HSJ Live 04.08.2014: Hunt announces 'managed breach' of waiting target

4.05pm The CQC has published a report it commissioned to improve the way it inspects hospital services for children and young people.

Following the introduction of its new way of inspecting acute hospitals, Sir Mike Richards, the chief inspector of hospitals asked Sheila Shribman to advise on how CQC inspects hospital services for children and young people including stand-alone specialist children’s hospitals.

Dr Shribman, a former national clinical director for children, young people and maternity at the Department of Health led a small team including clinical experts and CQC staff to design methodology to make sure the inspections were fit for purpose for children and young people.

Dr Shribman’s final report, Getting it right for children & young people (including those transitioning into adult services): a report on CQC’s new approach to inspection, has resulted in 73 recommendations a number of which formed the basis of two pilot inspections of specialist children’s hospitals (Sheffield and Alder Hey) that took place in May-June 2014. All the recommendations have now been considered and CQC accepts in whole or in part 70 of these recommendations. CQC has deferred making a decision on the remaining three.

Dr Shribman said: “I was delighted when Sir Mike asked me to oversee this work. It was hugely encouraging that the CQC recognised the importance of services for children and young people as well as the added complexities that children and young people bring to the inspection process. CQC’s new approach to inspection provides a real opportunity to drive up the standard of care for children and young people and reduce unacceptable variations.

“To do this CQC must get its inspection model right. My report sets out how CQC can begin to achieve this. It was a pragmatic report, focusing on what CQC can realistically be expected to deliver.

“The overall level of acceptance of my recommendations is encouraging although I would, of course, have hoped that more of the recommendations could have been accepted in full. The key now is that CQC should not become complacent. Momentum should not be lost. I would urge CQC to bring forward the review dates on the recommendations where decisions have been deferred.”

2.20pm A Devon commissioner’s plan to award community services contracts without putting them out to tender has been resisted by competing providers and a local authority.

The opposition was revealed as the Northern, Eastern and Western Devon Clinical Commissioning Group received around 260 responses to a consultation on the plan which was unveiled earlier this summer.

Concerns have been raised by the NHS providers set to lose out and the council, which has asked the CCG to “reflect” on its proposals.

HSJ understands they have stopped short of a formal challenge but sources said “robust discussions” were taking place.

1.49pm The Care Quality Commission has said there has been significant patient improvements in ten out of the eleven trusts placed into special measures by NHS England medical director Sir Bruce Keogh last year.

In a report released today the CQC reviews the progress of the “Keogh trusts”.

According to the report the factors for successful improvement are:

• the strength of leadership within the trust
• acceptance by trusts of the scale of the challenges they faced
• alignment between managers and clinicians
• the willingness to accept external support.

Despite improvements in maternity, the CQC said Medway has failed to make significant overall progress and will remain in special measures after being given an overall rating of ’inadequate’. CQC will work with Monitor to consider what further urgent action should be taken to ensure the quality of care improves at the trust.

1.27pm Patients who receive telephone consultations from their GP or a nurse are more likely to need care in the month after their phone call than those who see doctors face to face, a new study suggests.

Experts found that people who requested a same day appointment but were instead offered telephone triage from a GP were 33 per cent more likely to seek help within 28 days after the phone call.

12.38pm Cancer Research UK has launched a £6m initiative to support research into lifestyle and behavioural changes that can prevent cancer.

It’s estimated that more than four in 10 cancer cases could be prevented by lifestyle changes, such as not smoking, keeping a healthy body weight, cutting back on alcohol, eating a healthy diet, keeping active and staying safe in the sun.

Cancer Research UK has matched a £3 million donation received from the Bupa Foundation in 2013 to provide a £6 million cash injection that will fund the initiative for the next five years.

This includes two new funding streams:

• A three-year fellowship award to fund postdoctoral scientists and health care professionals to research behavioural changes that can prevent people getting cancer.
• A 12-month ‘innovation award’ drawing on expertise from a diverse range of experts, from health professionals to community groups, to develop new ways of researching cancer prevention.

Professor Linda Bauld, based at Stirling University, is leading the new initiative. She said: “With health services already overstretched and people living longer, prevention is going to be vital to address the problem of cancer, alongside other diseases with lifestyle risk factors such as heart disease and diabetes.”

11.58am Foundation Trust Network chief executive Chris Hopson had this to say about the waiting times story:

“Our members welcomed the announcement of the additional £250 million funding to reduce waiting times for operations for patients. It was clear recognition of the direct link between funding and performance - you get what you pay for - and that as NHS finances fail to keep pace with demand growth and inflation, it becomes more difficult to maintain or improve performance. Our members are already using the extra funding to reduce waiting lists which is good for patients and the NHS.

