HSJ analysis identifies six of the first legal challenges to emerge from providers, plus the rest of today’s news and comment.
6.00pm Take a look at HSJ’s Storify story on NHS England’s March board meeting, held earlier today.
Some of the mains points discussed include:
- This was David Nicholson’s final board meeting in his capacity as NHS England Chief Exective. Chair Malcolm Grant said his contribution has been “extraordinary”. Sir David said he will be watching the live stream of the next board meeting - and tweeting about it.
- Sir David said politicians should “not fiddle around with the organisation of the NHS”.
- Sir David also said the tariff difference between mental health and acute hospitals is due to the need for “more nurse staffing” in acutes. He added acutes also need extra support through the tariff because of money going into the better care fund in the future.
- NHS England’s chief nursing officer Jane Cummings said emergency activity needs to reduce by about 15 per cent or money moving to better care fund will pose risk. Sir David added that the better care fund is a “huge opportunity”, but if the cut in A&E activity not achieved then acutes would have to make 8 per cent efficiencies, which would be “impossible”.
- Sir Malcolm Grant said NHS England is concerned about specialised commissioning spending and knows it needs to “get a grip” on it.
- 1.8m people have participated in friends and family test so far, Tim Kelsey, NHS England’s director for patients and information revealed.
- NHS England’s chief operating officer Barbara Hakin said there is evidence that the NHS 111 hotline is beginning to have effect of stopping inappropriate A&E visits, but ambulance performance is a concern.
5.19pm More from Nursing Times, routine blood tests can help identify type 2 diabetes patients at increased risk of advanced chronic liver disease, according to research presented today at a major conference.
5.10pm Confidentiality clauses that may stop nurses and doctors that have been sacked or made redundant speaking out about failings in care are to be taken out of standard NHS “settlement agreements” in Scotland, Nursing Times reports.
Nearly half of nurses that have raised a concern about patient safety in the last year say it has led to negative repercussions for them personally, according to a survey by our sister title Nursing Times.
4.35pm Speaking at the Nuffield Trust Health Policy Summit, Andy Burnham has reiterated his call for integration between health and social care.
The shadow health secretary said the NHS is currently in a medical model that is stuck in the twentieth century and is too focused on body parts.
He said it does not make sense to the public that “the council deals with this part of your mum and the NHS does that bit”, and the the disparity between “protected’ health and cuts to social care is driving health to a cliff edge.
He added that “we have allowed social care to be degraded”.
Mr Burham praised Sir John Oldham’s independent review into integrated care, commissioned by the Labour party, as the “route map to integration without structural reorganisation”.
3.56pm Shadow health secretary Andy Burnham has now begun speaking at the Nuffield Trust Health Policy Summit.
Alternatively, you can follow the debate on Twitter using the hastag #ntsummit.
3.22pm Jeremy Hunt said the “national attitude towards reconfiguration has changed” at the Nuffield Trust Health Policy Summit.
The health secretary brought up the example of hospital reconfiguration in North West London, where all but one of local authorities were supportive.
He added that it was a local project that was led by doctors.
Follow the rest of his speech on Twitter with the hashtag #ntsummit.
3.10pm Speaking at the Nuffield Trust Health Policy Summit, Jeremy Hunt said he is optimistic about the future of the NHS and “humbled” by reactions to the Francis report by the NHS, and said it is “something it can be very proud of”.
The secretary also said he is in the only cabinet role where he know no other MP is jealous of his job, but it is “a lifetime privilege”.
3.03pm Health secretary Jeremy Hunt is now speaking at the Nuffield Trust Health Policy Summit.
2.52pm Also in The Telegraph, diets low in saturated fat do not lower cholesterol, prevent heart disease or help people live longer, according to cardiac scientist Dr James DiNicolantonio.
2.40pm The Daily Telegraph reports on a US-based study, which has found that dementia could be responsible for more deaths than cancer and heart disease combined.
2.32pm Deputy prime minister Nick Clegg said the NHS would “collapse overnight” without migrant workers, the BBC reports.
Speaking at his weekly LBC Radio phone-in, Mr Clegg was discussing a controversial Home Office report on the impact on migrants on British jobs.
2.21pm The Daily Mail also reports on the death of the heart patient, aged three, after a major delay in getting a hospital appointment at Royal United Hospital in Bath due to a glitch with its new computer booking system, an inquest has heard.
2.07pm Back to today’s papers, The Daily Mail leads on the warning by the World Health Organization that adults should halve their average intake of sugar to six teaspoons a day to help prevent heart disease, obesity and other serious illnesses.
