andrew.snowball@emap.com for access.

2.41pm Every health conference should have a “people’s panel” to encourage open conversations, according to a group of our comment writers.

2.05pm The Healthcare Financial Management Association, which worked on Sir Bruce Keogh’s seven day services report, has given detail on its research.

The HFMA’s research found that:

· The costs of implementing seven day services, and current service levels, vary within the eight hospitals looked at and may vary even more across the whole NHS. This suggests a local rather than a standard national approach to implementation is required.

· The range of costs for implementing seven day services at most providers, excluding London, is broadly five per cent to six per cent of relevant expenditure (i.e. the cost of emergency admissions excluding maternity) or up to two per cent of total patient care income.

· Seven day services for a hospital as a whole are unlikely to be cost-neutral under the present configuration of services. The move to seven day services does appear achievable, but it may be too expensive and unsustainable for all existing hospitals to move all their current range of services to a seven day basis.

Headed up by former HFMA president, Tony Whitfield, who is also the director of finance and deputy chief executive at Salford Royal NHS Foundation Trust, the research focused specifically at eight trusts in England.

Tony Whitfield said: “The introduction of seven day services is one of a number of challenges facing the NHS. NHS organisations need to think carefully about how they are going to implement seven day services and remain clinically, operationally and financially viable. In some areas it may drive the consolidation of services. What matters is that patients have access to the services they need every day of the week, but that does not mean that all hospitals need to provide all services at weekends.

“NHS finance staff have a role in making seven day services happen. If implemented, our work suggests a local rather than a standard national approach to seven days services is required as every hospital is unique. If the clinical case for seven day services is strong, internal NHS obstacles should not be allowed to prevent it.”

Mike Baker told the BBC he had been planning to retire but “decided to bring it forward and resign” when he read a report by the Care Quality Commission, which found that the records of cancer patients had been changed to fit with waiting time targets.

It is now subject to both an independent investigation commissioned by the trust and a formal police investigation.

1.45pm Scientists in Australia have grown the first kidney from stem cells, reports The Telegraph.

This breakthrough, published in the journal Nature Cell Biology, could help reduce the wait for transplants.

1.42pm The Telegraph reports that a doctor forged his own prescriptions for viagra because he was too embarrassed to ask his doctor for the drug.

1.05pm In our comment section Michael Scott argues that the payment system is essential to providing better care.

12.55pm Our sister title Nursing Times reports that one in four female prisoners self-harm each year according to a new study by academics from the University of Oxford.

A total of 139,195 incidents of self-harm, involving 26,510 inmates, were recorded during a six-year period between 2004 and 2009.

This ranged from about 20,000 to 25,000 incidents per year, with women accounting for roughly half of these.

12.51pm Guy’s and St Thomas’ Foundation Trust is live-tweeting from St Thomas’ A&E today to give an idea of the range of health concerns people turn up with. Have a read at @GSTTnhs

12.45pm Here’s the Chartered Society for Physiotherapy’s response to the seven-day working report.

Chief executive Phil Gray said: “Seven-day services have been shown to cut waiting times and allow physiotherapy patients to receive the treatment they need, when they need it.

“To be sustainable, however, they need proper investment to ensure the existing service isn’t simply stretched over an additional two days, which could actually reduce the quality of care rather than improve it.

“It is also essential that the health professionals delivering the service are involved in designing the new arrangements to ensure patients receive the best possible care.”

12.43pm Healthwatch England is launching a 12 week consultation today with patients, care users and their families to shape a strategy for a rights-based framework on care.

The organisation argues there are already some legal rights which are enshrined in the NHS constitution but nothing similar in care. The consumer rights will describe what people expect from the services they need and will be used to challenge services to do more to meet public expectations.

Special attention will be given to speaking to those groups that are rarely heard, particularly children and young people and those with mental health conditions, to ensure that the rights work for a broad range of consumers, particularly those with the most complex needs. 

