The health service faces its ‘most difficult’ year in balancing its financial plans, senior NHS England officials warned at a board meeting last week, plus the rest of the day’s news and comment.
5.48pm The head of the Winterbourne View Joint Improvement Programme, Bill Mumford, has resigned with immediate effect after another safeguarding incident was uncovered at one of the MacIntyre centres, the charity where he is chief executive.
In a statement on the MacIntyre website Mr Mumford said: “I regret to inform you that I have resigned with immediate effect from the Winterbourne View Joint Improvement Programme (JIP). There has been another safeguarding incident at MacIntyre, unconnected with the previous one, and which is being investigated by the police.”
The programme already faced a setback when it was revealed that the work to move people with learning disabilities back home would miss its June deadline.
Jan Tregelles, chief executive of the Royal Mencap Society, and Vivien Cooper, chief executive of The Challenging Behaviour Foundation said in a joint statement: “The work the Joint Improvement Programme was established to do still remains worryingly incomplete, with the June deadline to support people with a learning disability to move back to their communities having long passed. It is fundamental that the resignation of Bill Mumford does not further delay a vital programme of work that is already well behind schedule.”
4.45pm In Michael White’s latest column he argues that while MPs have had a tough time this week, the stories that covered health were not as revealing as the headlines suggested.
4.20pm In our Comment section the chief executive of Basildon and Thurrock University Hospitals Foundation Trust, | Clare Panniker, shares how the trust managed to make improvements and leave special measures.
3.15pm The government has announced legislation which introduces standards for health and social care providers. If approved by parliament they will become law in April 2015.
The fundamental standards will define the basic standards of safety and quality that should always be met, and introduce criminal penalties for failing to meet some of them.
The standards will be used as part of the Care Quality Commission’s regulation and inspection of care providers. The CQC will be able to hold providers to account if they are not being met, including through the courts where appropriate. Registration with the CQC will also be dependent on compliance.
The duty of candour will require NHS bodies to be open and transparent with service users about their care and treatment, including when it goes wrong.
The fit and proper persons requirement means that all directors of NHS bodies must pass a test proving they are fit and proper persons. The CQC will be able to insist on the removal of directors that fail.
3.08pm The Health Select Committee is holding a session on complaints and raising concerns with NHS Employers chief executive Dean Royles, NHS Confederation chief executive Rob Webster and Foundation Trust Network chief executive Chris Hopson giving evidence.
2.13pm Our story on the caveat added to the better care fund to help bail out A&Es struggling with reducing their admissions has sparked some lively debate. Here are some comments below, if you would like to join the discussion then you can register here.
“If the integration funded reorganisation doesn’t reduce A&E admissions surely it’s failed on that objective. Plan, Do, Study, Act - if your study doesn’t provide the anticipated or expected results undertake a root cause analysis, find out why and go back to planning. Good ideas do not always make for good results. Moving money about will only help in the short term; we have to look for sustainable results to benefit patient care. Please - let common sense prevail.”
“This sounds like a fudge to get us past next May, and a backdoor to feed the acute Trusts as it is basically just saying ‘carry on as you are’.”
“Clever plan, this removes the whole BCF ‘initiative’ without appearing to have made a policy U-turn. Where successful, investments in out of hospital care will save money on acute care. Where unsuccessful, the acutes will still be paid. Arent we back to where we started? PS: Cant they just sort out NEL tariff and stop dancing round the handbags!”
“The big problem here is that the ridiculous 30 per cent rule has made hospital based activity cheaper for commissioners. What incentive is there for any investment in community services when you can get acute activity at a third of the cost? We should rebase the NEL tariff and make CCGs pay 100% for growth and see the sudden change in emphasis and investment in community and primary care.”
1.39pm Directors of adult social services, in the wake of the government’s decision to put further conditions on the Better Care Fund, have warned that the management of part of the Fund moves further away from a model which balances clear expectations from Government with local ability to make them happen.
The Association of Directors of Adult Social Services president David Pearson said: “We are disappointed that the local discretion which was at the heart of the BCF has been eroded, and that the social care indicators - generic to the conditions originally built into the Fund and which brought our services centre stage - have been removed or pushed into the background.
