HSJ Live 10.12.2014: CQC agrees half a million pound out of court libel deal

5.20pm Politician’s priorities do not match those of health and social care managers, according to new research.

A report from the Chartered Management Institute has found that despite Westminster’s preoccupation with immigration, managers in the health sector say limiting the movement of labour across the UK is not a priority for them, with more opposed to the idea (36 per cent) than supportive (30 per cent). Other priorities include support for developing new, employer-led management apprenticeships 84 per cent and providing work experience for every young person, which had a net support level of 80 per cent.

The annual Future Forecast survey of 1,253 managers across all industry sectors, including 124 in the health and social care sector found that many key pledges from the leading political parties did not chime with the priorities of managers. Politicians are focusing on abolishing zero-hour contracts which only scored 30 per cent net agreement with health and social care sector managers, whereas 60 per cent supported an increase in the national minimum wage.

The report reveals that a focus on people and skills tops health and social care managers’ business priorities for 2015. ‘Developing people’ has made it into the top three management priorities for the year ahead, and joins ‘controlling costs’ and ‘managing performance’, as focuses for 2015. Training and development is also one of the areas most likely to see increased employer spending in 2015, with 50 per cent reporting that budgets are set to increase.

Health and social care managers’ personal resolutions for the New Year are also all about people. Not only are bosses pledging to support the development of their team’s skills (67 per cent), they are also keen to devote more time to their own professional development as leaders (55 per cent).

Ann Francke, chief executive of the CMI, said there was a “mismatch between the Westminster village and UK managers”.

Ms Francke said: “Our report shows that it’s all about improving productivity. Employers want people-focused policies that will help them upskill and motivate their teams.

“Rather than election rhetoric we need to see a commitment to shifting business culture in this direction.

“We must move away from an obsession with short-term priorities and help organisations to be clearer about their purpose, to better support their people, and to invest to grow future potential.”

3.55pm During Prime Ministers questions today, one of the topics of debate was the decision by NEW Devon CCG to impose certain restrictions on access to treatment for smokers and obese people. Here is an extract of the exchange below:

Mr Ben Bradshaw (Exeter) (Lab): What does the Deputy Prime Minister think of the fact that under his Government if he now needed an operation in Devon, he would be denied it because he smokes, as would the Communities and Local Government Secretary because of his size?

The Deputy Prime Minister: That’s a bit harsh. I do not think anyone would disagree with clinicians in Devon and elsewhere urging patients to look after themselves and prepare themselves for operation. My understanding is that the decision—or the announcement mooted—in Devon is about patients preparing for operations, but of course I disagree with the idea of, in effect, rationing in this way, which is one of the reasons we have announced, in total, £3 billion of extra money for our beloved NHS.

3.36pm The General Medical Council’s annual fee, paid by doctors with a licence to practise, will increase by £30 – from £390 to £420. The rise, the first since 2010, will apply from 1 April 2015.

The GMC will continue to provide support to newly qualified doctors at the start of their careers by freezing the provisional registration fee at £90. Doctors on a lower income will continue to be eligible for a 50% discount.

The decision to restore the 2010 level follows increased demand for the GMC’s services. In 2015, the doctors’ regulator expects to process more than 20,000 registration applications and more than 75,000 revalidation decisions, as well as handling an increase in serious complaints, which is likely to result in over 2,800 fitness to practise hearing days.

In addition, demands on its oversight of medical education have increased with enhanced monitoring of areas where there are concerns.

Looking ahead, the Council of the GMC is determined that everything should be done to bear down on cost to keep the ARF as low as possible.

This year the GMC fee also includes the Government’s new statutory levy on regulators to fund the work of the Professional Standards Authority. This will amount to £600,000 from April 2015 to the end of the year, rising to £800,000 in 2016.