Recent research by Healthwatch revealed that 1 in 3 of the 2,000 health and care users spoken to said they had personally experienced or knew someone who had experienced some form of abuse, neglect or malpractice whilst being cared for.

More than half of those affected by poor care in the last three years didn’t report it because they didn’t trust the system to do anything as a result.

Chair of Healthwatch England Anna Bradley said: “We are particularly keen to seek out the views of those groups that are rarely heard, particularly children and those with mental health conditions, to ensure we are giving a voice to the people who need the most help speaking up.

“We will be working with the network of local Healthwatch to collect feedback from all over the country to ensure local experience is reflected in the way decisions are taken about our rights and responsibilities, and how we can all play a part in creating a consumer focused national health and care service that is focused on what we need.”

12.26pm Have a look at our twitter account to see the festive gift that just arrived on our desk. @HSJnews

11.58am In his Scrubbing Up column for the BBC, Professor David Hunter asks whether “the disproportionate focus on inspection is part of the problem rather than the solution”.

11.50am In its leader column, The Daily Telegraph writes: “If Bruce’s Keogh’s long overdue strategy is a recognition that the NHS needs to respond to the requirements of a changing world, then it is welcome.”

However, it warns “this will need to be introduced sensibly. We have seen before in the NHS how targets and benchmarks can lead to perverse outcomes”. 

11.47am The Foundation Trust Network welcomes Sir Bruce Keogh’s report into seven-day services.

Chief executive Chris Hopson said: “This is an important step towards modernising the NHS to provide round-the-clock access to NHS care and expertise wherever you are a patient or in need.

“Sir Bruce’s report clearly identifies the standards we should expect from the NHS at any time and the issues we will need to overcome to achieve them. The case for safe and accessible NHS services operating to the same high standards at any time of day or night is well-made and undeniable.”

Mr Hopson added: “We now need to focus our energy on tackling the issues – how much will it cost, how is it staffed fairly, how quickly can we do it, how do we explain the changes to services that will be necessary to patients and the public? We need to see this in the light of both the proposals on major changes to the urgent and emergency care pathway, and learn from the early adopters of seven-day practice who are pioneering new services and methods of care.

“But we can no longer continue with a system that sees different standards, outcomes and experiences for patients depending on the time of the week and the FTN and its members are totally committed to playing their part in the changes that will need to come.”

The BMA called on health secretary Jeremy Hunt to backtrack on plans to strengthen the trust and foundation trust special administration regimes.

The changes have been included in the Care Bill, which faces its first test in the Commons today, and follow the legal battle over the future of Lewisham Hospital in south-east London.

11.24am In September we asked for your views on seven-day working. Here is the article again in the context of Sir Bruce Keogh’s plan.

11.21am A new report by the Institute of Diabetes for Older People estimates that £1 in every £8 is spent by local authorities on supporting people with diabetes.

The report also finds that over 70,000 people with diabetes are accessing local authority funded social care.

The national cost of providing care for these individuals is an estimated £1.4bn a year; or £4 million a day. However, without direct action the cost is set to rise to an estimated £2.5bn by 2030.

The report identifies integrated care as an opportunity to address the diabetes care challenge and calls on the Government to publish the National Diabetes Action Plan to provide a framework to improve services.

Director of IDOP Professor Alan Sinclair said: “For too long the cost and impact of diabetes on the disabled, the old and the vulnerable has been a hidden issue. Today’s report for the first time seeks to bring to light the scale of the challenge we face and the need to think and act differently in the way diabetes is prioritised, managed and resourced in the health and social care system. We already know thatsomeone with diabetes is admitted to hospital from residential care every 25 minutes, a figure set to rise to one every 10 minutes by 2051. This is a wake-up call about the need to better integrate care people with diabetes, improving outcomes and relieving pressures on the system.”