London cardiologist and health campaignerm Graham MacGregor told The Mail: “Added sugar is a completely unnecessary part of our diets, contributing to obesity, type II diabetes and tooth decay.
“We have known about the health risks of sugar for years and yet nothing substantial has been done.
“The new recommendations will be a wakeup call to the Department of Health and the Government to take action by forcing the food industry to slowly reduce the huge amount of sugar added across the board.”
1.52pm In reponse to the finding of the govenment commissioned review into duty of candour, a Department of Health spokesperson said: “The Francis Inquiry showed us just how important it is that the NHS is open about mistakes so that we can improve care. We welcome this review, and the strong leadership from Sir David Dalton and Professor Norman Williams.
“It is a thorough and well-argued report which deserves careful consideration. We are committed to introducing a statutory duty of candour. We will respond formally to the recommendations shortly.”
1.42pm Pressure is increasing on hospital accident and emergency departments in England because of care failures in Wales, the health secretary has said.
Jeremy Hunt told MPs there had been a direct impact on border town hospitals after a 10 per cent rise in Welsh patients using services in England since 2010.
He claimed health authorities in Wales acted as if the lessons of the inquiry into the Mid Staffordshire tragedy, in which hundreds more people died than expected, “stop at the border”.
1.32pm The Care Quality Commission has published its ratings of three hospital trusts, the first to receive judgements under its new inspection regime.
Heart of England Foundation Trust and Dartford and Gravesham Trust were both rated as “requires improvement” while Royal Surrey County Hospital Foundation Trust achieved a “good” rating.
The ratings can be viewed in the CQC’s report into the first wave of inspections.
1.24pm NHS providers will be required to tell patients about all but the very least serious patient safety incidents under the new statutory duty of candour, if the recommendations of a government commissioned review are adopted into law.
Based on current levels of incident reporting to the National Reporting and Learning System this would mean providers owning up to almost 100,000 incidents every year. This is 85,000 more incidents than envisaged under Robert Francis QC’s original proposal for a duty of candour on organisations.
The review, by Salford Royal Foundation Trust chief executive Sir David Dalton and Royal College of Surgeons president Norman Williams, also recommends the definition of harm be extended to include prolonged psychological harm and emotional distress. It was published today.
1.15pm The Guardian’s health editor Sarah Boseley writes that recent successes in tackling HIV are “are limited, but they give hope to those in the field that a cure is possible – one day”.
1.05pm The Guardian also reports on the second reported case of a baby born with HIV appearing to be cleared of the virus after being given treatment for the infection within hours of her birth.
12.45pm The Guardian leads on the success of a radical gene therapy to combat HIV using genetically modified cells resistant to the virus, following its first clinical trial.
12.30pm The Independent’s Alice Jones writes on broadcaster Sally Magnusson saying that the UK’s system for dementia care is “not fit for purpose”.
Speaking at the Bath Literature Festival, Ms Magnusson said society has a tendency to treat those with the disease as “less than human”.
12.16pm In today’s papers this lunchtime, The Independent reports that the care of Britain’s elderly is nearing “the brink of disaster” as funding cuts take their toll on some of the country’s most vulnerable people, according to a warning from a leading charity.
Age UK has said that hundreds of thousands of older people are not getting the help they need to live their daily lives as a result of the “catastrophic” impact of cuts combined with an ever-growing elderly population.
12.02pm Patient safety charity Action against Medical Accidents (AvMA) said it welcomes the recommendation for the introduction of a full unrestricted duty of candour, describing it as “a huge step forward for patients’ rights and patient safety” if it is accepted by the government.
AvMA chief executive Peter Walsh said: “All patients welcome the outcome of the review. It is unthinkable that the Government will ignore this recommendation.
“A full duty of candour would probably be the biggest advance in patients’ rights and patient safety since the creation of the NHS. For decades the NHS has frowned upon cover-ups but has been prepared to tolerate them. This will be an end to that.”
11.49am NHS England has developed a template to help health and wellbeing boards with their fund plans but the real test will be whether plans work to improve the integration of health and social care services, writes Julie Jordan, an associate at Mills and Reeve.
11.40am Providing quality care for the growing older population is often portrayed as a burden on the NHS, but with central support we can spread best practice across the country to care for them, argues David Oliver, visiting fellow at the King’s Fund, president-elect of the British Geriatrics Society and a commissioner for HSJ’s Commission on Hospital Care for Frail Older People.
“Worryingly, there is substantial evidence of ageism and age discrimination in health and care services,” he writes.
