Progress towards better representation of people of black and minority ethnic backgrounds at senior levels labelled “glacial”, plus the rest of today’s news and comment.

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5.30pm Tomorrow lunchtime make sure you take part in HSJ’s latest Twitter chat on commissioning end of life care and keeping terminally ill people out of hospital.

With an ageing population and death rates set to rise by 17 per cent from 2012 to 2030, the pressure on the healthcare system to provide end of life care will only increase. Hospitals will struggle to meet this additional demand and, in any case, research shows that most people do not want to die in a hospital setting.

Tomorrow at 12pm, HSJ – in association with Marie Curie Cancer Care – will be running a Twitter chat to discuss how we can commission care to keep terminally ill people out of hospital if there is no medical reason to be there.

  •  How can we move more resources to a community-based model of care?
  •  How can we ensure all end of life care is centred on the needs and preferences of the patient and his or her family?
  •  What needs to change to make this sort of care a reality?

Michael Cooke, Marie Curie’s head of analytics, and Phil McCarvill, Marie Curie’s head of policy for England, will be online taking questions and offering thoughts.

Follow the @HSJnews and @MarieCurieEOLC Twitter accounts to take part. We will be using #HSJEOLC – you can use this now to pose questions for the debate.

5.15pm Public Health England has estimated the number of deaths that can be attributed to particle air pollution in all local authorities in the UK for the first time.

The figures have been calculated by modelling annual average concentrations of man-made particles less than 2.5 microns in diameter, known as PM2.5 and their impacts on health.

It builds on figures produced for the Public Health Outcomes Framework which estimate the percentage of deaths associated with long term exposure to particulate air pollution in local authorities in England.

The estimates are made for long term exposure to particulate air pollution rather than short term exposure to high pollution episodes, such as those experiencelast week across the UK.

Sotiris Vardoulakis, PHE’s head of air pollution and climate change, said: “The report has been produced to inform public health professionals and air quality specialists in local authorities about the likely effects of particle air pollution on public health in the UK. The estimates are intended to help local authorities consider air pollution among other public health issues.

“Much outdoor air pollution comes from burning fuels to generate heat and electricity, and from vehicles. Measures that significantly reduce particulate air pollution or cut exposure would be regarded as important public health initiatives.”

The Committee on the Medical Effects of Air Pollutants has estimated that long term exposure to air pollution had an effect equivalent to 29,000 deaths a year in the UK in 2008, despite tighter environmental legislation in recent years.

Paul Cosford, PHE’s director of health protection and medical director, said: “Policies that encourage a shift from motorised transport to walking and cycling would be expected to reduce total vehicle emissions, including particulate pollution. If this could be achieved in towns and cities, then we could expect local improvements in air quality. There would also be health benefits from increased physical activity through walking and cycling.

“Local authorities could also consider other measures to improve air quality, such as implementing low emission strategies as well as the appropriate design of green spaces.”

5.00pm Following High Court action by the British Association of Physicians of Indian Origin (BAPIO) against the Royal College of GPs on the clinical skills assessment of its MRCGP examination, RCGP chair Maureen Baker said: “We welcome the verdict of the Court that the Clinical Skills Assessment (CSA), run by the RCGP, is lawful and fair.

“Patients have a right to expect safe care and it is our responsibility to ensure that all doctors who qualify as GPs meet the highest standards to ensure this safe care. That is the purpose of this exam, and the other requirements to become a practising GP.

“As an organisation committed to equality and diversity, we take multiple steps to ensure that our exam is robust, but fair to all candidates. These steps include giving our examiners and role players equality and diversity training, and ensuring that our examiners and role players come from diverse backgrounds.

“The RCGP has been at the forefront of identifying the differences in pass rates for some time, including that international medical graduates do not do as well in the exam as those from UK medical schools.

“Indeed, we were the first of the Medical Royal Colleges to publicly raise this issue and have commissioned and supported extensive research to understand what is happening and to try and identify what the causes may be.

“We have always been, and remain, concerned by this issue, and are determined to continue to work with all other interested stakeholders in both understanding it, and looking to remedy it.

“This will include working with both the GMC, as our regulator, and also with the training deaneries / local education and training boards who have responsibility for the training of those who take the examination. We will also continue to work with BAPIO, the British International Doctors’ Association (BIDA) and the BMA in relation to this issue.

