HSJ Live 02.05.2013: CCGs may have to use budgets for social care integration

5pm: Dr Steve Kell, Co-Chair of NHS Clinical Commissioners’ Leadership Group and Chair of Bassetlaw CCG has responded to HSJ’s story on CCG’s having a two per cent topslice off their budgets to fund integration.

He said: “We welcome the focus on integration and recognition of the need to look beyond the NHS. Clinical Commissioning Groups across the country are focusing on developing integrated care programmes which deliver innovative solutions for their populations.

“The Minister [Norman Lamb] has been a thoughtful advocate for integration but we would warn him that simply top-slicing CCG allocations and using these to fund social services will not deliver the integration in which he clearly believes.

“Many areas have already stretched budgets for healthcare and we should be striving to achieve different ways of working and not just shunting the money between health and local government.

“Integration needs new ways of working: joint commissioning; joint contracting and led locally by CCGs working with their patients, local authorities and providers to deliver innovative solutions for their patients and populations.”

4.25pm: The College of Emergency Medicine has called on NHS trust executives and commissioners to ensure A&E departments have the resources to cope with extra demand over the Bank Holiday caused by the NHS 111 crisis.

The CEM has issued a press statement on the ongoing problems facing the NHS 111 saying

trust executives and clinical commissioning groups need to provide the “appropriate resources” to meet the extra workload during out of hours and the coming Bank Holiday.

It said: “This workload has been steadily increasing on top of the core function of emergency departments in managing the patients who have emergency care needs.

“In our view 15-30 per cent of the workload attending an emergency department (depending upon location) should be managed by diversion to other accessible services or resourced co-located primary care practitioners.

“Better design of systems with ease of access to the full range of primary care services especially out of hours is vital at this time.”

The CEM said it has “strong reservations and concerns” about the level of investment that has gone into providing clinical support to the computerised algorithms being used by NHS 111.

The statement said: “This is leading to a default to the ultimate safety net of the NHS with the public being directed to attend their emergency department. We know that colleagues from a range of specialities are advising the Department of Health at present to help address this issue urgently and we hope this work can be progressed rapidly to create a NHS 111 system that is fit for purpose.”

You can read the statement here.

4.10pm: Two fascinating comments have been made on our story this morning about use of the 2 per cent top slice for social care integration.

One – by Warrington CCG chief clinical office Sarah Baker – says: “Yet another area of decision making being reserved to NHS England. Any area advanced in its understanding of integrated health and social care will be working together to deploy the totality of its health and social care spend to best effect for their population. 2% diversion may be more than is needed or less. But it cannot be moved to have effective impact without an understanding of the local health and social care economy dynamics. The CCG are far more likely to understand this than NHS England. So why would deployment require LAT approval?”

Another comment, anonymously, says: “Do they think that the 2% really exists? In most cases this is no more than a myth where commissioners overcook thier QIPP plans to present 2% in plan, then as year plays out they use the 2% to underpin the real position. This is no more than presentation - otherwise, if real, the local and national underspend would move up by a similar factor - it doesn/t. In fact, magically we all hit our “control totals” spot on. Case made. The 2% is a myth I am afraid.”

3.30pm: NHS England has issued a statement supporting the Royal Pharmaceutical Society’s call for health professionals and patients to work together to ensure better use of medicines.

A guide, called Medicines Optimisation: helping patients make the most of medicines, has been published by the Society which provides frontline professionals with four guiding principles to make sure that the right patients get the right choice of medication, at the right time.

The four principles are to aim to understand the patient’s experience, ensure evidence based choice of medicines, make medicines optimisation part of routine practice and ensure medicines use is as safe as possible.

Sir Bruce Keogh, medical director of NHS England, said: “There is still much to be done to help patients, the public and society more broadly to get the best outcomes from medicines. Too many hospital admissions caused by the adverse effects of medicines could have been prevented, so professionals and patients need to work much closer together.”

They have been endorsed not only by NHS England but also the Academy of Medical Royal Colleges, the Royal College of General Practitioners, the Royal College of Nursing and the Association of the British Pharmaceutical Industry.

More information can also be found on the Royal Pharmaceutical Society’s website.

11.15am: The Department of Health has published the minutes of a meeting between civil servants and Imperial Tobacco as a result of a Freedom of information request.

It has also revealed the number of meetings held between DH civil servants and tobacco companies between January and March this year.

You can download the documents here.

11am: The Vice-Chancellor of City University London, Professor Paul Curran, has been appointed by the Prime Minister as the new Chair of the Review Body on Doctors’ and Dentists’ Remuneration.