Niall Dickson, the Chief Executive of the General Medical Council said: ‘For five years we have succeeded in cutting or freezing our fee – increased demand now means we need to restore it to the level it was in 2010, if we are to continue to meet our wide-ranging obligations. These responsibilities have increased substantially in recent years with, for example, the introduction of revalidation and the oversight of postgraduate education.

‘In 2015 we will scale up our programme of engagement with doctors and medical students on ethics, professional standards and other practical issues of professionalism. In addition, we will roll out the Welcome to UK Practice programme for doctors new to the UK, take forward significant work to make better use of our data, progress plans to make the medical register much more useful and develop a national licensing exam. 

‘We will continue to offer reduced rates to those who are newly qualified or on lower incomes but we do recognise these are challenging times for all doctors and we are determined to provide value for money.’

3.35pm At a senior discussion today leaders from ten major national healthcare bodies in England signed a pledge committing to improving staff experience in their organisations, including wellbeing and engagement, which underpin quality care for NHS patients.

 Dr Dan Poulter (Health Minister), Simon Stevens (Chief Executive of NHS England) and Danny Mortimer (newly in-post Chief Executive of the NHS Employers organisation) are among those who have signed the pledge, which was developed by NHS Employers and announced at its NHS Staff Experience Summit today.

 The discussion focused on the five aspects of the pledge which states organisations will “work towards fostering a culture where the experience of staff working in healthcare is a positive one and enables them to deliver their role with care, compassion and commitment”. They are:

Lead by example to foster a culture that engages and listens to staff, and then acts with that knowledge and understanding in mind, both within our own organisations and across the health system.

Measure employee engagement and health and wellbeing within our organisations.

Increase and strengthen staff engagement throughout our work.

Promote a culture that recognises parity of esteem in relation to physical and emotional wellbeing and actively encourages better physical and emotional wellbeing for staff within our organisation.

Continue to build on the relationships we have with other stakeholders, sharing expertise and experience in safeguarding, improving staff health and wellbeing, and developing effective approaches to staff engagement.

 Danny Mortimer, Chief Executive of the NHS Employers organisation which ran the Summit and organised the pledge, said: “I’m extremely pleased the pledge has received the strongest possible support. Employers across the NHS have a real appreciation that their ability to provide the best experience to their patients and communities is profoundly linked to the experience of the people providing their services. This pledge challenges us to further our efforts to improve our workplaces, and I know that Boards across the NHS will extend their support for ever more ambitious and impactful programmes to improve staff experience.”

Dr Dan Poulter, Health Minister, said: “Listening to staff and supporting them is vital in creating the right working environment where patients receive the best possible care. This pledge will help improve the wellbeing of our NHS workforce.”

The pledge is supported by the best evidence and research. For example, a review published by NHS Employers in November demonstrated a compelling need to improve the evaluation of wellbeing plans in order to sustain them as part of NHS business planning.

 The signatories who also discussed the issues at the Summit were:

David Behan CBE, Chief Executive of the Care Quality Commission

Dr David Bennett, Chief Executive of Monitor

Prof Dame Carol Black, expert advisor on work and health Department of Health

Helen Buckingham, Chief of Staff at Monitor

Prof. Ian Cumming OBE, Chief Executive of Health Education England

Kevin Fenton, National Director of Health and Wellbeing at Public Health England

David Flory CBE, Chief Executive of the NHS Trust Development Authority

Charlie Massey, Director General, Strategy and External Relations Department of Health

Danny Mortimer, Chief Executive of the NHS Employers organisation

Jan Sobieraj, Managing Director of the NHS Leadership Academy

Simon Stevens, Chief Executive of NHS England

Rob Webster, Chief Executive of the NHS Confederation

1.30pm The Daily Telegraph reports that NHS screening misses more than 2,000 cases of breast cancer a year, research suggests. Women should be offered ultrasound scans because mammograms are missing too many cases, the study said.

Researchers called for radical changes in the UK following the findings from American trials.

1.27pm Hospitals across the North West paid the highest rates for locum medical staff, an analysis of expenditure on temporary staff in 2013-14 has indicated.