“We agree that further action is needed, and we are already working hard to find the best way of supporting the small number of trainees who fail to pass the CSA component of the MRCGP licensing exam to give them every chance of passing the exam.

“We are already developing further web-based learning resources and publications to help trainees and their trainers prepare for the exam and are reviewing how to improve the quality of feedback that candidates receive from the exam so that they can target any areas of underperformance with their trainer.

“We are also committed to acting on recommendations made in recent reviews to ensure the MRCGP minimises any possible risks of unfairness and we are very keen to work with the GP training community to develop effective training strategies for those who might struggle with the exam.

“Overall, around 95 per cent of candidates will pass the CSA. Of the College’s 30,271 Fellows and Members, who have declared their ethnicity, 30% are from a BME background.

“We hope that today’s judgment means we can now draw a line under the events of the past year and concentrate on delivering a robust and fair exam for future generations of GPs and for the benefit of our patients.”

4.45pm A clinical commissioning group in the North West is to part fund a £470,000 service for parents struggling to form relationships with their babies, becoming one of the first CCGs in the country to fund such a service.

The CCG is funding the scheme with charity Parent Infant Partnership UK. The two organisations have each contributed £235,000 for the three-year contract, which will be run  by social enterprise Person Shaped Support.

4.30pm South Devon Healthcare Foundation Trust has appointed an interim chief executive following the suspension of Paula Vasco-Knight after a tribunal found evidence that the trust had covered up claims of nepotism against her.

4.15pm South Somerset’s Symphony project constructs morbidity profiles for a range long term conditions – showing the true cost and the extent of multi-morbidities. Andrew Street, Panos Kasteridis and Jeremy Martin explain.

4.00pm Nursing Times also reports on an intravenous drug that is taken once a year over two years looking set to gain official approval as a new treatment option for multiple sclerosis.

3.45pm Our other sister title Nursing Times reports on a massive recruitment drive by a London hospital, with £3.5m investment into 250 additional nurses.

3.15pm In our sister title Local Government Chronicle, the size of the third sector delivering health and social care services more than doubled last year, research has revealed.

Data from website RBS SE100 showed that the combined turnover of social enterprises in health and social care grew 121% from 2011-12 to 2012-13.

3.00pm NHS spending private and voluntary services to provide 999 care has nearly doubled in three years, according to an investigation by The Telegraph.

The paper found that seven of the ten ambulance trusts in England increased spending on commercial firms and voluntary ambulances since 2010.

Cliff Mann, president of the College of Emergency Medicine, which represents emergency doctors, said: “When trusts began using private firms for 999 calls they said it was only as a ‘last resort’ but the scale here is nothing is like that – it’s deeply concerning.”

“It is incredibly wasteful – because trusts have to pay a premium to use these agencies – and it’s also potentially dangerous because they aren’t part of the normal system of monitoring so it’s harder to know how safe they are.”

2.30pm The Daily Telegraph (newspaper only) reports that Wales has the worst waiting times for diagnostic tests across Britain, according to new figures.

2.15pm The BBC reports that cuts to mental health care are costing the NHS millions in the long term, according to a study by the charity Rethink Mental Illness and the London School of Economics.

A reports argues the NHS could save more than £50m a year by strenthening early detection services.

Martin McShane, NHS England’s national director for long-term conditions, said the report was “very helpful”.

He said: “We recognise we must work to ensure that in everything we do mental health has parity of esteem with physical health.

“We have significantly invested in improving access to psychological therapies and dementia care.”

2.00pm Also in The Times, Jenni Russell writes that the UK “needs a revolution” in how it deals with the isolation of the elderly.

Following a warning last week from a leading psychiatrist from the Royal College of Psychiatry that depression in the elderly was the country’s “next big public health problem”,

Ms Russell writes:  “We can’t prevent physical deterioration or mental confusion, but much of what makes us sad as we age is dwindling social contact and the sense that we no longer command others’ interest, affection and respect”.

She mentions an idea from science professor, Heinz Wolff, that people could earn their own care in the future by using a time bank to help others now.

1.45pm The Times (newspaper only) reports that a 64-year old man died following “serious, repeated and systemic failures” after he was ignored for 14 hours by ambulance and hospital staff who seemed oblivious to his condition, an inquest in Nottingham was told.