“This sends an unequivocal message that saving the NHS money and reducing demands on the health services take a clear priority. We believe that joined up care can only work with a range of incentives which help to build an approach which is centred around people’s needs.
“Of course we all know that while NHS services have been protected they are facing increasing demands on their budgets as demand rises. We are concerned that any reduction in the funding of social care as a result of this change will only serve to make this situation worse by leading to more cuts in social care.”
“We must make sure that the newly-created Health and Wellbeing Boards led by councillors and doctors, which were designed to be at the centre of care-related local decision making, are given the opportunity to work with local people to shape new services.”
He finished by emphasising social care’s commitment to integrated and joint working, operating from a mutually agreed and sustainable financial basis, “as being the only sound basis upon which people with care and health needs can get the proper, seamless services they need and deserve.”
12.55pm David Dalton says that for providers in “chronic difficulty” the decision around which organisational model to adopt “is likely to be in conjunction with their regulator”.
He anticipates that in these circumstances organisations will be required to “set out the organisational model they wish to pursue to what timetable and with a trajectory to assure clinical and financial sustainability”.
12.50pm GPs are ideally placed to spot early warning signs of child maltreatment and to work with families to prevent them from getting worse, according to a joint report by the Royal College of General Practitioners, the NSPCC and researchers from UCL and the University of Surrey.
The report claims that giving family doctors the time, support and autonomy to work with vulnerable families in the community – as well as referring cases to social care services - could benefit children and families in the short and long term.
According to the NSPCC there is a large gap between cases of child maltreatment in the community and the proportion of cases receiving attention from children’s social care.
For every child who is subject to a child protection plan, they estimate that there are another eight not receiving services, and that this could be even higher.
The report suggests that GPs, as a first and on-going point of contact for parents and their children, are well-placed to work with other front-line professionals to act on concerns about issues such as child neglect and emotional abuse.
Dr Maureen Baker, chair of the Royal College of GPs, said: “Caring for children and their families is a major part of a GP’s work and we are pleased that today’s report acknowledges the unique skills and expertise of family doctors in this crucial area.
“GPs do the best they can to ensure that children are kept safe and well. By recognising early signs of strain in children and their families, which may involve physical or emotional symptoms, GPs can be of real help and in some cases help prevent situations or conditions getting worse.”
12.40pm The provider model review will emphasise the importance of “self-determination” of organisational models and will “give greater variety than the current FT/no FT model”, says David Dalton in the live Q&A.
12.24pm David Dalton says the review is not just about hospital chains, but joint venture models, organisations taking responsibility for a single service line across different trusts, or management contracts.
He says it will remain the responsibility of local commissioners to determine local need but that the review aims to help providers respond more flexibly to commissioners’ needs.
12.16pm In HSJ’s live Q&A David Dalton says he doesn’t want a “one-size-fits-all approach”, but a range of models.
Proposals set out in the Healthier Together consultation, which launched this morning, would see a centralisation of the emergency and high risk surgery currently performed across ten hospitals onto four or five sites.
The consultation is expected to generate intense political heat, coming less than a year before the 2015 general election.
12.02pm Our live Q&A with David Dalton has just begun. Join in the discussion around how providers should operate in the future.
11.40am Polly Toynbee writes in the Guardian that there is little sign of the “parity of esteem” for mental health and physical health services promised by the coalition. She argues that the mentally ill are instead being mistreated.
11.30am HSJ’s live Q&A with Sir David Dalton will begin in 30 minutes. Sir David will be discussing his work on the review into new provider models.
11.25am Current and past presidents of the Royal College of Psychiatrists have called the “postcode lottery” provision of mental health services for new mothers “a disgrace”.
In a joint statement Professor Sir Simon Wessely (president of the Royal College of Psychiatrists) and Professor Dame Sue Bailey (chair of the Children and Young Peoples Mental Health Coalition and immediate past president of the Royal College of Psychiatrists) said: “It is a disgrace that although one in ten mothers will develop a mental illness either during or in the first year after pregnancy, half of the women in the UK do not have access to specialist community perinatal mental health services. The current postcode lottery of provision means women are left to suffer, families risk breakdown, children suffer and society suffers. It is frankly unacceptable that suicide is one of the leading causes of death for women during pregnancy and one year after birth.
