The Care Quality Commission will adapt its approach to regulation to reflect the new provider landscape outlined in the NHS Five Year Forward, the watchdog’s chief executive has said, plus the rest of today’s news and comment

Live logo

4.50pm In HSJ’s leader column for this week Crispin Dowler argues there are no winners in the recent debate over the tariff for 2015-16.

4.45pm The Health Foundation has responded to the vanguards announcement.

Richard Taunt, director of policy at the Health Foundation, said: “We welcome any initiative which seeks to improve health care at an accelerated pace.

“Change is urgently needed across all parts of the NHS. Success for the vanguards will not just be whether they can improve patient care in their area, but how they can lead change which can then be adapted and replicated across the country.

“This is only partly about how new models of care can be developed; it is also how successful change can best be supported in a period of intense pressure for the NHS. As we highlighted in our recent report – Constructive Comfort – to encourage such change, national bodies need a radical shift in their approach to include redefining the measures for local success. This is the only way to make successful change in the NHS more likely.”

4.30pm Here is an interesting reader comment below our story on the 29 vanguard sites:

“This is a sensible, pragmatic way to test solutions and make some proper progress on integration. Many of the providers involved put themselves forward to protect their services from tendering, particularly those transferred through the TCS exercise. So whilst these experiments are underway there is a risk that elsewhere CCGs might be moving in the opposite direction and fragmenting services. Could NHSE not place a moratorium on re-tendering until we are clear about what good looks like?”

4.25pm The Royal College of GPs has responded to the announcement on the vanguard sites.

Maureen Baker, chair of the Royal College of GPs, said: “The health needs of our patients are changing as people live longer and develop multiple and complex diseases – and we need to find different ways of caring for them within the NHS.

“The College strongly supports integrated services and the need for new models of patient care, particularly the Multi-specialty Community Provider (MCP) model, which shares many characteristics of GP federations – a concept pioneered by the RCGP almost a decade ago and which encourages GP practices to combine their resources  - as well as other ‘at scale’ models of general practice that promote collaborative working across larger geographic areas.

“We are pleased that the majority of ‘vanguard’ sites announced today will follow this model and it is important that these areas get the support,  both in terms of investment and practical help,  they will need to transform care in their areas in the best interests of patient safety and care.

“The integrated Primary and Acute Care Systems (PACS) model has been an interesting development and in a few areas has received strong support from GPs and other primary care professionals, but generally we are looking to MCPs as the model likeliest to meet the needs of most communities.

“GPs are keen to do more but are under intense workforce and funding pressures.

“GPs and our teams manage 90 per cent of patient contacts across the health service for just 8.3 per cent of the budget.  We need the share of the NHS budget given to general practice to be increased to 11 per cent by 2017 and for 8,000 more GPs in England by 2020.

“NHS England’s Five Year Forward View recognises these pressures. We will continue to work with them to monitor the progress of these vanguard sites to ensure that they are delivering improved care to patients and that the unique strengths of general practice, valued so highly by our patients, remain at the heart of any new models of care that are introduced.”

4.10pm Rob Webster, chief executive of the NHS Confederation, has responded to the vanguard announcement.

He said: “Today’s naming of 29 vanguard sites, many of which are our members, is to be welcomed.  

“Improving services by helping different parts of health and social care work better together is essential for the future of the NHS. If redesigned services in these sites results in, for example, fewer unplanned hospital admissions, fewer hospital trips and more treatment in people’s homes, then that is good news for patients.

“It is pleasing that clinicians and local leaders have been able to put forward plans for redesigning services in their areas. What works best for patients is care designed by frontline clinicians who are delivering services.

“It is vital that the new models of care being supported here are properly assessed and evaluated, to test their effectiveness. Lessons from these 29 vanguard sites must be shared across health and social care. The fact that more than 260 groups put forward proposals shows the enthusiasm among clinicians to improve services, and we must not lose this momentum.

“The push to redesign services and better integrate health and social care needs to continue apace if we are to address significant challenges facing the health service and to secure a sustainable NHS.”

Amanda Doyle and Steve Kell, co-chairs of NHS Clinical Commissioners said: “The announcement of the vanguard sites today showcases some truly innovative plans that look to change the models of care and improve outcomes for patients, not just changing organisational structures and models. 

“What these successful bids highlight is the difference that strong clinical leadership, with provider and commissioners working together, can bring to the crucial work of transforming the NHS to ensure we deliver the best care possible for our patients and local populations.”

3.30pm Labour claims a number of cancer projects are “off-track”, following a series of parliamentary questions.

These include the roll-out of the new bowel scope screening programme, which will not now be completed in 2015-16, only one facility for Proton Beam Therapy will be open in 2018, rather than two being open in 2017, Labour say.

