The special measures regime for struggling hospitals has the potential to demoralise staff and hamper efforts to fill much needed vacancies, according to a high profile troubleshooter tasked with putting one trust back on track, plus the rest of today’s news and comment

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5.00pm The English NHS pulled out the stops in August with a major effort to clear the long wait backlog. But it didn’t work. The long waits position got significantly worse right across the board, writes waiting times expert Rob Findlay.

4.55pm Also responding the the King’s Fund report, Rob Webster, chief executive of the NHS Confederation, said: “Unfortunately, evidence of hospitals in financial deficit is a sign of our times with the NHS facing unprecedented financial pressures. These financial challenges require a sustained approach in the medium term.

“The King’s Fund report is a great contribution to the debate around the future of health and care as defined in the 2015 Challenge Manifesto.

“On the specifics, we have called for more to be done to support organisations in distress, so failure is only seen as a last resort.

“We believe that short-term solutions to long-term financial problems are not sustainable and we maintain that the only way to turn around a failing organisation is to look at the challenges being faced across the whole system, rather than trying to solve them in isolation within one trust.

“The rules of engagement around crisis-driven change needed to be clearer and we were pleased to have secured reforms in the Care Act to strengthen the involvement of patients and staff in the Trust Special Administration (TSA) process.

“As we continue to work on a cross-party committee advising on the new guidance to TSAs, we will be adamant that the rules for TSAs need to be as clear, realistic and meaningful as possible.”

4.33pm In response to the King’s Fund’s report published today, Siva Anandaciva, head of analysis at the Foundation Trust Network, said:“This report… powerfully articulates the consequences of using misaligned and short-term approaches to managing financial pressures in the NHS.

“The NHS provider sector is forecasting a half a billion pound financial deficit for the current financial year, as the costs of delivering high quality and accessible care continue to escalate.

!It is clear that this mass financial distress is not due to individual pockets of poor management or leadership. Many NHS providers with strong track records have been tipped into deficit by the hostile environment of low NHS funding growth and rising demand for services, despite the NHS budget ring-fence.

“Entire health economies are forecasting that they will go bust in five years time. To avoid this we need solutions that recognise the effect of system-wide factors on provider financial performance.

“We need solutions that prevent failure by increasing support for organisations in distress, so a provider does not have to ‘fail’ to receive assistance and support. And we need solutions that are long-term. Turnaround and churn of leaders and non-recurrent cash injections simply paper over the cracks and perpetuate the status quo.

“A multi-year planning and funding framework would give NHS and social care leaders a better and more stable basis to develop with local partners and communities the transformational improvements to healthcare their patients need.

“Later this month Monitor will published the 2015-16 National Tariff proposals for consultation. We hope that these proposals will send a signal that the 2015-16 financial year can be a launching pad for transformational change, rather than a continuation of financial decline.”

4.28pm The unprecedented financial pressures that the NHS is facing means there are no quick fixes for hospitals at risk of financial failure, according to a new report by the King’s Fund.

The report Financial failure in the NHS, published today, states warns that the prolonged slowdown in funding means that the NHS is now facing a period when even well-managed organisations will struggle to avoid financial failure.

It states the reasons for the deterioration in financial performance include weak leadership, legacy costs, the payment by result payment system, and the impact of the wider health economy.

The report also finds:

  • The balancing act between finance and performance cannot be maintained.
  • There are many factors that contribute to financial failure and some of these are not under the control of one organisation.
  • There is a lack of leadership within local health economies following the abolition of strategic health authorities.
  • National bodies need to agree a shared approach to dealing with funding challenges.

King’s Fund director of policy Richard Murray said: “Providers are operating in an extremely difficult financial environment.

“Developing an approach to financial failure that responds to this environment is a significant challenge.

“A nuanced approach is required based on an understanding of the whole local health economy and balancing a range of other factors.

“None of this makes for a speedy or straightforward process but there are no quick fixes.”

You can read the full report here.

