HSJ Live 03.06.2015: Three troubled areas to be put into 'success regime'

4.52pm NHS Providers has commented on the news of the first health economies to be placed in the “success regime”.

Miriam Deakin, head of policy, said: “We welcome the holistic focus the new success regime places on supporting local health economies to function effectively for patients – rather than focusing solely on individual institutions. Autonomous provider boards are best placed to deliver meaningful development but they need clear lines of accountability and the right policy and regulatory framework within which to deliver this, in collaboration with partners in their local area. The success regime will be critical in identifying and overcoming the structural challenges facing some local health economies and in facilitating collaboration to achieve this.

“We also appreciate the efforts the statutory bodies have made to align the regime with a complex policy and regulatory landscape which already includes special measures and a special administration process for NHS providers. We remain conscious of the need to reduce the existing burden of regulation and we particularly welcome the commitment from the central bodies to finalising the detail of the regime in partnership with our members, and other sector representatives, to ensure it delivers added value for all concerned.”

4.49pm Simon Stevens has also said NHS England medical director Sir Bruce Keogh is to review the current waiting times standards for elective care.

Sir Bruce will also consider whether a pilot scheme for ambulance services to be given two minutes longer to assess patient need before sending out a response vehicle should be expanded to the whole of the country.

It follows speculation in recent weeks about whether the national NHS bodies would make waiting times standards more flexible, amid severe financial problems and many organisations having difficulty meeting them.

4.16pm Simon Stevens has confirmed the three areas to be the first put into a new whole health economy “success regime”.

The areas are:

• north Cumbria;
• Essex; and
• northern, eastern and western Devon.

Mr Stevens was speaking at the NHS Confederation conference in Liverpool this afternoon.

The areas all have serious financial problems and some major care quality and performance issues.

The new policy is expected to see the organisations in these areas receive coordinated, and more direct, intervention and support from NHS England, Monitor and the NHS Trust Development Authority.

4.04pm Monitor also published its consultation on changes to the risk assessment framework this afternoon. Read it here.

4.02pm The first health economies to be put into the “success regime” were announced today. They are North Cumbria; Essex; and Northern, Eastern and Western Devon.

Monitor has published new information on this new approach to “whole system intervention” here.

3.54pm Monitor has launched an investigation into a Shropshire orthopaedic hospital over excessive waiting times and the accuracy of its reporting.

The regulator is probing Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, after becoming concerned that too many patients were waiting longer than 18 weeks for day case or inpatient procedures.

Monitor said it also had concerns about how accurately the trust is reporting its performance data for routine operations, after “potential problems were identified by a third party”.

1.55pm Today is the first day of the NHS Confederation annual conference. If you’re not there but want to follow the plenary speeches and other news from Liverpool, then HSJ’s team will be tweeting throughout the event. You can follow the tweets for all our reporters here.

Simon Stevens is currently delivering his speech in the conference’s main hall.

1.40pm A private company led consortium including two NHS trusts is now the only remaining bidder for a 10 year, £687m cancer services contract in Staffordshire, HSJ can reveal.

A statement leaked to HSJ shows the four Staffordshire clinical commissioning groups involved in the procurement, part of a wider £1.2bn tender process for cancer and end of life care, say the consortium was formed after two of the original five bidders pulled out.

The statement by the four CCGs and NHS England, due to be released this week, does not name the members of the consortium but a number of sources have confirmed to HSJ that it will be led by private company Interserve Investments. University Hospital North Midlands and the Royal Wolverhampton trusts will be partners.

11.16am HSJ’s editor, Alastair McLellan, has written a leader following our interview with Simon Stevens.

Alastair writes: “By signalling to NHS leaders that they must directly challenge the financial implications of clinical practice, [Simon Stevens] has effectively blown the NHS management dog whistle – trust boards will not only get the specific message, but understand the seriousness with which it must be treated.

“For the truth is that the efficiency savings that will have to be delivered by productivity improvements in the acute sector - including the levelling up of poorer performers to that of the most efficient comparable trusts - dwarf the contribution of any other factor.”

He adds: “For all the forward view’s welcome emphasis on prevention, out of hospital care models, integrated care led demand management and the reshaping of emergency and specialist pathways, its success depends on the part of the NHS to which it pays the least attention – making a step-change in the cost effectiveness of its day to day activities.”

11.02am The responsibilities of severely struggling clinical commissioning groups could be passed to other CCGs, local authorities or “integrated providers”, Simon Stevens has said.

The NHS England chief executive said his organisation would now be taking a tougher approach to the “small number of CCGs that are getting into serious difficulties”.

10.33am Urgent and emergency care will undergo a “complete redesign” and be in “a very different place by the middle of this Parliament”, Simon Stevens has announced.

Mr Stevens used his interview with HSJ to announce the launch of a “vanguard” approach for unplanned care at a number of pilot sites across the country. He also hinted at a change to the way emergency care performance is measured.

The work will include an overhaul of NHS 111, GP out of hours services, minor injuries and urgent care centres, ambulance services and accident and emergency departments.

It will also look at the “division of labour” between A&E departments and major trauma centres.

10.22am HSJ has published an exclusive interview this morning with NHS England chief executive, Simon Stevens. A number of different stories emerged from the interview, which we’ll spend some time teasing out on HSJ Live this morning.

Mr Stevens told HSJ that NHS trusts will ‘undoubtedly’ struggle to employ the doctors and nurses they need as the service clamps down on the cost of temporary staff from next month.

Stressing that guidance would be developed within days to make sure patient safety was not endangered, he nevertheless acknowledged the NHS would face “volatility” while the temporary staffing market is reset.

Mr Stevens also described the challenge of converting temporary staff into permanent roles as the NHS’s “single biggest operational financial risk”.

10.08am Cancer services should be funded via population-based payments to networks and lead providers, the NHS England chief executive has said.

Simon Stevens said that over time the NHS should not “obsess” about the payment by results tariff - “a mechanism that is used to reimburse a third of our total services”. Focusing on this in price setting “reinforces the fragmentation that we’re trying to overcome through the service redesign, the integration, the whole system working in many geographies”, Mr Stevens warned.

He predicted several shifts would lead to a “significant” reduction in the proportion of NHS care funded by tariff over coming years.

One change he cited was a move to “population based cancer funding to flow into cancer networks [and/or] lead providers” in some areas. This would replace what Mr Stevens described as “the highly atomised reimbursement mechanisms we [currently] have in cancer care”, whereby surgery is tariff funded but radiotherapy payments do not support developments in treatment.

7.00am Good morning and welcome to HSJ Live. We begin the day with a comment piece from Steve Rudland, healthcare practice manager of Hyland.

Steve argues that healthcare providers that get a grip on their unstructured patient data can enhance clinical care and patient experience.