The entry deadline for the HSJ Awards 2015 is midnight tonight, plus the rest of today’s news and comment

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5.35pm You can now catch up on Friday’s big three stories in our executive summary:


4.50pm HSJ’s South West correspondent Will Hazell tweeted some more information on Cornwall’s proposed devolution deal:

3.41pm Someone suffers a gastrointestinal (GI) bleed every six minutes, but half of the hospitals that patients are admitted to as an emergency cannot provide all the services they need for a GI bleed, according a report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

The enquiry is calling for round-the-clock access to gastrointestinal bleed services so that clinicians can begin treatment plans for patients as soon as the bleed is identified.

There are over 90,000 GI bleeds every year, but there were continue to be delays in recognising the condition, NCEPOD’s clinical co-ordinator in radiology Simon McPherson said.

“This is the case even with the severe bleeds reviewed in this study, where patients received four or more units of blood,” he added.  

“Recognising and treating GI bleeds as quickly as possible can be more urgent than caring for a patient with a serious heart condition.

“The sooner the GI bleed is recognised, and the patient is seen by the specialist, the better. But, without 24/7 access to GI bleed specialists, delays in recognition and treatment will continue – and continue to put lives at risk.”

The report found that many hospitals have no planning or procedures to bring together specialist advice and services rapidly for when a patient suffers a GI bleed.

“It is unacceptable that some hospitals still don’t have a GI bleed service able to operate on-site or that has access to services as part of a network, Dr McPherson said.

“Transferring patients to a hospital that has 24/7 endoscopy services is dangerous and places them at risk. We would like to see patients taken immediately to a hospital that can provide appropriate GI bleed services to minimise transfers.”

The study also highlighted inconsistencies in  care for upper and lower GI bleeds, and that poor care had occurred not only out-of-hours, but also during normal working hours, in contrast to  other healthcare conditions that tend to be affected by a reduced weekend service.

3.36pm In response to David Bennett’s speech at Healthcare Financial Management Association conferencetoday, in which the Monitor chief executive saidfoundation trusts must cut their deficits or face “completely eroded” freedoms, NHS Providers chief exectuive Chris Hopson said: “We share Monitor’s concern at the size of the financial challenge facing the NHS in 2015-16 and that, on the current trajectory, the NHS will be unable to stay within its budget.

“NHS providers delivered £2.5bn of savings last year and are planning to deliver even more this year.

“However, we need to recognise this may not be enough to enable the NHS to stay within its budget this year.

“Providers, commissioners, the Department of Health and the arms length bodies have a collective responsibility to ensure the NHS stays within its budget. Failure to do so risks weakening the case made to Government in the [NHS] Five Year Forward View on the need for an extra £8bn by 2020.

“In addressing this clear and present challenge, we would draw a distinction between the long term opportunities to realise efficiencies highlighted in today’s speech and the immediate short term actions the NHS may need to take if the imperative is to stay within this year’s spending limits. The former will require time, investment and planning; the latter are needed now.

“Plans have already been announced in areas such as reducing spending on agency staffing and management consultancy. NHS England, Monitor and the TDA are reviewing 2015-16 business plans. These may well be insufficient to close the financial gap the NHS faces.

“If so, as a system, tough choices will be needed as well as honesty and realism about the severity and speed with which action is needed. If the NHS budget cannot be increased, we need to come together as a single system to work out what else can be changed, be it planned commissioner surpluses or contingencies, staff numbers, waiting lists / access to services or capital spend. NHS Providers and its members are already discussing what further contribution the provider sector could make here.

“Whatever is decided and however great the pressure, we need to resist the temptation to think that these issues are best addressed by reverting to command and control and eroding provider freedoms. The way to meet this challenge is to enable, support and empower providers, rather than threatening or neutering them.”

2.58pm Dr Wollaston also gave this response to a policy announced by the health secretary this week, that the price of medicines costing more than £20 would be displayed on the bottle:

2.56pm Dr Wollaston has further tweeted:

2.53pm Following on from Jeremy Hunt’s comments about charging for missed GP appointments on BBC Question Time last night, health committee chair Sarah Wollaston, a former GP, has tweeted:

2.40pm EXCLUSIVE: A devolution deal for Cornwall, including greater control over health and care spending, is expected to be announced by the chancellor next week, HSJ has learned.

The ambition is that by the end of the decade the area will have moved towards a £2bn pooled budget combining health, welfare and social care spending.

