Older peoples’ charity warns of a “marked rise” in the length of time elderly people are held up in hospital while they wait for social care, plus the rest of the day’s news and comment

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5.30pm In case you missed it, Monitor is recruiting for a new chair.

5.25pm Here’s a blog post from someone who went through the NHS Leadership Academy programme recently and decided to leave halfway through. They share their misgivings about the programme.

5.05pm The Equality and Human Rights Commission has launched an inquiry into the non-natural deaths of adults with mental health conditions who die while being detained by the state.

The inquiry will look at suicide, homicide, unknown and accidental deaths of people in psychiatric hospitals, prison and police custody in England and Wales, to identify what can be done to help prevent more tragedies.

According to official figures 215 people died in prison last year - the highest number since records began. Of these 74 were suicides. There were 98 non-natural deaths of people detained in psychiatric hospitals and almost half of those who died in police custody in 2012/13 had mental health conditions.

The inquiry will look at existing evidence from 2010 to 2013 across the three sectors, to pinpoint trends and systemic issues that might be resulting in people losing their lives. It will also consider whether ethnicity, gender and sexual orientation and other protected characteristics under the Equality Act 2010 have a bearing on non-natural deaths.

A report on the findings will be published in spring 2015, with recommendations for action needed by relevant bodies.

4.18pm The rise in ‘non-accident and emergency’ A&E attenders is partly due to the offer to patients and the expectations the NHS itself has laid down, write Andy Williams and Alex Khaldi in our Resource section.

3.42pm A war of words has broken out between the lawyers representing Bristol CCG and Protect our NHS in a legal battle. HSJ reported earlier today that the CCG had agreed to amend its constitution after the local campaign group threatened a judicial review on the grounds the CCG was not meeting its legal requirements to involve patients and the public in decision making.

In a statement the CCG said Protect Our NHS had dropped the legal challenge and “no finding of unlawful behaviour by the CCG has been made”.

However, Leigh Day, acting for the campaigners, claims this statement is “misleading” and have renewed the threat of judicial review. They have written to the CCG’s legal representatives Bevan Brittan asking them to ensure their client withdraws the press release. The letter continues: “It is misleading and if your client refuses, we will write to draw it conduct [sic] to the attention of the court and invite the court not to make the agreed order and instead to grant permission and allow the case to proceed to a trial.”

3.20pm There are some thought-provoking comments beneath our story about NHS England possibly tendering out child and adolescent mental health services:

“The situation with Tier 4 CAMHS is a direct result of the fragmentation of children’s commissioning, the reluctance of NHS England to work with Independent Sector providers even though long standing arrnagements were in place and a lack of capacity to actively case manage placements.”

“Why the increased need for Tier 4 beds? Factors are the ousting of experienced and specialist clinicians from Tier 3, the focus on short term interventions which can’t tackle complex problems, lack of time to make complex clinical decisions, a lack of support for difficult risk management decisions other than to admit to Tier 4 and where has Tier 2 gone? Answers on a P45, please.”

“My daughter suffers from serious mental illness and this begain to reveal itself from the age of about 12. “Fortunately” we live very close to the tier 4 service in our area. She has had admissions under sections following full on manic/psychotic episodes which take her months to recover from. Some of the other poor young people on the ward she has been in and out of live many many miles away. This is extremely detrimental to their treatment since the involvment of family is clearly vital. The condition of the buildings that the ward is located in are frankly a disgrace. The state of the buildings and their layout and design was actually counter-therapeautic Something is now being done about this I believe.
The support in the community for our daughter was virtually non existent. Social services have no idea at all about children with SMI. Beds ARE vital - there is no way someone as ill as our daughter could be managed in the community. However there is certainly a point at which she could have come home if there was some intensive community based support. But it needs to be very intense (at least inititally and probably for sometime) and this means at least up to 12 hours a days of dedicated care plus 24/7 on call plus close and regular direct clinical supervision. This is probably less expensive than the FULL cost of inpatient care. But it is still pretty costly and it can’t replace the inpatient beds - they are still needed for the very acute phase. So the FULL costs associated with beds will not be realisible. The answer maybe something that lies between these two things but it will not be cost neutral - it will require considerable investment.”

