Jeremy Hunt has defended his controversial move to cap spending on agency staff, plus the rest of today’s news and comment
5.25pm A Department of Health audit has found the Care Quality Commission made “procedural errors” in relation to a decision to award two contracts to the consultancy firm McKinsey & Co, with a total value of nearly £1.5m.
The audit, commissioned by the DH in relation to allegations made by a CQC employee, found the regulator fell “short of the procurement requirements placed on a public body”.
However it dismissed allegations that the then CQC chair, David Prior, who was appointed a government minister this month, had engaged in “bullying or harassment” in relation to the procurement or that the CQC had entered into a “verbal contract” prior to the tenders.
4.45pm The Royal College of Emergency Medicine has joined the chorus of disapproval against the decision to suspend NICE’s work on safer staffing levels.
President Clifford Mann said: “There are real pressures on nursing levels in emergency departments. In addition, the variation between different departments is enormous. We are concerned about patient safety and staff welfare. We saw the work that we and others had been doing with NICE in this area as much needed and overdue. To learn that it is now taken away from an independent body and is back to the drawing board is very disappointing.”
2.45pm The Care Quality Commission has given a statement on the safer staffing story.
Professor Sir Mike Richards, chief inspector of hospitals said: “We assess staffing levels on all of our hospital inspections, as having sufficient staffing can clearly impact on the quality and safety of care received by patients. In order to make judgements we always take a rounded view - our judgements about staffing are never based solely on numbers. Our inspection teams observe the care delivered on wards, listen to patients and staff, look at staffing numbers for registered nurses and healthcare assistants and staffing rosters, assess the use of agency staff and whether they get proper inductions and can deliver a full range of care, look at incident reports to see whether staff have reported low staffing levels and check to see if staffing issues have been escalated if necessary. If we have concerns about staffing levels we can make unannounced visits to wards to check.”
2.40pm Labour has described the suspension of the safer staffing work by NICE as “worrying”.
Shadow health minister Andrew Gwynne said: “This latest development is worrying when combined with the Tories’ refusal to rule out staff cuts as part of their plan for £22bn of ‘efficiency savings’. Safe staffing levels are essential for patient safety and NICE’s programme of work was a major recommendation of the Francis Review.
“Staff shortages are a key reason why care problems are becoming more likely under the Conservatives. Under David Cameron, nurse numbers have failed to keep pace with demand and two thirds of nurses currently say patients are missing out on basic care because of understaffing.”
2.35pm On the suspension of NICE’s safer staffing work the Royal College of Nursing warned against basing staffing levels on cost.
Peter Carter, chief executive and general secretary of the RCN said: “It is widely recognised that you need the right number of nursing staff on wards to make sure patients get high quality and safe care. This has been set out in reports by Sir Robert Francis, Sir Bruce Keogh and Don Berwick.
“Commissioning NICE to develop safe staffing guidelines was a welcome recognition of the need for strong, evidence based staffing levels to assure patient safety.
“NICE has done excellent work on safe staffing, which was rigorous, well researched and respected. It provided clarity on what safe staffing looks like and importantly it put patient safety first.
“Hard working nurses are under a great deal of pressure and need to be properly supported, and these NICE guidelines played a vital role in doing this.
“If staffing levels are not based on evidence there is a danger they will be based on cost. We must not repeat the mistakes of the past, where staffing levels were cut to save money, and patients suffered as a result. We are concerned that this move is driven by affordability, and patients and staff must be assured that this is not the case.
“Whatever replaces the NICE guidelines must continue to emulate their evidence based and safety focused approach. Straying from this course now would be failing both staff and patients.”
2.35pm Strong reaction across the board today in response to the safer staffing story, but also the news that the public health budget will be cut by £200m.
Louise Silverton, director for midwifery at the Royal College of Midwives, said: “This comes at a time when we should be investing more in preventative services and when there is an increasing and necessary focus on this from organisations such as NHS England; this seems to be a case of sheer folly. To also describe this as non-NHS spending is also very misleading.
“So much illness is caused by lifestyle choices and illnesses that we could and should be preventing; cutting public health funding will not help. For example, if smoking cessations services are hit, midwives may struggle to refer on pregnant women who smoke. This will mean we may miss chances to not only improve the health of the mother, but also we lose the chance to improve the health, including the adult health, of her developing baby.
“This may also hit vaccination programmes, sexual health, family planning and obesity services. This lack of foresight will ultimately cost more in the long term.”
2.30pm Mental Health Nursing Academics UK have also raised concerns over the suspension of NICE’s safer staffing levels work.
