The third day of debate on the Queen’s Speech in the House of Commons, focusing on health, plus the rest of today’s news and comment.

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5.23pm Burnham: The deterioration of General practice has marked over the last few years.

5.12pm Andy Burnham says the problems found in the Francis report were primarily the responsibility of the local health board in Stafford.

5.00pm Simon Stevens’ NHS Confederation conference speech presented a new technocratic vision for the health service, but unless NHS England is more willing to take risks and challenge convention he will struggle to realise it, writes HSJ editor Alistair McLellan.



4.46pm The bickering over waiting times starts on both sides..

4.44pm Jeremy Hunt has started speaking. Speaking about teh government’s record on the NHS he said: “The facts speak for themselves.”

4.41pm Jeremy Hunt comments on HSJ’s story on Andy Burnham’s comments in front of a group of NHS union members and campaigners.

4.14pm A patient safety alert has been issued today by NHS England on standardising the early identification of Acute Kidney Injury. The alert has been issued to all NHS acute trusts and foundation trusts providing pathology services.

A national algorithm, standardising the definition of AKI has now been agreed. This provides the ability to ensure that a timely and consistent approach to the detection and diagnosis of patients with AKI is taken across the NHS.

This algorithm has been endorsed by NHS England and it is recommended that the algorithm is implemented across the NHS. When integrated into a Laboratory Information Management System (LIMS) the algorithm will identify potential cases of AKI from laboratory data in real time and produce a test result. The laboratory system will then send the test result, using existing IT connections to patient management systems.

Acute kidney often occurs when a person with longstanding medical problems becomes unwell for other reasons, such as infection or dehydration. Kidney function rapidily reduces and mild AKI increases the risk of harm to an individual with an increased risk of death and the need for more complicated treatment.

Dr Mike Durkin, National Director of Patient Safety, NHS England, said: “This patient safety alert will ensure steps are taken in hospitals across England to improve the detection and diagnosis of AKI. It is estimated that one in five emergency admissions into hospital are associated with AKI, prolonging inpatient care and contributing to around 100,000 deaths. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) estimates that a quarter to a third of cases have the potential to be prevented and early detection and the standardisation of defining AKI is a big step towards achieving this.”

Dr Richard Fluck, National Clinical Director for Renal Services,NHS England, added: “We need to help the public, patients and professionals understand what acute kidney injury is and why it is important. This is a global healthcare issue and the NHS is leading the way in measuring the scale of acute kidney injury and the impact on individuals and the population. We need to identify people who are at risk, monitor them appropriately, diagnose the problem early and provide reliable and consistent treatment to everyone.”

NHS England in partnership with the UK Renal Registry has launched a National AKI Prevention Programme which will include the development of tools and interventions. A priority for the programme is the development and adoption of e-alert systems, based on the test result, which will proactively notify clinicians when a patient has AKI, supporting implementation of AKI NICE guidance.

4.02pm Health secretary Jeremy Hunt has responded to the news Basildon has been taken out of special measures, claiming the trust’s turnaround as vindication of the policy.

He said: “This is a remarkable turnaround — and chief executive Clare Panniker and her team deserve huge credit for the changes they have made, which will truly turn a corner for patients who depend on their services.”

“The decision to place 11 trusts into special measures last summer was not taken lightly. But today looking at Basildon we can see that it was the right decision.”

3.20pm The government is using the Mid Staffordshire scandal to soften up the health service for privatisation, the shadow health secretary has said.

Mr Burnham made his comments during a speech to NHS staff and trade union representatives following his appearance at the NHS Confederation Conference in Liverpool last week.

2.07pm Dr Louise Irvine of the National Health Action Party has released a statement responding to HSJ’s story on the on the Northumbria Healthcare Foundation Trust PFI buyout:

Dr Irvine said: Northumbria NHS Trust was saddled with a PFI debt for building Hexham General Hospital that meant crippling repayments rising each year for 32 years.

“They have this in common with all PFI-funded hospitals: a rising debt to be paid out of an ever shrinking annual budget so that the debt takes a bigger and bigger share of the funds that are meant to be for paying staff and providing front line care. This is destabilising local healthcare economies, forcing cuts to services and hospital closures to save money to pay the PFI debts.

“Northumberland Trust found a solution which at least protects their hospital - their local authority has bought out the debt. But this would not be a model for other hospital trusts in financial criris. In most cases local authorities would have nowhere near the cash required, especially as many of the PFI debts are even bigger than in Northumbria. The headline cost of the Peterborough PFI for example is over £300 million. 

