17.25pm: Foundation trust regulator Monitor has published the 2012-13 consolidated accounts for the FT sector. They show that the sector overall delivered a surplus of £487m in the past financial year, and the amount of cash it held at year end had increased to £4.5bn, up from £3.9bn at the same point in the previous year. Twenty one FTs recorded deficits totalling £159m. Six of those trusts received bailouts from the Department of Health in 2012-13 in the form of revenue public dividend capital. The trust with the largest individual deficit was Peterborough and Stamford Hospitals FT, which finished the year £39m in the red.
16.08pm: In April NHS Surrey, a primary care trust with long-standing financial troubles, was split into six clinical commissioning groups. Read Steve Ford’s in-depth analysis of the prospects for the new organisations here.
15.36pm: Those looking for background on the two north western reconfigurations that received the health secretary’s backing this morning could check out our HSJ Local Briefing from last March on the reconfiguration plan for Greater Manchester’s hospitals and this one from September on Lancashire and Cumbria’s vascular controversy.
15.02pm: The transcript of this morning’s Commons debate - after Jeremy Hunt’s statement backing reconfigurations in Trafford and Lancashire and Cumbria - is now available on Hansard.
Labour shadow health secretary Andy Burnham backed the proposed centralisation of vascular services across Lancashire and Cumbria, but said Labour had “concerns” about the decision to downgrade Trafford General Hospital’s A&E ahead of the wider Healthier Together review, which is looking at the configuration of acute services across Greater Manchester. He told MPs: “Speaking as a Greater Manchester MP, I cannot see why it makes sense to pick off Trafford hospital ahead of this review without looking at things in the round.
“It does not feel to me that this is part of a coherent plan for the NHS in our city region, and I ask the Secretary of State today why his decision is justified, given that the wider considerations affecting health services in Greater Manchester have not yet been completed.”
The health secretary responded: “Let us examine what the right hon. Gentleman said only last week in Hastings.
“He said that people like him have a moral imperative to support the doctors who are making these decisions. Well, these changes are supported by the Trafford clinical commissioning group, Greater Manchester critical care network, the Royal College of Surgeons and many other doctors. How many doctors does he need to support this decision before he actually does what he said he would do last Friday, which is support doctors making difficult decisions? On the very day that NHS England is talking about the need to protect services for patients by facing up to difficult decision, his approach is more than inconsistent—it is irresponsible, and he knows it.”
14.29pm: However, Sir David may be pleased to note that readers seem more exasperated with the Competition Commission’s findings on the proposed Royal Bournemouth and Poole merger. One commenter writes: “Has the country gone insane!!!! If you are too small to survive you need to merge, but you can’t merge because then there is no competition!!”
While another adds: “So lets continue with two level three haematology units within seven miles of each other and countless other examples which fly in the face of common sense.”
14.05pm: Readers posting on hsj.co.uk today have responded angrily to Sir David Nicholson’s warning that there could be more care failures like the scandal in Mid Staffs without major service change. Heather Wood writes: “Appalling that Nicholson can make any reference to the failures at Stafford, since he is as tainted as anyone by what happened there. He has had the reins for a long time now, and has done nothing but wreck the culture. Any advances are down to scientific and clinical research, & clinical staff, not top of DH/NHS.”
13.59pm: In response to publication of the bereavement survey, Simon Chapman, public and parliamentary engagement director for the National Council for Palliative Care, said: “Although there are some encouraging findings, this is just the latest in a long line of reports which highlight unacceptable inconsistencies in end of life care, with hospitals once again performing especially badly. It’s five years from the Government’s End of Life Care Strategy and despite welcome progress, inadequate end of life care is still being tolerated in some places.
“There’s clearly something going very wrong in too many hospitals when it comes to the basic treatment of people who are dying, with bereaved people reporting that just 59% of hospital doctors and 52% of hospital nurses always showed dignity and respect. It’s also concerning to see it reported that of people who were able to die at home – the place that most of us would like to die – less than one in five had their pain managed completely all the time (compared with 63% in hospices), with many people in hospital also going without appropriate pain relief.
“The findings from this survey must be the final wake up call for all those involved in end of life care.”
