HSJ Live 27.11.2014: New NHS regulations come into force

4.10pm Somerset Clinical Commissioning Group is planning a major overhaul of its community services which will see a significant reduction in hospital beds and the potential procurement of an integrated service for patients with long term conditions. Under plans approved by the CCG’s governing body last week, it is envisaged that up to 100 community hospital beds will be permanently closed over the next five years.

Beds are expected to be closed entirely at a “small number” of the county’s 13 community hospitals, which are currently run by Somerset Partnership Foundation Trust. The remainder will host either step up or step down beds.

3.38pm The government has given financial backing to a bill that legislates for zero harm in the NHS and changes the way professional regulators determine fitness to practise.

In a clear signal of the government’s support for the Health and Social Care (Safety and Quality) Bill, the minister for life sciences George Freeman has this week asked MPs to approve what is known as a money resolution on the bill.

3.05pm Clinical commissioning groups across England are mulling the use of an unlicensed drug which could save the NHS millions of pounds,HSJ has learned.

Vale of York and Northern, Eastern and Western Devon CCGs are hoping to switch from Lucentis to Avastin for the treatment of age related macular degeneration, as are a number of other CCGs across the North East.

While both drugs are closely related, Avastin is listed at a 10th of the price of Lucentis.

2.20pm A review into whistleblowing concerns at a North West cancer trust has found “no evidence” of serious failings but highlighted areas in need of improvement.

The Christie Foundation Trust was investigated by Monitor and the Care Quality Commission after former staff members claimed its culture inhibited staff from highlighting problems with the senior team.

2.17pm A review of NHS whistleblowing by Sir Robert Francis QC will be delayed until next year, HSJ can reveal.

The Freedom to Speak Up review was due to be published this month but has been delayed due to the high number of contributions and evidence it has received.

Sir Robert, who chaired the public inquiry into care failures at Mid Staffordshire Foundation Trust, was asked to carry out a review of how the NHS treats whistleblowers by health secretary Jeremy Hunt, following concerns of a culture of cover up and victimisation of those who raised concerns.

2.06pm The idea of one organisation holding a budget for the whole of a defined group of patients’ care and working with other providers to drive cost and quality improvement is not new. But over the last few years there has been increasing interest in both the UK and the United States about how this can work in practice.

Alison Moore reports on how these ‘accountable care organisations’ have piloted a physician led model of care that improves quality, costs and outcomes in the US..

2.02pm Confused about what the new fit and proper persons requirement means? Joanna Dirmikis and Neil Grant of Ridouts solicitors outline the regulation and some of its hotly debated elements.

2.00pm David Cameron is believed to be putting Andrew Lansley, the former health secretary, forward as under secretary general for humanitarian affairs at the United Nations, The Daily Telegraph reports.

Mr Lansley, who was returned to the backbenches in the July reshuffle, would be in charge of the UN’s response to major crises in Syria, Iraq and South Sudan.

Lord Malloch Brown, the former UN Deputy Secretary General, questioned Mr Lansley’s skills and experience for the role.

“I think this is frankly a case of political dumping,” he told Channel 4.

“It’s an act of great cynicism to allow someone who does not have background and qualification in this area to be put forward.”

1.00pm The Guardian reports that preliminary results from trials in human volunteers of one of the leading Ebola vaccine candidates are promising, according to its British manufacturer GlaxoSmithKline.

The vaccine, developed with the National Institutes of Health in the US, is one of three being speeded into trials in the Ebola-hit countries of west Africa.

It is hoped that they can be tested on healthcare workers, burial teams and others at high risk of infection in January.

11.50am The number of obese people having weight loss surgery needs to double or triple in the UK so the soaring bill for treating type 2 diabetes can be cut, according to NICE.

The Guardian reports that up to two million people could be eligible for surgery. Only 6,500 people a year had it in 2009-10.

NICE says bariatric surgery can greatly help type 2 diabetics. The most modern operations, the stomach bypass and the gastric sleeve, do more than reduce stomach capacity – they “alter how the body handles glucose”, said Rachel Batterham, head of obesity and bariatric services at University College London Hospital Foundation Trust.

11.41am Browsing through this morning’s papers,The Guardian reports that the number of children in care has risen to its highest level for nearly 25 years following the death of Baby P and recent child sex exploitation scandals, the government’s spending watchdog has found.

Local authorities were looking after 68,110 children in March 2013 – a 14 per cent increase since 2008, a report by the National Audit Office said.

