HSJ Live 06.10.2014: 'Hostile' private provider ordered to pay whistleblowing nurse's costs

4.50pm In a blog post on the Progress Online site, Paul Corrigan, who is a former government advisor and worked closely with Simon Stevens, argues that “a manifesto based upon the policy that the Labour party loves the NHS more than the Tories will not be good enough to save the NHS”.

3.45pm Our story on Barts Health Trust employing a management consultant at a rate of £1m for 10 months has attracted some strong responses from readers:

“Sorry, but £1m on a single consultant over a period that looks like 9 months? Is it April 1st? Expecting this to be the headline of tomorrow’s Daily Mail!”

“It’s not right - Period!!! Whose money are they spending? Would they spend it like that IF it was theirs and they’d worked hard to get it? It’s ridiculous and they will probably get away with it. It’d be interesting to find who signed off on this and what he/she knows.”

“I don’t recall seeing an invitation to tender for these services but presumably there was open competition against a clear specification and that the best value for money offer secured the contract. To make an award of contract outside of these parameters would be extremely poor governance and probably negligent.”

3.30pm The ageing and growing population means that the NHS will require an additional 17,000 hospital beds in seven years unless improvements can be made to reduce the length of time for which patients are admitted to hospital, according to analysis by the Nuffield Trust.

The analysis, carried out for the Financial Times, finds that hospital admissions grew by 2 million (16 per cent)over the past seven years. If admissions continue to rise, population change alone will mean we need an additional 6.2 million additional ‘bed days’ (overnight stays) by 2022. This equates to 17,000 additional beds or 22 hospitals with 800 beds each. These pressures would amount to around a quarter of the £30bn funding gap facing the NHS.

However, the Nuffield Trust study finds that despite the 16 per cent rise in admissions between 2006/7 and 2012/13, the NHS has managed with fewer hospital beds. This was due to changes in the types of admission and significant reductions in the length of time people stayed in hospital: two-thirds of the overall increase in admissions during this period was driven by day-cases or short stays for investigations and diagnosis; and admissions lasting longer than a month were reduced by 13 per cent.

Nigel Edwards, chief executive of the Nuffield Trust, said: “The pressures on hospitals are immense, and this analysis suggests that demographic change looks set to be the most significant driver of pressures on NHS capacity in the future.

“But even if building several more hospitals were affordable, this wouldn’t be the right answer – hospital isn’t always the right place for frail older people. So we should look closely at alternative solutions first. 

“History shows we can manage rising admissions by carefully reducing the time people spend in hospital. This requires excellent and co-ordinated care in the community. But this too costs money.”

2.50pm The Care Quality Commission’s announcement that it will start to inspect whole health care economies seems to be popular among our commenters.

“Delighted to hear that whole systems will be inspected in future. This is the right fit with developments in the better local health and social care economies who are now working in an integrated way across the whole system and are very aware that if you squeeze one [part of the system, then the problem will pop up somewhere else. We do a lot of work with such economies, giving them the data intelligence which makes this happen in real time and real life. A strong integrated evidence base is also needed”

“This whole system approach is really necessary, and most welcome. Sure, individual organisations may have internal quality and performance issues that must be dealt with, but the worst experiences for patients (and the biggest opportunities for productivity improvement) are often at the boundaries between services.”

2.25pm Jeremy Hunt has taken to Twitter to question Labour’s £2.5bn NHS pledge, following a Guardian story that reported no money would be raised during the first year of a Labour government.

He tweets: “Shadow Chancellor confirms absolutely NO money would be raised in 2015/16. NHS patients and staff need promises they can depend on.”

“@andyburnhammp said ‘this is recurrent funding … money over the five years of the parliament that we can bank on’ – looks doubtful…”

1.50pm The National Institute for Health and Care Excellence has endorsed a decision support toolkit to be used alongside its guideline on safe staffing for nursing in acute hospitals.

The Safer Nursing Care Tool, developed by the Shelford Group, includes guidance on:

Provision for fluctuations in planned and predictable staffing variations, such as leave.

Identification of a preferred registered nurse/support worker split for each ward.

• Use of consistent patient factors and nursing staff factors to calculate nurse staffing establishments based on average care needs. 
• Support for the use of professional judgement with the toolkit.
• Encouraging analysis of patient acuity and dependency, by ward, twice a year. 

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “Our safe staffing guidelines provide evidence based advice on how to make the right decisions about nursing staff needs within the NHS. For our recommendations to be successfully implemented we expect nurses to use their professional judgement but we also recognise the importance of having access to the right toolkits.

“The Safer Nursing Care Tool is consistent with our guideline recommendations on setting establishments in acute hospitals and we are pleased to offer more support to registered nurses making staffing decisions so they can deliver safe care.”

The decision support toolkit should be used in conjunction with the NICE guideline. Alongside recommendations on setting establishments, the guideline also provides advice on how to determine nursing requirements on a shift-by-shift basis at ward level and organisation-wide advice on how to support and monitor staffing levels.

The directives were circulated last month by NHS England to its regional area teams.

These area teams have this year been instructed to review all contracts for GP practices using personal medical services, which are negotiated locally.

12.35pm The first four areas to trial NHS England’s care.data programme should be announced this afternoon, according to campaign group medconfidential.