The planned expansion of radiotherapy capacity –12 more linacs, and average fractions per machine up to 8,700 – will not now be met, the party claims.

Andy Burnham said: “David Cameron made a slew of promises to cancer patients in the early days of this Government. The reality is that cancer care has got much worse on his watch and his NHS plan has failed.

“It is not right that thousands of people every year who could benefit from radiotherapy are missing out because the Government broke its promise on buying new machines. Cameron’s policy of giving radiotherapy lower priority than drugs has left thousands without the life-saving treatment they need.”

3.10pm Children, people who are mentally unwell and other vulnerable members of society are being locked in cells and sometimes unnecessarily criminalised because police custody is being used as a substitute for social and health care, a report published today by Her Majesty’s Inspectorate of Constabulary has found.

2.55pm In the Evening Standard editor Sarah Sands describes her experience of the NHS response to a possible Ebola diagnosis.

2.45pm HSJ senior bureau chief Dave West has just tweeted: “The point of Stevens prominently ‘firingstarting gun’ on#5yfv now = more difficult for a new governmnt to stop this race & start a new one”

2.35pm Peter Carter, chief executive and general secretary of the RCN said of the 29 vanguard sites:

“The Five Year Forward View laid out in the clearest terms the need to meet our country’s changing needs and demands, so it is good news that this innovative programme is making steady progress.

“RCN members across the country look forward to seeing more detail about the individual sites, and how they might learn from their progress. The RCN is also keen to develop its role in this project, and to work with nursing leaders to ensure it meets the demands of a changing population, and a changing workforce.

“Frontline staff are often the driving force behind successful innovation and change in the health and social care system, and it is vital that they are involved in the programme as it develops, along with patients and carers.

“We also urge all of the political parties to commit to ensuring that this invaluable work continues in the next Parliament.” 

2.30pm Monitor has made some corrections to its list of providers who opted for the voluntary tariff.

St George’s University Hospitals Foundation Trust declined the voluntary tariff. Barts Health Trust did not originally make a decision either way so it was added to the default tariff list. It has now decided to opt for the voluntary tariff. Mid Staffordshire Foundation Trust was included in error because it has now been dissolved.

Here is the updated list.

2.10pm Richard Lewis, health partner at consultancy EY, has commented on today’s announcement on new care models:

“Accident and emergency departments are under unprecedented strain and simply throwing more money at the issue is no better than a sticking plaster. The system needs bold and innovative initiatives like today’s announcements.

“Getting GPs, hospital specialists and community staff working together will deliver a much needed shock to the system and is just one step in the journey toward better health and care integration.

“GPs understand the needs of the local population, and hospitals have the size and capability to manage financial as well as clinical risk. This would seem to be a partnership well worth making.”

A small team from Guy’s will work with Medway to strengthen its clinical leadership and support changes being made to improve care and standards.

Medway was originally buddied with East Kent Hospitals University Foundation Trust in September 2013 when it was first placed in special measures after Sir Bruce Keogh identified it as one of the trusts with high mortality rates.

1.50pm Chris Hopson, chief executive of NHS Providers and member of the New Care Models Board, has said of the vanguard announcement:

“We welcome today’s announcement of the first vanguard sites to develop replicable new care models. We strongly support the vision outlined in the Five Year Forward View that the NHS needs to rapidly develop new ways of delivering care to patients that better meet 21st century patient needs. We need to integrate health and social care, secondary and primary care and physical and mental health care and then provide that integrated care closer to home, wherever possible.

“Today’s announcement is an important early step in translating the Five Year Forward View into real change on the ground. NHS England and the other arm’s length bodies have moved with admirable speed to identify these vanguard sites. We also welcome the way this process is working. Sites have been shortlisted using patient, third sector and local government input. The final sites were selected by voting for each other in a form of peer review combined with other intelligence. There is a strong emphasis on really understanding their support needs and then providing the bespoke intensive support they want, as opposed to what the NHS system thinks they should have. There is also a real focus on how the learning developed will be shared and replicated, something the NHS hasn’t always done particularly well. This all feels different, as it needed to.

“We also welcome NHS England’s recognition that there should be no losers here. The enthusiasm generated by this process is palpable and lots of NHS Providers’ members have worked with the rest of their local health and social care economy to develop important, interesting and innovative new care models. The vanguards have been chosen for how advanced and replicable their models are. Those who have not been selected must continue to develop and deliver new care models that work for their local patients.

“NHS Providers looks forward to working with our colleagues in NHS England’s New Care Models team, NHS Clinical Commissioners, NHS Confederation and the Local Government Association on supporting the vanguards and all our members who want to move to new care models”.

