HSJ Live 21.05.2014: Many staff have concerns about NHS organisations' leadership

5.33pm And elsewhere our story on Labour’s report into repealing the health act has attracted a good debate. Here some comments from today:

“A lot of thought seems to have gone into this research and I suspect that any concrete policy proposals based on it - if effectively communicated - could prove to be very attractive to large swathes of the electorate. It is increasingly inescapable that more investment in an integrated care system is urgently needed with some form of increased taxation to pay for it. Have we yet reached the tipping point where the general public - especially in the south of England - can support this?”

“Presumaby a Labour government will remain signed up to G20 commitments to opening up health markets? The need for joined up integrated care doesnt sit alongside market forces, but I doubt Adam Smith himself could unpick successive governments attempts to harness the worst aspects of competition whilst ignoring any perceived benefits.”

4.50pm There have been some interesting reader comments on our story about trusts seeking extra funds to pay off bills. If you would like to join the discussion, then just register here.

“One of the problems with the current system is that everyone accepts that non-elective tariff is insufficient - so you cant really ‘punish’ those organisations who are failing bacause most are. As bail-outs are clearly now accepted, one has to question why we simply havent increased tariff to avoid this? So is this a deliberate policy to introduce more centralised control of NHS providers through the creation of a formal loan agreement, with strings attached? That way major service reconfiguration can happen and the respective Boards can do little to stop if because they have given up their sovereignty th the NHS ‘bank’.”

“I hear the argument that the tariff is insufficient a number of times. On that basis why are only 26 non FT providers making a loss whist the majority (76 non FT providers) not making a loss? Similarly why are only 39 FT providers making a loss whilst the majority (108 FT providers) are not? Also the tariff is based on what the average provider spends so are we saying that providers historically under reported what they spent resulting in the tariff being undervalued?
Also we saw in 2012/13 1% more spells being done than in 2011/12 - providers typically only incur marginal costs for this activity but actually receive full income for it. Then there is the “leakage” problem monitor reports about which hints at a whole raft of other things. So more than open to the debate that tariff is insufficient but so far I am not seeing the evidence for it. Yes 2014/15 contracting round is difficult but that is because the public sector doesn’t really have any more money and so we are talking cuts/rationing/transformation/next buzz word - not of which is easy to deliver. If it is that latter that is actually causing the problem then I have a lot of sympathy. Having worked in an acute setting the focus typically is on maintaining the status quo or growing which is no longer the world we are in. Some providers are tackling that and dong a good job of it I suspect…”

“As the tariff is an average of cost by definition there will always be Trusts which spend more than they earn for specific procedures. Swings and roundabouts come into play, with some procedures at a Trust delivering profit and others a loss - so the net effect is complex but there are bound to be overall winners and losers.”

4.06pm NHS England is to launch a new pilot scheme that aims to help general practitioners assess the care and support needs of people with long-term conditions.

A new assessment tool, known as patient activation, is designed to help GPs put people with long-term conditions at the centre of the care and support they receive. It measures the knowledge, skills and confidence these patients have to manage their own health, and highlights where they need extra support.

The pilot, which will cover 150,000 people, is being launched in partnership with The King’s Fund, The Health Foundation, five clinical commissioning groups and The Renal Registry.

Dr Martin McShane, NHS England’s director for long-term conditions, said: “I wish I had known about patient activation thirty years ago; I’m very excited about its potential to improve peoples’ lives. It’s about understanding that when talking to patients that there are two experts in the room – one with individual experience, the other with medical expertise. This pilot will bring together the best of both, putting patients at the heart of their consultation.”

3.53pm In Michael White’s column he argues that hospital care is far more complex than Hinchingbrooke’s recent award for best patient care suggests.

It is alleged that between 2008-2012 students going through the trust’s in-house training programme - which it no longer runs - had access to exam papers prior to their final tests.

Some 850 students went through the training programme during the four years but it is not yet known how many may have had access to exam papers or how they may have gained access to them.

3.22pm In our Comment section senior fellow at The King’s Fund Michael West says that regulators are looking at what being well led really means at all levels of an NHS organisation but there is still room for improvement.

3.10pm In the HSJ editor’s latest Leader he looks at the stalled momentum behind the Better Care Fund.

