Reaction and full analysis of the news that the majority of NHS providers have opted for the “voluntary” tariff offer, plus the rest of today’s news and comment
The move follows the pricing authorities’ decision to withdraw the payments – worth up to 2.5 per cent of contract income – from those providers that rejected the latest tariff offer and opted instead to remain on 2014-15 prices next year.
Monitor and NHS England today confirmed that 30 of the 241 NHS providers rejected the “voluntary” tariff offer. They said in a statement that since these providers “would not be contributing proportionately to the shared NHS-wide 2015-16 efficiency goals through the tariff deflator, they will instead be ineligible for discretionary payments, including CQUIN, next year”.
4.30pm Trade union GMB has suspended a planned strike over pay at Woolwich Hospital in order to consult members on a new pay offer that has been put forward.
If the deal is accepted the majority of members will see their pay rise from £7.10 to £7.72 per hour over the course of the dispute, a pay rise of 8.7 per cent says GMB
The five day strike for over 250 GMB members working for hospital contractor ISS Mediclean at Queen Elizabeth Hospital Woolwich was due to start on 9 March.
A High Court injunction against the strike put forward by ISS was dismissed in November last year.
GMB’s claim was for full parity with comparable NHS staff working under the Agenda for Change agreement to end the two tier workforce. The offer on the table moves the lowest paid staff up to the new minimum NHS rate of £7.72 per hour (£15,100 per year) as from 1 April 2015.
4.25pm Health and wellbeing boards should be at the centre of managing winter pressures, says London Councils.
London Councils says the boards, which bring together councillors, patient representatives and representatives of Clinical Commissioning Groups, are best placed to plan and prepare for the excess demand experienced by all health and care services in recent months.
It claims health and wellbeing boards have gained experience from taking an important role on Better Care Fund plans, which seek to integrate the health and social care system and are due to come into force this April.
Councillor Teresa O’Neill, London Councils’ Executive member for health and wellbeing, has written to the Secretary of State for Health, Jeremy Hunt and the Shadow Secretary of State for Health, Andy Burnham, urging them to devolve more responsibility to London health and wellbeing boards. Her call comes after plans were announced last week to give full control of Greater Manchester’s health budget to its Health and Wellbeing board.
Cllr O’Neill said: “The government’s plans to devolve full control of Greater Manchester’s health spending are hugely encouraging as they re-affirm a commitment to integrating health and social care.
“We believe the only way London can begin to address the huge health and social care challenges it faces is by joining up services better.
“First and foremost, it’s imperative that health and wellbeing boards are involved in planning for winter pressures to prevent the sort of crisis which affected Croydon hospital and others.
“It makes sense that the same people who have been planning for the Better Care Fund should be involved in planning for winter pressures.
“We strongly urge ministers to look closely at this and our other recommendations. Not doing so, risks undermining the great work done so far to better co-ordinate people’s care and could mean we see the same A&E crisis next winter, if not a worse one.”
The body, which represents all 32 London boroughs and the City of London, is also calling for the government to make the additional £37 million provided to help with winter pressures to be included in yearly council budgets.
4.00pm The capability of the Parliamentary Health Service Ombudsman to investigate complaints and obtain evidence has been seriously questioned in light of the inquiry into failings at University Hospital of Morecambe Bay Foundation Trust, HSJ can reveal.
Concerns were raised after the Kirkup inquiry’s conclusions contradicted a PHSO investigation last year on the question of whether Morecambe Bay midwives colluded over evidence to an inquest.
The Kirkup inquiry said there was “clear evidence of distortion of the truth” by midwives, describing how they were given a crib sheet of “model answers” before the inquest into the death of Joshua Titcombe, who died as a result of failings at Morecambe Bay in October 2008.
3.55pm The Health Foundation has responded to the voluntary tariff news.
Adam Roberts, senior economics fellow at the Health Foundation, said: “It is positive that the majority of providers now have clarity on the national prices they will be using come April this year, and can start proper planning on how they will meet the costly pressures that are still associated with this enhanced option.
