Learning from Wales’ new end of life care delivery plan and the rest of today’s news

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4.30pm: Read HSJ’s full story on the decision to suspend the review into children’s heart surgery here.

3.26pm: Nicholson to PAC on gagging order stories today: “To connect me to any cover up is entirely inappropriate.”

3.25pm: Sir David Nicholson tells MPs on Public Accounts Committee: “There have been a lot of things said in media this morning which are completely untrue.”

3pm: A selection of tweets from HSJ’s James Illman who is covering the appearance of Sir David Nicholson and Tim Donahue at the Public Accounts Committee:

“NHS paid £100m in compensation to @CSCHealth_UKI to buy out of original deal, Donohoe tells committee”

“Renegotiation of @CSCHealth_UKI deal was a ‘good deal for tax payer’ says Donohoe. @margarethodge not impressed”

”@margarethodge : “How much more money r u going 2 spend w/ this rotten company( @CSCHealth_UKI ) on this hopeless system (@CSC_Lorenzo)”

“NHS will pay @CSCHealth_UKI a forecasted £2.2bn overall including £500m on @CSC_Lorenzo Donohoe tells PAC”

”@CSCHealth_UKI have received £1.1bn to date from NHS Donohoe tells@margarethodge

2.25pm: Responding to this afternoon’s decision NHS England has released a statement from three key figures who will take forward the review of children’s heart surgery services.

Professor Sir Bruce Keogh, medical director for NHS England said: “NHS England will now study [the reviews] recommendations in full to learn from them. We will institute a new process that recognises the very strong case for redesigning services to meet the demands of the future whilst addressing the legitimate concerns in our local communities.”

Professor Huon Gray, national clinical director for cardiac care for NHS England said: “We are pleased the Independent Reconfiguration Panel’s (IRP) endorsed the case for children’s heart surgery and interventional cardiology to be provided only by well-resourced, specialist teams providing round the clock cover, and the use of national standards for commissioning the pathway of care.

“But the Independent Reconfiguration Panel has also raised some really important issues, which mean we cannot implement change immediately.  This is matter of regret for everyone who wants to improve care for children today.”

Dr Jacqueline Cornish, national clinical director for children and young people for NHS England added: If we are not able to make progress swiftly, children will be the losers.

“We will take the time to listen before coming up with a new proposition, working with patients, clinicians and the providers of services. We intend to announce a new way forward in the autumn, with plans for implementation within 12 months.”

2.20pm: Dr Aidan Bolger, lead cardiologist at East Midlands Congenital Heart Centre at Glenfield Hospital, said he welcomed the IRP report and the decision of Jeremy Hunt to suspend the review.

He said: “The review was supposed to create a national network of surgical centres which were safe and sustainable. Now we, along with our colleagues in the other trusts and NHS England will work together to make that a reality using the right evidence, common sense and always with what’s best for patients at the forefront of our minds.

“As well as thanking the IRP and the Secretary of State for making a difficult and principled decision we want to thank the many thousands of people who have supported our centre; members of Heart Link, Keep the Beat, local MPs from all parties, our local councillors, the LINks and local media who have given us their continued support.

“Most of all I want to recognise the extraordinary job my colleagues have continued to do, despite the uncertainty of the last three years; they have continued to provide the very best care for children across the east Midlands, each day.” 

2.15pm: Dr Hilary Cass, President of the Royal College of Paediatrics and Child Health, has reacted to the decision to suspend the review on children’s heart surgery.

She said: “The need for reconfiguration has never been more urgent – and as today’s IRP report states and the Health Secretary reiterated, the status quo is not an option.  It is encouraging that NHS England has been tasked with devising a plan to take forward the review quickly.  Decisions around complex issues such as reconfiguration will always involve some difficult judgement calls and hence be open to challenge, however robust the process.  It’s important to identify and acknowledge where there have been shortfalls, but we cannot let the problems with this particular process stall further what is crucial for ensuring safe and sustainable health services for children.”

1.20pm: HSJ is hosting a twitter chat on our list of the top 100 clinical leaders list. Follow #hsjclinicalleaders on Twitter to take part.

1.10pm: Health Secretary Jeremy Hunt has suspended controversial plans to reform children’s heart surgery in England because of a “flawed analysis” which led to the recommendations.

The NHS had planned to concentrate care in fewer specialised units by stopping surgery at Leeds General Infirmary, Glenfield Hospital in Leicester and the Royal Brompton in west London.

Mr Hunt told the House of Commons: “The Independen Reconfiguration Panel report also concludes that the outcome of the Safe & Sustainable review was based on a flawed analysis of the impact of incomplete proposals, and leaves too many questions about sustainability and implementation.

“This is clearly a serious criticism of the Safe & Sustainable process. I therefore accept their recommendation that the proposals cannot go ahead in their current form and am suspending the review today.”

Mr Hunt said the argument for improving care was unchanged but that the public did not have confidence in the review.

NHS England will now lead on the process and will reveal its next steps by the end of July.

12.20pm: Monitor has authorised Western Sussex Hospitals NHS Trust as a foundation trust, only the second one since April 2012.

The authorisation, which is effective from 1 July, means Western Sussex is the first acute trust in its county to be made an FT.  