The study of £69.8m of spending by 37 NHS providers found the region’s average pay rate for locums (£65 per hour) was more than 40 per cent higher than in Yorkshire and the Humber, which paid the lowest rates of £46 per hour.

The analysis by financial services firm Liaison also found relatively high levels of locum spending in accident and emergency departments, which it said was driven by an “acute” shortage of specialist staff.

1.25pm The Guardian reports that NHS spending on management consultants who charge up to £4,000 a day has soared to £640m a year under the coalition, despite ministerial pledges to reduce the pay out, official figures reveal.

The amount hospitals and other NHS organisations spend on external advice has more than doubled, from £313m in 2010, the Department of Health said.

David Oliver, a former government adviser on care for older people , obtained the figures under freedom of information laws. Vital NHS funds, he said, were being wasted over advice on issues the service should not need.

11:55am A government backed review of NHS procurement has been expanded to examine the “concerning” risk in temporary staff bills, its head has revealed to HSJ.

Lord Carter, the Labour peer appointed by the Department of Health to lead the review, said it would seek to assess a broader “scale of opportunities” for savings in the NHS.

The review was originally established to help the DH cut £2bn from the NHS’s £22bn procurement bill by 2015-16.

11:45am The National Institute for Health and Care Excellence (NICE) is updating its guidance to support adults and children with diabetes and help them have as normal a life as possible. The institute has opened consultation on two draft guidelines for adults with type 1 diabetes and children and young people with either type 1 or 2.

Diabetes is becoming more common in children and young people in the UK. Last year there were 24,000 children with type 1 diabetes and 450 with type 2.

Since the publication of the 2004 recommendations there have been major advances in managing type 1 diabetes in children and the updated guideline is the first national guidance to set out how to help children achieve blood sugar levels as near to the normal levels in healthy children.

The draft recommendations propose achieving better control by offering intensive insulin management either with multiple daily injections or portable devices (insulin pumps). Insulin therapy should be offered alongside dietary advice specific to treatments such as courses to help understand how carbohydrates affect blood sugar or medicines.

Children with type 2 diabetes are often overweight or obese and this can lead to further problems with their kidneys, blood pressure or cholesterol levels. The updated draft guideline also includes new detailed recommendations for healthcare professionals on how to diagnose and treat these complications.

There are over 370,000 adults with type 1 diabetes in the UK.

Most adults do not achieve their blood sugar targets and increasing numbers will go on to suffer kidney failure or ketoacidosis – a condition where the body starts to break down fats as a source of fuel and which in the worst cases can lead to dehydration, coma or swelling on the brain.

As with the draft guideline for children, there is a call for healthcare professionals to support adults to achieve normal blood sugar levels taking into consideration their personal preferences, day-to-day lifestyle and any potential complications.

This includes a draft recommendation for adults with type 1 diabetes to be seen at least every 3-6 months to have their blood sugar measured. It also calls for adults to be supported to self-monitor their blood sugar at least 4 times a day and even more frequently if they are not reaching targets or are carrying out certain activities such as driving or sport.

Other key priorities include making sure all adults with type 1 diabetes go on a structured education course to better understand their condition and offering multiple daily insulin injections as the treatment of choice.

Professor Mark Baker, director of clinical practice at NICE said: “In the past decade there have been major changes in how we routinely manage both adults and children with diabetes and it is now possible for many to achieve much stricter targets for their blood sugar levels. Both draft guideline updates cover new knowledge and technologies which support better diabetes control, with evidence-based advice on how to use this to support adults and children in living their lives to the fullest.

“There are recommendations on the appropriate diagnosis, insulin therapy, dietary advice, hospital care and education courses to offer adults and children with diabetes, as well as their family and carers. We now want to hear from all those involved in the care of adults and children with diabetes to inform our recommendations and shape the final guideline.”