What’s more, this type of approach would generate a new postcode lottery depending on the political colour of the council.  It also just passes the debt from one public authority to another and the money still comes from taxpayers to pay the extortionate debts of the PFI companies.

“A much better solution that would protect our hospitals would be for the Treasury to take on all the individual PFI debts centrally - amounting to about 2% of the NHS budget - and then use its strong central bargaining power as government to renegotiate the debts down to a fair rate of return.

“This is what the National Health Action Party is demanding of this government or the next. It is a solution to the PFI problem that is practical and fair and would protect NHS services.”

1.58pm A North East trust has received approval from the Treasury and Monitor to buy out its private finance initiative contract with a local authority loan – the first time such a deal has occurred in the NHS.

Northumbria Healthcare Foundation Trust will terminate the PFI contract which paid for the construction of Hexham General Hospital by borrowing £114.2m from Northumberland County Council.

1.40pm The foundation trust regulator has sent a strong signal that using “patient clusters” as a means of funding for mental health service will be maintained as a more complex payment regime is developed.

Adrian Masters, managing director of sector development at Monitor, told the NHS Confederation Conference last week that the “clustering” method of payment was a “helpful way of knowing how people are spending resources, the results they are getting and the activity they are doing… We should continue using the clusters.”

1.36pm Full story here: Basildon and Thurrock University Hospitals Foundation Trust has become the first trust to come out of special measures after a Care Quality Commission inspection rated the trust “good”.

Chief inspector of hospitals Sir Mike Richards recommended Monitor remove the Essex trust from special measures after the inspection found “significant improvements”.

1.02pm: Basildon and Thurrock University Hospital NHS Foundation Trust has been removed from special measures by the health sector regulator Monitor after making improvements in services for patients.

This follows a recommendation from the chief Inspector of hospitals as a result of a full inspection of the trust by the Care Quality Commission.

More follows…

1.00pm: The Health and Social Care Information Centre has published its first audit report about Busting Bureaucracy in the NHS.

Accompanied by a new self-assessment toolkit, the report makes a series of recommendations to help acute trusts spend less time on paperwork and more time providing direct care to patients.

In a statement, the HSCIC said it has been working with 16 acute trusts in England to understand local burdens of bureaucracy, since a pledge to increase efficiency and reduce burden was made last year by the Secretary of State for Health.

Key findings from the audit include:

  • On average, junior doctors spend two thirds of their time accessing or updating patient notes.
  • More than two thirds of trusts type up paper notes retrospectively into an electronic system.
  • The use of Computers on Wheels has reduced ward round times by 45 minutes.

The HSCIC has made 13 recommendations based across three themes, all of which are supported by the 16 trusts. These relate to controlling burden and bureaucracy; implementing processes and technology adoption.

The HSCIC now plans to work with two trusts to implement the recommendations in depth, with a view to establishing the early impact of this activity later this year. It will also extend its audit work to include mental health and community trusts.

The Busting Bureaucracy programme extends the HSCIC’s breadth of work to support health and social care providers in reducing burden, ensuring data security and encouraging transparency.

HSCIC Chair Kingsley Manning said: “High quality data is crucial to transforming care, which is recognised by both health professionals and the public. However we want to work with providers to stamp out unnecessary bureaucratic burden on those who provide care.

“Our first audit report and recommendations today, along with the new self-assessment toolkit, are steps towards ensuring the right data is recorded to support better care, but in a way that does not place an unnecessary burden on staff.”

The Busting Bureaucracy audit report, self-assessment toolkit and top tips for reducing bureaucracy can be viewed at:

12.18pm: The Department of Health expects to recover up to around 15 per cent of the estimated £2bn of costs shouldered by the NHS for “health tourism”, a DH official has said.

This figure was indicated last week by Kate Dixon, deputy director of the the department’s visitor and migrant NHS cost recovery programme.

11.38am: NHS England has defended the controversial patient record-sharing programme following what it admits was an ‘enormous outcry’ in the way it was initially implemented.

Tim Kelsey, the national agency’s director for patients and information, suggested there should have been more discussion with patients about the ownership of their health records before the sharing regime was launched in last year.

11.30am: In The Guardian: older lung cancer patients are being denied life-saving surgery, a charity has claimed. Those aged 75 or over who are otherwise in good health and whose cancer has not spread are five times less likely to be given life-extending surgery than younger patients, Macmillan Cancer Support said.