“There is a risk of continuing to make the mistake of relying on short term initiatives with non-recurring money.”
11.29am The NHS Alliance said it “fully supports” the King’s Fund report Making our health and care systems fit for an ageing population.
Chief executive Rick Stern said: “We agree that personalised care is the only way forward, and to ensure that we are able to achieve this for every patient, we are working hard to break down the boundaries that currently exist between different parts of the health and social care sector.
“As the King’s Fund suggests, there are great examples across the country of where innovative thinking around helping people to ‘age well’ is already taking place, and it’s essential that we share this learning, as there is still a long way to go before we reach our final goal.
“We also agree that integrated working across teams is important, and that is why the NHS Alliance is committed to bringing all primary and social care providers together.
“We need to ensure that GPs, nurses, pharmacists, housing providers, mental health services, hospital trusts, and the voluntary and community sector are having the right conversations, and are working together to achieve a shared goal.”
11.20am Health and care services are failing to keep up with the country’s demographic changes, according to a report by the King’s Fund released today.
One in five people in England are expected to be over the age of 65 by 2030.
The report Making our health and care systems fit for an ageing population, argues that changing services for older people will require a “fundamental shift towards care co-ordinated around individual needs rather than single diseases, and that prioritises prevention and support for maintaining independence”.
The report finds areas of care that need improvement, including:
- enabling older people to live well with stable long-term conditions, avoiding unnecessary complications and acute crises
- improving collaboration between the NHS and social care to ensure that patients can leave hospital promptly once their treatment is complete, with good support available in the community
- ensuring that in times of crisis, older people have rapid access to urgent care, including effective alternatives to hospital
The report also points to areas where there has been local innovation. These include inclue:
- Gnosall GP surgery, Staffordshire: Patients over 75 have an annual health review, and experienced ‘elder care facilitators’ support patients, help them navigate the system and draw up care plans
- University Hospitals Birmingham: The trust’s Dignity for Older Patients Project, consists of 506 ‘dignity champions’ from different teams work to promote dignity in care
- Newcastle West CCG/ Newcastle City Council: The bodies have developed an ageing well strategy, including targeted health checks to indentify risk factors people aged 40–74, and encourage older people to be volunteers and health champions.
David Oliver, visiting fellow at The King’s Fund, said: “The health and care systems have a long way to go to adapt to the twin challenges of an ageing population and tighter funding.
“Many local service leaders are transforming services for older people, but we urgently need to see their experiences spread more widely.
“But marginal change will not be enough; transformation is needed at scale and at pace.”
11.12am NHS England has announced that it has added a new drug to the national cancer drugs fund to treat advanced cervical cancer.
The cancer drugs fund list is a single national list of approved fast-track drugs giving uniform access to treatment across England, which is run by NHS England.
The body said around 500 women every year could benefit from this use of the drug bevacizumab, which is already used in the treatment of other cancers.
The drug is routinely available on the NHS in England before any other country in the world, NHS England says.
NHS England’s chemotherapy clinical reference group decided to make the drug available after trials showed it could extend the lives of women with advanced cervical cancer by nearly four months compared to chemotherapy alone.
Its chair Peter Clark, said: “This new addition to the list demonstrates NHS England’s commitment to achieving maximum benefit to patients from the £200 million Cancer Drugs Fund.
“The process of updating the list is led by cancer specialists, and should ensure that patients benefit quickly when new drugs become available that are backed by good evidence from trial data.”
Robert Music, chief executive of Jo’s Cervical Cancer Trust, said: “The addition of bevacizumab to the Cancer Drugs Fund is very positive as for women who receive a late stage diagnosis of cervical cancer, the prognosis can often be poor.
“When this is the case, any extra time that can be provided through new drugs becomes extremely valuable. We hope this will result in extended survival without impacting on quality of life for those facing non-curative treatment.”
11.00am Follow HSJ reporter Will Hazell as he tweets live from NHS England’s March board meeting.
On the agenda today: mental health parity of esteem, Care.data, and commissioning system finances.
10.50am Providers are increasingly willing to use the procurement, patient choice and competition regulations to challenge decisions, experts have stated, after HSJ analysis identified six of the first legal challenges to emerge.
10.38am The Nuffield Trust Health Policy Summit now underway. Health secretary Jeremy Hunt and shadow health secretary Andy Burham are set to speak later today.
You can follow what is being discussed on Twitter through the hashtag #ntsummit.
10.26am In HSJ’s Insights and Influence channel, the next wave of CQC inspections will be a challenging time for hospital trusts and the regulator alike as all parties will be in an experimental phase, argues, says Joanna Shar, a solicitor at Ridouts LLP.