Both draft guidelines are now open for consultation. All registered stakeholders and members of the public are now able to submit their comments via the NICE website until Wednesday 4 March 2015.

NICE is also updating its guidelines for type 2 diabetes in adults and diabetic footcare; these are due to open for consultation in January 2015.

10.50am Looking to this morning’s papers, The Financial Times reports that five government departments, including the Department of Health, awarded G4S and Serco fresh work during a period in which Whitehall “gave the impression”  that all business with the two outsourcing companies was on hold until the outcome of a review.

The Cabinet Office was widely understood to have barred Serco and G4S from winning new government work until they had they undergone a period of “corporate renewal” after both companies were referred to the Serious Fraud Office for overcharging on electronic monitoring contracts.

But an investigation by the Commons public accounts committee found that the two companies were quietly awarded 14 pieces of additional work worth £350m in the probation period that ended in February for Serco and in April for G4S.

10.38am Nearly a third of current adult smokers reported that they had used an electronic cigarette (e-cigarette, also called vapouriser) in the past. 

Figures published by the Health and Social Care Information Centre look at survey participants’ smoking habits and for the first time included questions around e-cigarette use. Three per cent of adults reported that they were currently using e-cigarettes.

The Health Survey for England 2013, which covers a range of health and care topics, included questions on social care, eye care and end of life care. The findings estimate that among the adult population in England in 2013:

Smoking

• There has been a steady decline in the proportion of current women smokers over the last decade of seven percentage points (24 per cent in 2003, 17 per cent in 2013). However, the proportion of current male smokers has changed less; down from 27 per cent in 2003 to 24 per cent in 2013.
• One per cent of non-smokers reported that they had ever used e-cigarettes.
• Self-reported exposure to second-hand smoke was highest among those aged 16-24 with over half of participants in this age group (59 per cent of men, 55 per cent of women) reporting at least some exposure.

Social care for people aged over 65

• One third (33 per cent) of women and under a quarter of men (23 per cent) reported needing help with at least one activity of daily living.
• 35 per cent of women and 22 per cent of men, reported that they needed help with an activity that was important to living independently.
• Help with activities important to independent living was most frequently provided by a spouse or partner for men (47 per cent) and by a daughter for women (38 per cent).

Eye care

• Almost one in three women (29 per cent) and two in five men (41 per cent), reported that they did not have an eye test at least every two years, which is the minimum frequency recommended by RNIB^.

Participants were asked to rate their eyesight assuming that they were using their glasses or contact lenses, if needed:

• Almost two thirds of adults rated their eyesight as excellent or very good, (62 per cent of women and 66 per cent of men). Eight per cent of both sexes said that their eyesight was fair or poor.
• Self-reported eyesight got worse with age; and a quarter of adults aged 85 and over, (24 per cent of women, 26 per cent of men), rated their eyesight as fair or poor.

End of life care

Around a quarter of participants reported that someone close to them had died from a terminal illness in the last five years (26 per cent of women and 23 per cent of men). Of these:

• More than four out of ten participants (42 percent of women, 47 per cent of men) reported that the place the person close to them had died was a hospital. 30 per cent reported their loved one died at home.
• More than four out of ten women, (43 per cent) and a third of men (33 per cent), provided personal care, other care or both types of care⁹ to the person close to them that died.
• More than three quarters of adults (78 per cent of women and 76 per cent of men) said that they would definitely take on the role of caring again in similar circumstances.

HSCIC Chair Kingsley Manning said: “The publication of the Health Survey for England provides us with valuable information on the health and lifestyle of the population. This report enables us to find out information on how these topics affect members of the public.

“For the first time we have been able to look at the use of e-cigarettes within our report, as well as looking at topics such as eye care, end of life care and social care.”

Read the report here: http://www.hscic.gov.uk/pubs/healthsurveyeng13

7.00am The Care Quality Commission has reached an out of court settlement with its former deputy chief executive who had sued for libel over claims she was part of an alleged cover up.