HSJ Live 18.3.2013: Nicholson says past gagging clauses to be lifted

6pm: Sir David Nicholson has accepted he is paid expenses to travel first class home to Birmingham so he could guarantee being able to work.

5.53pm: Up to 11th March there have been 44 compromise agreements in the NHS at a cost to taxpayers of £1,319,335 MPs are told.

5.45pm: Sir David Nicholson tells MPs the ban on gagging clauses will be applied retrospectively to people who may have been previously gagged.

5.45pm: Stewart Jackson MP says he feels the gagging clause issues point to a pernicious culture of paying people off.

5.35pm: Margaret Hodge MP quotes the rules on payments which says Treasury approval should have been sought for any payments outside the contract.

5.31pm: Sir David Nicholson admits it is a theoretical possibility that judicial mediation could be used in a case where the Treasury has turned down a severance payment.

5.27pm: Sir David says he knew Dame Barbara Hakin was under investigation by the General Medical Council and says he couldn’t wait for GMC. He says she does not receive any extra money.

5.23pm: Sir David Nicholson says Jeremy Hunt was not informed about the decision to appoint Dame Barbara Hakin as interim deputy chief executive of the NHS Commissioning Board.

5.20pm: Public Accounts Committee explores the resignation of Mid Staffordshire chief executive Martin Yeates and Sir David Nicholson says he does not know whether Mr Yeates was gagged.

5.15pm: Sir David Nicholson claims he was a whistleblower at the start of his NHS career but doesn’t give any details.

5.15pm: The Public Accounts Committee about to move on to the issue of gagging clauses in the NHS.

5.05pm: The main message from us is do, says Margaret Hodge.

5pm: We don’t have a view on how to take the NHS forward in the next period of austerity beyond 2015 Sir David Nicholson tells Public Accounts Committee after Margaret Hodge MP raises issue of 60% more consultants due to be trained by 2020 at a cost of £2.2billion.

4.50pm: Mangers in Partnership has urged NHS employers to confirm publicly that they will not operate a blacklist of people who have been made redundant in the latest re-organisation of the NHS following a letter to NHS chiefs by Sir David Nicholson last week.

4.45pm: Sir David Nicholson says consultants have to buy-in to the corporate objectives of the organisation. That’s how you get the real change, he says.

4.38pm: To characterise the NHS as one culture would be a caricature, Sir David Nicholson tells Public Accounts Committee.

4.30pm: Meanwhile: Health Secretary Jeremy Hunt tweets: @Jeremy_Hunt: “Continuing talks on Govt response to Francis Report. Pleased that all DH Ministers & staff will be getting real experience on NHS frontline.”

4.27pm: Sir Bruce Keogh says the committee which decides on Clinical Excellence Awards has been asked to consider activity and outcomes data when deciding on awards.

4.22pm: Sir David Nicholson says “it’s all about outcomes” in relation to shifting the system to put the patients first.

4.20pm: Thousands of clinical staff are going leadership training says Sir David Nicholson to improve the quality of leadership in the NHS.

4.18pm: Sir David Nicholson says we need to improve the quality of people leading the system to help improve productivity in the NHS. He says appraisals and quality of them are crucial. He says it is incredibly to do but Margaret Hodge MP says she disagrees.

4.13pm: Sir David Nicholson tells Public Accounts Committee that where CCGs want to provide more flexible services for patients and the local NHS provider can’t deliver then it’s right that they are able to seek different providers.

4.10pm: Sir Bruce Keogh tells Public Accounts Committee he would like to see the clause in the consultants contract which allows a consultant to refuse to work at weekends be “rectified.”

4.04pm: “What is being demonstrated by evidence is so removed from reality of what is going on in our hospitals,” says committee chair Margaret Hodge MP.

4.02pm: Chris Heaton-Harris MP says NHS Employers is going into contract negotiations with both hands tied behind its back because of the rise in pay under new contracts and clinical excellence awards.

Mr Royles says his approach to negotiations is aimed at a “joint problem solving approach” with the British Medical Association.

3.58pm: Chris Heaton-Harris MP tells Sir David he has just finished reading the Francis report and doesnt think he should be in the job he’s in. The MP says there is no accountability at the top of the NHS.

3.57pm: Margaret Hodge MP says the evidence this afternoon at the Public Accounts Committee is a “poor show”.

3.56pm: Fiona MacTaggart MP questions how many consultants pay attention to their job plans?

3.55pm: Sir Bruce Keogh says he is in the process working with 10 specialties, 9 surgical and 1 medical to publish clinician level outcomes data and will be in a position to do that by the end of the summer.

3.50pm: Sir David Nicholson says he did not see the reports from Don Berwick in 2008 warning about mortality data until he appeared before the Mid Staffordshire Foundation Trust Public Inquiry.

3.45pm: Sir Bruce Keogh, NHS medical director, says there has been a three per cent reduction in mortality year on year and suggests productivity should be monitored on patient outcome.