The analysis by Picker Institute Europe, seen exclusively by HSJ, revealed data generated for the friends and family test is so skewed by different collection methods it “cannot be reliably used to compare performance”.

The study – due to be published next month in the Journal of Health Services Research and Policy – joins a growing list of reports that have criticised the test’s reliability, undermining prime minister David Cameron’s ambition that it be used as “a single measure [for] quality of care across the country”.

2.24pm The Care Quality Commission has told Maidstone and Tunbridge Wells NHS Trust that it needs to improve the care it provides to patients at Maidstone Hospital, in Maidstone, Kent.

The CQC has told the trust that it needs to make improvements at the hospital, in Hermitage Lane, following an unannounced inspection in February at which it was found to be failing to meet the national standards relating to care and welfare of people, staffing, and assessing and monitoring the quality of service provision.

The inspection took place in response to concerns raised by CQC. Inspectors looked at the care of patients undergoing surgical procedures at the hospital, and at the provision of care for children.

The team included CQC inspectors alongside a hospital governance specialist, a Consultant Surgeon, a Pathology specialist and two experts by experience – members of the public with experience of using services.

CQC found that people having surgery at the hospital had not always received safe care either before or after their surgery. This led to risks to people’s health, safety and welfare.

While all the people inspectors spoke to were positive about the care they had received before and after surgery, some said they were not happy about the number of delays and cancellations they had experienced while waiting for their surgery to take place.

Inspectors also found that some people had not had the chance to speak to their surgeon before surgery, and that some were not asked for their consent until they were on a trolley waiting to go to theatre. This meant that, while they had consented to surgery, they might not have had sufficient time or information to make an informed choice.

Amongst other findings:

• Patients did not always receive care from appropriately qualified staff.
• Arrangements were not in place for patients to receive on-going care from their consultant.
• Children receiving care at Maidstone Hospital did not always have access to staff trained in paediatric medicine.
• The paediatric resuscitation team did not routinely contain a paediatrician out of hours.

Overall, CQC found that the provider did not have adequate processes in place to assess or monitor the quality of the services checked at this inspection. This meant that risks to patient’s health, welfare and safety were not being managed appropriately.

Professor Edward Baker, Deputy Chief Inspector of Hospitals for the South, said: “We’ve identified some serious issues at this hospital around surgical services. The trust need to take action to rectify these issues.

“Patients are entitled to be treated in services which are safe, effective, caring, well run, and responsive to their needs. Our inspectors will return unannounced in the near future to check that the required changes have been made.”

1.39pm Hospital trusts needed financial help last year to fend off legal threats from suppliers, update “obsolete” medical equipment and even keep electricity supplies flowing, according to a raft of pleas for bailouts seen by HSJ.

Details of these and other requests for financial assistance were released to HSJ under the Freedom of Information Act by the independent trust finance facility, which is part of the Department of Health.

1.10pm The introduction of waiting time standards for mental health care “must happen next year”, a health minister has told HSJ.

Norman Lamb was speaking exclusively to HSJ ahead of the publication of interim guidance by NHS England for the introduction of choice of provider in mental health.

1.00pm Guardian columnist Madeleine Bunting writes that British children are facing a mental health crisis.

She argues that “this is an epidemic that will fall disproportionately on the poorest, with consequences that will last a lifetime”, creating a “cruel lottery for children”.

The paper reports on AstraZeneca chair Leif Johannson telling the pharmaceutical firm’s shareholders not to pressurise it into recondering its rejection of a £69m takeover by US rival Pfizer.

Mr  Johannson said: “We have decided that it is necessary to issue a statement to make absolutely clear that Pfizer’s final proposal, which the board rejected, is not capable under Takeover Panel rules of being increased or even suggested at being increased, privately or publicly, with or without the board’s approval or recommendation.”

Also in The Guardian, E-cigarettes are more effective than nicotine patches and gum in helping people to quit smoking, according to a study by University College London.

However, Professor Robert Webb, who led the study, noted that if e-cigarettes were to be provided by the NHS as a smoking cessation tool, it would need to be licenced by the Medicines and Healthcare Products Regulatory Authority

“I think it would be perfectly reasonable for people to consider e-cigarettes for use with their patients,” he said.

“The NHS would only get involved where the products had that mark of approval. I don’t think the NHS could engage with e-cigarettes outside that process.”