The report outlines ten recommendations to improve care, developed in consultation with health and social care sector experts.  These include the need for the Government to publish the National Diabetes Action Plan, to provide a mechanism for improving diabetes care across the health and social care system.  The report also identifies the need for greater support to NHS and social care commissioners to ensure local services are commissioned in line with best practice and are responsive to patient needs.

11.15am The Daily Mail reports that consultants who refuse to work weekends could lose their jobs.

Sir Bruce Keogh also plans to impose fines of up to £12m on hospitals where patients experience poor care on weekends.

11.11am Hospitals and emergency departments will be able to be closed more easily under an amendment to the Care bill due to be debated in the House of Commons today, reports the Financial Times.

The changes have already been approved by the House of Lords and will give Jeremy Hunt fresh powers to authorise closures and changes where a NHS trust had been placed into administration.

11.01am The Times reports that one in four children with diabetes is at risk of amputations and blindness because only 17 per cent have good control of their condition.

An audit of the records of the 25,000 children with diabetes in England and Wales indicates that only one in 15 children get all the recommended diabetes care checks.

10.56am Nearly half a million elderly and disabled people have been denied social care because of council funding cuts, reports The Times.

Research by the London School of Economics shows that 483,000 people have either lost homecare support or are no longer eligible to claim it.

10.53am The BBC reports that there has been a sharp increase in racist attacks in the NHS.

A Freedom of Information request revealed that the number of racist verbal and physical attacks has risen by 65 per cent in five years.

10.50am Here’s our special coverage on seven-day working - with insight and analysis from experts on the best way forward.

10.47am The Independent reports on the case of Margaret John, who is asking for the right to end her life in a humane way. The Supreme Court is looking at her testimony this week as well as the case of the late Tony Nicklinson, who suffered from locked-in syndrome.

10.38am The Academy of Medical Royal Colleges welcomes plans for seven day care.

Professor Terence Stephenson, Chairman of the Academy of Medical Royal Colleges said: “It is unacceptable that for a patient admitted as an emergency, the chances of dying may be 11 per cent higher on a Saturday and 16 per cent higher on a Sunday. The Academy recognises that moving to successful seven-day care will not be easy to achieve, but has led the argument for this principle. We know that junior doctors feel clinically exposed at weekends and that hospital chief executives are rightly worried about weekend clinical cover. The Academy has contributed to the Forum on Seven Day Services and will continue to work with NHS England. The findings from the evaluation of the impact of high intensity specialist led acute care (HiSLAC) that the Academy and University of Birmingham are leading on will be an important next step.”

Professor Norman Williams, Seven day services steering Group Chair and President of the Royal College of Surgeons, said: “It is not acceptable that over weekends and bank holidays, patients receive a lower standard of care than they would during the week. We must use these findings from this NHS England report and the recent Academy report and work together to strengthen the standards and quality of care given to patients regardless of when they are admitted. Royal Colleges will work with NHS England to help implement the delivery of the ten clinical standards that underpin this work.

“As the report acknowledges moving the whole service to seven-day care will not be cost-neutral. Whereas some economies can be achieved by centralisation of services and improving outcomes, extra costs seem inevitable. The further detailed economic modelling needs to be done urgently so that NHS and the public can understand how much better care will cost.”

Sir Bruce Keogh, NHS England’s medical director, said he was setting out “pretty radical changes” which were backed up with some “pretty hard levers” to make sure hospitals complied.

He said the hospital trusts will be contractually bound to run a full service seven days a week. Breaches could cost them up to 2.5 per cent of their annual income of up to £500m.

Sir Bruce indicated the changes, which could cost around £1bn to implement, would result in hospitals making more efficient use of equipment and expertise.

7:00am Good morning and welcome to HSJ Live. We open proceedings with a piece from Michael Scott, chair at the NHS Confederation community health services forum and chief executive at Norfolk Community Healthcare, on how reform of the NHS payment system can help the service move closer towards integrated care.