While Help the Hospices public policy director Jonathan Ellis said: “Today’s findings show hospice staff lead the way in ensuring people at the end of life and their families are cared for with the utmost dignity and respect – values which lie at the heart of hospice care.
“However, there is still too much variation in the care that dying people receive, with too many people still not getting the care they need and this has to change. Most people currently die in hospital and the continuing low ratings for end of life hospital care are deeply concerning and must be tackled.”
13.39pm: The Office for National Statistics has published the results of its 2012 National Bereavement Survey. The survey, commissioned by the Department of Health, aims to assess the quality of end-of-life care in England.
The key findings were:
- The overall quality of care across all services in the last three months of life was rated by 44 per cent of respondents as outstanding or excellent.
- Respondents of those who died of cancer in their own home rated the quality of care most highly (63 per cent).
- Being shown dignity and respect by staff was highest in hospices (84 per cent ‘always’ for hospice doctors and 82 per cent for hospice nurses) and lowest in hospitals (59 per cent ‘always’ for hospital doctors and 52% for hospital nurses).
- For those who expressed a preference, the majority preferred to die at home (81 per cent), although only half of these actually died at home (49 per cent). The most commonly reported place of death was a hospital (52 per cent).
- Two-thirds of respondents (64 per cent) reported that no decisions had been made about care which the patient would not have wanted. However, 17 per cent of respondents said yes to this question.
13.30pm: After reading an NHS England press release about the “6Cs” of nursing, which states that “care” and “compassion” are among the “values essential to compassionate care”, HSJ’s End Game blog wonders if the seventh C might be for Circularity.
13.13pm: HSJ senior correspondent Crispin Dowler has a piece on economic regulator Monitor’s work on the NHS funding gap, and it’s chief executive David Bennett’s conclusion that even if the NHS did “pretty well everything we can think of” to make savings it would not “quite close the gap”. Crispin writes: “The message in all this talk of financial gaps is the NHS needs radical change to protect its services and finances. People are capable of radical change − but they need to know it has a chance of success.”
12.25pm: The Department of Health has now issued a statement on Jeremy Hunt’s backing for two contested reconfigurations in the North West. The changes will lead to the eventual downgrading of Trafford General Hospital’s emergency department to a minor injuries unit, and the centralisation of inpatient vascular services for Lancashire and Cumbria in three hospitals across the region. On Trafford, the statement says: “Trafford General Hospital has one of the smallest type one A&E departments in the country and treats a relatively small number of patients for unplanned emergency or acute care. Figures from 2010/11 show that at its busiest, the A&E department saw on average seven patients an hour and overnight this fell to only two patients an hour.
“Many patients with life threatening illnesses or injuries are not taken to Trafford General Hospital. In fact over half of local residents already use other A&E services nearby, in one of the three large university hospitals within a 10 mile radius of Trafford.
“There are also concerns over intensive care and emergency surgical services. According to the Greater Manchester Critical Care Network the intensive care unit needs to treat 200 patients per year in order to continue to provide safe care and maintain the skills of staff, but currently treats less than 100.
“Guidance from the Royal College of Surgeons Guidance in 2006 also states that emergency surgery should serve a population of ideally 450,000 to 500,000. However, Trafford General only serves a population of 100,000.”
On Lancashire and Cumbria, it states: “A similar programme across Greater Manchester to make changes to stroke services, resulting in three specialist centres for acute stroke treatment, was implemented in 2010 and is estimated to have saved 249 lives.
“The Health Secretary has asked NHS England to work with the local NHS in Cumbria and Lancashire to address outstanding concerns about the changes and ensure plans are in place to help those who have further to travel.”
11.44am: The Foundation Trust Network has issued an angry response to the Competition Commission’s provisional findings on the proposed Royal Bournemouth and Poole FTs merger.
Chris Hopson, Chief Executive of the Foundation Trust Network, said: “This is a mess. On the same day, one arm of Government argues for urgent reconfiguration to deliver clinically and financially sustainable NHS services; another arm of Government puts yet more barriers in the way of an NHS hospital merger designed to achieve precisely this objective. It shows that NHS foundation trusts and trusts are now being asked to do the impossible - rapidly change to avoid another Mid Staffs, but in a policy environment that prevents this from happening at the required pace.