2.05pm The government last night tabled amendments to the Criminal Justice and Courts Bill to introduce an offence of ill-treatment or wilful neglect.

At present, prosecutions for a statutory offence of ill-treatment or wilful neglect can only occur in respect of certain settings, such as mental health care, where a person lacks mental capacity, and in relation to children in certain circumstances.

Care and support minister, Norman Lamb, said: “Our healthcare system is the envy of the world. The NHS is full of caring and compassionate staff delivering the best care for patients. But the Francis Inquiry showed that sometimes the standard of care is not good enough. That’s why we are making it a criminal offence when a patient suffers ill-treatment or wilful neglect.

“This is not about punishing honest mistakes — it is about closing the gap in current laws so that this type of poor care cannot go unpunished. The proposal is part of a package of measures after Francis to ensure better protections for patients, more support for NHS staff and greater transparency and openness in the NHS.”

A full news story will follow shortly.

Three of the seven trusts - Derby Hospitals Foundation Trust, Ipswich Hospital Trust and Walsall Healthcare Trust - told HSJ they had failed to meet their statutory duty to provide the data because of problems with their Lorenzo patient administration systems.

All three introduced the system between February and March.

Derby said “the implementation of Lorenzo” had “hindered the production of referral to treatment and activity data”.

Bristol CCG maintains that “in substance” it has had “proper” arrangements for public involvement in place since its inception in April 2013. However, following the challenge by Protect Our NHS it has agreed to amend its procurement policy and constitution to describe the arrangements for public involvement in more detail

Lawyers for the CCG described the issue as a “technical” issue and said the CCG had agreed to pay 80 per cent of the campaigners’ “reasonable” legal fees as “continuing to debate technical points would have incurred further legal costs, and the CCG wished to dispose of the claim quickly”.

Colchester Hospital University Foundation Trust’s board will need to ratify the decision at a meeting on 12 June before it is given the green light.

A report paper by Amanda Hallums, divisional director - women’s and children’s services, said: “On the basis of the risk assessment it is recommended that option 2 – reopen “on demand“ as birth centres be agreed by the trust board subject to working with North East Essex Clinical Commissioning Group.”

1.10pm Health leaders in south west London have rallied to support the chair of Merton Clinical Commissioning Group after a local councillor called for his resignation, the Richmond and Twickenham Times reports.

In a statement to the paper the chairs of local CCGs said they were “disappointed” that local councillors are “attempting to play politics over the serious challenges faced by the local NHS”.

The CQC refused to discuss the nature of the action it is taking for legal reasons.

Lakeside Medical Centre in Sittingbourne was inspected in March in response to concerns raised by an anonymous person.

12.05pm The Medical Protection Society is “disappointed” that criminal sanctions for wilful neglect will be added to the Criminal Justice and Courts Bill.

Dr Nick Clements, head of medical services at MPS, said: “MPS is extremely disappointed and concerned to see that the new criminal sanctions for ill-treatment or wilful neglect will be added to the Criminal Justice and Courts Bill, which is already halfway through Parliament. This criminal sanction will have a huge impact on the professional lives of doctors and it must be given time to receive the serious scrutiny it warrants; not just rushed through as an amendment to an existing bill.

“MPS strongly opposes the new criminal sanctions as we believe the current regulatory, disciplinary and criminal framework is already effective at censuring unprofessional behaviour and there is no justification for new legislation.

“The government has focused too much on penalties and not enough on creating an open learning culture. Doctors must feel able to report accidents and near misses so they can learn from mistakes.”

Age UK said that, since June 2010, the NHS has lost almost 2 million “bed days” due to patients unable to be discharged because they are waiting for social care assessments, a care home place, a care home package or adaptations to be made to their own homes.

The delayed discharges have cost the health service £526m, the charity said.

It has estimated that older people are now waiting, on average, one day longer in hospital before finding a place in a residential care home compared with 2010. The latest figures suggest that patients who need to be transferred to a residential home are waiting an average of 30 days.

10.54am Research by the All Party Parliamentary Group on Sepsis reveals a large number of hospital trusts are not properly recording the illness sepsis.

