New framework lays out how Clinical commissioning groups will be rated each quarter on their effectiveness.

4.15pm: The NHS offers no alternatives to hospital care for the critically ill, the former chief executive of the NHS Confederation has said. Mike Farrar told an audience that in other countries spending can be largely directed at the patient so care can be continued in the home, while in the UK hospitalisation is the only option for critically ill patients.

“Rather than have hospital by choice we have hospital by ‘default’”, he added.

Describing the experience of his mother, who was admitted to hospital after being diagnosed with vascular dementia because her husband wasn’t able to support her around the clock, Mr Farrar said: “[I saw with my own mother that] hospitals are where people go to die…We haven’t built the system properly to have a proper alternative.”

Farrah, who stepped down as head of the confederation at the end of September, was speaking at Hospital Directions 2013, a conference for hospital managers.

2.50pm: Clinical commissioning groups will be rated each quarter on their effectiveness across six domains under an NHS England assurance framework to be published today. To learn more about how the ratings system will work, read Dave West’s full story here.

2.45pm: Another of our reporters, Judith Welikala, is at NHS Alliance conference 2013. She’s tweeting the day’s developments from @JudithWelikala.

2.38pm: A big welcome to Will Hazell, our newest reporter here at HSJ. Will will be covering competition and regulation, as well as healthcare news from the North West and the West Midlands. He can be reached on Titter via @whazell. Say hi!

2.08pm: A majority of the trusts placed into special measures following Keogh review inspections have expressed concern about the costs of improving care, even if most have backed the additional scrutiny they have received, according to HSJ analysis. Click here to read Sophie Barnes’s story.

1.20pm: Medway NHS Foundation Trust has been told it must take urgent further action to deliver improvements for its patients or risk changes being imposed on its leadership.

Monitor is escalating its regulatory action after discovering that the problems at the trust are broader than those uncovered by Sir Bruce Keogh in August, which caused it to be put into special measures.

The regulator believes that, given the range of significant issues it faces, the trust must now set out and stick to a credible plan to transform the services it provides.

Separately, Monitor is concerned that the trust’s failure to properly address poor A&E performance, and problems identified by the Care Quality Commission in midwifery and maternity services last month mean that it continues to operate in breach of its licence.

The regulator requires the trust to take further action, including preparing and implementing the necessary clinical strategy, and has imposed a new condition on the trust’s licence to provide NHS services. This new condition means that Monitor can ensure the trust has the appropriate leadership to deliver the necessary improvements.

Paul Streat, Regional Director at Monitor, said: “We know that staff are working hard to improve the quality of the trust’s services, but we need the organisation’s leadership to do more to make sure that urgent change happens quickly. The new licence condition gives us the power to make changes at the top if the current leadership fails to deliver.”

1.10pm: There is greater support for non-profit groups running NHS services than private companies, with support for private firms providing services falling markedly, a survey shared exclusively with HSJ has revealed. To see the full results of the Ipsos Mori poll, read the full article here.

1.00pm: In our BME issue this week, HSJ editor Alastair McLellan writes that the NHS must conquer its nervousness over leadershipdiversity. Click here to read the full leader article.

12.50pm: Three leading NHS managers have questioned the validity of the current UK A&E crisis. The group of NHS Trust chief executives argued that the all year round influx of elderly patients was the real concern facing accident & emergency services.

The interventions came during a panel discussion dealing with the emergency care crisis at Hospital Directions show in central London yesterday.

The panel included Stuart Bain, chief executive of East Kent Hospitals University NHS Trust; Dr Alfa Sa’adu, medical director of Ealing Hospital NHS Trust; and Mary Edwards, chief executive or Hampshire Hospital NHS Foundation, and all concluded that the talk of specific winter crisis is incorrect.

During the debate a member of the audience pointed out that data shows that admission rates are the same throughout the year, suggesting winter is not the main reason A&E departments across the UK are failing.