“NHS England says mergers are essential to delivering sustainable safer services and the Competition Commission says mergers are not in the best interest of patients. We don’t who’s in charge and trusts are piggy in in the middle of opposing bureaucracies.
“Looking at the difficult financial future for the NHS, the Royal Bournemouth and Christchurch Hospital and Poole Hospital NHS foundation trusts announced 20 months ago that the best way to clinical and financial sustainability was to merge. They are still stuck in a Kafkaesque merger nightmare process that has cost millions of pounds and seems likely, in the end, to prevent a perfectly sensible merger designed to deliver better and affordable NHS care.
“Poole Hospital is now under investigation by Monitor, the health sector regulator, on the grounds that it may no longer be financially viable. If the Government wants to avoid NHS providers heading over the financial cliff edge, with all the resultant risks for patient care, it has to quickly find better ways of supporting those who are trying to do the right thing, recognising that we should so without rewarding failure.
“A good start would be for Jeremy Hunt to rapidly follow up his recent public comments on reviewing the applicability of the general UK merger control regime to NHS mergers that are key to ensuring clinical and financial sustainability.”
11.25am: Health secretary Jeremy Hunt, speaking in parliament now, has accepted recommendations to proceed with two reconfigurations in the North West. The first will see the accident and emergency department at Trafford General Hospital downgraded first to an urgent care centre, and, over time, to a minor injuries unit. Mr Hunt said the hospital would become a centre of excellence for elective orthopaedic surgery.
However, he added that the changes would only take place if the three neighbouring A&E departments that will need to take Trafford patients are consistently meeting waiting times targets.
Mr Hunt has also accepted proposals for a reconfiguration of vascular surgery in Cumbria and Lancashire. The changes will concentrate all complex vascular surgery in three centres across the two counties, run by North Cumbria University Hospitals Trust, Lancashire Teaching Hospitals Foundation Trust, and East Lancashire Hospitals Trust.
11.07am: A number of organisations have issued responses this morning to NHS England’s “call to action” to bridge what it estimates is a £30bn NHS funding gap.
NHS Confederation chief executive Mike Farrar said: “The NHS is under unprecedented pressure and is experiencing unprecedented demand. Addressing these issues requires unprecedented thinking. But it does not mean we should abandon everything from the past. The traditional values of care and compassion must be at the heart of the NHS of the present and the future.
“NHS England is right to call for an honest and realistic debate between NHS staff, the public and politicians about what needs to change. When that debate has been had, it is crucial that those in charge of the NHS make the changes a reality.”
Chris Ham, chief executive of think tank the King’s Fund said NHS England’s move signalled a “welcome willingness to initiate an important and wide-ranging debate about the future of the NHS and social care”. He added: “Fundamental change is required to respond to the needs of an ageing population, changing burden of disease and rising patient expectations.
‘The government’s recent NHS reforms failed to address these challenges. This time politicians and policy-makers must deliver - this means having the courage to transform services, rather than making further bureaucratic and structural changes.”
However, Steve Kell, Co-Chair of NHS Clinical Commissioners, cautioned against moving too fast. He said: “Clinical Commissioning Groups will play their part in this and we welcome the opportunity to develop five-year Commissioning plans.
“However we are also well aware that to engage properly takes time. To develop sustainable solutions that are owned by our populations involves taking our local communities with us on the journey this call to action is starting. It will also need to involve local authorities and public health.
“For the Call to Action to succeed it must be built from the local upwards. CCGs are small, lean organisations with limited capacity to take undertake new endeavours. We must make this work, but it must also be recognised that to localise what should be a massive public engagement exercise takes time and resources and so we would question whether it would be possible to develop realistic solutions in time for 2014. CCGs will help lead the conversation, but today is just the start of a dialogue which will need to continue for sometime.
“To bring about major sustainable change will take bravery - not only from clinicians and the NHS but elected leaders at all levels. It will also take time and all the parties signed up to the Call to Action must recognise this and be realistic in how they support and enable CCGs to deliver their part.”
