NHS England is reporting a £136.8m deficit in specialised commissioning against a planned surplus of £59.9m.

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5:38pm This year’s HSJ 100 will be unveiled tomorrow morning at 6am. Last year, Sir David Nicholson was named the most influential person in health, followed by Robert Francis QC. Only one in five on list were women.

One year on, how much will the list have changed? Join in the discussion. Our hashtag is #HSJ100

5:08pm Another update from the health select committee hearing, David Pearl, chair of the Medical Practitioners Tribunal Service said the GMC would like legislation to give the GMC a right of appeal before the next election.

He also said the GMC wants the Medical Practitioners Tribunal Service to be put on statutory footing.

4:54pm The discussion at the health select committee hearing has turned to the issue of doctors with criminal convictions, HSJ reporter Will Hazell (@whazell) tweets.

Niall Dickson said convictions such as child sex offences are “incompatible” with the idea of being a doctor and those individuals should be struck off.

4:41pm Here’s more from the health select committee hearing, via @whazell:

Committee chair David Tredinnick asked what the GMC has done to address the disproportionate number of BME doctors who experience GMC procedures.

GMC chair Sir Peter Rubin responded that this was more a case of doctors having trained in another country rather than ethnicity.

4:28pm An update from the health select committee’s accountability hearing with the GMC, courtesy of HSJ reporter Will Hazell.

Committee chair David Tredinnick cut short a discussion on NHS England’s interim deputy chief executive Dame Barbara Hakin, saying it is “controversial”’ and the GMC should not have to answer on the hoof.

For more updates follow @whazell on Twitter.

4:15pm The Evening Standard reports on figures from NHS London revealing less than a quarter of three-year-olds in London have been vaccinated, well below the national average.

Dr Andy Mitchell,medical director for NHS England in London, told The Evening Standard: “Some London boroughs have particularly low flu vaccination rates for their two and three-year-olds. I would urge parents to talk to their local doctor or pharmacist about the vaccine so that the whole family can enjoy a happy, healthy Christmas this year.

“During winter it is important we protect at-risk groups such as the young by vaccinating them against seasonal flu. Ensuring your child is vaccinated can help prevent children from experiencing this unpleasant illness.”

3:53pm Some updates the health select committee’s accountability hearing with the GMC:

Una Lane director of registration and revalidation at the GMC said NHS restructuring the disrupted the revalidation process. She also said revalidation is a catalyst for many providers putting in place robust governance processes and can drive every single doctor to periodically seek feedback from their patients.

Niall Dickson, the GMC’s chief executive and registrar said the profession is getting used to revalidation.

GMC chair Sir Peter Rubin said unless we have good A&E role models and the right environment in departments, we wont get new doctors into emergency medicine.

For further updates, follow HSJ reporter Will Hazell on Twitter: @whazell

3:45pm Did you catch our expert debate today on whether patient safety be improved by supporting clinicians as they take clinical decisions?

If didn’t get the chance, don’t worry. You can watch it on demand at www.hsj.co.uk/hsj-tv

3:24pm HSJ reporter Will Hazell is at the health select committee’s accountability hearing with the General Medical Council. Follow him on Twitter @whazell for any updates.

2:50pm Senior medical and nursing leaders in Leeds have announced they are to set up a new institute to “provide a more joined up service” between different NHS organisations in the city.
The Leeds Institute for Quality Healthcare is a collaboration between the NHS in Leeds and the University of Leeds.
Dr Gordon Sinclair, clinical chair of Leeds West Clinical Commissioning Group, said: “Some of our traditional ways of working are changing. We are getting much better information about illness and treatment, we have rapidly advancing technology and different options for providing care.

“We believe the best way to tackle this is by getting all the nursing and medical leaders in the city together to plan new ways of working.”
Amanda Thomas, executive medical director for Leeds Community Healthcare Trust said: “Ensuring innovation and excellence across the system is a challenge for us all, and the new Institute is dedicated to making the most of our clinical knowledge about the best treatment and care.

I am sure the new institute will make a huge difference to the care people receive.”