The rapid rise in children in care followed coverage of Baby P’s death in 2007, the report noted. Almost every local authority said they were expecting or experiencing an increase in referrals linked to child sexual exploitation after high-profile cases in Rotherham and other towns, auditors said.

11.23am Here’s what the Department of Health had to say about the duty of candour: “NHS patients will be informed and receive an apology if there has been a mistake with their care that has led to significant harm, under new laws coming into force today.

“The duty of candour, a major part of the government’s drive to make the NHS more open and transparent, places a legal duty on hospital, community and mental health trusts to create a culture where clinicians say sorry for accidents.

“It means that when incidents result or could have resulted in death significant physical or psychological harm, patients will be notified and given both a verbal and written apology.

The health secretary Jeremy Hunt said: “The Mid Staffordshire scandal showed just how important it is for doctors and nurses to be open about mistakes so we can learn and improve.

”This is a new era of openness, one that will help make the NHS the safest healthcare system in the world.”

As part of its inspection regime, the CQC will assess whether systems are in place to support the duty of candour and review how incidents were handled. Trusts that do not meeting the standards can receive a warning, fine or be prosecuted.

Peter Walsh, chief executive of Action against Medical Accidents, said:

“This today is the biggest advance in patient safety and patients’ rights in the history of the NHS. For over 65 years the system has frowned on cover ups but in effect has tolerated them. Not only has this caused gross injustice and harm, but has meant the NHS continued to fail to learn lessons to improve patient safety. We applaud the government for having the courage to give zero tolerance to cover ups. However, we now need serious investment in awareness raising and training for staff to help realise the full benefits of this bold initiative and make cover ups a thing of the past.”

11.11am The Department of Health has launched a consultation on plans to transfer responsibility for the commissioning of renal dialysis and surgery for morbid obesity from NHS England to clinical commissioning groups.

As reported by HSJ earlier this week, the proposal to shift responsibility for renal dialysis services has been met with opposition from patient groups while CCGs are concerned they will not be given the resources to do the job.

10.56am Today is the first day the Care Quality Commission will be enforcing two new regulations for the NHS.

The duty of candour and fit and proper persons requirement for directors come into force today for NHS trusts and foundation trusts

The statutory duty of candour for providers is supposed to ensure there is an open, honest and transparent culture, particularly when things go wrong.

The fit and proper person’s requirement for NHS board members is to make sure that providers have systems in place to carry out appropriate checks before a job offer or appointment is made. This will include whether the person is of good character, is physically and mentally fit and has the necessary qualifications, skills and experience for the role.

During registration, the CQC will check that the provider understands the requirements of this regulation and ask them what systems they have in place so that they can meet it. The CQC has said it will not be its responsibility to identify that NHS board members are “fit and proper persons”, with this duty resting with providers.

The duty of candour and fit and proper persons requirement for directors are part of new fundamental standards, with the remaining standards coming into force from April 2015.

The two regulations which come into force today will be extended to all other health and social care providers from April via additional regulations, still subject to Parliamentary approval.

10.30am Better investment for multi-disciplinary teams and the full integration of these within healthcare services is needed to drive quality of care for patients, the British Association of Plastic, Reconstructive and Aesthetic Surgeons has said.

The call follows a study of BAPRAS members showing that four out of five plastic surgeons have observed improved patient care outcomes as a result of the treatment being managed by an MDT.

Some of the main benefits of MDT working identified by surgeons as leading this improvement include better co-ordination of care, fewer unnecessary patient hospital visits and more informed healthcare decision-making, given the input from a broad range of specialists.

Other advantages include producing evidence-based decisions that are less likely to result in patient dissatisfaction and possible litigation, as well as more opportunities to effectively train junior healthcare professionals by exposure to senior expertise.

Peter Budny, BAPRAS communications chair and consultant plastic surgeon, said: “The biggest difference I have seen is with patients where the choice of therapy is not clear or the patient has a particularly complex case. Having committed individuals working together helps inform decision-making anddeliver more personalised, effective care for patients, ensuring holes in provision are minimised. Further investment in MDTs would not only benefit the more complex cases but would also ensure that simple ones are ableto be dealt with more promptly.”

 10.20am In case you missed it yesterday, the health service’s savings targets for 2015-16 has been revealed.

Under the marginal rate rule, hospitals are paid just 30 per cent of normal prices for all emergency admissions above 2008-09 levels. However, the national NHS “tariff” for the coming financial year, which will be put out to consultation by Monitor and NHS England later this afternoon, proposes to increase this rate to 50 per cent.

9.55am Good morning and welcome to HSJ Live.