Latest reaction to the Barker commission’s interim report, plus the rest of today’s news and comment.

Live logo

5.43pm The largest healthcare union has warned of a “winter of unrest for the NHS” as it reveals plans to ballot members for industrial action.

Unison is to seek an emergency vote at its annual healthcare conference this month which will give the organisation permission to ballot its 450,000 NHS members over potential industrial action in response to the government’s imposed pay deal.

A meeting of the union’s healthcare executive met on Wednesday and agreed to put an emergency motion to delegates at the conference in Brighton on 15 April.

The action follows the health secretary’s decision to reject a 1 per cent pay deal for all staff last month.

5.14pm A Sussex Clinical Commissioning Group has voted to serve notice on its community services contract with East Sussex Healthcare Trust after flagging concerns with the current offering.

High Weald Lewes Havens CCG has served 12 months’ notice on its £18m a year community services contract with the financially troubled provider.

The CCG had previously raised concerns with East Sussex over “the access to and consistency of NHS community services”. A report to the commissioner’s March board meeting states that these concerns include “ad hoc and unnotified” closures of the trust’s minor injury service, “inequitable access” to district nursing, and “intermittent closure” of a midwifery-led unit.

5.11pm Care Quality Commission inspectors visiting Brighton and Sussex University Hospitals were told of “significant tensions” and “racially motivated bullying and harassment” among staff at the trust, a report published this week reveals.

An inspection team including the regulator’s chair, David Prior, and chief inspector of hospitals Professor Sir Mike Richards visited the trust in December and January, in response to “serious allegations raised by whistleblowers”, a CQC statement said.

Employees told the team there were “significant tensions” amongst staff “in particular for staff from Black [and] Minority Ethnic groups who said they felt disadvantaged and, at times, subject to racially motivated bullying and harassment”.

4.59pm The government is moving forward with plans for plain packaging of cigarettes, after an independent report found it was “very likely to have a positive impact on public health” and stop children from taking up smoking.

Sir Cyril Chantler, the paediatrician who led the review, was “persuaded that branded packaging plays an important role in encouraging young people to smoke”.

He said he was “not convinced” by the tobacco industry’s argument that plain packaging will increase illicit cigarettes.

Commenting on the review , Dr Jenny Hatchard from the Tobacco Control Research Group at the University of Bath and UK Centre for Tobacco & Alcohol Studies said:

“The Chantler Report has concluded that branded packaging plays an important role in persuading children to smoke, and he dismisses the counter arguments on illicit put forward by the tobacco industry.

“Our own research has exposed how the tobacco industry has misrepresented evidence on standardised packaging and generated misleading press stories about how it will lead to an increase in illicit trade. We hope the coalition government will now move ahead with tobacco packaging regulation as part of its wider strategy to reduce the serious harms to health caused by tobacco products.”

4.01pm Dean Royles, chief executive of NHS Employers, has commented on the European Working Time Directive report which we covered earlier today on HSJ Live.

Mr Royles said:

“We were pleased to be able to provide an important employers’ perspective in the report. Employers want competent staff who are well trained and supervised. We don’t want them working ridiculous hours that can reduce their ability to give safe high quality care. Patient safety and the health and wellbeing of staff were central to our evidence.

“We need a positive response to further compelling arguments for replacing the outdated ‘new deal’ contract. We believe a fresh contract for junior doctors will help deliver better training, better care and a better relationship with employers for this valuable group of staff.

“The report also certainly provides further compelling weight to the need for consultants to change the way they work. Agreement on changes to national terms and conditions are needed to create more support for junior doctors at all hours, to provide better patient care at the weekends and greater safety during handovers between shifts.”

2.43pm The chief executive of the NHS Confederation’s Mental Health Network has commented on the DH new guidance on the use of restraint - “Positive and Proactive Care”. Stephen Dalton said:

“Keeping service users and staff safe is the highest priority for providers of mental health services, no exceptions, and our members are continually looking at ways to improve the care offered to service users, and their experience of mental health services.

“The Department of Health and the Royal College of Nursing have carried out a genuinely important and difficult piece work, but an essential one. The definitions in Positive and Proactive Care will help service providers understand their own practice and performance, and to determine the best way to improve. What is crucial is that service providers are supported to properly embed any changes they need to make, and to properly demonstrate the improvements these bring.

“This is not easy, so we are pleased Positive and Proactive Care aims to support staff working in difficult situations, and to enable them to contribute to the continual improvement of services and service users’ experience.

“The Mental Health Network will continue to work with members to support the spread of best practice and with the Care Quality Commission on developing assessment and inspection of providers.”

2.08pm The UK Green Investment Bank has announced its latest investment in the NHS. GIB will be providing £1.1m to finance a £3.1m energy efficiency project with Cheltenham General Hospital, managed by Gloucestershire Hospitals NHS Foundation Trust.