2:23pm Health minister Jane Ellison revealed that specialised commissioning is £196.7m behind plan in 2013 to date.

NHS England is reporting a deficit of £136.8m, against a planned surplus of £59.9m.

Ms Ellison was responding to a question in parliament by Paul Burstow, a former health minister and MP for Sutton and Cheam.

2:00pm HSJ has learnt the £3.8bn Integration Transformation Fund is being quietly renamed the Better Care Fund. The prase has apparently come from communities secretary Eric Pickles.

Here’s what some of you on Twitter thought of the name change:

Simon Chapman, director of policy and parliamentary affairs at the National Council for Palliative Care (@SimonSimply):

“Integration Transformation” is provider-focused jargon. “Better coordinated care ” wd be better.”

Jon Sacker, deputy director of communications for the Health Foundation (@jsacker):

“Yes, thank you Eric Pickles - let’s not hint we might actually have to do anything difficult”

Nick Golding, HSJ news editor (@NickGolding):

“How tedious. Triumph for spin over a rare initiative which aimed to do what it says on the tin. Everything’s about better care”

1:30pm Also in Nursing Times, NHS commissioners have been criticised for failing to answer questions about patient safety and staffing issues at an urgent care centre in Loughborough.

1:28pm Our sister title Nursing Times reports that around 300 health visitors will be trained to become local experts on domestic abuse, under plans announced by the Institute of Health Visiting.

These experts will then “disseminate” their knowledge to other colleagues, the institute said in its first annual report, which was published last week.

1:09pm Ahead of the G8 dementia summit tomorrow in London, Zara Aziz, a Bristol-based GP, writes in The Guardian: “Dementia screening should not be a tick-box exercise, which is what it has become. We should be looking at the consequences of any diagnosis and what the long-term implications are for the patient and their family.

“As it stands, there is little capacity in the system to offer timely post-diagnosis support, through memory services at the clinic and social services, in all of our newly diagnosed patients and their carers.”

12:59pm Tony Beddow, former chief executive of the West Glamorgan health authority and Morriston NHS Trust, has told the BBC’s Felicity Evans that it is difficult to get to grips with the problems in the NHS because of “competing pressures” and the complexity of the health care system.

His comments follow criticisms of the Betsi Cadwaladr University Health Board in north Wales by the Welsh assembly’s public accounts committee.

12:50pm With government advisors set to upgrade ketamine from a Class C drug to Class B drug, the BBC speaks to long term ketamine users, one of whom is is had serious serious damage to her bladder and is waiting for a bladder-stretching operation.

12:30pm The charity Breakthrough Breast Cancer has responded to a report from the all party parliamentary group on cancer, which found that patients in some areas of England are four times less likely to get an early diagnosis.

Hilary Tovey, ssistant director of policy and information, said: “Breast cancer is not a done deal.  It is essential that the NHS is fit for purpose for the 41,000 women, and 350 men, who receive a breast cancer diagnosis in England each year.

“To achieve this requires a focus on earlier diagnosis, ensuring fair and routine access to all effective treatments and that local plans are in place to ensure that breast cancer prevention is of primary importance.  At a local level this means that CCGs and Local Authorities must work together with local hospitals to make cancer a priority.  Strong national leadership is needed to ensure that patients are not missing out on the best possible care because of where they live.

“Services must be designed to allow people to be treated as individuals.  Breakthrough Breast Cancer has led the way on giving patients the opportunity to feed into the improvement and development of their local services through our Service Pledge initiative.  Our ambition is that this should be rolled out to all patients across the NHS in the future.”

12:21pm Unpredictable financial flows caused by unsettled commissioning structures are causing problems for trusts, according to Trust Development Authority chief executive David Flory.

At a King’s Fund event today, Mr Flory spoke of the “really significant financial pressures” facing 31 trusts under his organisation’s remit.

12:15pm While the G8 Summit on dementia in London tomorrow is a something to celebrate, national progress is stalling and challenges remain to get the issue front of people’s minds, writes Ben Nunn, senior account manager at MHP Health.