10.59am: And here’s some more insight from the latest HSJ/Capsticks hospital chief executives barometer. Asked to identify the reasons for the recent spike in pressure on accident and emergency departments, 93 per cent of respondents cited “increased acuity” of the patients coming through their doors. “Increased attendances” and “poor access to out of hours care” were the joint-second most widely cited factors - they were each cited by 78 per cent of respondents.
10.57am: More on that funding gap. In an opinion piece in the Times Matt Ridley argues that NHS spending will rise but that this is not “necessarily a disaster”. He writes: “that we spend a growing proportion of our income on health makes sense for three reasons: there are more treatments that work, we’re getting older, and other things like food and clothing are so much cheaper.”
10.44am: The Mail’s splash this morning is the story of a retired nurse who died after NHS Direct failed to send her an ambulance. Under the headline “Just one more NHS statistic”, the paper reports that Gillian Given, 58, died of a massive heart attack following a call to the telephone triage service.
An inquest heard a recording of the call, made by her husband James, in which Ms Given could be heard screaming with pain in the background.
The coroner yesterday ruled that human error amounting to neglect played a part in her death.
10.40am: In other NHS news this morning, the Mail carries a comment piece on the “Sick truth about the great NHS redundancy racket”. On page 15 of the paper, Zoe Brennan details the phenomenon of the NHS boss who leaves one post with a pay off, only to be rehired in another top role shortly after.
Although she links it to the commissioner-side reforms brought about by the 2012 Health and Social Care Act, most of the examples given are on the provider side, which the Act did not affect.
Anyway, she fulminates: “The NHS fat cats who are now jostling for new highly paid jobs after this latest round of redundancies are unlikely to question the ethics of their payouts.
“Not when they are laughing all the way to the bank.”
10.33am: HSJ’s latest “barometer” survey of hospital chief executives adds some interesting new detail to the recent debate about the merits of collapsing the NHS’s purchaser-provider split. Trust chiefs apparently see little value in the split, with respondents rating its usefulness at 3.1 out of 10, with 1 being “not at all useful” and 10 being “very useful”.
10.29am: A number of papers also carry stories this morning about the public accounts committee’s scathing assessment of the Serco contract to provide GP out of hours services in Cornwall. Committee chair Margaret Hodge MP said: “It is disgraceful that the public had to rely on whistleblowers to find out that the out-of-hours GP service in Cornwall, provided by private contractor Serco, was short-staffed and substandard, and that service data was being manipulated, making the company’s performance look better than it was.”
10.15am: But those foundation trusts looking to make a head start on major service reorganisation had better take a look at this morning’s other big NHS story. The Competition Commission has announced it is minded to block the first proposed merger between two NHS foundation trusts - between Poole Hospital and the Royal Bournemouth and Christchurch Hospitals - stating that it would lead to a substantial lessening of competition in 58 services, including maternity and accident and emergency.
10.10am: And here’s HSJ’s report on NHS England chief executive Sir David Nicholson’s thoughts on the funding gap. Sir David said yesterday that the conversation his organisation was initiating now would have a “real tangible outcome” at the end of this year, when it would be used to inform NHS England and clinical commissioning groups’ “concrete investment and disinvestment plans” for 2014-15 and 2015-16.
9.52am: HSJ reporter James Illman, who broke the £30bn story last week, has another funding gap exclusive this morning. NHS England strategy director Robert Harris warns that by 2025 that gap could widen to an “eye watering” £60bn.
9.50am: Most national papers this morning carry stories on NHS England’s report warning that the health service faces a £30bn funding gap by 2020-21 without major service reorganisation. The Times reports that “health service bosses” are warning that the NHS will “not survive without radical change involving widespread hospital closures”.
8.48am: The voluntary sector can provide the NHS with commissioning support and expert patient knowledge to ensure better outcomes writes Sue Thomas in HSJ today.
“There are a range of specially designed tools and resources that can help the NHS provide better care, be it through ‘Neurowatch’, where a data picture of an area’s neurology performance, or our online tool ‘Neuronavigator’, which can risk stratify individual populations and assess staffing and budget requirements”, she writes.