HSJ Live 27.04.2015: Tariff proposal threatens delayed discharge schemes

6.18pm: We have published our daily digest summarising Monday’s significant developments for healthcare leaders.

2.18pm Monitor’s pricing team are readying themselves to be able to refer rejected tariff proposals for 2015-16 to the Competition and Markets Authority as soon as next month, should the regulator’s board decide to do so.

A report going to Monitor’s April board meeting on Wednesday says the regulator’s pricing team “aims to be in a position to refer the 2015-16 national tariff to the CMA in May 2015, should the board decide to do so” at next month’s meeting.

2.14pm Monitor has agreed steps Sherwood Forest Hospitals Foundation Trust will take to deal with financial and leadership problems.

The trust has been in special measures since July 2013 and is expected to post a deficit of £32.7 million for 2014-15. Monitor said it had made improvements to the care offered, but it is not seeing some patients quickly enough for routine operations.

The trust will now:

• Develop a short-term financial recovery plan to address immediate concerns about its financial position;
• Draw up a long-term financial recovery plan to secure services for patients in the future;
• Employ a turnaround director; and
• Develop a plan to make sure recent improvements in the time it takes to see patients in accident and emergency are maintained in the long-term.

The trust will also be required to draw up an action plan for improving the way it is run. 

1.51pm Basildon and Thurrock University Hospitals Foundation Trust has appointed Nigel Beverley as its new chair.

Mr Beverley will join the trust next month, but will formally take over the role from acting chair Bob Holmes in July.

The trust’s previous chair, Ian Luder, stepped down in January in order to stand as the UKIP candidate for South Basildon and East Thurrock in the general election.

1.49pm Clinical leaders are ‘more willing to challenge or ignore diktats and messages from above’ than their managerial colleagues in clinical commissioning groups, research shared exclusively with HSJ has found.

CCGs are also “perceived by the players within [them] as less beholden to any higher authority than their [primary care trust] predecessors”, according to the first year findings of a three year study into the role of clinicians in CCGs.

The study found a divide between CCGs that believe their main role is to commission secondary care, and those that believe their priority should be addressing primary care.

12.59pm Schemes to reduce the number of patients with a delayed discharge have been scaled back because commissioners can no longer afford to fund them under current tariff arrangements, trust chief executives have told HSJ.

Some acute trusts that signed up to the enhanced tariff option have been told by commissioners that they will have to fund schemes to speed up patient discharges themselves.

A number of trusts have taken on this cost, while others will have to scale back services because they cannot afford the cost.

10.46am The Daily Telegraph reports that the NHS is already spending funds that were intended to cope with pressures next winter.

It is thought the decision may have been made to prevent a “spring crisis” and bad publicity in the run up to the general election.

Health officials have been told to keep running schemes that were set up last winter to ease the burden on hospuitals until the end of this month.

10.36am The CQC has rated Bradford Teaching Hospital Trust as ‘requires improvement’.

Safety was rated as ‘inadequate’, effectiveness, responsiveness and leadership were rated as ‘requires improvement’, and caring was rated as ‘good’.

Sir Mike Richards, the CQC’s chief inspector of hospitals said: “There have been some significant organisational changes introduced over the last few months, including changes in the leadership team with a new chair and chief executive in post. New appointments had also taken place throughout the different clinical and managerial levels across divisions and departments.

“I do have concerns that many of the changes to systems and processes have yet to be embedded in practice and the lack of maturity of these arrangements meant that they were untried and tested with regard to robustness and effectiveness.
 
“I do commend the trust for the many areas where they have been able to demonstrate good and outstanding practice. The palliative care and elderly care teams have been doing some ground-breaking work.
 
“There had been a commitment by the executive team to consult and involve staff, particularly the clinical body. However, further work was needed to engage staff over improvements For example; a major challenge for the trust was the age of the buildings and some of the estate stock, particularly at Bradford Royal Infirmary. Improvements to the facilities were in progress with a new build on the Bradford Royal Infirmary site.
 
“They also need to address as a matter of some urgency the back log of patients waiting for follow up appointments.
 
“While there are some signs that this trust is improving, a number of these improvements are new and need time to become fully embedded – the new executive team still need to engage more fully with staff. We will return in due course to check that the improvements we have identified have been made.”

10.29am Chief medical officer Dame Sally Davies has said consumers must accept higher food prices if they want to see a reduction in the use of antibiotics in farming, The Times reports.

10.28am The Guardian (newspaper only) reports this morning that millions of pounds could be saved by the NHS if people with terminal illnesses were allowed to die at home instead of in hospital, charities have said.

Figures from the latest Office for National Statistics survey of bereaved people found that 85 per cent of those loved ones who died in a hospital expressed a wish to die at home.

Marie Curie, which provides care and support to those with terminal illness, said people were being denied the chance to die where they wanted because of factors including a lack of 24/7 community support, poor co-ordination between services and the failure to provide fast and free social care support for people at the end of their lives.

10.14am Patients who always see the same GP are more likely to have cancer symptoms missed, The Daily Mail reports.

A study by academics at the University of Bristol and Cancer Research UK found that if doctors know patients well, they could mistake warning signs for ongaing medical problems or depression.

The study of 18,500 patients found that people with bowel cancer who saw their normal GP were diagnosed, on average, a week later than others.

10.12am The Daily Mail reports that doctors are being told to ask all patients over 75 if they will agree to a ‘do not resuscitate’ order.

New NHS guidelines urge GPs to draw up end-of-life plans for over-75s, as well as younger patients suffering from cancer, dementia, heart disease or serious lung conditions.

They are also being told to ask whether the patient wants doctors to try to resuscitate them if their health suddenly deteriorates.

The  NHS says the guidance will improve patients’ end-of-life care, but the Mail reports that some medical professionals say it is “blatantly wrong” and will frighten the elderly into thinking they are being “written off”.

7.00am Good morning, we start the week with the news that recently merged London North West Healthcare Trust finished the last financial year £55.9m in the red – £8m higher than its planned deficit for the year.

The trust was formed in September through a merger of Ealing Hospital Trust and North West London Hospitals Trust. Both trusts were already planning large deficits for 2014-15, of £13.6m for Ealing and £21.5m for North West London.

The NHS Trust Development authority agreed with the trust to increase the combined deficit by a further £12.8m – to £47.9m – to cover the costs of the merger.