HSJ Live: 13.12.13 NHS misses A&E target for first time this winter

4:57pm HSJ has learned that two commissioning support units are planning to merge. Central Midlands CSU – which covers Birmingham and the Black Country – and Staffordshire and Lancashire CSU are in talks over forming a single organisation.

HSJ understand that in merging the CSUs hope to increase the chance they will be included on NHS England’s procurement framework for support services. As a result of the merger, Central Midlands CSU is planning to make 47 redundancies.

4:20pm HSJ’s Sophie Barnes has provided a good overview of the A&E performance data - and the slippage against the national standard for the first time this winter - here.

4:05pm There’s been a lot of coverage today of the BMJ’s festive issue, and in particular its attempt to quantify James Bond’s alcohol consumption and the likely health implications.

The BMJ analysed how many times the super spy drank in all of Ian Fleming’s novels, and observed his weekly alcohol intake was over four times the advisable maximum alcohol consumption for an adult male.

It concluded that were Bond to be real he may suffer from “alcoholic liver disease, cirrhosis, impotence, and other alcohol related health problems” and that his drinking would put him at “serious risk of injury or death”.

It is of course not the first time that news organisations, tongues firmly in cheek, have attempted to analyse the health of treasured characters from popular culture. As we move into the festive season, here’s NBC’s assessment of old St Nick’s health.

3:20pm Our story on large foundation trusts wanting to take over primary care providers has attracted a lot of reader comment. Here’s a selection:

“This is definitely the way forward and would have the greatest impact on the increasing number of patients attending A&E departments. It is after all in the trust’s best interests to provide services in the community which patients choose to use instead of A&E departments. Primary care has singularly failed to do this.”

“For practices ‘owned’ by FTs, won’t there be a conflict of interest in their role as commissioners of secondary care? And potentially an associated weakening of the independence of their CCG?”

“Structural integration between organisations in localities is a red herring which raises hackles about empire-building and who is calling the shots. Focus on the patients, the pathways and building the right relationships and integration of care delivery (not structures) will follow. There is as much fragmentation within single, large and overly diverse organisations as between them, so leave the structural dabbling to the politicians.”

2:56pm: Interesting tweet from Stephen Thornton (@Thornton_health) earlier today. In response to HSJ reporter David Williams’ story about University Hospitals Birmingham wanting to take over GP practices, Mr Thornton, who used to be chief executive of the Health Foundation, tweeted: “Good for them. Let’s have some real competition in out of hospital care. Shake up the cosy cartel.”

2:18pm Interesting follow up to the comment piece which Peter Walsh has written for HSJ on the duty of candour, which we covered earlier today on HSJ Live. Five groups representing patients and NHS whistleblowers have written to Jeremy Hunt insisting that he agrees not to restrict the duty.

The groups argue that if the duty was limited to cases which caused death or gave patients severe disabilities, this would “legitimise” cover ups of incidents of harm below the NHS definition of ‘severe harm’.

The signatories to the letter include representatives from Action Against Medical Accidents (Peter Walsh), Cure the NHS, National Voices, Patients First, and the Healthcare and Patient Involvement Association.

2:01pm The Times also has a health opinion piece, but this one returns to the subject of dementia, which received a lot of attention this week in relation to the government’s G8 summit on the issue.

Philip Collins applauds the extra money unveiled by the prime minister to try to find a cure to the disease. However, he warns “it would be disastrous to wait until one of the geeks runs in from the lab with an exciting invention”, and argues the NHS needs to get used to caring for an ageing population with more chronic conditions.

1:43pm As mentioned earlier, a lot of columnists in the national papers are discussing the NHS today following the inspection findings published yesterday.

In the Telegraph, Fraser Nelson, editor of The Spectator, says that while some of the stories may be lurid, “we are simply being shown problems that have existed for years”. However, he argues the difference is that “previous health secretaries - Labour and Tory - have not been very interested in exposing them”.

1:24pm Serco’s contract to provide out of hours services in Cornwall is going to be cut short by 17 months, following a mutual agreement between the outsourcing giant and commissioners.

The contract has been dogged by controversy after the company admitted some of its staff had falsified data to make the company’s performance appear better than it was.

1:17pm Want to read HSJ on your tablet? This week’s issue is now available on our app.

12:43pm Doctors routinely accelerate the death of terminally ill patients with lethal drug doses, a Labour peer said yesterday.

The Telegraph reports that Lord Davies of Stamford, a former government minister, told the House of Lords that he knew doctors who spoke privately of “helping the patient on his way” with lethal doses.

12:37pm The Telegraph also carries a letter from the families of resdents abused at Winterbourne View, saying they are “dismayed” with the lack of progress made by the government.

In the letter, the families say they received assurances from care minister Norman Lamb that no one with a learning disability should have to live in an assessment and treatment unit miles from their family (see the HSCIC report covered by HSJ Live earlier today). However they are “deeply saddened” that so little had been done, and say that “every government promise that is not met, is another day when [people with learning disabilities] are put at significant risk of neglect and abuse”.

12:23pm The Daily Telegraph reports that the Playing Fields Legacy fund has said the NHS could save “billions” by investing in new playing fields. The charity said it was “ridiculous” the government was proceeding with multi-billion projects like HS2, while not funding playing fields.