An Austrialian study has found that a third of first time mother suffer depressive symptoms, The Guardian reports, but a leading psychitrist has warned that there were likely to be similar proportions in the UK.

Jim Bolton, a member of the Royal College of Psychiatrists and a London-based consultant psychiatrist, said: “If a similar study was done here, I wouldn’t be surprised if the results were similar. Usually the sorts of mothers who are at greater risk of depression are younger mothers who feel they can’t cope and mothers living in situations of adversity or deprivation or partner violence.”

Dr Bolton called for an overhaul of maternal mental health monitoring in the UK, noting that around half of  women who experience depression after having children are not identified by GPs, midwives or health visitors.

11.00am The chief executive of BMI Healthcare has resigned.

HealthInvestor reports that Stephen Collier will leave the private healthcare company before the end of 2014.

10.57am Our live webinar on how data can be used to improve outcomes and performance is due to kick off in 3 minutes. Watch live here.

The view was taken by 43 per cent of the 2,000 NHS staff questioned for a survey published by The King’s Fund.

The poll shows the opinion is also shared by 16 per cent of the executive board members who were surveyed.

Most staff (89 per cent) said they thought their organisation encouraged feedback from patients, while 61 per cent thought the feedback would be acted upon.

10.40am Here is the full text of Simon Stevens’ speech to the King’s Fund annual leadership summit.

10.40am “SS: By July 29 NHS Equalities Council will have had to figure out how to increase BME leadership. Situation at the moment not acceptable”

10.40am “SS: Not visited Hinchingbrooke but think it’s interesting instance of broader point, there are other ways of making small hospitals viable”

10.39am “SS: As I look at the red-rated trusts at the moment, they are eerily familiar from 10 years ago”

10.38am “SS: Many of our better performing organisations are in the north of the country. Obviously too simplistic but is it something structural?”

10.38am “SS: Looking for ppl who respect our history w/out being a hostage to it, create unconventional partnership, challenge clothesless emperors”

10.37am “SS: Committed to NHS E playing its part in system leadership …plugs the many senior vacancies. (Head of specialised commissioning)”

10.37am “SS: In our analysis lets have quantitative analysis, in hospitals PTLs in regular use. We know how to do this, let’s do it more regularly”

10.36am “SS: We need to give careful weight to community’s own ideas about access and specialisation (within funding envelopes)”

10.36am “SS: Diversity in leadership has gone backwards in some areas”

10.35am “SS: In England our spending on health management is among the leanest in the world”

10.34am “SS: Hope we can avoid hubris on the one hand and defeatism on the other. Let’s always remember we’re here for a social purpose”

10.33am At the King’s Fund event Simon Stevens is now speaking, here are some of Ben Clover’s tweets:

“SS: King Canute or surfing the winds of change, that’s the choice we have in the NHS”

10.31am Our reporter Ben Clover is at a King’s Fund event where Simon Stevens is speaking. Follow @benclover on Twitter for live updates.

We will be covering some of the highlights.

10.28am At 11am today watch our live webinar on how to use data to improve outcomes and performance.

10.17am Health secretary Jeremy Hunt has hailed the courage of “truly inspirational” dementia campaigners for putting the condition “on the map”, The Daily Telegraph reports.

Speaking at the Alzheimer’s Society first ever Dementia Friendly Awards, the Secretary of State paid tribute to individuals and groups who have fought to change public attitudes towards the condition.

10.08am In The Times leader it is argued that the NHS should “embrace [e-cigarettes] at the earliest opportunity”.

10.00am The Independent reports that e-cigarettes are considerably more effective in helping people quit smoking than over-the-counter treatments such as nicotine gum and patches, a new study by UCL academics has found.

The study of 6,000 people who had successfully quit smoking showed that 60 per cent were more likely to kick the habit than those who used nicotine replacement therapies or nothing.

9.40am: NHS England chief executive Simon Stevens is due to speak on leadership at the King’s Fund annual leadership conference today, at 10.10am. HSJ Live and on Twitter @Benclover will cover the speech, which is expected to touch on management and culture.

7.00am Welcome to HSJ Live. We begin the day with the fourth article in our Lessons from India series. Hilary Chapman, chief nurse at Sheffield Teaching Hospitals Foundation Trust, examines the role of staff and ownership of engagement.