This has mobilised an additional £1.1m of private sector investment, from the Aviva Investors REaLM Infrastructure Fund, with the project also receiving a £900,000 grant from the Department of Health.

The project will finance the installation of a 1.3 MW combined heat and power unit at Cheltenham General Hospital. The project is a “spend to save” model where repayments will be paid for from the cost savings generated by reducing electricity consumption. The GIB says the project will save the trust money from day one.

As well as reducing the trust’s energy costs by 40 per cent, the project is expected to reduce greenhouse gas emissions by 30 per cent.

The GIB has also published a report scaling the opportunity for improving energy efficiency in the health service.

1.25pm Just over a third of the organisations which received approved patient data releases from the NHS between April and December last year were private firms, an audit published today said.

Over that eight month period the Health and Social Care Information Centre released 459 patient data sets that required approval because they contained pseudonymised or identifiable data, the audit said.

In total, 347 of the releases were of pseudonymised data. The remaining 75 releases were of identifiable data, of which four went to private firms.

1.21pm Britain’s biggest private healthcare provider has been spared from having to sell off seven hospitals after the new competition watchdog heavily watered down plans to shake up the sector.

The Competition and Markets Authority dropped the provisional plans affecting BMI under its final ruling, narrowing the focus of action to central London.

It is ordering US-owned rival HCA to sell one or two sites in the capital - prompting the company to pledge it will launch legal action.

1.18pm The Department of Health plans to change the law to allow chairs of NHS trusts to serve on the boards of more than one organisation, in a move it says could smooth the takeover process for unsustainable providers.

The chairs and non-executive directors of foundation trusts are already able to sit on more than one board, but those of non-FT providers are not. The DH now intends to remove that restriction, saying it is “no longer justified or fit-for-purpose”.

1.14pm An influential King’s Fund commission has floated the idea of introducing new charges for NHS services, in a bid to challenge the discrepancy in funding models between health and social care.

The think tank’s commission on the future of health and care, led by former Bank of England monetary policy committee member Kate Barker, is mooting the introduction of payment for NHS care.

Ms Barker told HSJ’s sister title Local Government Chronicle it was “straightforwardly odd” that people diagnosed with cancer received free treatment on the NHS but people with dementia faced potentially large bills for social care.

“It comes across as novel and shocking [to suggest patients should pay for NHS care], but it’s a provocation to challenge people to say why they think it’s right to do that in one case but not another.”

12.20pm The implementation of the European Working Time Directive in the NHS has had an adverse impact on training in certain medical specialities, including surgeons and doctors working in acute medicine, an independent taskforce has found.

The report was commissioned by the government in response to concerns about the impact of the directive on patient care and doctors’ learning. The taskforce, which was led by Royal College of Surgeons president Norman Williams, found that although some groups of doctors are able to receive the training they need within the 48-hour week, this is very challenging for others.

The directive was fully incorporated as regulations into the NHS in 2009 and means that trainee doctors work for a maximum 48 hours a week across a six-month period.

The taskforce found it has had a beneficial impact in terms of preventing doctors from working very long hours and jeopardising patient safety through fatigue.

However it concluded that the rules, along with associated court judgments stipulating when rest periods must be taken, have introduced an inflexibility into working patterns which has impacted on the quality of training for some doctors, and continuity of patient care.

The taskforce recommends:

  • That the NHS should review best practice in the design of working practices, and share examples of the successful delivery of patient care and the training of junior doctors;
  • The specific challenges faced by some specialties should be addressed in further work;
  • The lack of flexibility brought about by the court judgments is tackled, whilst ensuring doctors don’t suffer undue fatigue;
  • The possibility of creating protected education and training time for junior doctors should be explored;
  • More consideration should be given to encourage wider use of the right for individual doctors to opt out of the current restricted hours.

12.07pm The Health and Social Care Information Centre urged the Department of Health in December to intervene in NHS England plans to publicise the controversial project, HSJ has learned.

Information centre chair Kingsley Manning wrote to a senior DH official to raise concerns about the “adverse impact” he believed NHS England plans would have on “public and professional opinion”.

The correspondence, obtained by HSJ under the Freedom of Information Act, reveals tensions between the two organisations over the programme, which is owned by NHS England but in which the Information Centre plays the key delivery role.

11.41am The Care Quality Commission has commented on new Department of Health guidance to reduce the use of restraint and stop its inappropriate use in health and care settings. 

Dr Paul Lelliott, deputy chief inspector of hospitals and CQC lead for mental health, said: “This guidance is an important contribution to ensuring that people with mental health problems receive services that are compassionate and caring. Positive relations should be the basis of good, safe care and the use of restraint should always be a last resort. CQC’s work has shown that people who provide care services too often lack a proper understanding of when or how restraint should be used. This new guidance from the Department of Health is an important step in improving that understanding. CQC is working with the NHS Confederation to develop supplementary guidance explaining how we will interpret and apply the new DH guidance and explaining the implications for organisations.”