“In the absence of any long term treatments, global leaders need to show how they are helping people with the disease to live well,” he argues.

12:09pm The HSJ100 2013 - our list of the the most annual people in health- will be published at 6am tomorrow on hsj.co.uk.

Outgoing NHS England chief executive David Nicholson topped last year’s list.

Who do you think has had the biggest impact on health in the past year? Let us know your thoughts. Our hastag is #HSJ100

12:00pm HSJ’s Will Hazell reports on Monitor increasing its scrutiny of foundation hospitals’ accident and emergency performance this winter, after being requested to do so by the health secretary.

The regulator announced yesterday that it had “agreed to supplement its routine monitoring” to ensure foundation trusts hit the flagship four hour waiting time target.

11:50am A reminder that it’s only 10 minutes to go until you can watch HSJ’s free webinar on patient safety and clinical decision support.

Make sure you register here to watch this webinar

11:45am Outsourcing giant Serco underestimated how long it would take to restructure community health services in Suffolk, its healthmanaging director has told HSJ.

Valerie Michie also admitted she would be “insane” not to consider that recent scandals which have engulfed the company and sparked a high-profile criminal investigation would have “implication in the health market”.

In a wide-ranging exclusive interview with HSJ’s James Ilman, she outlined Serco’s healthcare strategy, stating it was focusing on two areas: community healthcare and non-patient facing services in acute settings.  

11:39am According to The Independent, a survey of of nurses, midwives, paramedics, and social care staff carried out by the trade union UNISON, has found 55 per cent think cuts to healthcare had “significantly impacted on patient care and safety”.

Two in five of those questioned said they thought also found they believe the NHS is at risk of privatisation.

11:31am The Daily Mail reports that a man has died after being attacked with a bottle by a dementia patient on a hospital ward.

Richard Bowman, was a retired businessman who previously served with the Royal Regiment of Fusiliers, was found by nurses at West Suffolk Hospital in a pool of blood. He died 12 days after the attack

Mr Bowman had been admitted to the hospital with a chest infection.

“We don’t know for sure if he died because of the beating,” his son Charles Hawes said. “But I can only say what everyone else is saying – it didn’t help his situation. His body was fighting something else. He had to have surgery on his leg afterwards to repair the damage and needed a skin graft.”

A spokesman for West Suffolk Hospital said: “We would like to take this opportunity to extend our sincere condolences to the patient’s family.

“We are taking this incident extremely seriously and are carrying out a full internal investigation, as well as assisting the police.”

11:20am Also in The Daily Telegraph, a study of 2,000 men over a 35 year period that following five healthy lifestyle rules can deduce the risk of dementia by two thirds.

The rules are: regular exercise, not smoking, maintaining a low body, following a healthy diet and low alchol intake.

Peter Elwood of Cardiff University’s School of Medicine, who led the study, said following these rules had a “far more beneficial effect than any medical treatment or preventative procedure”.

11:09am In The Daily Telegraph, a new report by the all party parliamentary group on cancer has warned of stark regional divides in the level of care that cancer patients receive across the UK, with some patients facing longs waits and lacking access to treatment.

According to the report, premature death from cancer is twice likely in Liverpool as it is in Kensington and Chelsea in West London.

John Baron, chair of the parliamentary group, said late diagnosis and differences in access to radiotherapy and drugs is a “national disgrace”.

11:05am In today’s papers, The Guardian reports on rising rates of black and minority ethnic people finding stem cell donors for blood cancer treatment.

10:47am Simon Stevens, who will replace David Nicholson as NHS England chief executive next April, gave a speech on innovation and health this morning at the World Innovation Summit for Health in Doha.

He discussed the need for new models of care to promote innovation, the impact of technology from outside healthcare, out of hospital care, and new funding models.

He is currently president of the global health division at UnitedHealth Group.

10:33am Up to one in five patients could be suffering unnecessarily in hospitals across the UK because medics are making basic blunders in prescribing drips, experts have warned.

10:30am How can patient safety be improved by supporting clinicians as they take clinical decisions?HSJ is holding a free webinar today at midday to explore the answer to this question.