3.44pm Four clinical commissioning groups in west Berkshire have dropped proposals to merge into one organisation, HSJ has learned.

2.53pm The BBC reports that increasing numbers of paramedics are leaving NHS ambulance services.

At least 1,015 paramedics left their job in 2013-14, compared with 593 in the same period two years earlier, according to figures obtained by the BBC.

2.40pm Conservative MP Liam Fox has praised Nick Clegg for “giving prominance” to the issue of mental health in his address to the Liberal Democrat Party conference.

In a comment piece for the ConservativeHome website, Mr Fox said the neglect of mental health is a “national disgrace”.

“Reform of mental health care is one of the last great social reforms we need if we are to be a genuinely civilised society in the 21st century. It is a challenge that we must all accept, whatever our political allegiances,” he added.

Mr Fox said he made mental health one of his central issues when he ran for the Conservative leadership in 2005, and even launched his campaign at a North London community mental health facilitycommunity mental health facility. One of his colleagues told him at the time: “I was going to vote for you but not if you are going to talk about things like that. It’s not what the public want to hear about.”

2.02pm A national strategy for digital technology in mental health could help improve services, according to a new report that found few providers allow patients to book appointments online.

The Future’s Digital: Mental Health and Technology points to slow progress on the adoption of technology in the sector, despite a strong appetite among providers and users.

However, the Mental Health Network, which produced the paper, claims there is a consensus within the mental health service that changes are needed.

1.46pm Some ambulance staff in the North West will not respond to “potentially life threatening” calls during strike action next week, the region’s ambulance trust has claimed.

The union in question, Unison, has refuted the claim.

1.15pm Did you miss HSJ’s webinar on the new Care Quality Commission inspection regime yesterday? Not worry, you can catch up on it here.

As the CQC prepares to publish its definitive methodology for its new inspections this autumn, debate about the regime and its sustainability continue to rage.

HSJ, supported by Ridouts Solicitors, brought together leading figures including Adam Cayley, regional director of Monitor, and Sir Mike Richards, the chief inspector for hospitals, for a webinar debate about the challenges and successes of the new regime.

The discussion was chaired by HSJ editor Alastair McLellan, and broadcast live by workcast. Now you can watch the debate in full and see what the experts had to say about questions put to them.

The panel also included Neil Grant, a partner at Ridouts Solicitors.

12.42pm The NHS waiting list for planned care has now grown to more than 3 million, despite the £250m government drive to boost the number of operations performed over the summer months.

The latest data, covering August, showed the waiting list jumped from 3.07 million in July to 3.13 million.

12.00pm The Financial Times reports that the National Institute for Health and Social Care (NICE) has rejected a cannabis-based drug, developed by British biotech company GW Pharmaceuticals, which could be used to treat multiple scerlosis.

NICE said the drug Savitex provided “only a modest benefit at a significant cost to the NHS”. Critics have viewed the decision as a snub for homegrown innovation.

Justin Glover, chief executive of GW Pharmaceuticals, said: “To have our home market effectively restrict access to a medicine that is being adopted in other countries seems to me a terrible shame.”

11.50am The Daily Telegraph reports that eating healthily costs three times as much as consuming unhealthy food and the price gap is widening, according to a Cambridge University study.

Researchers found that for almost 100 items of food the average cost of 1,000 calories from healthy items such as lean salmon, yogurts and tomatoes cost an average of £7.49 in 2012.

The same calories from less healthy items, such as pizza, beef burgers and doughnuts, cost an average of £2.50.

11.39am Also in The Times, the NHS cannot afford better mental health services without risking cuts elsewhere, according to experts.

From next year patients with mental health problems will have the same right to prompt treatment as those with physical illness, and Nick Clegg wants to spend half a billion pounds on improving “Cinderella” services.

The plans have been widely welcomed, but hospital leaders said the rest of the NHS could ill afford to lose money. A report on hospital finances by the King’s Fund think-tank yesterday prompted warnings that the NHS is “on the verge of financial meltdown”.

