HSJ Live 23.01.2014: Reaction to NAO waiting times report

5.07pm Over half of frontline NHS staff in England are now having flu vaccinations, according to data from Public Health England.

The Public Health England figures, published today, show that 494,083 (53.1 per cent) were vaccinated by 31 December 2013 – a proportion 21 per cent higher than at the same time the previous year (44 per cent or 436,579 staff).

The ‘flu fighter’ campaign is run by NHS Employers.

4.52pm Rob Findlay, who is an expert on waiting times and blogs for HSJ, has written about the NAO’s report on waiting times for elective surgery.

4.24pm Dr Michael Dixon, chair of the NHS Alliance has said that “the current system for developing premises to look after patients outside hospital is not fit for purpose and threatening to slow down much needed NHS reforms”.

Speaking in London today on the primary care estate he argued that at a time when investment in primary care premises is most needed - because of the need to move care out of acute settings - the development of primary care premises has grinded to a halt.

To kick-start the redevelopment of primary care premises the NHS Alliance has called for local decision making on new premises “with clinical commissioning groups in the driving seat”, “ensuring that there is cash in the system to support new and improved premises”, and establishment of a ‘Fighting Fund’ drawing on unused capital from the secondary care sector.

3.51pm The Royal College of Nursing has also commented on the National Audit Office report. Dr Peter Carter, chief executive and general secretary of the RCN said:

“It’s deeply worrying that incorrect information and inconsistent methods of recording waiting times are seemingly widespread across the NHS. This invariably will put more pressure on services and staff - accurate waiting time data should be used to make the case for investment and innovation in the health service, but what we’ve seen is that many staff have been put under tremendous pressure to meet targets but not given enough resources to achieve these.

“We need to see trusts and NHS England work with staff to put this right and give us meaningful data with which we can improve NHS services.”

3.17pm In addition to the reaction to Jeremy Hunt’s speech which we’ve been reporting throughout the afternoon, there has also been a number of responses to the NAO’s report on elective surgery waiting time statistics. Here’s the statement from Matt Tee, chief operating officer at the NHS Confederation:

“The introduction of the 18 week maximum wait was a significant milestone in improving patient experience. We do have to remember though that it is only a measure, not an actual outcome.

“The 90% RTT (referral to treatment)  standard has been achieved on all but two months since August 2008. The RTT target looks at a whole-system experience - it’s not just about treatment in a hospital, it includes diagnosis, decision to treat, access and other elements - so it is important that no single part of the health service is celebrated or vilified for it being achieved or missed.

“A good pathway - which means a patient is seen and treated inside 18 weeks - requires commissioners and providers working together across the whole system  to drive down waiting times. We need to acknowledge that the whole system is under more pressure than ever, and what we are seeing in this report is that this can have a major impact on elective care, as measured through performance targets like 18 weeks.”

2.47pm Tim Kelsey and Mark Davies have written a piece for HSJ arguing that collaboration between the NHS and its US counterpart is an important step on the road to modernising the health service.

A memorandum of understanding is being signed today by the health secretary and US secretary Kathleen Sebelius. It agrees to share solutions around the use of information and work on challenges of technology adoption together.

2.30pm Here’s what Chris Hopson, chief executive of the Foundation Trust Network, has to say about the speech:

“Naming a lead clinician is one means by which many trusts already help ensure a holistic and integrated approach to managing care inside and outside hospital, as will the introduction of a lead clinician for older people in the community, and of more co-ordinated care planning for people with long term conditions.

“However, to get the most beneficial outcomes for patients, many of our members will continue to go beyond the prescribed approach of naming a clinician above a patient’s bed to ensure that patients and their families know who they can go to for advice about their care, and to build on this to ensure that relationships between doctors and nurses, and patients and their families remain compassionate and cohesive.”

2.15pm Sir Stephen Bubb, CEO of the Association of Chief Executives of Voluntary Organisations (ACEVO) has this to say on Jeremy Hunt’s speech:

“Today’s announcements are a welcomed step towards a real culture shift within the NHS in improving the care patients receive. Providing ‘whole stay’ doctors, ensuring consultants are accountable for patient care and liaising with GPs, means there should be a real improvement in personalising care.  However meeting patient’s needs means supporting the voluntary sector in providing community solutions. ACEVO is working with national organisations such as the Foundation Trust Network, trusts and clinical commissioning groups (CCGs) to strengthen partnerships between the voluntary sector and the NHS.”

2.00pm Here’s the BMA’s reaction to the health secretary’s speech. Dr Paul Flynn, Chair of the BMA’s Consultants Committe, said: 

“Doctors share the view that patient care should be at the centre of the health service and support the principle of strengthening the doctor-patient relationship.  

