Fit and proper person test proposals, CQC rating system, outlining a new model for primary care; and the rest of today’s news

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5.33pm: We have published further coverage on the big developments on the fit and proper person test today: Exclusive: NHS England and CCG managers dodge fit and proper person test

4.22pm: Cathy Warwick, chief executive of the Royal College of Midwives, has issued a statement on the government’s migrant access plans. She said: “There is no reference to maternity services in the document. We need to know what this means for users and for midwives as to what maternity care women will be entitled to, because this could create uncertainty and confusion.

“The extension of charges to primary care services such as GPs is a concern. This may deter some women, such as those from vulnerable groups including those that have been refused asylum or have been trafficked, from accessing care at this level. I fear that these women could fall through the cracks and only find their way into the health system when it is too late, if at all. Women from these groups are often already in poorer health and these steps could have negative consequences for their pregnancy and the developing baby.”

4.08pm: HSJ editor Alastair McLellan tweets: “Eric Pickles (at 3hrs 10mins) adding ten years to the age of the NHS:”

3.33pm: The DH has now published the full consultation on its plans for a fit and proper person test and other moves which it says will increase accountability.

2.19pm: We are publishing, in conjunction with the Nuffield Trust, a series of opinion pieces/articles with leading sector figures. Here is one with NHS England chair Sir Malcolm Grant.

It includes: “There is the tension on the one hand between moving away from being operationally accountable to the secretary of state to being accountable through a mandate – which is what it says in the legislation. And on the other, actually supporting the government in ensuring that along with our other partners such as the NHS Trust Development Authority, the National Institute for Health and Care Excellence, and Monitor and Care Quality Commission, that the issues such as waiting times in accident and emergency, such as NHS 111, respond appropriately to public need.

“We can’t do everything by the mandate. We have to be on the front foot, working with the Department of Health and others to ensure that operationally, the system doesn’t keep tripping over itself.”

12.30pm: We have published an initial story on the fit and proper person test proposals.

11.33am: In relation to the fit and proper person test and sanctions for care failures, the DH statement on the subject says:

“Directors in charge of care homes and hospitals that allow neglect and abuse to take place could be held personally and criminally accountable for failures in care, under proposals unveiled by Care and Support Minister Norman Lamb today.

“Plans announced today include moves to introduce a fit and proper test for directors, as part of work to address problems in the current system that fail to hold company directors to account for serious failures in care.

“The consultation forms part of the work to begin rebuilding trust in the health and care system, shaken by serious failures in care due to scandals like Winterbourne View and Mid-Staffs.

“Some of the key proposals to ensure that directors of organisations are personally held to account include:

” - The introduction of a compulsory ‘fit and proper’ person test for directors, resulting in removal from their post upon failing the test;
” - Addressing the loophole in the system where providers responsible for appalling failures in care can escape prosecution; and
” - Making it easier for the Care Quality Commission (CQC) to prosecute providers and their directors where there are clear failures to meet very basic standards of care. Remarkably, there have been no prosecutions for failures in care since the CQC was established.”

  • HSJ analysis of the detail of the proposals will follow shortly

11.24am: Breaking…. the DH is making announcements today about the “fit and proper person” test for NHS directors, introduced in response to Francis. Early indications are that it appears it will be applied to directors when they joining providers - therefore those in existing posts will be checked if and when they move to a new organisation.

Further detailed coverage from HSJ will follow

11.17am: The Times also carries a short piece saying care and support minister Norman Lamb is to unveil plans to close a loophole in the care system that allows providers responsible for failures in care to escape prosecution.As a result directors could face criminal charges where care falls below acceptable standards, ministers hope.

11.06am: The Times is also carrying a story on the DH a senior civil servant who spent £73,000 of DH money on preparing for a grilling for MPs.

It reports that Tim Donohoe hired a management consult on up to £1,700 a day for 52 days ahead of a public accounts committee session on the national programme for IT. Committee member Steve Barclay, who sits on the committee, said it was “unbelievable”.

In apparent contradiction to the Daily Mail report earlier, no money was spent in relation to NHS England chief executive Sir David Nicholson.

11.01am: The DH has announced the appointment of Ian Hudson as Chief Executive of the Medicines and Healthcare Products Regulatory Agency.

A statement says: “Dr Hudson is currently the MHRA’s Licensing Director, responsible for the majority of medicines licensing activities. He is the UK delegate to the Committee on Human Medicinal Products (CHMP) at the European Medicines Agency and has been its vice-chairman since October 2012. He will take up the post in September when Sir Kent Woods steps down after ten years with the Agency.”