Their statement reads: “Mental Health Nursing Academics UK echo the concerns of the Royal College of Nursing, Sir Robert Francis and others included in the Safe Staff Alliance about the recent decision to suspend the safe staffing programme at the National Institute for Health and Care Excellence, including any further meetings of the advisory committee. The development of these staffing guidelines by NICE was a clear recommendation of the Francis Report.
“Our interests focus primarily on the two mental health topics (mental health in-patient settings, and mental health in the community) which now become part of the work of the Mental Health Task Force. We have serious concerns that this task force will have the capacity, resources or expertise required to undertake a comprehensive review of the evidence base before it is scheduled to report. Given that the work on nursing in adult inpatient settings (non-mental health) has been completed and will be adhered to, we believe that this is further evidence of a lack of parity of esteem for mental health care.
As an organisation which represents mental health nursing academics working across all higher education institutions in the UK we are acutely aware of the need for these guidelines to help maintain safe practices. There is clear evidence which suggests appropriate levels of qualified nursing staff has a direct relationship with patient safety, quality of care, and the education of the next generation of students. Mental Health Nurses working in acute inpatient settings particularly are increasingly working longer shifts (12 hours) and with less qualified staff despite evidence which demonstrates negative patient and safety outcomes. We would welcome a statement from the Chief Nursing Officer or the Mental Health Task Force which offers reassurances to our concerns.”
2.20pm Northern, Eastern and Western Devon Clinical Commissioning Group did not break procurement regulations when it awarded a £100m community services contract without going to tender, Monitor has provisionally found.
However the regulator said the CCG must “do more to ensure that their decision… is in the best interests of patients”.
The decision is a provisional view and could change when Monitor publishes its final findings later this summer.
1.45pm Boards need to move from “putting all their investment into quality and safety” to achieving a better “balance” with financial success, the chief executive of the Care Quality Commission has said.
David Behan was speaking to HSJ about the health secretary’s plan for the CQC to consider “use of resources” in its rating of NHS trusts and foundation trusts. Jeremy Hunt revealed the move in an interview with HSJ yesterday afternoon.
Mr Behan said he supported the change as a “logical development” of its current approach.
1,20pm Jeremy Hunt has defended his controversial move to cap spending on agency staff. The health secretary said current rates paid by the health service are “not market forces at work, but market failure”.
The health secretary was speaking exclusively to HSJ at the end of a week that has seen new controls unveiled for NHS executive pay and agency spending, plans announced to give hospitals individual targets for procurement savings, and work suspended on the National Institute for Health and Care Excellence programme to determine safe staffing levels.
He insisted the health service should not interpret these measures as a signal that national priorities were “swinging back” from a focus on quality at the end of the last parliament to a focus on finances.
The chairman of the public inquiry into poor care at Mid Staffordshire Foundation Trust spoke out after HSJ revealed NHS England chief executive Simon Stevens had asked the National Institute for Health and Care Excellence to cease work on safe staffing levels.
The halted programme was a specific recommendation made by Sir Robert. In his 2013 report he described NICE as the “accepted authority” to carry it out. The recommendation was immediately accepted by health secretary Jeremy Hunt.
Head of nursing Gail Adams said: “Every year the NHS spends a huge amount of money on agency workers because it simply does not have enough nurses to keep going.
“It’s surely no coincidence that since NICE came up with recommendations concerning the numbers of nursing staff needed in acute clinical settings, there are now more nurses – both agency and NHS – working in A&E departments.
“With NICE’s work well underway on the safe staffing levels needed in maternity, mental health and community services – areas of the NHS that are chronically understaffed – there was clearly a fear that the forthcoming guidance would mean the need for yet more agency nurses.
“Increasing the numbers of nurses on wards might cost more money, but it also means improved patient care and safety. Today’s decision will do little, if anything, to engage and build public confidence.
“To move towards an NHS that is safely staffed to meet the growing demands being placed on it, we need to take a serious look at workforce planning and design.”
12.15pm The announcement yesterday that two planned care targets would be dropped has been widely welcomed by experts, who agreed the targets were overly complicated and created “perverse incentives”.
12.10pm NHS Clinical Commissioners has welcomed the move to drop two planned care targets, and has called for for CCGs to have increased resources if they are to take on increased responsibility.
Co-chair Amanda Doyle said: “We are really pleased that Jeremy Hunt has taken a positive move to eliminate perverse incentives around managing referral to treatment time and waiting times – this is good for patients and good for local NHS systems.
“We also welcome the move towards greater transparency and agree with the Secretary of State that patients and local people should have more information about those who are accountable for buying local healthcare services. We are keen to make sure the metrics and performance targets are right and CCGs must have the ability to influence what’s measured. It’s good to hear that the Kings Fund are leading the work to get that right and we looking forward to working with them to make sure our members can feed in to the process.”