“We wholeheartedly welcome the Maternal Mental Health Alliance’s Everyone’s Business campaign which calls for accountability for perinatal mental health care to be clearly set at a national level and complied with, for community specialist perinatal mental health services meeting national quality standards to be available for women in every area of the UK and for training in perinatal mental health to be delivered to all professionals involved in the care of women during pregnancy and the first year after birth.”
The health sector regulator wants to find out whether those patients offered a choice of different hearing aids and tests feel their interests are better served than those who are not given a choice.
It is thought that around 500,000 over-55s in England who suffer from hearing loss and use the relevant NHS services are able to choose between different providers.
The survey of ‘Hear and Treat’ services - where call handlers give medical advice over the phone to avoid ambulances being sent out unnecessarily - found that 74 per cent of callers had complete confidence in the call handler, while 87 per cent said they were treated with dignity and respect.
Eleven per cent did not have confidence in the call handler. Sixty-three per cent felt the reasons why they were not getting an ambulance were explained to them clearly, 27 per cent said it was not explained fully. Seventeen per cent disagreed with the reasons for not sending an ambulance.
10.50am The creation of new organisational models should be driven by providers rather than the government “dictating” change from the centre, according to Sir David Dalton, who is leading a review into possible hospital reforms.
In a letter to the health secretary Jeremy Hunt giving an update on the review’s progress, Sir David said that “the adoption and development of new organisational models is for the sector to drive, not the centre”.
He added: “The role of the centre is to create a more permissive environment, removing barriers and enabling – but not dictating – change”.
10.38am A consultation into potentially one of the largest reconfigurations of healthcare has been launched today.
Under the Healthier Together proposals emergency and high risk general surgery in Greater Manchester would be centralised at four or five sites - currently it is offered at ten sites.
10.18am A group of just 19 acute trusts were paid almost half of NHS England’s £11.2bn budget for acute specialised services in 2013-14, exclusive analysis by HSJ revealed.
The research also showed that England’s 19 standalone specialist hospitals shared 13 per cent of the national budget. The remaining 40 per cent was split between 51 independent and more than 200 NHS providers.
The HSJ analysis of outturn spend for all providers with NHS England specialist services contracts in 2013-14 revealed for the first time the challenge the commissioning board faces in its bid to centralise such services into 15-30 centres.
Its chief operating officer Dame Barbara Hakin said: “[I will] put my hand on my heart and say that this is the most difficult year that we’ve faced in terms of balancing the plans.”
Her comments came after papers submitted to the board revealed NHS England had not yet agreed on plans to balance its £97bn budget for 2014-15.
NHS England chief finance officer Paul Baumann, who wrote the report, told the meeting: “I don’t think we’ve ever been quite this late in the year without a set of plans which are all laid to rest and ready to be acted upon.”
10.00am The Daily Telegraph reports that a trust that discharged 800 patients with suspected cancer was warned that patients could be dying because of the mistake but failed to act for a year, an investigation has found.
An inquiry into West Hertfordshire Hospitals Trust was launched last November, after it was discovered that for three years patients referred urgenly to the trust with symptoms of cancer were being automatically removed from waiting lists.
9.52amThe Daily Mail has published an investigation into the cost of car parking at hospitals.
The paper received freedom of information replies from 153 trusts and found that 74 of them made more than £500,000 from car parking in the last financial year.
9.45am The Financial Times reports that a simple test to detect Alzheimer’s disease early has come a step closer, as UK scientists announce that certain proteins in blood can predict the onset of dementia in people suffering from mild cognitive impairment.
A partnership between King’s College London and Proteome Sciences, a UK biotechnology company, developed the potential blood test during a 10-year programme funded partly by Alzheimer’s Research UK.
7.00am Good morning and welcome to HSJ Live. HSJ will host a live Q&A with Sir David Dalton, chief executive of Salford Royal Foundation Trust, at 12pm today.
Sir David is leading a government review of new provider models. You can pose your questions and share your thoughts with him here.