10.20am In his leader column, HSJ editor Alastair McLellan argues that it is to be expected that hospitals being inspected will challenge the inspectors, but too many successful challenges will undermine the credibility of the CQC’s process.
10.15am The Care Quality Commission must do more to improve the consistency of its judgements, the chief inspector of hospitals has said.
He spoke after it emerged a leading London teaching hospital successfully challenged the regulator’s plan to issue it a warning notice.
Speaking exclusively to HSJ, Sir Mike Richards admitted the CQC had downgraded a planned warning notice to University College London Hospitals Foundation Trust to a less serious “compliance action”.
He said this followed a “fair challenge” from the trust that highlighted one of the regulator’s biggest difficulties: ensuring consistency of judgement.
10.10am Tim Kelsey, NHS England’s director for patients and information, is now discussing the controversial care.data programme at its board meeting this morning.
For @whazell on Twitter for further updates.
10.01am The Health and Social Care Information Centre has agreed to four steps to improve the transparency of its decision-making at its board meeting yesterday.
- Conducting an audit of all the data releases made by its predecessor organisation, NHS Information Centre, and report on this to the HSCIC board by the end of April
- Appointing three new non-executive directors to the HSCIC board: Sir John Chisholm, executive chair of Genomics England Ltd, Professor Maria Goddard, director of the Centre for Health Economics at the University of York and Jan Ormondroyd, former chief executive of Bristol City Council
- Producing a report detailing all data released under the HSCIC, including the legal basis on which data was released and the purpose to which the data is being put. This report is set to be published on 2 April and will be updated on a quarterly basis.
- Writing to all recipients of HSCIC data releases reminding them of their responsibilities under their data sharing agreements with the HSCIC, including the right to audit their use of data released to them, as well as the HSCIC’s intention to publish details of their access.
HSCIC chair Kingsley Manning said: “We very much welcome recent announcements by the Secretary of State, including his intention to strengthen the legal basis of the HSCIC, which will increase patients’ ability to object to the indirect use of their data and reinforce the requirement for their interests to be at the forefront when decisions to release data are made.
“The HSCIC is absolutely committed to improving its own transparency and engagement with the public. In both reviewing the actions of the old NHS Information Centre and publishing our own decisions, we are encouraging public scrutiny. The clear benefits to patients of research and analysis of medical outcomes must drive our lawful release of data. This is why we were created by the Health and Social Care Act 2012.
“The appointment of three new non-executive directors will strengthen our board. They join our new chief executive, Andy Williams, who is taking up his role in April, in creating a strong and accountable organisation.”
Non-executive director Sir Nick Partridge said: “I am glad to take responsibility for reviewing past data releases from the NHS Information Centre and producing a comprehensive report. This is the start of building the public’s trust in the transparency of HSCIC decision-making and that the organisation is operating to the highest standards.
“We must be open and honest about all our decisions and processes. I want to challenge the organisation in order to understand why and when decisions were taken, to ensure that patients and the public can have confidence in the organisation’s work in the future.”
9.57am The new statutory duty of candour should cover events which cause moderate harm to patients, not just serious harm and death, a government commissioned review has recommended.
Salford Royal Foundation Trust chief executive David Dalton and Royal College of Surgeons president Norman Williams were asked to consider what the proper threshold should be for the new duty of candour on organisations by health secretary Jeremy Hunt late last year.
They have concluded that the new duty should include ‘moderate’ harm, as defined under the NHS’s existing National Learning and Reporting System. This would include incidents that do not cause permanent harm, but which most patients would regard as ‘significant’ events.
The review also recommends that organisations found to have breached the duty, which will be policed by the Care Quality Commission, should face sanctions which have an impact on an organisation’s reputation. This could include warning notices or the removal of board members.
9.50am At NHS England’s board meeting, outgoing chief exective Sir David Nicholson has said the tariff difference between mental health and acute hospitals is due to the need for “more nurse staffing” in acutes.
He added acutes also need extra support through the tariff because of money going into the better care fund in the future.
Follow @whazell for regular updates this morning.
9.44am HSJ reporter Will Hazell is tweeting from NHS England’s board meeting this morning.
Follow him on Twitter (@whazell) for any updates.
7.00am Good morning and welcome to HSJ Live.
We start with the news that an increase in the number of private ambulances arriving at Hillingdon Hospitals Foundation Trust’s accident and emergency department has led to “operational difficulties”, the trust has disclosed.