In England there are at least 112,000 cases of severe sepsis and septic shock each year. This is a figure nearly four times higher than the total reported by trusts in response to Freedom of Information requests by the parliamentary group.

Trusts recorded a total of 23,368 cases of severe sepsis and 5,016 cases of septic shock – a total of 28,384 (25 per cent) of the 112,000 total. These figures come despite the fact that 64 per cent of trusts reported that they have mechanisms in place for recording both forms of sepsis. 43 trusts admitted to having no mechanisms in place at all.

The data also reveals that less than a third of trusts (30 per cent) frequently give patients the critical antibiotics for severe sepsis within the first hour of hospital care.

Dr Ron Daniels, co-author of the report and CEO of the UK Sepsis Trust which provides secretariat to the All Party Parliamentary Group on Sepsis, said: ‘There is a pressing need to improve the way sepsis is recognised, recorded and reported. Sepsis is a frighteningly common condition accountable for as many admissions to hospital as heart attacks. Appropriate resources must be available to deliver immediate and ongoing care to patients and relatives.’

Sarah Newton MP, Chair of the All Party Parliamentary Group on Sepsis, said “Sepsis is a major killer and the first step to fighting it is recording it properly. There is huge room for improvement in how Trusts record sepsis and sepsis deaths.”

10.38am An ambulance crew run by South Western Ambulance Service Trust stopped to pick up a pair of hitchhikers and dropped them off at the next town while taking a patient with a severe blood clot, The Times reports.   

The trust defended the decision, saying the hitchhikers were on a “dangerous” road and the crew were “doing the right thing”.

However, the trust has launched an investigation following a complaint by the patient.  

10.35am In The Guardian, an “unexpected summer crisis” is developing in accident and emergency departments, bucking the normal trend of waiting times being worse in winter than summer, the Labour party has claimed.

The figure show a record number of patients attending A&E in any one week and a record number then admitted to hospital wards.

10.30am The Daily Telegraph reports on its front page that millions of people over the age of 50 risk harming their health if they follow new NHS guidance telling them to take statins, according to a warning from leading doctors to the health secretary.

In a letter to Jeremy Hunt, the prominent clinicians, say that the majority of the National Institute for Health and Care Excellence panel responsible for drawing up the guidelines has “direct financial ties” to firms that manufacture statins.

10.20am The Financial Times reports that ministers are intervening more than ever in the running of the NHS despite reforms intended to take politics out of the health service, a report from the King’s Fund has found.

In its report, Reforming the NHS from Within, the think tank said it was time to locate accountability for operational issues “where it properly belongs”.

This contractual requirement emerged after HSJ submitted requests under the Freedom of Information Act to eight large GP providers, asking for information about online access to GP records, practice participation groups, practice income, and submissions to a consultation on the GP sector.

Virgin Care was the only provider which did not respond.

The seven which replied under the act included The Practice, a corporate chain which runs dozens of practices; IntraHealth, another corporate provider; and The Hurley Group, the large provider which runs about a dozen practices and health centres in London.

The national commissioning body has confirmed to HSJ that it is considering measures to reduce the number of “long distance transfers within CAMHS”, including “any necessary tendering for services.”

It comes amid widespread concern over the specialised CAMHS services - known as tier 4 services - commissioned by NHS England. In February, HSJ revealed that a moratorium by NHS England on commissioning new services was exacerbating a shortage of specialist mental health beds for younger people, and leading to young people being placed in facilities many miles from their homes.


9.46am HSJ reporter James Illman is at the King’s Fund this morning where they are discussing reform within the NHS. Follow him on Twitter for live updates @jamesillman

7.00am Welcome to HSJ Live. We kick things off with a comment piece by King’s Fund chief executive Chris Ham, who argues that less emphasis should be placed on targets and inspections.

Instead, he says sustainable improvement in the NHS will come from strong commitment and learning from high performers in England and abroad.

Reforming the NHS from Within, a report published today by the King’s Fund, calls for a fundamental shift in how the NHS is reformed and a stronger emphasis on devolution within the health service.

You can read the full report here.