Phil Booth, coordinator of medConfidential, said: “It’s crucial that patients are given the full picture if care.data is to be attempted. Fundamental issues about the consent process and who will be able to use patients’ data, and for what, are still not properly nailed down.

“It’s all very well to make promises, but patients must be able to trust those promises are true. NHS England cannot fudge what it says to doctors and patients, or it risks another crisis of confidence.”

“We look forward to reading what NHS England are actually proposing.”

In an interview with HSJ, Steve Field said inspectors would also scrutinise the performance of NHS 111 services, as part of an increasingly system-wide approach to inspections in 2015.

“We’re going to start [reviewing] how we look at the system and how joined up it is,” he said.

“This will come in gradually, but we’re going to pilot it just after Christmas.

11.40am The Financial Times reports on its front page that the NHS will have to find billions to build and run more than 20 new hospitals by early in the next decade unless it can treat more patients in the community or their own homes, according to analysis by the Nuffield Trust.

The analysis shows hospital admissions grew by 2m, or 16 per cent, over the seven years to 2013. If admissions continue to rise, an ageing and growing population will need an additional 6.2m overnight stays in hospital by 2022, the equivalent of 22 new hospitals. This demand alone would be responsible for a quarter of the £30bn shortfall the service is expecting around the turn of the decade.

The West Midlands acute trust had predicted a £3m deficit for 2014-15 in April but now expects to finish the year £10.6m in the red, according to its September board papers.

Its plan to break even in 2015-16 has been revised to an expected loss of £13.1m.

According to the papers, Burton’s altered financial prediction is partly due to a downwards revision in its cost improvement programme target, from £11m to £7m. The original figure was considered to be “overly stretching”, it said.

Nurse Elaine Fernandez was awarded more than £80,000 by an employment tribunal last year after it ruled she was unfairly dismissed and suffered detriment for making protected whistleblowing disclosures.

In the latest development, tribunal judges awarded Ms Fernandez a full costs order, which means she will receive an estimated £30,000 to cover her legal costs. Tribunal judges criticised provider Allied Healthcare for its approach to the case.

11.05am In our Comment section Nigel Edwards, chief executive of the Nuffield Trust, sets out a clear explanation of the Transatlantic Trade and Investment Partnership agreement, that is receiving so much attention at the moment due to concerns over what it means for the NHS.

Figures show the trust paid £935,500 to Titanium Global Solutions from October 2013 to July 2014.

The trust confirmed the payment was made for the services of management consultant Donald Muir, a director the Surrey based firm.

While Barts would not confirm how many days Mr Muir had worked for the trust, the payment to Titanium meant he was paid more than Mark Davies, the former interim chief executive of Imperial College Healthcare Trust who HSJ revealed charged £2,000 a day. Bart’s chief executive receives a salary of £275,000.

10.07am The Times splashes on controversial guidance given by the Care Quality Commission which appears to allow families who are worried about the treatment of their relatives in care homes to secretly film them.

A public information sheet setting out the factors that they need to consider when carrying out covert surveillance will be issued at the end of the month by the health watchdog.

The controversial guidance from the CQC will be seen as official endorsement of using  secret cameras and comes after a series of care home scandals have been uncovered by the method.

Andrea Sutcliffe, the chief inspector of adult social care, told the paper that covert surveillance should only be used as a last resort.

9.45am The national papers are NHS finance-focused this week, with The Independent running a week-long investigation into the state of finances.

In a letter signed by leaders of unions, charities and medical royal colleges, including the British Medical Association and the Royal College of Nursing, they warn that the health and care system is “buckling under the twin crises of rising demand and flat-lining budgets”.

9.40am The Guardian also reports that Labour’s key election pledge to give the NHS an extra £2.5bn a year has been questioned after the party admitted that the money would not be available until halfway through the next parliament.

The party has confirmed that none of the £2.5bn pledge would be raised during the first year of a Labour government.

Only an unspecified amount would be available in the second year, because Labour would need to steer a budget through parliament and pass legislation before its planned mansion tax, levy on tobacco firms and tax avoidance crackdown would yield any income.

9.35am The Guardian has a two page report on NHS finances, including an interview with Cambridge University Hospitals Foundation Trust chief executive Keith McNeil, who says that a lack of money means the trust will struggle to deliver the level of services it currently delivers.

The announcement came as the party leadership called for a £1bn real terms funding increase for the service for 2016-17 and 2017-18, and suggested greater rises should come in the final years of the next parliament.

HSJ understands conversations are ongoing at the highest levels of government about the possibility of some providers running out of cash, and how this can be avoided.

7.00am Good morning and welcome to HSJ Live.The delivery of care within the NHS requires continuous improvement to keep up with increasing expectations on services, advances in medicine and changes in the lives of our patients. Lisa Hollins and colleagues discuss the successful changes made by six large trusts.

The majority of patients experience hospital care through outpatient services. But this setting is also one of the areas where patients report the greatest number of delays and concerns.

The Care Quality Commission’s assessment of outpatient care has found few examples of best practice and listed many areas of further work.

Six large trusts came together in July to spend a day sharing good practice, highlighting themes for development and reviewing breakthrough areas for the next 5-10 years.