10.57am: We have published an analysis by Crispin Dowler of the future of the NHS payment system, which is being opened up for debate. There is also a news story on the views of the Monitor director who is carrying out the work.

10.45am: Steve Kell, prominent CCG chair and vice-chair of NHS Clinical Commissioners leadership group, has written on this blog about the potential for a large cut to CCGs’ administration budgets, and the damage it could do. It follows a story by HSJ featuring Dr Kell’s views on the matter, following the 2015-16 spending review.

10.42am: The Daily Mail is running a story on second page about former NHS chief Sir David Nicholson and two other bosses taking the help of consultants with a headline “£73k to ‘coach’ the man with no shame”.

The paper reports that the trio had relied on the consultants’ “technical reports” to face the Commons hearing last month over the problems dogging the disastrous NHS IT system. The cost of coaching for two officials was revealed in a Commons health committee hearing yesterday.

10.37am: The Guardian follows up its story on Tameside Hospital Foundation Trust, reporting the resignation of chief executive Christine Green and medical director Tariq Mahmood.

It says Green offered her resignation after a board meeting with NHS England medical director Sir Bruce Keogh’s team to discuss its outlier status on mortality rates.The paper runs a desperately weak leader column headlined “Distraction therapy” which strings together some unrelated NHS news into “another bleak 24 hours for the NHS”.It says the Tameside resignations, on top of the CQC admitting it had been wrong not to initially release the names in the Morecambe Bay report plus NHS Direct pulling out of two 111 contracts adds up to “a service under mounting pressure”.But it ends on a hopeful note: “There are reasons for optimism. The concerns of junior doctors and local GPs did trigger action. Now the chief executive has resigned.”The tide may have started to turn”.

10.33am: Health bosses will have to keep pursuing efficiency and savings after the next general election, the chair of the Commons health select committee, Stephen Dorrell, has told MPs. HSJ report

10.31am: Adult social care and health service leaders have highlighted issues that still need to be ironed out before NHS and social care services can be fully integrated, a new poll indicates. HSJ report.

10.30am: The Daily Mail reports that GPs and doctors’ leaders have attacked plans to crack down on “health tourism” by making migrants pay for the care.

Clare Gerada, of the Royal College of GPs, claims the reforms could result in migrants “wandering around” with infectious diseases. And the BMA insists doctors would not be prepared to “enforce immigration checks” and did not have the time to be “arbiters” of who should get patient care.Proposals unveiled by health secretary Jeremy Hunt yesterday include a new £200 “healthcare levy” for anyone seeking a UK visa for more than six months , a charge to see GPs for stays less than six months and a new system to track the use of the NHS by migrant workers.

10.23am: Following on from my previous entry, Hansard shows Lord Howe also said yesterday on CQC ratings: “CQC plans to commence rating providers of acute care from December, with the aim that all these providers receive a rating before the end of 2015. It will begin to develop ratings for mental health trusts during 2014, and for other NHS trusts, such as community healthcare and ambulance trusts, during 2015-16.


“As for the evolution of these ratings, the Government do not expect the CQC to have fully developed ratings for hospitals by the end of this year. That would be unrealistic. The initial ratings will not be a final product. They will instead represent the first stage in an ongoing development process. The Government expect that CQC will improve its methodology over time, and one of the most robust ways to do that is to continually test the methodology in the field. The new Chief Inspector of Hospitals will spearhead the new approach to assessing hospitals, using his clinical expertise to develop an effective approach for rating. I direct noble Lords to the CQC’s consultation document A New Start, which sets out all these plans in some detail.”

10.08am: Patrick Leahy, who works in public affairs for a royal college, tweets: “Earl Howe made clear in the Lords yesterday that the first new CQC ratings of hospitals will be published at the end of this year.”

10.01am: Several healthcare Tweeters have drawn attention to a good piece by Nick Timmins published on the Guardian website yesterday, about the Care Quality Commission predicament.

He writes: “Some organisations are set up to fail. Not deliberately of course. But in their creation lie the seeds of their destruction - reputationally, if not organisationally.

“But there remains a worry that it is yet again being set up, unintentionally, to fail. Ministers appear keen to have an Ofsted-style star ratings system for hospitals. But hospitals are not schools; they are vastly more complicated. Even great hospitals can have poor departments and vice-versa. It has to be remembered that not everything at Mid-Staffordshire was awful. And the worry is that history will repeat itself. That the new CQC will award a five or four star rating to a hospital (or whatever) and it will then be found to have something dire going on somewhere within it and the credibility of CQC will be undermined all over again. “

8.20am: Good morning, today on HSJ’s commissioning channel, John Rooke explores why the model of the community physician needs to be based on a holistic patient offer and clinical collective accountability − starting with a new GP contract.