England and Wales have the worst five-year lung-cancer survival rates in Europe among the over 75s, according to the charity.

11.20am: The Times reports emergency consultants are leaving Britain in record numbers.

Figures seen by the paper have found that one in 25 emergency consultants emigrated last year, three times as many as the year before.

In The Times’ leader column, the paper argues that emergency consultants have become fed up doing the heavy lifting for GPs and warns that Britain “cannot afford an A&E brain drain”.

The paper claims: “The country’s hospitals are inundated with patients waiting too long for rushed care in chronically overcrowded emergency departments, mainly because they have been ill served by their GPs.”

It adds: “The fundamental problem driving patients to hospitals in unmanageable numbers remains an NHS contract negotiated with ten years ago and still substantially unreformed, that does not require GPs to guarantee out of hours cover.

“The result is that timely GP appointments are relatively easy to obtain for those who are not at work or school, but infuriatingly elusive for those who are.”

One in three university-trained nurses are being rejected for NHS posts because of their inability to simple sums such as calculating how many 15mg tablets constitute 30mg, The Times reports.  

Also in The Times, the National Institute for Health and Care Excellence has advised doctors to stop prescribing aspirin for atrial fibrillation, a common heart condition that increases the risk of strokes.

The new guidelines are estimated to affect about 300,000 patients with the condition.

More from The Times, older lung cancer patients are six times less likely to be offered surgery than younger patients with similar fitness levels, new research has found.

Macmillan Cancer Support chief executive Ciaran Devane said: “We should not send the message that to older people that it is OK to discriminate”. He said it was “deeply sad” that the UK’s cancer surval rates in the over 75 age group “continue to lag behind Europe”.

11.06am: The Daily Mail reports this morning that sick patients are finding it harder to see a doctor as many GPs close their doors during the afternoon.

An investigation by the paper has revealed that a quarter of surgeries shut for at least one half-day during the week while others close up for lunch.

11.00am: The Daily Telegraph reports that thousands of multiple sclerosis patients could be denied drugs that can help sufferers in pain, under NICE recommendations, experts have warned.

Neurologists said the decision to reject two cannabis-based drugs for symptoms of MS could leave thousands of patients suffering “horrendous” pain and immobility.

In a letter to the paper the chief executive of the MS Society and seven leading neurologists criticised the decision and said the decision had been made “behind closed doors”.  

10.55am: Prior to this morning’s statement from the Nursing and Midwifery Council calling on political parties to implement a draft Bill on the regulation of care professionals, HSJ spoke to NMC chief executive Jackie Smith. Read our interview here.


10.43am Kate Granger response to Daily Mail coverage of her NHS Confederation speech:


10.20am The Nursing and Midwifery Council has today called for a first parliamentary session commitment from all political parties after the draft bill, Regulation for health and social care professionals was not included in the Queen’s Speech.

The “revolutionary” draft bill published by the Law Commission earlier this year would have enabled the NMC to make fundamental and much needed changes to its current system of delivering public protection.  

Jackie Smith NMC Chief Executive and Registrar said: “Neither the NMC nor the public can afford to wait until “parliamentary time allows” to see this Bill become law. The government’s failure to commit to the Bill severely damages our efforts to further improve patient safety, by modernising the regulation of healthcare professionals.  

“I urge all of the political parties to make a public commitment today, to including this Bill in their plans for the first session of the next parliament. The public and the professions deserve to see the commitment honoured.

“Until these commitments are made we continue to be stuck with a framework that David Cameron described as “outdated and inflexible”. Last week’s missed opportunity is a serious blow to our reform programme.”

10.13am There is “no excuse” for providers and commissioners of care to ignore national guidance that supports young people who are disabled or have long term health needs move from children’s to adult services, England’s chief inspector of general practice, Professor Steve Field, will say today.

The Care Quality Commission has found that young people who have physical disabilities or illnesses and so rely on lots of therapies and treatments, are not always receiving the necessary care and support when they move on to adult care services, despite guidance being available for the last ten years.

The process, called “transition”, can be a vulnerable time for young people and their families as they stop receiving health services that they have had since birth or a very young age – for example, to support their mobility, breathing, swallowing, or pain – and move on to the equivalent adult services, which can be structured and funded differently.