“We note however that even with the new more generous tariff there is still a drop in income of over £1bn for the provider sector. With providers already running an in year deficit of over £700m, even the enhanced option still represents a substantial challenge for 2015-16. Without large efficiency savings, we can expect the level of deficit to become even greater next year”.
The Health Foundation hopes that NHS England and Monitor can now work with the remaining 30 NHS Trusts to come to a mutually acceptable agreement quickly.
3.00pm Mental health charity has found that nearly 9 in 10 of emergency services staff and volunteers surveyed have experienced stress, low mood and poor mental health at some point while working for the emergency services.
The charity surveyed 1.5 per cent of all staff and volunteers - 3.627 people.
The online survey also revealed that more than half (55 per cent) had experienced mental health problems at some point.
Despite the greater prevalence of mental health problems among emergency services personnel, Mind’s research indicates that they are less likely to take time off sick as a result. Just 43 per cent of emergency service workers and volunteers surveyed said they have taken time off work due to poor mental health.
Paul Farmer, chief executive of Mind, said: “Not only are many of our blue light personnel struggling with their mental health, but they’re less likely to seek support or have time off sick than the general workforce. The programme we’ll be delivering over the next year aims to ensure that the estimated quarter of a million people working and volunteering within police, ambulance, fire and search and rescue divisions are able to talk openly about their mental health and access the support they need to stay well, recover and continue doing the vital and challenging roles they do serving the community.
2.40pm The ex chief executive of NHS England, David Nicholson, has just tweeted on the subject of Manchester devolution:
“London has a stronger case for devoln than greater Manchester if only the shadow sec of state for health had been a london MP”
2.35pm The entry deadline for the Patient Safety Awards has now been extended to 13 March. Enter now for a chance to showcase your project in front of NHS leaders.
A letter sent by NHS England, Monitor, NHS Trust Development Authority and the Association of Directors of Adult Social Services says that operational resilience programmes put in place for 2014-15 should continue into April. These should be funded by commissioners.
“[Clinical commissioning groups] will be expected to fund all these schemes in full during April pending the resolution of 2015-16 plans in the planning round,” the letter states.
Rob Webster, chief executive of the NHS Confederation, said: “Local systems now have certainty about prices for next year and providers and commissioners can concentrate on working together to plan for delivering services next year. We expect that there will be a lot of tough local decisions to be made in a tough year. The delay in agreeing these prices has had an unfortunate impact on delaying these decisions.
“The Enhanced Tariff Option has not been agreed by everyone. Urgent work is needed to resolve the delay in agreeing prices for 2015/16 with those providers on the Default Tariff Rollover. Hopefully, the developments announced today can accelerate this process.
“It is too simplistic to paint the last few months as a battle between commissioners and providers, and the suggestion of winners and losers is nonsense. The financial challenge for the NHS means this year’s tariff was always going to be difficult. There is simply not enough money in the system to comfortably balance provider budgets with the ability of CCGs to manage their local health economy effectively. The most important message now is that providers and commissioners need to work together, based on a shared purpose, to ensure sustainability and invest in new models of care needed in the future. As part of this, measures like increasing resources to mental health services should be honoured.
“The current payment system is too often a barrier for them in doing this and we would be keen to see progress in accelerating reform of the national tariff, which is a key recommendation of the 2015 Challenge. The NHS Confederation will continue to work with members and national bodies to ensure this is a top priority for the NHS over the coming year.
“We will need to take time to review the process for agreeing the 2015-16 National Tariff and see what lessons should be learned for agreeing prices next time. The NHS Confederation is determined to work with NHS England and Monitor to ensure the whole system has a strong voice and that our members are able to constructively engage at an earlier enough stage to help shape proposals.”
The FT watchdog will investigate City Hospitals Sunderland, Gateshead Health, Lancashire Teaching Hospitals and Wirral University Teaching Hospital FTs.
In a statement released today, Monitor said it had not yet decided whether to take regulatory action, but will announce the outcome of its investigations “in due course”.
