HSJ’s roundup of Wednesday’s key stories

Running out of time

It has been six weeks since George Osborne announced there would be £200m in-year cuts to public health budgets, but local authorities are still waiting to hear how deeply the axe will fall in their area.

It is now almost a third of the way through the financial year, and the wait has been blamed on a promised consultation on how the cut should be shared out not being signed off. Because so many departments are involved, the document needs to be agreed across government.

Lack of correspondence from both the Department of Health and Public Health England has made it difficult for councils to prepare for the cut, which is likely to involve renegotiation of contracts with NHS providers, public health directors told HSJ’s sister title Local Government Chronicle.

A DH spokeswoman said the consultation would be published “shortly”.

Smoke and mirrors

Mortality rates should not be used as a “smoke alarm” to identify poor quality in hospitals.

That is the finding of an NHS England commissioned study, which found “no significant association” between hospital wide standardised mortality ratios and the proportion of avoidable deaths in a trust.

The study looked at the link between the two main mortality indicators and the proportion of avoidable deaths in a hospital as determined by case note reviews.

It recommends that “avoidable death rates” should not be used to compare trusts’ care quality - calling into question government plans to “band” hospitals according to their projected rate of avoidable deaths.

Professor Nick Black, who led the study with colleague Helen Hogan of the London School of Hygiene and Tropical Medicine and Lord Darzi of Imperial College London, told HSJ: “Dreadful though any avoidable death in a hospital is… they make up such a small proportion of the [annual] 15 million hospital admissions, that no metric based on hospital deaths is a meaningful indication of the quality of that hospital.”

Evolve or die, CCGs told

There has much debate among HSJ readers about the findings of a Nuffield Trust-commissioned report, shared exclusively with us, which argues that clinical commissioning groups would need to “radically evolve” to be sustainable once new care models are developed.

One reader proposed “merging CCGs with [NHS England] area teams to provide a ‘holding to account’ role for [accountable care organisations]” as the “the best step forwards”.

Another said the concept of commissioning “needs to evolve and develop” and argued that “the role of [health and wellbeing boards] should be at the forefront of this”.

“Wouldn’t it be refreshing to evolve and develop commissioning in line with evolution of service models and provider models so the ‘system’ matures at the same time and pace,” they added.

However, there was some scepticism among readers about the effectiveness of new integrated care models.

One reader questioned whether there was “any convincing evidence that the integration of care will actually work either in terms of outcomes for patients or increased efficiency”, while another asked “where on earth is the expertise, experience and vision going to come from to deliver the kind of transformational change” needed?