The full details of the deal are still to be finalised, but chancellor George Osborne is expected to make reference to it when he delivers the emergency budget on Wednesday, according to several senior figures involved in discussions.

It is expected to mean Cornwall developing a similar approach to that proposed for Greater Manchester earlier this year. It would be the first area outside of a major city to win a devolution deal.

1.57pm The General Medical Council and the Academy of Medical Royal Colleges have launched a consultation aimed at making doctors “better professionals, communicators and leaders”.

The organisations will seek views on a proposed framework for generic professional capabilities over the next three months, including the outcomes that all doctors will have to demonstrate by the end of their postgraduate specialty training.

The framework “clarifies the core knowledge, skills and behaviours which doctors need and which are common across all medical specialties, such as effective communication, team-working and patient-centred decision making,” they said in a statement issued today.  

“These and other key capabilities described in the framework are essential for safe, high quality clinical care and will support doctors’ development as high performing, compassionate and caring professionals,” the statement continues

The organisation will also look into how the framework can be incorporated into all stages of training.

GMC chief executive Niall Dickson said: “UK trained doctors are valued and recognised across the world for their technical expertise. But alongside this it is vital that every senior doctor has the personal and professional insights and capabilities to deliver, lead and manage high quality care in complex teams, often in stressful environments or rapidly changing clinical circumstances.

“Patients rightly expect doctors to be good team players, have situational awareness and where necessary to provide effective leadership - they also expect their doctors to be professional, principled and expert communicators.

“Other safety critical industries such as aviation have significantly improved their training and performance by developing insights into these critical aspects of human behaviour and performance.

“There is evidence that an awareness of these human factors and associated generic professional capabilities improve professional practice.

“By acknowledging, encouraging and embedding the development of these high level professional insights, skills and capabilities into medical training, there is an expectation that we can promote and enable a higher and more consistent level of care for patients.

“Clinical skills are absolutely vital – they are necessary but on their own not sufficient to guarantee excellent care for patients.‘

The Academy’s education strategy committee chair Dr JP van Besouw said: “Being a good doctor always means more than simply having the relevant specialist skills – crucial though that is.

“Good doctors need effective communication skills, to be able to work in teams and act as professional leaders as well as understanding the context and ethics that underpin healthcare. All these skills are required to make a doctor an effective professional.

“It is therefore really important that we identify the right range of these generic attributes that all doctors whether a GP, a hospital doctor or a psychiatrist need to have.

“We are pleased to have worked with the GMC on developing this framework for Generic Professional Capabilities and will welcome views from doctors, employers and the public on the proposals.”

1.46pm NHS England has today launched a information standard launched today requiring all NHS and adult social care organisations to meet the communication needs of people with a disability, impairment or sensory loss by 31 July 2016.

The standard will include making sure patients get information in suitable formats and that, if needed, support from British Sign Language (BSL) interpreters is guaranteed.

Research conducted by the charity Action on Hearing Loss found that more than a quarter (28 per cent) of patients with a hearing loss did not understand their diagnosis after visiting the GP.

It also found that two in three BSL users did not get an interpreter, even if they had requested one.

The charity’s policy and campaigns director Roger Wicks said: “It is vital that everybody understands the information and advice they receive from their GP or hospital.

“The Accessible Information Standard is the first time the NHS has provided clear guidance on what people with hearing loss and deafness should expect from health and social care services, and what staff should provide.

“So long as it’s properly implemented, it will enable patients to access services, to understand information they are given, to manage their own health and to participate fully in decisions about their treatment – things that many of us take for granted.

“While it can’t be denied that these adjustments will come at a cost, it’s now time for providers to acknowledge hearing loss for the serious health issue that it is, and to reap the benefits of enabling proper access.”

1.28pm A gene therapy treatment to help people with cystic fibrosis may be available within five years, The Guardian reports.

The results of a year long trial show only a small and variable improvement in the lung capacity of those children and adults who took part, but scientists now believe they have provided gene therapy is possible in cystic fibrosis.

With more work, they say that by 2020 they could have a treatment that will at least help stabilise patients.

12.40pm A quick reminder that today is your last chance to enter the HSJ Awards 2015.

The entry deadline is midnight tonight.

There are 22 categories to enter this year, including a new category to showcase the organisation that best improves outcomes through learning and development.