11.33am A pensioner had to sleep in a cramped storeroom at a flagship NHS hospital because all the wards were full, The Times reports (newspaper only).

Ian Semmons said that a porter jokingly told him he was going into a cupboard before putting him in a room full of medical supplies.

Mr Semmons, 65, a former member of the General Medical Council panel and chairman of the charity Action on Pain, spent nine hours in the room – from 2.30am until 11am on July 14 – before a ward bed was found for him at Norfolk and Norwich University Hospital.

11.20am The Times reports that every patient in England could be asked by their GP if they are happy to have their medical records used for research, as health chiefs try to resurrect the controversial ‘’ data-sharing scheme.

NHS England insisted it would not retreat on the central thrust of the scheme and has refused to bow to critics who want patients to be automatically excluded unless they explicitly allow their data to be used.

Hundreds of GP practices will test ways of explaining the scheme to patients, using letters, leaflets, emails and text messages.

11.12am In today’s papers, The Guardian reports that England’s major hospitals are making preparations to isolate and treat patients suspected of having Ebola if a serious outbreak occurs in Britain, the NHS said yesterday.

An NHS spokeswoman confirmed that all hospitals with the capacity to isolate patients, in side rooms or elsewhere, were “gearing up” for the possibility of receiving Ebola patients.

10.51am There are three policy issues that are hampering the NHS’s future. The future of the health service should be shaped around the local system in which the NHS operates, writes John Deffenbaugh, director of Frontline.

10.37am Mergers, special administration and franchising have so far been unconvincing when it comes to turning around failing trusts, argues Richard Murray, director of policy at the King’s Fund, in a comment piece for HSJ.

It’s time for a broader, more sophisticated approach, he suggests.

10.25am Croydon Clinical Commissioning Group has joined forces with its local authority to create a £1.7bn plan to change the way health and social care services for over 65-year-olds are commissioned.

Final approval to move to an outcomes based capitation payment model was agreed at Croydon CCG’s board meeting on Tuesday following sign off from Croydon Council at their cabinet meeting last week.

The contract will be drawn up over the next year and will have an expected start date of 2016.

10.12am An investigation into maternal deaths and failings at the University Hospitals of Morecambe Bay Foundation Trust looks set to be delayed for the second time.

Chair of the inquiry Bill Kirkup has confirmed to HSJ that the timetable for the inquiry to publish its findings, expected this autumn, had been placed under review.

10.01am Following a successful launch last year, HSJ in partnership with Celesio is again celebrating the up and comers who are making a real difference to healthcare.

We will name our latest collection of Rising Stars as the new year starts, and we are looking for your nominations.

Our aim is to celebrate the people whose work and decisions are already improving healthcare, and who are considered likely to be the NHS leaders of the future. A panel of expert judges will decide on the final 25.

You can make nominations now. Please be sure to give the individual’s name, job title, organisation and a short description of why you think the person should be considered as an HSJ Rising Star.

The closing date for nominations is Monday 3 November.

9.55am The special measures regime for struggling hospitals has the potential to demoralise staff and hamper efforts to fill much needed vacancies, according to a high profile troubleshooter tasked with putting one trust back on track.

Manjit Obhrai, who was brought into Queen Elizabeth Hospital King’s Lynn Foundation Trust as interim chief executive when it was placed in special measures last year, also said Monitor appointed “improvement directors” were seen as “spies” by some cynical clinicians.

He told HSJ special measures had the potential to have a “detrimental effect, particularly with staff recruitment”.

7.00am Good morning and welcome to HSJ Live. Collaboration between the NHS and higher education institutions is often hindered by differing perceived demands and values. Kate Springett and colleagues explain the tensions and why we must resolve differences.

Many UK-wide NHS documents reflect requirements for research education to enhance practice and improve patient care. They outline the benefits of research to patients and service delivery.

Managing this at the same time as providing an excellent service can be challenging, they write.