11.16am In the same paper, at least one in four people with high blood pressure have abandoned their medication or take too little to combat their risk of heart problems, scientists have said.

A study by the University Hospitals of Leicester NHS Trust and the University of Leicester found “alarmingly high levels” of patients fail to take prescribed drugs, which may lead to them requiring further costly treatment.

11.09am The Daily Mail also reports that an artist from Wales is demanding the right to be treated on the NHS in England.

Mariana Robinson, 60, has a life-threatening pancreatic condition and needs a biopsy before it can be diagnosed and treated. She claims the Welsh NHS has left her waiting for months.

11.03am In the Daily Mail, electronic cigarettes could be included in the smoking ban in Wales, the paper reports.

Ministers in the Welsh Assembly fear e-cigarettes, which are thought to be used by one million Britons, could “normalise” smoking.

10.58am The Times reports that the NHS has ‘buried the truth’ about the huge variation in standards of care out of misguided loyalty to the ideal of a universal health services, according to its chief regulator.

David Prior, chairman of the Care Quality Commission, said that patients needed to know that neighbouring hospitals could differ so wildly that it could mean the difference between life and death.

He added that about 30 hospitals in England were likely to be offering “crap care” while about 10-20 were outstanding, following the first round of an improved inspection regime.

10.44am With more people living longer than ever before, how can we transform our health and care services to meet the needs of the 21st century? That’s the question asked by Catherine Foot and Richard Humphries of the King’s Fund.

10.40am In The Guardian, Jackie Ashley has written a comment piece on the Barker report.

She says the options listed by the commission on how to pay for an integrated health and social care service are not “attractive”: “Politicians, with their eye on the election, won’t like a single one”.

“But the trust is that the current system is failing, and it isn’t going to get better of its own accord. The honest answer, for all politicians, is to spell out the facts and figures and ask the public for the answers,” she concludes.

10.28am The Daily Telegraph reports that healthy schoolchildren were kept indoors yesterday as government experts’ conflicting messages about the dangers of smog led to widespread confusion.

The Department for Environment, Food and Rural Affairs warned of “very high” levels of pollution due to a mixture of dust from the Sahara and industrial emissions from Europe arriving on a south-easterly breeze.

But its own advisers at Public Health England admitted that the “vast majority of people” would feel no effects.

10.05am There will no doubt be a lot of reaction to the Barker commission’s interim report throughout the day, and here at HSJ Live we’ll keep you abreast of what people are saying.

Here’s what Rob Webster, chief executive of the NHS Confederation had to say:

“I welcome this interim report from the Commission. With demographic changes impacting on social care as well as the NHS, and rising numbers of people needing long-term and ongoing support, our 2015 Challenge – calling for a frank and honest conversation between the public and politicians – applies equally to social care.

“There is now a consensus that joined up or ‘integrated’ services for health and social care are essential in the 21st century. This fits the needs of patients.  A similar approach for health and social care finance could, in principle, help make this a reality.  There will be much to consider in taking this forward - from real term budget allocations for local government reducing by 14 per cent in the last four years, to the balance of risk across the health and care system, and the issues of charging for social care versus free NHS care. These will need to be addressed if we are to spearhead positive change towards a truly integrated health and care system.

“Delivery of such a radical development must be accompanied by a greater emphasis on commissioners setting standards and rewarding providers for delivering quality care and outcomes, not just how much activity they carry out. It’s also important that the way care is financed reflects the real needs of people, not theoretical models.

“Crucially, we must face up to the need to look at the value our public services deliver, and how we resource them. This report is a valuable part of the debate and the NHS Confederation looks forward to providing the voice of NHS leadership to as we look to develop a positive future for the health and care system.”

9.58am The health and social care systems are no longer fit for purpose, an independent commission established by The King’s Fund has concluded. The commission, chaired by Kate Barker, said the time had come for ‘a new settlement’ to meet the needs of 21st century patients and service users.

The interim report from the Barker commission says that England should move towards a single, ring-fenced budget for health and social care, with services singly commissioned and entitlements more closely aligned.

Ms Barker said: “The current systems rub up against each other like bones in an open fracture. The lack of alignment between them leads to serious problems of co-ordination, with the NHS and local authorities battling over who should pay for what, and patients, service users and their families left confused and bewildered. This is not sustainable – we need a new settlement fit for the 21st century.

“This report is our stake in the ground. The prize we seek – a single, seamless health and social care system that offers equal support for equal need –is a significant one. This necessitates making choices about how to pay for a better system – hard choices that we must look squarely in the eye.”

6.00am Work in the US around long term and community based residential care provides an interesting model for the English health and social care system to consider, Shreshtha Trivedi reports.