12.35pm Here are the trusts who rejected the ‘voluntary’ tariff offer:
- Alder Hey Children’s NHS Foundation Trust
- Barts Health NHS Trust
- Cambridge University Hospitals NHS Foundation Trust
- Central Manchester University Hospitals NHS Foundation Trust
- Chelsea and Westminster Hospital NHS Foundation Trust
- Great Ormond Street Hospital for Children NHS Foundation Trust
- Guy’s and St Thomas’ NHS Foundation Trust
- Imperial College Healthcare NHS Trust
- Kettering General Hospital NHS Foundation Trust
- King’s College Hospital NHS Foundation Trust
- Lancashire Teaching Hospitals NHS Foundation Trust
- Leeds Teaching Hospitals NHS Trust
- Liverpool Heart and Chest NHS Foundation Trust
- Moorfields Eye Hospital NHS Foundation Trust
- Nottingham University Hospitals NHS Trust
- Oxford University Hospitals NHS Trust
- Queen Victoria Hospital NHS Foundation Trust
- Royal Brompton and Harefield NHS Foundation Trust
- Royal Free London NHS Foundation Trust
- Royal National Orthopaedic Hospital NHS Trust
- Sheffield Teaching Hospitals NHS Foundation Trust
- The Clatterbridge Cancer Centre NHS Foundation Trust
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust
- The Royal Marsden NHS Foundation Trust
- The Walton Centre NHS Foundation Trust
- University College London Hospitals NHS Foundation Trust
- University Hospital Birmingham NHS Foundation Trust
- University Hospital Of South Manchester NHS Foundation Trust
- University Hospitals of North Midlands
12.01pm Dave West:
Either way, the use of a mixture of pricing systems likely to prove a headache for financial planning on all sides for next 13 months
— Dave West (@Davewwest) March 6, 2015
12.00pm HSJ’s Dave West tweets:
Remaining on this year’s prices of course is much more appealing to those with a lot of elective & specialist work, eg the Shelfords
— Dave West (@Davewwest) March 6, 2015
11.55am To see a full list of providers of NHS care which have opted to go for NHS England and Monitor’s “voluntary” tariff offer, see the attached word document on the right hand side of the page.
11.39am As part of their announcement this morning on the providers which have accepted the “voluntary” tariff offer, NHS England and Monitor said:
“A revised timetable for planning, contracting and dispute resolution in 2015/16 has already been agreed between Monitor, the NHS Trust Development Authority and NHS England. In revising the timetable we sought to:
- ensure that sufficient time is allowed before draft full plans are submitted
- allow enough time between the draft and final plans for feedback to be responded to
- give due consideration to other commitments such as year-end accounting.
“The final NHS Standard Contract will be issued next week, together with an updated version of the ‘Dispute Resolution Process for 2015/16’, and more detail on administering the Ehanced Tariff Option and the Default Tariff Rollover.
11.30am Responding to the announcement that 88 per cent of providers have accepted the enhanced tariff option for 2015-16, Chris Hopson, chief executive, NHS Providers, said: “This result demonstrates that, as a priority the new Government and the statutory bodies, need to work with providers to identify the solutions needed to ensure the long term viability of an NHS delivering high quality care.
“Providers can no longer guarantee the right quality of patient care, meet NHS constitutional performance targets and deliver financial balance on what they are currently paid.
“Trusts have told us that they recognise and welcome the extra £500 million investment in the provider sector created by Monitor and NHS England’s enhanced tariff option for 2015/16. 88% of providers have voted for that option but they have told us that they are clear about the basis on which they have made this decision.
“The enhanced tariff option will not cover the costs of the patient care NHS foundation trusts and trusts will be expected to provide in 2015/16. Provider deficits will therefore rise, targets will be missed and there will be growing risks to the quality of patient care.
“The introduction of a marginal rate for specialised commissioning – with providers only being paid 50% or 70% of the care they give and the cost of drugs and devices their patients use – is still strongly opposed by all providers of this type of care. We recognise the need to control the pressures on NHS England’s specialised commissioning budget but believe the best way to achieve this is through extended collaborative consideration of the options available rather than a late arbitrary imposition of a new marginal rate.
“Historically, the discussion of the NHS payment system has been focused on providers of acute care as they are the ones who are paid directly through the tariff. But the impact of this financial squeeze cannot be underestimated for providers of ambulance, community and mental health care. NHS Providers is particularly concerned that our mental health members tell us that many CCGs appear unwilling to meet their proscribed commitment to increased funding for mental health. They also tell us it’s not clear whether and how the funding to meet the new mental health access standards and targets will reach the providers who are required to deliver these new commitments.