Stewart Maltby, from Farnsfield near Mansfield, did not receive the fluids that he required after suffering kidney failure because of a catalogue of errors.

During his care there were also delays getting him to hospital after his GP dialled 999 asking him to be admitted on November 5, 2012.

At the hospital, despite his condition deteriorating, no one stepped in to save him, with healthcare professionals apparently too busy. He died on 7 November.

1.15pm A formal complaint over the handling of a Dr Foster Intelligence audit into mortality rates at Bolton Foundation Trust has been substantially upheld. 

The Dr Foster Ethics Committee, who undertook the investigation into the complaint, concluded that Dr Foster had fallen below the standards expected of them.

The audit, published last year, raised concerns over the high number of cases had been recoded as sepsis.

Two independent reviews conducted following the audit found there was no evidence of wrongdoing by the trust.

Trust chair David Wakefield, who lodged the complaint on behalf of the trust, welcomed the outcome of the review,

He said: “I hopeDr Foster learn from this. They failed to follow the processes expected in an audit such as this and their conclusions on our clinical review process were flawed.

“Their failure to recognise the bigger patient safety issue — early identification and treatment of sepis — temporarily and unnecessarily damaged the reputation of the trust.

“We believe they owe a duty of care to all trusts and clinicians in areas where it impacts on the confidence of patients.

“We are proud of the work Dr Jackie Bene and her team have undertaken in the treatment of sepsis over several years and we were saddened by the negative publicity surrounding this audit at the time. 

“We are disappointed that Dr Foster have not apologised to the trust and in particular to Dr Bene.”

12.45pm Ben Goldacre writes for The Guardian about what the Tamiflu saga reveals about drug trials and the pharmaceutical industry.

He argues: “That is a scandal because the UK government spent £0.5bn stockpiling this drug in the hope that it would help prevent serious side-effects from flu infection.

“But the bigger scandal is that Roche broke no law by withholding vital information on how well its drug works. In fact, the methods and results of clinical trials on the drugs we use today are still routinely and legally being withheld from doctors, researchers and patients.

“It is simple bad luck for Roche that Tamiflu became, arbitrarily, the poster child for the missing-data story.”

12.30pm With a recent review raising questions about the government’s stockpile of Tamiflu, The Guardian looks back to 2005, when countries including the UK began accumulating the anti-flu drug over fears of a bird flu pandemic.

In March that year, Liam Donaldson, then the UK’s chief medical officer, said: “We must assume we will be unable to prevent it reaching the UK. When it does, its impact will be severe in the number of illnesses and the disruption to everyday life.”

12.00pm The Royal College of Surgeons has elected its first female president.

Orthopaedic surgeon Clare Marx will take up the position in July. Her presidency is will last three years, subject to annual re-election by the RCS Council.

Ms Marx is currently associate medical director at Ipswich Hospital Trust, and served as vice-chair of the NHS’s surgical never events taskforce. 

Outgoing president Norman Williams, said: “This is an historic day for the College as we welcome the first female president-elect.  

“I know she will perform the role with great aplomb. Her work on patient safety and efforts to improve the quality of care demonstrates her commitment to the values we hold dear.”

11.50am A growing amount of evidence shows that little progress is being made on improving diversity at the top of the NHS – and this is compromising patient care, writes Roger Kline, research fellow at Middlesex University and associate with Public World.

“Staff are the most important asset the NHS has and their fair treatment is a prerequisite for the best possible patient care,” he argues. “First the snowy white peaks have to accept we have a very serious problem and listen to, and engage with, BME staff.”

HSJ today exclusively reports on a study led by Mr Kline, which has found the proportion of senior NHS positions held by people of black and minority ethnic backgrounds has barely changed in eight years.

11.35am In today’s papers, The Guardian’s editorial states: “The government has spent more than £500m stockpiling the drugs against a flu pandemic. On the face of it, that was a bad call.

The paper argues: “The protocols surrounding trials need to be streamlined so that in short-lived pandemics, where a huge cohort is suddenly available…. Like all great science, it is an idea with the beauty of simplicity.”

11.15am Ministers should review the use of a widely used anti-flu medication, scientists have said after new research questioned the efficacy of the drug.