3.43: Margaret Hodge MP pushes Dean Royles on whether some consultants will get a cut in pay as a result of doctors contract re-negotiations. She says the reason he is evading the question is because “there isn’t a hope in hell” of consultants getting a pay cut.

3.43: @dwilliamsHSJ tweets: Dean Royles argues waiting lists and death rates suggest quality went up. Implies productivity shd take this into account.

3.43pm: NHS Employers chief executive Dean Royles says it is difficult to measure consultant productivity and maintains value for money was achieved.

3.42pm: Meanwhile: Full details of the changes to the GP contract announced today have now been published by the Department of Health: http://www.dh.gov.uk/health/2013/03/gp-contracts-response/

3.40: Margaret Hodge MP says taxpayers did not get value for money from the consultant contract changes in the NHS.

3.35pm: MPs on the Public Accounts Committee begin by questioning Sir David Nicholson on the cost of the new consultants contract which resulted in no increase in productivity compared with the money spent.

Chair Margaret Hodge appears incredulous when Sir David says the changes me the 1.5 per cent target on productivity and says this was an “unambitious” target for Sir David to aim for.

3.30pm The Public Accounts Committee has got underway with questions focused on the consultants contract and gagging clauses. The committee will not explore NHS IT as a result of emergency debate on press regulation.

3.20pm: Today’s Public Accounts Committee, where Sir David Nicholson was due to face MPs, has been cut short due to an emergency debate in Parliament on press regulation.

3.11pm: As background to the GP contract development, an HSJ investigation last year shed light on the huge variation between GP practices’ income, apparently unjustified by their varying populations. Today’s contract proposals involve phasing out the minimum practice income guarantee, which causes some of the inequity, albeit only over seven years. It is unclear whether the government is proposing to change the formula used to calculate practice income.

3.09pm: The health secretary has backed concern about health inequalities raised in a report published today. The report calls for agencies to do more to address the problem. The BBC has covered Mr Hunt’s response.

1.54pm: The government has today announced the outcome of its consultation on changes to the GP contract, which will be imposed on GPs in 2013-14. It statement said Gps “have been urged to support the changes in order to make sure patient care improves across the country”.

It confirms that payments under the organisational domain of the QOF will be scrapped in favour of four new enhanced services, although the statement indicates there may be a phasing of this change, under which practices could stand to lose funds.

The DH said it had made some concessions to the BMA, which has opposed the changes. It has “deferred implementation of the two NICE recommended indicators for referral to cardiac and pulmonary rehabilitation services until 2014/15”; “phasing in thresholds for two of the indicators (on physical activity) and giving a greater proportion of QOF funding to these and the new indicator on blood pressure control”; said it will “adapt some elements of the new enhanced services to ensure that they are implemented in a phased way”; and a scheme to promote early dementia diagnosis will “focus on patients who have a higher risk of dementia because of their clinical condition (eg vascular disease or a long term neurological condition)”.

In 2013-14, proposed payments for promoting telehealth “will focus on preparatory work this year while processes and protocols for management across a range of long term conditions are developed”.

13.32pm Intellect, the trade body representing the UK’s information and technology sector, has published a report on the government’s ambition for a “paperless NHS” by 2018. It concludes the ambition is achievable but success will “require a very different way of thinking and acting, for users, buyers and suppliers of health and care solutions and services”.

The report also calls for the implementation of automated capture and storage of information that allows NHS data to be structured, coded, processed and analysed to bring maximum benefits to the patient and NHS staff, regardless of organisational and system boundaries.

13.24pm The letter from Sir David Nicholson warning senior SHA and PCT employees who are being made redundant due to the NHS reforms against taking on a new job within the NHS in less than six months has atrracted a lot of comments on hsj.co.uk.

One anonymous commentator writes: “take whatever you can get is my view - after the utterly appalling treatment that’s been meted out I think that people being made redundant have the right to do whatever is best for them, and the idea that they should pause and somehow consider whether taking on an opportunity that comes up is in the overall interests of the NHS is frankly hilarious.”

12.43pm The British Medical Association has said it is against a statutory duty of candour being imposed on doctors arguing it could lead to “defensive practice” among medics.

The BMA has said it acknowledges  “a need to address the underlying culture in the NHS that can prevent doctors from reporting concerns” but says a new law which it labeled a “blunt instrument” could create the wrong culture.

In his report following the Mid Staffordshire Foundation Trust Public Inquiry, Robert Francis QC, recommended a statutory duty of candour for NHS staff to speak up to their managers or organisations following incidents of death or serious injury. This duty would also apply to NHS organisations backed by a new criminal law for anyone who attempted to stop an employee from raising concerns.

The Government is due to unveil its response to the Francis report next week.

12.17pm: Bill Morgan, former advisor to Andrew Lansley and now consultant with MHP Health Mandate, has highlighted the confusion about the government’s proposals for regulators after the Francis review. He says: “hopefully full response [to Francis] will put it all in context. #francis worried about overlap in responsibility for tackling failure”.

