HSJ Live 28.08.2013: Steve Field appointed first chief inspector of general practice

1.44pm: The Association of Independent Healthcare Organisations has also commented adding “data to be published by the Private Healthcare Information Network (PHIN) will be directly equivalent to and comparable against information on the performance of NHS hospitals in England. We’re surprised the provisional findings fail to recognise this”.

Its chief executive Fiona Booth says “it’s essential that Britain makes much better use of its independent healthcare providers to meet the increasingly complex and urgent health challenges facing the nation and the health service.”

1.34pm: Private provider HCA has also responded to the CC’s report. Keith Biddlestone, commercial director at HCA International, said: “ten years ago, hospitals now owned by HCA were sold because they weren’t thought viable. Huge investment by HCA has converted them into world-class centres offering innovative, complex care in a safe clean, compassionate environment that patients around the world seek out every day.”

According to the group, London has witnessed a strong record of new entry and expansion of private health providers in recent years, demonstrating that barriers to entry are low. “The CC has a legal duty to ensure that any remedy is both proportionate and effective; it is difficult to understand how a remedy that would force HCA to divest hospitals in London could be justified on these grounds.”

1:03pm: BMI Healthcare has said it rejects “any assertion” that “its hospitals exercise market power or that we make excess profits at the expense of patients”. Chief executive Stephen Collier said: “the Commission’s belief that BMI Healthcare makes excess profits ignores financial realities such as the necessary costs of keeping our hospitals equipped with the ever more expensive technology required to meet the needs of patients, commissioners and insurers. Without any state subsidy, sufficient economic return has to be generated by our business in order to fund these costs”.

He adds: “in a depressed UK market, with significant spare capacity and ‘little or no growth in demand’, to quote the Commission, BMI Healthcare’s owners have taken nothing out of the business they bought in 2006, instead reinvesting every penny earned over and above the cost of capital back into our hospitals”.

Mr Collier goes on to say in a statement: “prices for the vast majority of procedures undertaken in our hospitals are set by the NHS or by insurers, uniformly across our entire group. Less than one in seven of our patients pays for their own treatment, with their prices being set locally by individual hospitals”.

12:50pm: Nuffield Health has said it welcomes the findings of the competition commission. Chief executive David Mobbs says, “as the Competition Commission has recognised, as much as £190 million is being spent unnecessarily every year due to the market dominance of HCA, Spire and BMI allowing them to drive up prices. Our status as a charity, for which we have been criticised by other hospital providers, allows us to act free from the demands of shareholders and place greater emphasis on putting patients before profits.”

We are specifically pleased to see that they have addressed our concerns around the lack of competition, particularly in London and the power of HCA, BMI and Spire over the largest insurers, have shown ambition to stamp out consultant incentives and are calling for more information to be provided to consumers.

12:43pm: “At a time when the private hospital sector is already under pressure from a decline in the take up of private medical insurance and margin pressure from the increased level of NHS work being undertaken, the proposal for the forced divestments of up to 20 hospitals will create further uncertainty in the sector for the hospital groups, lenders and investors”, says Dr Mark Jackson, special advisor for restructuring and financial consultant Zolfo Cooper.

He comments on the Competition Commission’s findings on private hospitals saying “the range of prices charged for the same procedures by private hospitals does strongly suggest that pricing and completion in this market requires careful review”.

11:44am: More on Professor Steve Field’s appointment as first chief inspector of general practice - NHSEngland’s GP lead and deputy medical director Mike Bewick told HSJ that the work of the chief inspector, in collaboration with NHS England’s commissioning, would bring about a “sea change” in identifying and addressing poor quality general practice.

11:38am: Monitor has rejected claims from foundation trusts with large private finance initiative commitments that they should be treated differently than others under the regulator’s new system for measuring financial risk.

The rating is based on just two metrics: liquidity, or the number of days’ operating costs the provider could cover with its available cash or cash equivalents; and capital servicing capacity, or the number of times the organisation’s income covers its financing costs. Those worried about the new measure argued that “PFIs should be treated differently”, because the “proposed approach penalises NHS foundation trusts with large PFIs by making them appear risker”.

10:42am: The Telegraph also reports on the BMA warnings against plans to charge migrants and short-term visitors using the NHS.