“Greater continuity of care can improve clinical outcomes and doctors have also called for greater integration between primary and secondary care, and community and secondary care.  

“In addition, doctors have outlined support for more seven-day services to be available and we believe delivering more urgent and emergency care should be the priority.

“Work patterns should promote and support continuity of patient care and where opportunities lie for improvement these need to be explored. It is crucial however that working patterns also safeguard the need for a healthy and productive work-life balance for doctors, as that is also crucial to protecting patient safety and care.”

1.41pm There’s been a lot of reaction to Jeremy Hunt’s speech this morning on “whole-stay doctors”. Here on HSJ Live we’ll let you know what people have been saying about it throughout the afternoon.

Kicking things off is the Royal College of Physicians: “We welcome the secretary of state’s support for a ‘whole stay doctor’ who is responsible for the standard of care delivered to each patient during their hospital stay.”

The RCP adds: “Patients and carers should know where they can receive information about their care. Every patient should be given information about which consultant is responsible for their care and how they can be contacted.

“The RCP’s Future Hospital Programme has set out a vision for acute medical services that are centred on the needs of patients. We are currently working with potential partners in the NHS to develop implementation of Future Hospital.”

1.27pm The Daily Telegraph has some coverage of Jeremy Hunt’s speech today.

The paper reports that the health secretary has said that doctors should stop thinking of patients as “bodies harbouring a pathology” and “bed blockers” and instead recognise them as people.

Mr Hunt will back a campaign started by Dr Kate Granger, a terminally ill doctor, to encourage clinicians to greet their patients and give them their names.

As revealed by HSJ in an exclusive interview, Mr Hunt wants every patient to have a named doctor who is in charge of their care throughout their stay in hospital.

1.13pm There is an “unreasonable risk” of having a disabled baby if women undergo home births, according to medical ethics experts and reported in The Times.

Julian Savulescu of the Centre of Practical Ethics at the University of Oxford and Lachlan de Crespigny, an obstetrician and gynaecologist at the University of Melbourne said that doctors should warn prospective mothers about the risks. If there is a problem during childbirth the delay in getting to a hospital can lead to brain injury that causes life-long problems.

A study by Oxford researchers three years ago found that babies born at home were almost three times as likely to die or suffer serious problems as those born in hospital.

However, senior policy adviser at the National Childbirth Trust Elizabeth Duff said that home birth should be considered a “mainstream option for women in the UK, provided a pregnancy is straightforward”.

1.08pm In The Times, British heart attack patients are a third more likely to die than those in Sweden according to a study.

Thousands of people have died because the NHS has been too slow to adopt new treatments according to the researchers from the National Institute for Cardiovascular Outcomes Research at University College London.

The researchers looked at data from 400,000 patients in 242 British hospitals and 120,000 patients in 86 Swedish hospitals. They found that in the UK 10.5 per cent of patients died within 30 days of a heart attack compared with 7.6 per cent in Sweden.

12.53pm Browsing through today’s papers, The Daily Mail reports on a major study published in the Annals of the Rheumatic Diseases, which found that women who takehormone replacementtherapy after a hip or knee replacement are up to 50 per cent less likely to need repeat surgery soon afterwards.

12.19pm Monitor is closely watching the decisions clinical commissioning groups are making about transforming community services contracts, its chief executive has told HSJ.

Community services contracts were let by primary care trusts in 2010-11 - the year when they were required to cease providing services directly - usually on terms of between three and five years.

However, very few CCGs have begun tendering the contracts and anecdotal evidence suggests many are looking to roll on the contracts or avoid tendering them all together.

12.06pm An exclusive from HSJ’s David Williams: the Cabinet Office has conducted a “deep dive” investigation on behalf of the prime minister to examine the health system surrounding Portsmouth Hospitals Trust.

The exercise took place late last year, and was one of six undertaken around England. The Cabinet Office confirmed that it took place, but refused to give any details of what prompted the investigation, or what the outcome of it was.

The Cabinet Office would also not say either to HSJ or to NHS leaders in Portsmouth which other areas it was reviewing.

11.51am On the subject of named lead clinicians, Chris Hopson, chief executive of the Foundation Trust Network, said: “The Francis Report and ‘Hard Truths’, the Government’s response, raised crucial issues about quality of care in the NHS, which all trusts are committed to addressing. One of the issues it recognised was the complexity of safety, including the need for strong communication and co-ordination between all the professionals involved in a patient’s care. 

“Naming a lead clinician is one means by which many trusts already help ensure a holistic and integrated approach to managing care inside and outside hospital, as will the introduction of a lead clinician for older people in the community, and of more co-ordinated care planning for people with long term conditions.