The last year has been a crucial period in the development of the NHS. The need to improve efficiency, while maintaining or improving quality, has been combined with the challenge of introducing new care models and navigating increasing levels of government and regulatory scrutiny.

The winners will be announced at an event at Grosvenor House Hotel in London on 18 November.

Click here to enter the HSJ Awards 2015

12.29pm EXCLUSIVE: NHS England national commissioning operations director Dame Barbara Hakin is to retire by the end of the year.

Staff were due to be told of her decision today. An appointment is expected to be made to “a reshaped national director role” in coming months.

Dame Barbara has worked in the NHS for 41 years and been an NHS England national director since its formation in 2012. She oversees its regional and area teams, and her responsibilities have included operational performance and the development of clinical commissioning groups.

11.45am The Daily Mail has revealed details of a locum doctor in Scotland who was paid £19,000 to do a week’s work (newspaper only).

The unnamed consultant psychiatrist, hired at the last minute from an agency during a desperate staff shortage, cost the health service the equivalent of a £1m a year salary.

NHS Western Isles health board paid the doctor, a specialist in old-age care, £19,305 including VAT for 40 hours on duty plus the rest of the week on call.

11.33am Huffington Post executive editor Paul Waugh has tweeted that Number 10 has confirmed there are no plans to charge patients for missed GP appointments:

11.25am The Daily Mail reports that more than 14 million patients were forced to wait over a week for a GP appointment in the past year, official figures show.

A quarter of the population now have to wait at least seven days to see their doctor, with the figure as high as two thirds in some areas, according to the findings of the NHS’s GP Patient Survey of 850,000 people in England.

This number has ‘soared’ by 40 per cent in four years as understaffed surgeries struggle to meet the demands of a growing and ageing population.

11.18am The Guardian has shared a clip from BBC’s Question Time last night in which Jeremy Hunt appaeared to announce a new government policy about missed GP appointments.

Following on from comments in which the he said he would support charges for missed GP appoinments “in principle” but “in practical terms it would be difficult to do”, the health secretary said: “I’ve taken a step… towards that this week by announcing when people do miss an appointment, they will be told how much that has cost the NHS as a first step.”

Mr Hunt also said that for all medicines costing over £20, the price will be displayed on the outside of the medicine pack, with a label saying “paid for by the UK taxpayer”.

10.43am Experts have criticised NHS England’s latest safe staffing guidance on mental health inpatient care, raising concerns that the model used ‘lacks rigour’.

NHS England published the Mental Health Safe Staffing Framework this week. The guidance avoids setting specific staffing levels for inpatient wards, arguing: “To do so may result in less consideration for local needs, and underestimating the number of staff required to ensure care delivery maintains therapeutic benefit.”

The framework recommends the use of two workforce tools and a checklist for lead clinicians to present to their board. It also provides advice on how mental health services can review their workforce planning.

However, a number of leading experts on nursing workforce have expressed their doubts about the framework to HSJ.

10.28am In case you missed it, here’s our roundup of yesterday’s key stories:

Monitor announced that in future there will be a “bias towards avoiding” the use of the special administration “failure regime” “unless necessary”.

The regulator carried out a lessons learned review of the dissolution of Mid Staffordshire Foundation Trust, which overran its budget by nearly £5m.

It found this happened in part because of the weak bargaining position of the administrators, who lacked legal powers to compel neighbouring NHS bodies to accept their proposed solution and therefore got bogged down in a lengthy negotiation process.

Meanwhile, an independent review found that bullying is prevalent across the London Ambulance Service and the trust has a “blame culture” in which bullies are perceived to have been rewarded.

What’s more, a social enterprise which provides community services across Cornwall and oversees the county’s 14 community hospitals has said that it will not seek an extension to its current contract, which ends in March 2016.

Peninsula Community Health has been providing community services across Cornwall and the Isles of Scilly since 2011.

Steve Jenkin, the mutual’s chief executive, has told colleagues that in light of the “challenging financial climate”, the organisation’s board has decided not to try and extend its contract.

10.19am Mid Cheshire Hospitals Foundation Trust chief executive Tracy Bullock has tweeted:

10.07am The Daily Telegraph reports almost a quarter of schemes paid for out of the Prime Minister’s challenge fund to give patients access to GPs at evenings and weekends have been cut back after patient demand failed to meet expectations.