The panel will include Dr Rakesh Patel, NIHR academic clinical lecturer in medical education and honorary specialist registrar in nephrology at the University of Leicester.

He will be joined by Dr Peter Williams, consultant in acute and emergency medicine and clinical lecturer for acute medicine at St Helens and Knowsley Trust.

10:21am In his weekly HSj column, Michael White argues you don’t have to be Voltaire’s Dr Pangloss to hope that good will come of 2013’s crises − and personal experiences of the NHS show genuine care is alive and well.

“A family member my own age had a stroke in October and was extremely well looked after for a week in the acute stroke unit,” he says. “More to the point, the personal as well as medical care felt caring.”

10:16am Speaking of winter pressures, United Lincolnshire Hospitals Trust has issued this statement:

“United Lincolnshire Hospitals NHS Trust is currently experiencing high demand for beds and services at Lincoln County Hospital. We are asking members of the public to help us during this busy time and only use A&E if absolutely necessary and to call NHS 111 24 hours a day or seek advice from a GP or local pharmacist. We would advise people with minor injuries to consider attending their local walk-in centre in the first instance.

“With the continued support of our staff we have taken actions to meet the demand for our services. Additional ward rounds ensure people who are well enough to go home are discharged in a timely fashion which then frees up beds for other patients. We are also working with our local commissioners to help care for patients with less severe medical conditions in community based facilities.

“The hospital is liaising with Lincolnshire GPs to ensure that patients not requiring hospital care are not referred to hospital during this busy time.

“No single incident has caused this pressure.”

10:11am Monitor has agreed to add to its monitoring of foundation trusts to help them cope with winter pressures on emergency care.

It is in response to a request from health secretary Jeremy to develop relationships with NHS England and the NHS Trust Development Authority (NTDA) to manage potential demand for services over the coming months.

Under the new arrangements, Monitor will monitorthe achievement of foundation trusts against the national A&E standard on a weekly basis, help identify any local barriers to trusts treating patients within four hours and agree on remedial actions with the trust.

Where foundation trusts are needed to help to meet A&E targets, for example from commissioners or social care providers, Monitor will work with NTDA, NHS England and local urgent care working groups.

The leaders of the organisation will meet to review progress and discuss any national measures that might need to be taken. 

David Bennett, Monitor’s chief executive, said: “Monitor is committed to playing an active role in joined-up planning across the NHS in order to put patients first and ensure they get the services they need this winter.

“Our primary duty as regulator is to protect and promote the interests of patients, so we must do what we can to ensure that performance against the emergency care access standards remains strong and that no-one is subject to undue clinical risk as a result of excessive waits for treatment.”

10:00am The Department of Health paid £1.5m to the financial advisors who acted for the government in the sale of the majority stake in Plasma Resources UK, the blood products company, reveals Ben Clover.

The most recent DH accounts reveal the sum was paid to French firm Lazard for facilitating the sale of 80 per cent of the firm to Bain Capital, the private equity firm founded by former US presidential candidate Mitt Romney.

9:56am Councillors in South Gloucestershire have voted to refer plans to axe outpatient and diagnostic services at a local site to the health secretary, HSJ’s Sarah Calkin reports.

Almost all acute healthcare is due to cease at Frenchay Hospital when North Bristol Trust consolidates the bulk of its services in a new private finance initiative hospital at its Southmead location next year.

9:44am In resource centre, Dr Eric Kelly looks at negative perceptions of telehealth and shares his experience of deploying a GP led telehealth programme that has reduced admissions and improved patient outcomes.

7:00am Good morning and welcome to HSJ Live. Tim Kelsey, national director for patients and information at NHS England, has written for HSJ about the friends and family test and opening up the NHS through digitisation to real-time patient feedback.

Mr Kelsey argues that while the test has its critics, “the evidence after six months is of overwhelming human benefit”, and that from next year NHS England will require every local organisation to give people the opportunity to comment on, as well as rate, services. He signs off: “We are witnessing the birth of a new knowledge economy and a new social movement. The future is open.”