As part of its national report, which the chief inspector will launch at a closed event this afternoon, CQC has spoken to people who have experience of the transition process and reviewed a sample of services across the country to find out what works well and what needs to improve.

The regulator has found that there are problems with the transition process with some children’s services stopping before their equivalent adult services have started, that families are confused and distressed by the lack of information and support given to them, and that generally, people’s experiences of this process varies across England.

In response, CQC has set four priorities for action:

  1. Commissioners and providers must listen to, involve and learn from young people and their families about what they want from their care
  2. Existing national guidance must be followed so that young people are appropriately supported through their transition
  3. GPs should be more involved, and at an earlier stage, in planning for transition
  4. Services must be tailored to meet the needs of young people transferring from children’s health services and include extra training for healthcare staff, such as community nurses, in caring for young people

Professor Steve Field said: “Despite plenty of guidance being available on what good transition planning and commissioning should look like, there continues to be a significant shortfall between policy and practice. There is no excuse for people not receiving the care they need.

“It is unacceptable that young people and their families are being excluded from planning and decision-making about their care and for them to be without essential services or equipment temporarily, while arrangements are resolved.

“While our review found many committed professionals who provide excellent care, there needs to be a system-wide change, with commissioners and providers of health and social care working together at every level.

“Planning and discussions with young people and their families must start early, with clear funding responsibilities and providers and commissioners must listen to what people want from their care. In particular, general practice has a crucial role to play as the single service that does not change when a young person becomes an adult. GPs should be more involved in transition arrangements.

“Collectively, these priorities will stop young people with complex physical health needs from falling between gaps of care and not getting the support they need.”

As part of CQC’s new approach to inspection which will begin from October, CQC will investigate transition arrangements when it visits primary and community healthcare services. Its findings will be reflected in the overall rating – of Outstanding, Good, Requires Improvement, or Inadequate – that CQC will award to services. These ratings will celebrate best practice and hold providers to account to make improvements.

Care minister Norman Lamb said: “Young people with disabilities and long term health needs deserve the best possible care which doesn’t reach a cliff edge once they reach 18. The transition process needs to be better. I strongly support the clear statement of principles from the CQC and I welcome the fact that with their new more robust inspection regime, there will be consequences for providers in terms of the rating they receive if these principles are not followed.”

10.05am The original Daily Mail story can be read here.

10.00am The chief executive of the NHS Confederation has responded to Daily Mail coverage of a speech given at the body’s annual conference in Liverpool last week by Kate Granger, a campaigner for better care.

Rob Webster, the confederation’s chief executive said:” The decision to ask Dr Kate Granger to close this year’s NHS Confederation Annual Conference and Exhibition was an easy one. I believe her insights about what we must treasure in the NHS and what needs to change are as important as the views of Simon Stevens and Jeremy Hunt. That is why she had a place on the main stage of the biggest and most important healthcare conference of the year.

“That decision was vindicated by what I can only describe as one of the finest and most powerful speeches I have ever witnessed. It was a genuine privilege to hear Kate describe in a very balanced way her experiences as a doctor and a patient in the NHS. I am pretty sure every person in the audience felt the same. The silence in the Echo Arena during her talk; the standing ovation she received afterwards; and the outpouring of support on social media is strong evidence that I am right.

“I was deeply saddened to see the way in which Kate’s messages, which are rooted in humanity and respect for the individual, have been reported by the Daily Mail. It is ironic that the Mail appears not to have listened to what Dr Granger actually said – treating Dr Granger with neither respect nor humanity, and failing to reflect the messages that she gave to the audience. They didn’t even spell her name correctly. She wrote on Twitter that the article made her “never want to speak again”.

“As a service, we are looking to ensure that voices like Kate’s are heard. Alongside Kate, this year’s conference had staff and patient voices throughout. That’s because we are building on the dedication and commitment of staff and the public to the NHS whilst working on the areas we know we need to get better. This is one of them. My mission is to help make sure we get there.

“Kate is a remarkable woman. She has made a huge impression on the health service - as a practising doctor and a campaigner for improving care. Watch her session. Talk about it, share it with friends and colleagues. Spread the word.

“In years to come, I know “Hello My Name Is” will be one of the fundamentals of the new NHS and we will have one person to thank: Dr Kate Granger.”

7.00am Good morning and welcome to HSJ Live. We begin the day with a comment piece from Ciarán Devane, chief executive at Macmillan Cancer Support, on how the health service can make the NHS constitution a reality on the front line.