The panel agreed and pinpointed the aging population as the real issue and because of that, the change in the kind of care that is required. Stuart Bain said: “Over 30 per cent of patients in our hospitals need care for confusion right up to dementia, they’re there for acute illness [dementia] which was not the case 20 years ago. My staff are not well trained for mental health”.

“We need to train our GPs to care for the elderly, rather than A&E departments,” he added. The panel believed it was crucial for hospitals to increase their geriatric units and train staff in mental health in order to deal with the increasing number of elderly patients.

11.45am: In a Leadership article, Paula Vasco-Knight and colleagues consider what NHS England can do to tackle equality and inclusion in the NHS. To read this and other articles from our BME issue click here.

Join the discussion on the issues covered this week by using the hashtag #HSJBME on Twitter.

11.40am: The friends and family test should not be viewed as a statistic but as a “line of site measure”, the NHS England director leading the roll out of the new test has told HSJ.

Tim Kelsey, NHS England national director of patients and information, said that it was legitimate to use the test to compare hospitals, but this should be in the way that people would use “Trip Adviser” rather than as a “formal statistical measure”.

To read the full story and keep up with the latest on the friends and family test, click here.

11.20am: A deliberate slowdown in the treatment of people with less serious ailments and the discovery of groups of patients who were not previously recorded in national statistics could be behind growing waiting lists, experts have said. To read Ben Clover’s full story - click here.

11.15am: The BMA has welcomed the government’s announcement today of a new review into standardised cigarette packaging. Professor Sheila Hollins, Chair of the BMA Board of Science, said: “It is welcome news that the government is set to overturn its decision from July and look again at the evidence around the benefits that introducing standardised packaging will bring about.

“The BMA has long campaigned for the government to introduce standardised packaging as a way of helping smokers quit and to help non-smokers, especially children who are heavily influenced by tobacco marketing, to never start.

“As doctors we see first-hand every day the devastating effects of tobacco addiction and we call on the government to make a decision quickly and to introduce this at the earliest possible opportunity in order to help put an end to a life-long addiction that kills and destroys health.”

11.08am: The number of patients who access healthcare online will grow “exponentially” in coming years, according to Clare Gerada, the former chairwoman of the Royal College of General Practitioners.

The leading medic said the growth will come in line with increases in internet shopping and banking. Click here to read the full story

11.00am: Almost half of lung cancer patients have experienced delays at some stage of their care, according to a new report. A poll of just over 400 patients and carers found two-thirds (64 per cent) believe they received a prompt referral to hospital but 46 per cent have suffered a delay at some point. Full story here.

10.50am: As a part of our BME issue Paula Vasco-Knight, chief executive at Torbay Hospital, spoke to HSJ’s Shreshtha Trivedi about how she was told she was “a risk” in a leadership role and NHS England’s plan to promote racial diversity. To listen to their conversation, click here.

10.25am: Last night saw the unveiling of HSJ’s BME Pioneers list 2013. Our list celebrates the outstanding contributions of healthcare professionals from BME backgrounds. To find out who made it, click here.

10.10am: The government has announced an independent review into cigarette packaging in England, following further calls to prevent young people from taking up smoking.

Daivd Cameron decided not to go ahead with uniform packaging back in July when the topic was last brought up in parliament. While the government has told the BBC that it never ruled out the policy, a spokesman said that it was open minded about how to proceed, following a pilot scheme in Australia intorduced a year ago.

The review is to be led by paediatrician Sir Cyril Chantler, and will focus on the Australian experience with the scheme.

Labour has attacked the announcement of a review as a ‘delaying tactic’

9.45am: Good morning - We kick things off with the news that Robert Francis QC, the man who led the public inquiry into the serious failings at Mid-Staffordshire NHS Trust, has agreed to become president of the Patients Association.

Mr Francis promised that as head of the campaigning charity he would do all he could to rid the NHS of bad care.

He said: “The Patients Association have been ardent campaigners for the safety and well being of patients for decades, and as core participants they ensured that the patient voice was well represented throughout the Inquiry. As President I will support the organisation as they continue to carry out their invaluable work.”