The study suggested that Tamiflu, which is used to prevent and treat influenza, shortens flu symptoms by between a day and half a day. But the authors said there is “no good evidence” to support claims that it reduces flu-related hospital admissions or the complications of influenza.

11.00am HSJ reporter Nick Renaud-Komiya is tweeting from the Association of the British Pharmaceutical Industry conference today.

Follow @NickRenKom on Twitter for regular updates throughout the day.

10.45am At least four in 10 local areas will see councils and NHS groups share more funds than required by the government’s £3.8bn better care fund, new analysis reveals.

A study of draft health and care integration plans by the Local Government Association shows that 57 of 135 health and wellbeing boards plan to share more cash than the government requires.

10.30am In his leader column, HSJ editor Alastair McLellan says the foundation trust pipeline is low on the NHS’s priorities and has almost run dry – the government should process no more applications after the summer.

10.15am The NHS Confederation has also welcomed Monitor’s strategy for 2014-17.

Its chief operating officer Matt Tee said: “We have previously voiced our concern about how proactive the NHS is when it comes to dealing with failure.

“The NHS Confederation welcomes the risk-based approach to regulation Monitor is taking so that it better supports organisations that are in danger of failing.

“Early intervention is necessary so that changes are planned to avoid them being crisis-driven. It is also important to remember that change affects the wider health economy, and not just the organisation in isolation, which is why the focus on whole system changes is welcomed.

“Provided that regulators such as Monitor are willing to support organisations before they reach a crisis, we will have a better chance of rising to the challenges facing the whole system. This is why our 2015 Challenge calls on both politicians to create the space for the change needed and local NHS organisations to be ready to make the essential changes.

“Our members would also support a renewed patient focus. Regulation can often be perceived to just be about outputs, evidence and audits, and we sometimes forget what regulators are trying to do – help organisations deliver better patient care.”

10.00am The Foundation Trust Network has said it supports Monitor’s corporate strategy for 2014-17, launched today.

Head of policy Miriam Deakin said: “Monitor’s strategy comes at a crucial time. Patient expectations for the quality and accessibility of services are understandably rising, while financial pressures continue to grow, and there is significant pressure for service change.

“We particularly welcome that the strategy spells out how Monitor will operate in its role and use the full range of its regulatory powers to advance its core duty to protect and promote the interests of patients.

“This means striking the right balance between letting local trust boards have the independence to make decisions that are right for their communities, against the need to manage risks to services and to intervene if providers get into difficulty.

“Monitor must also work together closely with other key national bodies, including the new Competition and Markets Authority, to minimise burden and duplication for trusts and to ensure a consistent regulatory approach that puts the interests of patients first.

“Immediate priorities for our members include respecting foundation trusts autonomy and ability to deliver for patients and avoiding undue performance management, developing fair pricing mechanisms for care across acute, community, mental health and ambulance settings, ensuring risk is shared across the whole system; and ensuring that procurement, choice and competition work in the best interests of patients.

“We look forward to working with Monitor as it translates the positive intentions of this strategy into effective day-to-day operation as the sector regulator.”

9.45am In a HSJ interview, David Bennett said it will be easier for the regulator to assuage commissioners’ concerns about NHS competition rules now that Sir David Nicholson is no longer in charge of NHS England.

He said Simon Stevens, who took over as NHS England chief executive this month, was probably “more sympathetic to the role that competition and choice can play” in the health service.

9.30am EXCLUSIVE: The huge uncertainties facing NHS providers mean Monitor will have to focus less on “the numbers” in trusts’ financial plans and more on their capability to deal with change, the regulator’s chief executive has said.

David Bennett told HSJ that mounting financial pressures on the health service had created a “pressing need” to accelerate major reforms to the way care was delivered, and that Monitor needed to play a significant role in “turbo-charging change”.

7.00am Good morning and welcome to HSJ Live. We begin with the news that a study has found the proportion of senior NHS positions held by people of black and minority ethnic backgrounds has barely changed in eight years, with progress towards better representation labelled as “glacial”.

A study by a Middlesex University academic found the number of appointments to NHS trust boards of people from a BME background dropped from a high of 8.7 per cent in 2006 to just 5.8 per cent in 2013 – its second lowest rate since 2007.