The DDRB makes recommendations on the pay for all 203,000 doctors and dentists working in the NHS.

Professor Curran’s appointment was announced by Health Minister Dan Poulter, who said: “I am pleased to confirm that Professor Paul Curran, Vice-Chancellor of City University London, has been appointed as the Chair of the DDRB.  He brings extensive and varied experience of pay and workforce issues and will help maintain the legitimacy of the pay review body process during a challenging period of pay restraint.”

Professor Curran said: “I am delighted to be appointed to this post at a challenging time for public sector pay. The DDRB has an essential role advising on pay, which is important in recruiting, retaining and motivating doctors and dentists.As a group we will consider a range of pay, economic and labour market evidence. 

“We will visit acute trusts, health boards and primary care organisations across the UK to meet representatives of management and the doctors and dentists to whom our recommendations apply.”

The DDRB was created in 1971 and is operated by the Office of Manpower Economics.

10.40am: NHS Blood and Transplant has launched its strategic plan for the next five years to reduce the cost of blood units and to increase organ donation.

Improvements will be achieved by delivering efficiency savings allowing the price of a unit of blood to drop to £122 in 2013/14 from the current price of £123.

NHS Blood and Transplant will also build on the recent increase in deceased organ donation by 50 per cent since 2008 by launching a new UK wide strategy for 2013-20.

It also aims to better integrate end-to-end blood supply chain from donor through to hospital blood banks.

NHS Blood and Transplant Chief Executive, Lynda Hamlyn, said: “Our purpose is clear – to save and improve the lives of as many people as possible and our ambition is to be the best organisation of our type in the world.

“We want to be the supplier of choice to our customers, respected globally for our clinical and scientific expertise and recognised by our staff as a great place to work.”

10.20am: Health Service Journal will be hosting a twitter chat to discuss the worsening crisis in A&E departments today at 1pm. Follow #HSJEmergency on Twitter to take part.

10am: The Care Quality Commission has delayed a critical report into the care delivered at a private hospital following representations from its owners, The Times is reporting.

According to the newspaper the CQC report, which was removed from the regulator’s website shortly after it was posted online, said patients at Mount Alvernia Hospital in Surrey “were put at significant risk of harm to a life-threatening level.”

The newspaper says children admitted for surgery were placed “at risk of unsafe and inappropriate care and treatement.”

A spokesman for the CQC said that after “last minute” representations from BMI Healthcare the CQC had agreed to give further consideration to two issues raised by the company.

The CQC carried out inspections at the 76-bed Surrey hospital in December and January and found failings including inappropriate use of DNARs (Do Not Attempt Resuscitation) and a lack of suitable ventilation system in operating theatres.

One patient died after staff were told by a consultant not to attempt resuscitation, but the CQC found there was no DNAR form in place and the patient was still being treated. In another incident a DNAR form was completed after a patient had died.

Children’s surgery at the hospital has been suspended.

BMI Healthcare chief executive Stephen Collier said: “The hospital’s practices let BMI and our patients down and I apologise for that.

“In 2012 we were not maintaining the high standards that we and our regulators demand at Mount Alvernia.

“I want to reassure our patients that the hospital has already been in touch with anyone who may have been affected by a particular incident. “

“I have personally written to all patients who were admitted for treatment at Mount Alvernia in the last year explaining what has happened and providing contact details should they want to discuss the matter further with us.”

9.40am: In the other story, and exclusive interview with care minister Norman Lamb, he sets out how clinical commissioning groups may be required to use part of their budget to fund integration with social care. It is part of discussions ahead of next month’s comprehensive spending review, and follows media speculation that NHS funds will increasingly be spent on social care.

9.38am: We have published two major exclusive news stories today. The first is Ben Clover’s exclusive analysis of A&E waiting times - showing a severe failure to meet the 95 per cent four-hour target in recent weeks, and an apparent failure to hit the target overall in 2013-14.

8.31am: What does the new commissioning landscape look like, post-April 1? The number of hand-offs in commissioning responsibility along the patient pathway have increased significantly.

As commissioning changes, Sarah Baker explains how Warrington clinical commissioning group hopes to find its way through the early days of the new system to provide patients with a seamless service.

8.14am: Good morning, a key recommendation from the inquiry into events at Mid Staffordshire Foundation Trust concerns changing NHS culture to one that pays closer attention to patients. However, creating a patient-centred culture has been a long-held objective for the NHS, even being an objective of The NHS Plan in 2000.

So is there a need for the Francis report’s proposed culture overhaul or should we focus on addressing the factors which hinder the latent, patient-centred culture? David Buchanan and colleagues investigate.