Four of the 20 areas which received cash from the £50m fund have cut the extra hours offered and in one case suspended Sunday surgeries altogether.

10.03am The heads of 20 leading health bodies have criticises the government’s plans to cut public health budgets by £200m “harmful both to the health of the population in England and to long-term efforts to reduce cost pressures”, in a letter to The Times this morning.

“Public health services target some of the most significant challenges of our time, such as smoking, alcohol misuse, obesity and inactivity,” the letter states.

“For the NHS and social care to cope with challenges posed by growing demand and limited resources, there needs to be an increased emphasis on preventing ill-health.

“NHS England’s Five Year Forward View, which has been fully adopted by the government, recognised this reality. It made prevention its cornerstone, establishing a consensus around which real progress could be made,” it adds.

The letter calls on the government to “take note of the weight of evidence and recognise that cuts to public health services would be deeply counter-productive to the health of our nation”.

The signatories of the letter are as follows:

  • Professor Karen Middleton, Chief executive, Chartered Society of Physiotherapy
  • Shirley Cramer, Chief Executive, Royal Society for Public Health
  • Professor John R Ashton CBE, President, Faculty of Public Health
  • Professor Cathy Warwick, Chief Executive, Royal College of Midwives
  • Tom Wright, Chief Executive, Age UK
  • Kay Boycott, Chief Executive, Asthma UK
  • Delyth Morgan, Chief Executive, Breast Cancer Now
  • Simon Gillespie, Chief Executive, British Heart Foundation
  • Dr Penny Woods, Chief Executive, British Lung Foundation
  • Barbara Young, Chief Executive, Diabetes UK
  • Lynda Thomas, Chief Executive, Macmillan Cancer Support
  • Arlene Wilkie, Chief Executive, The Neurological Alliance
  • Mark Winstanley, Chief Executive, Rethink Mental Illness
  • Jon Barrick, Chief Executive, The Stroke Association
  • Prof Russell Viner, Officer for Health Promotion, Royal College of Paediatrics and Child Health
  • Dr Liam O’Toole, Chief Executive, Arthritis Research UK
  • Deborah Arnott, Chief Executive, Action on Smoking & Health
  • Jackie Ballard, Chief Executive, Alcohol Concern
  • Ben Reynolds, Acting Coordinator, Sustain: the alliance for better food and farming
  • Paul Farmer, Chief Executive, Mind

9.50am The BBC reports on comments made by Jeremy Hunt on Question Time last night, that he did not have a “problem in principle with the idea of charging people for missed appointments”.

The health secretary said: “I think in practical terms it could be difficult to do but I’ve taken a step towards that this week by announcing that when people do miss an appointment they will be told how much that’s cost the NHS.”

9.40am EXCLUSIVE: Monitor’s chief executive will today warn that foundation trusts could see their freedoms ‘completely eroded’ if they do not do better to reduce a sector-wide deficit projected to reach £1bn in 2015-16.

David Bennett is expected to reveal that the latest forecasts show the FT sector finishing this year an “unaffordable” £989m in the red – nearly three times worse than the £349m deficit it recorded in 2014-15.

FTs are supposed, and are generally held, to be the financially strongest part of the provider sector. Its 2014-15 deficit made up less than half of the overall deficit of £822m recorded by the whole provider sector that year.

7.01am: NHS England last night set out a list of specialised services, treatments and drugs which it will now routinely fund, following a three-month consultation and prioritisation process.

It approved 29 for routine funding. It rejected seven which it had considered.

In the case of two particularly controversial drug treatments - Vimizim for Morquio A Syndrome and Ataluren for Duchenne muscular dystrophy - NHS England said it would await the outcome of ongoing highly specialised technology appraisals by the National Institute for Health and Care Excellence.

HSJ has covered patient, clinical and political concern about the absence of routine funding for these treatments, and NHS England’s processes.

The national cost of specialised treatments has been growing quickly, largely because of new treatments, and this trend is expected to continue. NHS England’s clinical director for specialised services said earlier this week that it would not be able to afford many new specialised treatments, due to a decision to focus investment on out of hospital care.

7.00am Good morning and welcome to HSJ Live. Today is your last day to enter the HSJ Awards 2015.

What does winning an HSJ Award mean?

That question is answered in this video by the team from Wrightington, Wigan and Leigh Foundation Trust, who won the coveted provider trust of the year award at last year’s ceremony.

You can enter the awards here.