HSJ Live 22.12.2014: Unannounced £740m revenue boost shows DH was in 'desperate trouble'

4.55pm Our story on NHS England plans to trial pharmacists in A&Es on a nationwide basis has attracted fierce debate amongst readers:

“Fiddling while Rome burns. Why is it that Bruce Keogh and co are faffing around with every answer other than providing proper resources for a sector that is clearly failing? I would like to be a fly on the wall when he tries to convince Jeremy Hunt that he knows what he is doing. The reason that A&E has fallen over isn’t about a few patients with minor illness. The idea that employing some cough-lozenge salesman will sort it several years of incompetent NHS staff planning and resourcing out must be deeply insulting to people on the front line like Clifford Mann at the Royal College of Emergency Medicine.”

“When will someone acknowledge that GP access is the biggest issue. Easier access to your GP means less likely to go to A&E. Earlier access to GP for chronic illness means less likely to deteriorate and need admission. Waiting until they arrive in A&E is too late to avoid overcrowding.”

“Are there a lot of medicines related admissions and can pharmacists prevent them or will they just be saying ‘GP to sort out’? We looked at pharmacists (with our community pharmacists) for out of hours / urgent care and they are more expensive than GPs and with a narrower scope of practice.”

“A systematic review in 2009 found that 6.5 to 7.5 per cent of admissions were medicines related and that 69 per cent of these were avoidable. Pilots which deploy clinical pharmacists from wards or the hospital pharmacy are found to be effective. It isn’t about using community pharmacies for OOH.”

“Let’s get this straight once and for all: this is about pharmacists acting up and pretending to be doctors. It is about assuming a mantle of clinical authority and responsibility that you have not earned in the right or honest way. If an individual wants to practice crucial and critical clinical decision making in an emergency care setting where even simple problems maybe far more complex than one realises, then one should go to medical school, not into the field through the back door. What is happening is fundamentally dishonest and everybody knows it. Only in the NHS can this kind of insanity prevail.”

4.00pm Trade union GMB has described the leaked ambulance target response time change proposal as “ridiculous”.

Tony Hughes, GMB regional officer for ambulance services in London and East of England, said: “These proposals from the Association of Ambulance Chief Executives are ridiculous. They will only serve to bring worse outcomes for patients. The proposals are clearly motivated by the run up to the general election so that the Tories can show that Ambulance Services are meeting their targets. This is so far from the truth.

“If these plans go ahead we will see people die more often that we see at the moment from conditions that can be treated if the right resource is got to them in good time.”

3.50pm The Health Foundation has responded to our story on the Department of Health receiving an unannounced revenue boost.

Chief economist Anita Charlesworth said: “NHS finances are under increasing strain and it has been clear for some time that the NHS would need additional funding next year to cope with increased pressures. The scale of the financial challenges facing the NHS is huge. Without this year’s extra money most hospitals in England would not be able to balance their budget. The Department of Health is now having to commit almost three quarters of a billion pounds extra to meet NHS running costs for this financial year. This is in addition to the extra £1.25 billion for 2015-16 announced by the Chancellor just 3 weeks ago. 

“The NHS is struggling to meet extra demand. To meet that challenge spending on temporary staff is accelerating and hospitals are running out of saving schemes. It is difficult to imagine how the financial situation can be turned around quickly and NHS finances will continue to be precarious.”

3.30pm The Times reports that “bed blocking” dips at Christmas as hospitals get better at arranging home care, according to patient leaders who urged the NHS to make the same efforts during the rest of the year.

A record 5,000 patients well enough to leave were stuck in hospital last month because of problems finding them support at home or in residential care, costing 140,000 NHS “bed days”.

Yet analysis for Healthwatch England found that these delays drop over Christmas as hospitals make more effort to plan how patients will be cared for when they leave.

At the inaugural HSJ annual lecture, held in conjunction with advisory firm FTI Consulting, the NHS England chief executive set out the first steps for implementing his vision.

Registered users of hsj.co.uk can now watch a video of the lecture for free. If you are not a subscriber or registered users you can sign up online.

He will replace Sir George Alberti in June.

Sir Bob is currently permanent secretary at the Department for Communities and Local Government.

He has a wide range of experience in finance roles in the public sector after having trained as an accountant and worked at the Greater London Council, the Inner London Educational Authority and the London Borough of Hounslow.

The unusual move indicates the Department of Health would otherwise have been highly likely to overspend its revenue limit for 2014-15, health finance experts said.  

The revenue departmental expenditure limit increase was funded by an additional £250m from the Treasury, and a further £490m transfer from the DH’s own capital budget.