1.45pm David Nicholson has just tweeted his support for the Five Year Forward View:

“Great interview by Simon Stevens on#wato get behind the 5yfv and make it work for patients”

Of the 23 multispecialty community providers (or MCPs) and primary and acute care system (or PACS) sites announced this afternoon, none include a trust from the Shelford Group, which represents the 10 biggest and most prestigious regional teaching and specialist centres. No Shelford Group trust is leading a PACS, despite an expectation among some that large, leading acute providers may be well placed to start running primary care services.

NHS England’s director for the new care models programme Samantha Jones told HSJ “there was nothing intentional” in the absence of the large teaching trusts from the vanguard, and said that work developing trial sites for a further care model initiative, called “viable smaller hospitals”, had been delayed.

1.28pm Stevens asked if he’s been put under pressure by politicians to announce these new care models at this time. He says “absolutely none”, new care models announced now to coincide with new financial year.

1.27pm Stevens says we should judge staff by the change they’re able to bring. Big improvements, but a lot more to do.

1.27pm Stevens is asked about CCG officers earning more than guidelines. Stevens says NHS should be careful to bring its admin costs down and has already brought them down by 30 per cent. He says NHS is the cheapest health service in Europe.

Stevens says the big challenge is more about how we re-design care.

1.26pm The health service needs to act in a more coordinated way, including turning temporary staff into permanent, Stevens said.

1.25pm Back to Stevens in the WATO interview who says that admissions have risen by about a third and need to look at different way of delivering services.

Speaking exclusively to HSJ, David Behan said the CQC would update its oversight in line with the growth of new provider models and would begin looking at care quality along pathways to a greater degree and, for the first time, across localities.

“Clearly if we’re going to have a radical redesign of services we need to think about what that means for the work which we undertake,” Mr Behan said.

1.18pm Jim Mackey from Northumbria Healthcare Foundation Trust, one of the organisations selected as a vanguard, is being interviewed.

He says the vanguard option allows them to further develop their seven day services, hubs of integrated services and incentivising staff to work together.

1.18pm Stevens says there were 269 bids for vanguard sites. Interviewer asks whether the work underway in the 29 sites will be spread more widely.

Stevens says the three or four different models set out in the five year forward view will start to be implemented over a five year period.

1.17pm Stevens says more services can be delivered in the community through the vanguard sites.

1.17pm Stevens says the reality is that there are different sets of challenges in different areas. He says they will “go with the grain” on what changes staff want to make.

1.16pm Stevens says this is not “administrative reorganisation”, recognises what staff have said is the best way for improving care in their areas.

1.15pm Simon Stevens is now being interviewed on BBC’s WATO. He says too many different parts of the service are fragmented and too many people “passed from pillar to post”.

1.15pm We have mapped where the 29 vanguard sites are, and the type of care model they will adopt.

1.10pm Nigel Edwards, chief executive of the Nuffield Trust has commented on the vanguard sites announcement.

He said: “The Forward View set out an impressive vision of the different approaches that local areas can take to adapt for the future, and today’s announcement kick-starts the transition to these approaches. Many of the 29 areas chosen by NHS England are well known within the NHS for containing organisations already at the cutting edge of health and social care. In that sense there are no real surprises: these are organisations that have a head start in developing new approaches to better meet the needs of their local communities. 

“The real test for this project, therefore, is how it is spread more widely to areas where such pioneering practice doesn’t exist. Achieving the kind of radical change that the NHS England Five Year Forward View outlines will require doctors, nurses and social workers to work together in fundamentally different ways. This kind of change takes time and is heavily dependent on whether or not they have trusting, functioning relationships. 

“It is tempting to focus on organisations and structures, but the real gains will come from breaking down ways of working that are the product of decades of operating in silos. We need to give local areas time to try new approaches, the space to learn from mistakes, and, crucially, the chance for these approaches evaluated in a rigorous and consistent way.” 

1.05pm Andy Burnham MP, Labour’s shadow health secretary, responding to NHS England’s announcement of 29 ‘vanguard’ areas for integration, said:

“We welcome the vision set out by NHS England but it will never be turned into reality if current Government policy remains in place.

“Huge cuts to social care are on the way if David Cameron is re-elected and they will severely damage efforts to integrate services at a local level. In addition, the Government’s drive to increase competition in the NHS is leading to greater fragmentation of services and making integration harder to achieve.

“The NHS cannot take five more years of this Government. Labour will bring the NHS and social care together in a fully integrated service, increase investment and repeal the rules that require NHS bodies to put services out on to the open market. This is the only way to make integration a reality and, until these changes are made, the Five Year Forward Way will remain an aspiration rather than a reality.”

1.02pm NHS England has selected 29 ‘vanguard’ areas to develop new models of integrated services which can be replicated across the country. The sites include some of the most challenged health economies in England and well established pioneers of joined up care.