12:13pm The Times has a story on how a daily pill could halve the risk of breast cancer.

Trials found that the drug anastrozole cust the chances of breast cancer by 53 per cent among women at a higher risk of getting the disease.

12:02pm The Daily Mail editorialises that the information released this week is a “terrible indictment of Labour’s stewardship of the NHS”, It asks, “how much longer can the political class - and the Left in particular - go on arguing that a monolithic system run entirely by the state is the most efficient and caring means of delivering [services]?”

11:54am Turning to the national press, it will be no surprise to HSJ readers that the NHS features rather heavily in today’s papers.

The Daily Mail has the splash “National Health Shambles”. It calls the inspections into GPs and maternity services, and the information released about never events, “damning”.

11:42am There is no excuse for surgical never events, NHS England’s patient safety director has said.

Speaking to HSJ following the release of figures yesterday showing 152 never events were reported between April and September, Dr Mike Durkin said it was “very disappointing” there was still such a high number of these events.

11:36am A duty of candour may be the biggest breakthrough in patient rights and safety in living memory, according to Peter Walsh, chief executive of Action Against Medical Accidents.

Writing for HSJ, Peter says however that “the champagne has been left on ice” until further details are confirmed about how the duty will be implemented. He is particularly concerned that the duty will be restricted to only fatal and severe cases, and says this might “actually make things worse”.

11:20am In addition to missing the headline figure, the pressure placed on A&E services last week had a knock on effect on other areas of service.

The number of calls to NHS 111 answered within 60 seconds dipped below 95 per cent for the first time since August, and there was a slight rise in cancelled operations and ambulance handover delays.

11:14am Some reaction to the news of the first national breach this week of the A&E target from NHS England deputy chief executive Dame Barbara Hakin:

“It is of course disappointing that any patient has to wait longer than they should in A&E however we are now seeing many patients than ever before. 

“Last week was the busiest so far this year, with 415,400 attendances and 105,800 emergency admissions - the highest number of emergency admissions since we started collecting data in November 2010.”

She adds: “We knew this winter would be difficult but it is important to stress the NHS continues to deliver a good service with 94.8 per cent of people going to hospital for urgent care this week treated, admitted or discharged within four hours.  This is thanks to the hard work and dedication of our frontline staff.”

11:09am A drug company has been fined over £380,000 for a cartel arrangement which saw it collude with a rival in the prescription drugs for care homes market.

The Office of Fair Trading ruled that Tomms Pharmacy owner Quantum Pharmaceutical made a deal with Lloyds Pharmacy that neither would poach the other’s customers - a breach of competition law.

10:58am Patient satisfaction with GPs has slightly fallen, according to an Ipsos Mori survey. The survey found that 86.2 per cent of patients rate their overall experience of their GP practice as good, a 1.4 per cent drop on 2012.

The survey also found that trust in doctors and out-of-hours services has fallen marginally.

10:48am The NHS has missed the national accident and emergency four hour target for the first time this winter.

In the last week 94.8 per cent of A&E patients were seen within four hours. It’s the first time since April the NHS in England has missed the 95 per cent standard.

10:30am One in five patients with learning disabilities are being treated 100km or more away from home, according to the Health & Social Care Information Service.

The HSCIS’s report, which was commissioned in response to the events at Winterbourne View Hospital, also found that almost half of inpatients in their census were being treated in hospitals located in just 8 per cent of local authorities.

10:18am Our supplement this week, in association with Bupa, looks at why out of hospital care makes sense for patients and the NHS. Download it here.

10:15am Dr Katerina Kolyva, director of continued practice at the Nursing and Midwifery Council, has written for HSJ on why the NMC wants to hear the views of HSJ readers on its proposals for revalidation.

The NMC is launching a public consultation on revalidation in January.

10:01am Read the HSJ100? Here’s Alastair McLellan’s editorial on what it means for the NHS as it heads into 2014.

It looks like it might be another difficult year, as the NHS adjusts to a new inspection regime and commissioners and providers grapple with the challenge of service reconfiguration. But Alastair suggests the mantra for NHS leaders in 2014 might be “let’s not waste a good crisis.”

9:52am Steve and Claire’s analysis builds on a comment article which Carmel Gibbons, head of health practice at Odgers Berndtson, has written for HSJ.

Carmel argues that for board members, “it is no longer enough just to bring the right professional credentials… [they] also have to be passionate and compassionate ambassadors for good patient care and be accountable if it all goes wrong”.

9:43am Steve Ford and Claire Read have written a piece analysing the impact the Francis, Berwick and Keogh reports have had on the chairs and non-exec directors of healthcare trusts.

9:38am Unite, the country’s largest union, has accused the health secretary of a “parliamentary sleight of hand”.

The union is urging MPs to vote on Monday against a clause which Unite says Jeremy Hunt “hastily inserted into the care bill” and which they claim would make it easier to close or privatise hospitals.

7:00am Good morning all and welcome to HSJ Live. Kicking things off, chief executive of the Foundation Trust Network, Chris Hopson, writes for HSJ on the nine things which providers would urge NHS leaders to do to get the 2014-15 planning round right.