11.45am The Guardian reports that a controversial plan to delay the dispatch of ambulances in some urgent medical cases is to be put on hold after a backlash against the “highly dangerous” proposals.

As Jeremy Hunt was accused of keeping parliament in the dark about the plan, the Department of Health indicated that it was highly unlikely that the changes would be introduced by the original target date of the first week of the new year.

11.40am The Guardian reports that overstretched health staff are prescribing drugs for pre-school children to treat hyperactivity, rather than offering psychological interventions.

More than a fifth of educational psychologists say they know of preschool children who are given medication such as Ritalin even though the NICE guidelines recommend psychological interventions should be tried first.

11.35am The Daily Telegraph reports that more than 80,000 people a year could be saved from dementia by lifestyle changes to protect the brain, according to a report.

Lord Darzi, chairman of the World Innovation Summit for Health, said people should adopt a “use it or lose it” attitude to their brains as a working group prepares to publish a study that suiggests that 3m cases of dementia could be avoided in Britain by 2040 through lifestyle changes.

11.10am Only four accident and emergency departments managed to meet the four hour target last week.

This struggle to meet the target came amid the highest ever admissions since the data started being recorded weekly in 2010. There were 111,062 patients admitted last week.

Just 84.7 per cent of patients at major A&Es were seen, treated, admitted or discharged within four hours.

10.45am Ambulances could be allowed to take longer to reach some seriously ill patients under plans to rewrite NHS targets, The Times reports.

Health chiefs insisted that the proposals could improve care by cutting down the number of ambulances sent out needlessly and getting the right sort of paramedics to patients, but leaks about the plans provoked a political row after the government was accused of keeping them secret.

Labour claimed that Jeremy Hunt was showing “contempt for parliament” by not telling the Commons that he had approved the changes in principle.Aides insisted that no final decision had been taken because doctors must also sign off on the plans.

About 3m calls to 999 a year are placed in the “red 2” category - the second most serious - for which an ambulance, car or motorbike must arrive within eight minutes. These include breathing difficulties, fits and symptoms of stroke.

Ambulance chiefs want to reclassify almost half of these calls, giving them 19 minutes to respond. They also want to give call handlers an extra two minutes to decide whether to send an ambulance in cases where it is unclear whether symptoms are life-threatening.

10.40am The Times reports that the mummified body of a nurse who had been accused of inappropriate conduct towards a child lay undisturbed in her home for seven years.

Anne Leitrim, 58, was last seen in June 2007 after receiving a final warning by Homerton University Hospital following a disciplinary hearing.

She failed to turn up for work in August or answer letters and phone calls, and her position at the hospital was terminated.

10.30amThe Times reports that tens of thousands of patients have been promised faster diagnosis and more personalised treatment as part of a project that aims to make DNA analysis a routine part of NHS care.

Eleven hospitals across England will start recruiting patients in the new year as part of the “100,000 genomes project”, which aims to make the genetic revolution in medicine an everyday reality in the health service.

Minsters want to transform how the NHS treats cancer and amny other diseases, wih sequencing of patients’ entire genetic code becoming a normal first step in deciding on treatment.

Reading a person’s entire genetic code cost more than £1bn when the Human Genome Project was completed a decade ago, but the cost has now fallen below £1,000.

Hospitals in London, Manchester, Liverpool, Birmingham, Newcastle, Southampton, Oxford, Cambridge and Exeter have been chosen to recruit about 40,000 patients with cancers of the breast, prostate, bowel, ovaries and lungs and 11 rare diseases. The first patients will have to agree to have their DNA placed in a “reference library” for pharmaceutical companies to use when developing targeted drugs. Relatives will also have their DNA analysed, as will the tumours, making a total of 100,000 genomes.

9.55am In case you missed any of our coverage of the new planning guidance for 2015-16, which was published on Friday, then we’ll be covering the highlights in Live today.

Planning guidance for the NHS in 2015-16, published this afternoon, reveals NHS England wants to set up a cohort of health economies that can develop “prototypes” of new care models such as primary and acute care systems, and multispecialty community providers.

The guidance, The Forward View into Action, says those sites chosen to be in the “vanguard” must already have a record of “tangible progress” to new ways of working over the past year and positive relationships between commissioners and providers.

7.00am Good morning and welcome to HSJ Live. We begin the day with an opinion piece from Emma Spencelayh, who argues that as the NHS evolves we have to address questions about foundation trusts’ status within the health economy.

She writes that there is a fundamental contradiction in the status of foundation trusts which needs to be resolved:

“On the one hand, we expect foundation trusts to operate in a quasi-market environment, competing for patients and referrals, and achieving financial balance.

“On the other, we expect them to act for the greater good, often against their own financial self-interest (such as working with other stakeholders to shift care into the community).”