However, to get the most beneficial outcomes for patients, many of our members will continue to go beyond the prescribed approach of naming a clinician above a patient’s bed to ensure that patients and their families know who they can go to for advice about their care, and to build on this to ensure that relationships between doctors and nurses, and patients and their families remain compassionate and cohesive.”

In an exlcusive HSj interview, health secretary Jeremy Hunt revealed Care Quality Commission inspectors will check whether hospitals have the name of each patient’s “whole-stay doctor” clearly marked above their bed..

11.44am James Forsyth argues in The Spectator that Jeremy Hunt is continuing in the tradition of Aneurin Bevan.

He writes: “Hunt is about as different personally and politically from Bevan as it is possible to be: he is the son of an admiral, not a coal miner, and a Thatcherite, not a socialist.

“He does, however, share Bevan’s desire to know what is happening inside every NHS hospital. He begins his day by reading, and replying to, a patient who has written to him about the care that they have received from the NHS.”

11.36am Leaders of three clinical commissioning groups have written to the chief executive of an acute trust setting out concerns about the quality of the care it provides, HSJ’s Nick Renaud-Komiya reports.

Ursula Ward, chief executive of Portsmouth Hospitals Trust, has been asked to explain how she intends to tackle recurrent problems such as cancer waiting time breaches and poor accident and emergency performance in the letters from senior figures at three CCGs. Find out which ones here.

11.14am A four-year-old boy who died following major heart surgery on a controversial hospital ward should have been receiving high-dependency care when he suffered a cardiac arrest, an inquest heard on Wednesday.

10.57am The BBC speaks to Sue Walker, who is on the waiting list for a hip replacement repair, about how her operation was cancelled as she was preparing to go into surgery.

10.49am Jeremy Hunt explained to ITV Daybreak this morning that the National Audit Office was “very careful not to say that hospitals were deliberately misrepresenting” waiting time figures. He said “they talked about inconsistencies” and “some underreporting and some over reporting”.

The health secretary said: “We’ll sort that out. We’ll make sure that you can properly compare hospitals.”

He added: “The thing that I think shocks people the most is that people have to wait over a year for their operation. The figures show that those have gone down from 18,000 people at the time of the last election to just 218, and I think people should be reassured by that.”  

Research by the National Audit Office discovered trusts in England were often “mis-recording” data, with some saying either patients waited less time than they did for treatment, or longer.

10.32am Attendances to accident and emergency departments have fallen over the course of the past year, according to NHS England data.

Between October and December attendances dropped to 5,289,000, down from 5,351,000 in the same period the previous year − a fall of 1.2 per cent.

10.23am EXCLUSIVE: A majority of clinical commissioning groups could close over half of their funding gap by implementing best practice interventions, NHS England guidance shared with HSJ claims.

The national body examined over 500 possible measures to see if they could help close the health service’s funding gap, estimated to be £30bn by 2020. It highlighted 20 interventions, which it believed could have the greatest impact on service quality and finances.

10.15am In Resource Centre, solicitor Katie Mickleburgh reviews the newly enacted Defamation Act 2013 and considers the implications for NHS organisations.

10.01am In an exclusive interview ahead of a speech today at Guy’s and St Thomas’ Foundation Trust, on the theme of “patients as people”, Jeremy Hunt revealed to HSJ’s Ben Clover that Care Quality Commission inspectors will check whether hospitals have the name of each patient’s “whole-stay doctor” clearly marked above their bed.

The health secretary said he wanted patients to be able to “contact” their named medic to “unblock bureaucracy” during their hospital stay.

The move is one of the recommendations in the government’s response to the Francis inquiry into poor care at Mid Staffordshire Foundation Trust and it has already been taken up by University College London Hospitals and King’s College Hospital foundation trusts.

However, HSJ understands take-up of the measure across the rest of the hospital sector has been low.

9.55am David Bennett writes in HSJ that Monitor’s proposals should allay trusts’ concerns about the merger regime and help to ensure that competition is used to benefit patients.

“There is considerable concern about the impact of statutory merger controls on trusts, and I have listened carefully to these,” he says.

“Monitor would highlight risks, but only in the most extreme cases would we use our regulatory powers to block a transaction.”

9.45am Speaking to HSJ’s Will Hazell, David Bennett admitted Monitor is intervening more regularly at foundation trusts than in the past, due to a “a declined appetite for risk”.

The regulator’s chief executive said foundation trusts were “largely autonomous organisations, left to get on and do their own thing, but with an arm’s length relationship with a regulator”.

He added: “That’s effectively what the legislation says, but what it doesn’t say is how long that arm should be.”