“The idea of a ‘managed breach’ is a sensible and welcome approach that ensures we focus on reducing waiting times for patients and recognises the growing pressure on the NHS.

“However, it is essential that the NHS moves away from short term injections of funding as it’s an inefficient use of resources. Far better that we move permanently to new and sustainable models of care that are appropriately funded, with all parts of the NHS including GPs, community and ambulance services playing their part in helping to manage the increased demand the NHS faces.”

11.32am The NHS Confederation has commented on Jeremy Hunt’s announcement about the “managed breach” of waiting times targets.

Director of policy Johnny Marshall said:

“Once it’s been decided that a patient needs an operation or other kind of elective treatment, it is crucial that this takes place without undue delay, as we know this can be distressing for patients. All our members will be acutely aware of the impact delays can have on a patient’s peace of mind; staff throughout the NHS - frontline and behind the scenes - will already be doing everything they can to deliver timely waits.

“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. The whole health and care system is under more pressure than ever - A&E attendances are at a record level, and elective procedures rising year on year - so it is not particularly surprising that performance targets like 18 weeks are becoming harder to achieve, as there is finite capacity in the health service. We need to change how we use this capacity to sustain the NHS we all value so much, and ensure we invest in the right places at the right time.

“This injection of additional resource is welcome, but even more important than ‘more of the same’ is the commitment from politicians of all parties to face up to the unprecedented challenges now facing the health and care service, as set out in the 2015 Challenge, and to have an honest debate with the public about what needs to be done to solve these challenges, so the NHS we all value so highly remains fit for purpose.”

10.37am Also in The Times, at least 600 people died in one week as a result of last month’s heatwave, government statistics suggest.

In the week to July 18, when temperatures peaked at 32C, 7 per cent more died than the five-year average, according to data from the Office for National Statistics.

10.31am The former chief executive of Marks & Spencer, Sir Stuart Rose, is set to become a Conservative peer, The Times reports.

Sir Stuart is currently leading a high profile review into NHS leadership.

10.20am You can read the full text of Jeremy Hunt’s speech this morning at Royal Surrey County Hospital Foundation Trust here.

10.17am NHS England chief executive Simon Stevens has also commented on the “managed breach” of waiting times story. He said:

“The NHS has made huge progress over the past decade in slashing long waits, so the median wait for patients having an operation is now under 10 weeks. To lock-in that achievement - and go further in eliminating the longest waits - CCGs are now using earmarked extra funding to commission more elective surgery. As a result they  expect their local hospitals to use the summer and early autumn to ensure they can then meet the performance standards which NHS patients are entitled to.”

10.10am Labour has responded to Jeremy Hunt’s speech on NHS waiting times.

Shadow health minister Liz Kendallsaid: “David Cameron promised to protect patient care, but instead he has lost control of waiting times.

“The number of people waiting more than 18 weeks for their treatment has increased by 50 per cent since 2010, and the cancer waiting time target has been missed for the first time ever.

“The Tories say they don’t want anyone waiting more than a year for their treatment when they should be guaranteeing nobody waits more than 18 weeks. The truth is that the Tories have mismanaged the NHS - and it is patients who are paying the price.”

9.57am Our full story on the health secretary’s waiting times announcement is now live.

The health secretary was this morning due to give a speech in Surrey about addressing waiting times for treatment.

Jeremy Hunt was set to announce a “managed breach” of key waiting times targets for several months while the service treats extra patients to tackle its long list backlog.

We will publish a story on the announcement shortly. In the meantime here is some information based on pre-released details.

Jeremy Hunt was also expected today to announce a review into why some patients - currently 574 - are waiting longer than a year for treatment.
Mr Hunt was due to speak in Surrey this morning. He was expected to say that, following the announcement in June of £250m additional funding for elective care, “more than 100,000 extra treatments” would be carried out “over the summer”.
The most recent elective performance figures, for May, revealed the English waiting list had exceeded 3m, for the first time since March 2008.
The additional funding is designed to pay for extra treatments to reduce the list. Hospitals and commissioners have been encouraged by national officials to spend most of the money in July and August. They have been told to reduce lists by September so targets are met in that month, according to documents seen by HSJ.
Focusing on reducing the list backlog means hospitals will have to treat many patients who have already waited longer than 18 weeks, therefore they are very likely to breach the headline national inpatient target for at least 90 per cent of those who are treated to have waited less than 18 weeks.
A DH statement said: “Because operations on longer waiters are often more complex and difficult, they take more time and resources. This means that over the next few months… there will be a managed breach of the target. However, by the end of the year the NHS will start meeting the target again.
“The NHS will also conduct an immediate casework review to investigate every person waiting that is over or close to 52 weeks [waiting]. It will make treating these waits a priority unless there are strong clinical reasons for the wait or the patient chooses to wait for longer.”