The vanguard areas will be expected to spend the next year establishing three of the new models of care set out in theNHS Five Year Forward View. These are: multispecialty community providers (or MCPs), primary and acute care systems (or PACS), and enhanced health in care homes.

The expectation is that the MCPs and PACS areas will be ready to run on a single capitated budget to pay for health services for a defined population by the end of 2015-16.

1.00pm Simon Stevens will be on BBC’s World at One shortly. We’ll give updates.

12.50pm Medway Foundation Trust has a new buddy. Guy’s and St Thomas’ Foundation Trust has agreed to work with the struggling trust to help it implement its 18 month turnaround project.

A story will follow shortly.

12.00pm We will be revealing the new Five Year Forward View “vanguard” sites at 1pm. Follow @HSJnews, @dwilliamsHSJ and @davewwest for the news and analysis.

11.30am The Guardian reports that ministers have been accused of failing cancer patients after it emerged that crucial aspects of the government’s 2011 cancer strategy have been delayed.

11.20am The Telegraph reports that undergoing hormone replacement therapy any time up to a decade after the onset of menopause reduces the risk of heart disease by 48 per cent, a study by Oxford University has concluded.

The reserach found that a typical woman who starts taking HRT around the time of their menopause, or up to 10 years later, had a far lower chance of developing heart disease and a 30 per cent reduced risk of death over seven years, compared with a woman who is not taking HRT.

11.10am The Daily Mail reportsthat 70 NHS bosses of Clinical Commissioning Groups earn more than the £125,000 maximum recommended by the NHS.

One took home £280,000 last year, although this included the fees of the recruitment agency that headhunted him.

Conservative MP Charlotte Leslie, who sits on the Commons Health Select Committee, said: “It is incredible that senior managers are getting paid this kind of money when the NHS is struggling for funds to meet soaring demand.

“Not only are they raking in obscene salaries, they are also unaccountable, with no regulatory body like doctors and nurses have.

“If executives think it is okay to accept this kind of pay, it suggests they either don’t understand the financial pressures on NHS finances, or they don’t care. Either way, most people will find this utterly shocking.’

HSJ editor Alastair McLellan has tweeted in response to the story: “Is it just me - or has the apparently sensible @CLeslieMP now completely lost the plot on pay 4 senior NHS leaders?”

11.00am The BBC reports thatplans to privatise up to £75m worth of NHS services in Cornwall have been abandoned, bosses have confirmed.

Last year, Kernow Clinical Commissioning Group was asking for bids to run services including outpatient appointments, follow ups and non-complex operations in cardiology, gynaecology and general surgery.

However, the clinical commissioning group said procurement of the services was now not the way forward.

10.35am Ashford and St Peter’s Hospitals Foundation Trust has been given a ‘good’ rating by the Care Quality Commission.

At the inspection in December the regulator found that services were good for being effective, caring, responsive, and well led, but required improvement for being safe.

CQC found that the trust had a new senior leadership team promoting the delivery of good quality care with a clear statement of vision and values. The team was leading by example in focusing on quality and safety while improving the experience of staff working at the trust.

In the accident and emergency department, which was busy throughout the inspection, CQC saw that staff were kind, compassionate and caring.  When emergency admissions came into the department, staff were prompt and responsive to people’s needs, while still taking care to be sensitive in explaining what was needed.

Inspectors observed kind, compassionate care being delivered in a respectful way in all services with patients reporting that they were kept informed and involved at all stages of treatment.

Safety and quality of services were a priority for the trust, which was reflected by staff at every level. The trust had a strong reporting culture and was keen to share learning from incidents.

But the inspection found the biggest single safety issue was the impact of staff shortages and the difficulties in recruiting and retaining staff. While the trust used agency, locums and bank staff to help deal with the shortfalls,  Safe staffing levels were not being consistently met. Staff indicated to inspectors that the issue with staffing levels was putting them under extra stress and some staff were leaving because of this.

The ambulance service introduced an “immediate handover policy” last month, which allows ambulance crews to leave patients waiting at accident and emergency during periods of intense demand in order to respond to 999 calls.

However, clinicians at Brighton and Sussex University Hospital Trust, which has struggled to meet the A&E four hour target over the past year, have said the policy is “unsafe and likely to pose a notable increase to risk for patients in the emergency department”, according to a report in the trust’s February board papers.

9.30am Good morning and welcome to HSJ Live.

We start the day with a piece from Resource Centre. Achieving parity of esteem for mental health in a sustainable way requires a change in attitudes towards attention, value and expectations, argues Michael West, a consultant to GE Healthcare Finnamore and former mental health policy lead at the Department of Health.