“This is a temporary solution to an increasingly difficult problem that genuinely threatens the structural integrity of the NHS. It’s crucial that we use the opportunity of a new Government to work together to find a long term sustainable solution to this problem.
“The national payment system is ultimately about realistic funding for NHS providers so they can deliver safe and high quality patient care, distributed equitably across the entire sector. Until this happens, we will continue to get what we pay for”.
However, the biggest hospital trusts in England have rejected the deal.
A total of 211 out of 241 NHS trusts and foundation trusts - 88 per cent of all NHS providers - has opted the pricing authorities’ offer.
The community and mental health provider, which currently runs the service, claims that there were “serious errors” in the way in which its bid for the contract was assessed.
The three year contract, which contains an option to extend for a further two years, was awarded earlier this year to Inclusion Drug Services, a provider which is part of South Staffordshire and Shropshire Healthcare Foundation Trust.
11.00am Jeremy Hunt has sent a message to NHS staff about the Morecambe Bay investigation’s findings published this week.
“Everyone working in the NHS will have been deeply saddened by the revelations this week about the needless maternal and infant deaths in Morecambe Bay’s maternity unit. But whilst we know that things go wrong, and sometimes terribly wrong, it was the apparent cover up that followed in the hospital which makes the report so shocking.
“Health professionals are human and they make mistakes like anyone else, but because the work they do carries so much inherent risk, it is vital that these mistakes are reported and studied so that we learn how to minimise the risk of them happening again.
“Last October the professional regulators made it clear that staff must be open and honest with patients, colleagues and employers when something goes wrong with treatment or care.
“But I recognise that some staff will still hesitate to speak out because they aren’t always confident that their colleagues or managers will respond in the right way. Policies and processes will not succeed if they do not go hand in hand with a change in culture, whereby patients and staff alike feel able to speak out and be confident that they will be listened to.
“So I have asked NHS Medical Director Professor Sir Bruce Keogh to work with all the health professions, the regulators and employers to look at how and whether those codes need to be strengthened further, and how they can be better applied across the NHS, to ensure people are always supported when they speak out about mistakes so we can turn the NHS into an organisation that is open, accountable and truly committed to learning. We need to ensure that everyone speaks up instinctively, confident they will be heard and in the firm knowledge that any lessons will be learned and applied.”
A spokesman said: “The Royal College of Emergency Medicine welcomes the publication today of the Nuffield Trust’s report, What’s Behind the A&E Crisis?
“The College agrees that the performance of A&Es should not only be judged by the 4 hour target - we also need to look at bed occupancy rates, delayed discharges, and the problem of ‘Exit Block’ in departments.
The College also agrees that primary care practitioners should be given the support necessary to provide high quality urgent-care services, and that the complexity of different services which has been built into the system should be simplified.”
9.45am Monitor has launched investigations into the finances at four foundation trusts in the north of England.
Monitor has opened investigations at:
· City Hospitals Sunderland Foundation Trust
· Gateshead Health Foundation Trust
· Lancashire Teaching Hospitals Foundation Trust
· Wirral University Teaching Hospital Foundation Trust
Paul Chandler, regional director at Monitor, said: “People rely on their local hospitals and they want to know that they will be able to continue to receive high quality care for years to come.
“We have launched these investigations to find out more about the financial situation at each trust and to establish what can be done to improve things.”
Monitor has not yet decided whether regulatory action will be required, but will announce the outcome of its investigation in due course.
9.25am Good morning. Today on HSJ Live we start with new research from the Nuffield Trust, which concludes there is an “undue” focus on the four hour target for accident and emergency departments, which can “distort” behaviour inside hospitals and health systems in ways that do not benefit patients or staff.
The What’s behind the A&E crisis? report says a set of “richer performance indicators” could sit alongside the four hour target.
The authors also write that the urgent care system is “near breaking point” and the “continued financial squeeze” will “accelerate” the pace at which the system reaches it.