12.02am HSJ’s CSU reporter David Williams has tweeted about his exclusive story that commissioning support units are likely to be allowed to enter into long term deals with clinical commissioning groups.

He said: “does today’s CSU story mean that NHS CSUs have the market sewn up? not quite - many still probably won’t survive.”

11.48am: We have published a timeline - which is free to access - showing the development of the United Lincolnshire Hospitals and Gary Walker saga, with links to HSJ’s coverage since 2005. Mr Walker will tomorrow appear before the Health committee where he will be asked about his allegations about NHS regional and national management.

11.40am The Royal College of GPs has launched a code of conduct for doctors using social media in association with Doctors.net and Lime Green Media. The press release describes the Social Media Highway Code as a “collation of practical and supportive advice based around a 10-point plan”. RCGP chair and twitter user Claire Gerada is a co-author.

She said: “We were the first Medical Royal College to have an active patient group, the first to trend in the UK on Twitter, and now we are the first to produce positive, practical guidance on Social Media usage in order to protect the interests of both patients and healthcare professionals.”

10.47am Sir David Nicholson has warned primary care trust and strategic health authority managers who receive large redundancy pay outs against seeking work in the NHS within the next month, HSJ reports. In a letter to PCT and SHA chairs and chief executives Sir David says indivduals should think about the “possible reputational damage to themselves and to the NHS” of doing so and recommends they wait at least six months.

10.35am Private sector firms are to be discouraged from competing with NHS commissioning support units, an exclusive story on hsj.co.uk reveals. David Williams reports that independent sector firms are set to be encouraged to work with NHS commissioning support units rather than sell directly to clinical commissioning groups.

10.29am NHS news dominates page 2 of the Daily Mail this morning.

“NHS in talks over £8.50 charge to call out a doctor”, reads the main story’s headline.

“The sick could also be forced to pay for their hospital meals or increased charges to watch television on NHS wards”, the story goes on.

The ideas were devised by the NHS Confederation, the paper reports, but campaigners including the patients association say the plans undermine the principle of care being free at the point of use.

The story is based on an NHS Confederation report Tough Times, Tough Choices which calls for patients and the public to be more involved in the difficult decisions facing the NHS due to the “unprecedented financial predicament”facing the health service. HSJ carries the story here.

10.17am As revealed by HSJ last month David Nicholson is to face MPs on the Public Accounts Committee this afternoon to face questions about the winding down of the National Programme for IT. Committee chair Margaret Hodge told HSJ Sir David would be specifically questioned on arrangements struck between National Programme provider CSC and the Department of Health which sparked allegations that an unfair advantage was being handed to the company. According to the PAC agenda the session will also look at management of hospital consultants and termination agreements in the NHS. Other witnesses include NHS medical director Sir Bruce Keogh, director general of policy, strategy and finance Richard Douglas and chief executive of NHS employers Dean Royles. Check HSJ Live this afternoon for updates from the committee as it happens.

Sir David is also expected to be questioned on his own expenses, and possibly on the use of “gagging” clauses.

10.10am The Times has a page nine story headlined: “New avoidable-deaths scandal to put more pressure on NHS chief”. The paper reports that “hundreds of vulnerable patients are dying prematurely because of failings in care” and cites a report into the care of people with learning disabilities, due to be published tomorrow. The report comes after a three-year investigation in the west of England saying nearly half of the deaths in that group could have been avoided if they had received the same treatment as other patients.It follows an interim report last year by the University of Bristol and The Times intimates that the timing of the full report’s release “raises concerns that the Department of Health has sought to limit its impact”.

10.08am Over the weekend the Daily Telegraph reported that the government was planning to make manipulating or falsifying NHS data a criminal offence as one of the “main responses” to the Francis report. Robert Francis QC recommended that it should be a criminal offence to “dishonestly” make an untruthful statement to a commissioner or regulator or make or be party to a “wilfully or recklessly false statement as to compliance with safety or essential standards” in quality accounts

9.55am The Daily Telegraph is reporting on comments from health policy blogger Roy Lilley that NHS chief executive Sir David Nicholson is to quit by September. Mr Lilley told ITV’s Daybreak programme this morning that “sources” had told him Sir David would be “gone in September”.

Mr Lilley, a former Conservative councillor said:

Sir David is due to appear before the Public Accounts Committee this afternoon where he is expected to face questions about his expenses as well asthe National Programme for IT.

8.16am Due to its scale and complexity the NHS is overwhelmed with the richness of the data sources that it holds. However, the value of these data sets is inevitably diminished by the absence of clear links and routes to bring them together, analyse them and utilise their full value.

The push for a paperless NHS can be one of the most meaningful and high-impact policy drivers of the next few years, revolutionising the way in which clinicians, patients and commissioners engage with issues of performance,safety, outcome and cost, writes Eileen Milner on HSJ today.