Co-chair Steve Kell said: “Our members will be pleased to hear the Secretary of State reaffirm his support for the role of CCGs as system leaders and the need for them to work across all parts of the local health and care system. It is essential though, that with any increased responsibility comes increased resources to ensure that CCGs can truly transform care for their patients and local populations.”
12.06pm Further reaction on the public health budget cut comes from Action on Smoking and Health.
Chief executive, Deborah Arnott, said: “The NHS faces a £22bn funding gap by 2020 which the NHS five-year forward view makes clear can only be bridged by a radical upgrade in prevention and public health. If the gap isn’t closed the outcome will be major cuts in services. Even thinking of cutting local authorities’ public health budgets at this time is unbelievable. It would be pinching pennies to waste pounds.”
12.05pm There has been a strong reaction to our story on the proposed £200m cut to the public health budget.
Karen Middleton, chief executive of the Chartered Society of Physiotherapy, said: “These short-sighted cuts came just hours after Jeremy Hunt spoke of the importance of tackling obesity and supporting public health. Simon Stevens made the same point the previous day.
“They also pose risks for greater integration as NHS organisations, if they know their funding is to be protected, will be reluctant to pool resources with local government in case it is simply taken away like in this case.
“Prevention is absolutely crucial if we are to overcome the major public health challenges of obesity and physical inactivity and we must accept it costs money upfront – that is the nature of the beast.
“But that investment, in weight management programmes, in smoking cessation services, in physical activity schemes, will save money in the long-term by reducing the demand on the NHS and social care.
“More importantly, it has the potential to save and transform lives, enabling people to fulfil their potential, and we must do everything in our power to make that happen.
“We remain committed to working with local government and public health officials on this essential agenda.”
11.10am Yesterday our website went down, which also affected our HSJ Awards site.
Apologies to anyone who wanted to submit an entry. You can do so now through this link.
The deadline is 19 June.
11.07am The chief inspector of hospitals said he would ‘love’ the Care Quality Commission to rate local health systems, rather than specific providers, but suggested there were potential obstacles to inspecting clinical commissioning groups.
Sir Mike Richards faced questions from provider chief executives at the NHS Confederation conference today, with many calling for a broader inspection regime to focus on commissioners and wider health systems.
Sir Mike said: “Yes we’d love to look at systems. Technically we’re regulators of individual providers but we’re getting to the point now where we can look at localities, and we can start looking at ‘Blankshire’ in the round.”
The health secretary said improving efficiency and productivity “doesn’t just stop at the front door of a hospital, it’s also about what happens outside a hospital”.
He has asked King’s Fund chief executive Chris Ham to help him and NHS England to develop “transparent metrics” to hold CCGs “accountable for the way they deliver healthcare”.
In a speech at the NHS Confederation conference, Jeremy Hunt said the Carter review’s findings would shortly be announced and they are “absolutely staggering”. The review by Lord Carter has investigated procurement practices across trusts.
In September Lord Carter will set out the amount of money trusts could save by adopting “best practice” procurement processes.
The move to drop the admitted and non-admitted elective waiting time targets is expected to be announced by the health secretary this morning.
The third elective target - the “incomplete standard”, which states 92 per cent of patients who have not yet started treatment should have been waiting no more than 18 weeks - will be retained.
Speaking exclusively to HSJ today, Jeremy Hunt said he did not want a situation where “we have the government and Monitor asking for transformation and efficiency, and the CQC inspection regime asking for a different set of priorities around safety and quality”.
It was, he added, “really important…that the whole system is aligned around what it is we are expecting of people running hospitals”.
The decision appears to mark a significant departure from recommendations of the Francis report.
NICE moved to suspend work on the safe staffing programme yesterday, in response to a speech by NHS England chief executive Simon Stevens to the NHS Confederation conference in Liverpool.
The proposal has prompted fears among NHS commissioners of a knock-on impact on their services.
The cut was revealed by chancellor George Osborne this afternoon, and was billed as a saving of £200m on “non-NHS” spending.
10.45am Yesterday was a huge day for health policy. HSJ broke the story that NICE has been told to suspend its work on safer staffing levels, and two key waiting time targets have been dropped after Bruce Keogh concluded they create “perverse incentives”. George Osborne set out where government cuts could fall, including a £200m cut to the public health budget.
The Care Quality Commission has been tasked with inspecting hospital’s progress at making efficiency savings, as part of its overall inspection process.
Jeremy Hunt told trusts they would have to make a set amount of procurement savings, starting in January, and also set out proposals for new metrics to measure the performance of CCGs.
Finally, chief inspector of hospitals at the CQC, Sir Mike Richards said he would “love” to inspect whole health systems rather than individual providers but set out some of the barriers that need to be overcome first.