Dr Mark Porter, chairman of the BMA Council, is quoted saying: “The BMA believes that anyone accessing the NHS services should be eligible to do so, but the government’s plan for extending charging to migrants and short-term visitors are impractical, uneconomic and inefficient.”

10:40am: Trade Union GMB has called for talks with ambulance employers to avoid an official ballot on strike action over cuts to sick pay.

GMB, UNISON and Unite members working in England’s ambulance services have voted to reject proposals to apply up to 25% deductions to sick pay.  The proposals were put forward in June as a way of matching the changes made earlier this year to sick pay for other health workers.  

10:30am: The BMA has warned that charging migrants and short term visitors accessing healthcare in the UK could cause unintended damage to the NHS.

It said there was no evidence that income from charging short term visitors or migrants would be sufficient to cover the significant cost of the increased bureaucracy necessary to run the system.

It also warns that registering migrants at GP practices would increase the paperwork burden on already overstretched services.

10:24am: Cambridgeshire and Peterborough Clinical Commissioning Group has cut the value of its £1bn integrated older people’s services tender by £200m HSJ has learned.

A spokesperson confirmed the revised value adding the “range of services” being tendered for had changed but said the CCG would not discuss which services had been excluded, and the reasons why.

10:17am: More on the Competition Commission’s report - private healthcare groups may face having to sell off sites the watchdog finds. The Competition Commission has ruled that almost 20 hospitals may have to be sold because stifled competition is pushing up prices and medical insurance premiums for private patients.

Incentives to doctors could also be slashed, and private hospitals could be barred from further tie-ups with NHS hospitals in areas where there is little competition, the commission concluded.

10:12am: The BBC’s business editor Robert Peston has written on the Competition Commission’s findings. He says the CC dislikes the incentives the hospitals give to consultants - cash or access to consulting rooms and secretarial support - for making referrals to them. These incentives encourage consultants to recommend hospitals to patients on the basis of what suits the consultants, not what is in the interest of patients, says the commission.

“It suggests a ban on most incentives for consultants designed to encourage them to recommend particular hospitals. The thrust of these reforms can be seen as trying to alter the balance of power away from the private hospital providers and towards the insurers and consumers,” he writes.

He adds “what is striking is that the profitability of the hospital groups has risen sharply over the past few years, and - according to the commission -the return they make on their investment is more than double the cost of that investment”.

10:02am: Private patients pay for lack of competition the Competition Commission (CC) has found. Many private hospitals face little competition in local areas across the UK, leading to higher private medical insurance premiums and charges for private patients, its provisional findings on privately-funded healthcare services reveal today.

The CC identified 101 hospitals facing little local competition, some of them in clusters of hospitals under the common ownership of one of the major hospital groups, namely BMI, Spire and HCA.

The majority (about 80 per cent) of private patients fund their treatment through private medical insurance companies (PMIs) very often paid for by employers. The prices charged by operators to insurers are set nationally, but the CC believes that the lack of competition in many local areas, where insurers will have little choice but to use the local operator, results in higher premiums for all patients. Self-pay patients also face higher charges in areas with little local competition. The two larger insurers, Bupa and AXA PPP, achieve significantly lower prices than the smaller insurers and have some countervailing buyer power, Bupa more than AXA PPP. However, no insurer has countervailing buyer power that can fully offset the market power of BMI, Spire and HCA.

9:41am: The Care Quality Commission (CQC) has appointed Professor Steve Field as its first Chief Inspector of General Practice.

The Chief Inspector of General Practice will lead CQC’s inspection and regulation of providers of primary care services across the public, private and independent sectors. He is expected to introduce a ratings system for registered primary care providers that identify good as well as poor care.

Health Secretary Jeremy Hunt commented on the appointment: “In Steve Field we have found a formidable Chief Inspector of General Practice who will speak up for patients without fear or favour. Steve will have the power and authority to judge how well each practice is serving patients, help us to celebrate the best practices, and take tough action where standards aren’t up to scratch”.

Professor Field is a GP in Birmingham and was formerly NHS England’s deputy national medical director responsible for addressing health inequalities.

8:36am: Good morning, one of the recommendations of the Francis report was that the role of foundation trust governors be expanded.

Today on HSJ’s leadership channel, Josephine Ocloo discusses its idea that governors should play a greater role in the governance of patient safety.