Trust chief executive Marianne Griffiths said: “For the last three years there has been a rigorous examination of every single aspect of the work our staff do, and Monitor has concluded that our services are excellent, they are safe, they are efficient and they are sustainable. It is the biggest vote of confidence we could receive.”

Western Sussex, which runs St Richard’s, Worthing and Southlands hospitals, was formed under difficult performance and financial circumstances in 2009.

Since then the trust has delivered steadily improving performance, including consistently hitting waiting time targets, its A&E performance is among the top five nationally and debts have been repaid at a rate of £5m a year.

12.15: The struggling East of England Ambulance Service Trust has been undermined by in-fighting, confusion and a “sense of helplessness” among senior managers, according to a damning independent report.

The report, ordered by the Trust Development Authority in March after a sustained period of poor performance saw the trust miss a series of targets, raised serious concerns about many areas of the organisation.

It said individuals needed to be held accountable for “wrong doings” and highlighted finances issues, a lack of board-level accountability and the failure of senior management to listen to staff.

The report’s author, West Midlands Ambulance Service Foundation Trust chief executive Anthony Marsh, made 25 recommendations.

Details here.

12pm: A selection of today’s stories from HSJ:

Health Education England has announced plans to develop the bands one to four staff groups including opening up routes into professional roles such as nurses or doctors. Read the story by Shaun Lintern here.

James Illman reports confusion surrounding the flagship Care Connect project to allow patients to give online feedback on their treatment, after NHS England gave mixed signals over whether comments would be moderated to prevent defamation. Read his story here.

Campaigners fighting to save a children’s heart unit are hoping health secretary Jeremy Hunt will reverse the decision today. Details here.

A new survey suggests that while hospital doctors have concerns about the introduction of a chief inspector of hospitals they are significantly less opposed to the reform than senior management. Details here.

11am: Younger people should not get priority for surgery over fit over-75s because older people who keep in shape are far more likely to recover from operations than unfit youngsters, according to research by Newcastle University and Newcastle FT, reported in the Daily Telegraph this morning.

The Daily Telegraph also reports on officials figure that show 90 patients died from falls in hospital last year with tens of thousands more injured. See the full story here. And in a separate story the paper reveals a sharp rise in the number of patients over 90 being taken to hospital by emergency ambulances. 

10.30am: NHS England chief executive Sir David Nicholson will face questions by MPs on the Public Accounts Committee this afternoon.

Sir David is due to answer questions about the controversial national IT programme for the NHS and is also expected to be asked about the use of taxpayer’s money to fund compromise agreements.

He is expected to face criticism from Conservative MP Steve Barclay who has used the Freedom of Information Act to reveal £2m has been spent on 52 compromise agreements, including gagging clauses since 2008.

Mr Barclay has said: “It is simply not plausible that the man who was supposed to be running the NHS was seemingly unaware that employees threatening to speak out were being offered golden goodbyes in return for a vow of silence.”

The Daily Mail reports on the figures obtained by Mr Barclay which it says shows at least 38 English NHS hospitals have paid off staff without Treasury approval through judicial mediation.

In total trusts spent £2m gagging 52 staff in this way, the paper claims.

Judicial mediation was the method by which former United Lincolnshire Hospitals Trust chief executive Gary Walker was paid off and reportedly “gagged” through a confidentiality clause.

The paper claims the true extent of the use of judicial mediation may be much higher as 50 hospitals did not respond to the FOI request.

HSJ has previously reported on the issue here.

10.20am: Zara Aziz, a GP partner in a practice in north-east Bristol and part of local consortia group has written an opinion piece for The Guardian arguing proposals for GP out of hours services will not work.

She writes: “GPs working out of hours would not address the social care problem: after hours we have little access to social services. The proposals from Royal College of GPs’ chief exec, Clare Gerada, for family doctors to take back responsibility for certain group of patients, are unworkable, as GP workloads mean there is no capacity to achieve this.  Many GPs already have plans for out-of-hours care for their severely ill patients in order to avoid hospital admission.

“Commissioning groups are planning better access to rehab at ome, community geriatricians and safe haven beds, and this will help ease the strain on hospitals.”

10.15am: The results of a controversial review of plans to close children’s heart surgery units at three hospitals in England is set to be published later today.

The NHS plans to end surgery at Leeds General Infirmary, Glenfield Hospital in Leicester and the Royal Brompton in west London. This was challenged in the high court and Health Secretary Jeremy Hunt ordered a review of the decision in October.

Ten hospitals currently perform the surgery, but the Joint Committee of Primary Care Trusts said expertise should be concentrated on fewer sites.

It follows the findings of the public inquiry into the Bristol Royal Infirmary scandal in 2001.

The inquiry, led by Sir Ian Kennedy, found between 30 and 35 babies died between 1990 and 1995 while over the whole decade up to 170 might have been saved if they had been operated on elsewhere.

10am: Last night HSJ unveiled its list of the the top 100 clinical leaders in the NHS at an event held at the Royal College of Physicians in London.

From a longlist of more than 250 people, a panel of judges including Dr Phil Hammond, Dr James Kingsland and Niall Dickson selected the final 100 names that form this year’s selection.

From the 100 the judges went on to rank a top 10 of the most influential clinical leaders. Joining Sir Bruce in the top 10 are the newly appointed chief inspector of hospitals, Sir Mike Richards, at number two, and David Cameron’s new health tsar, Dr Don Berwick, at number three.

You can view the full list of clinical leaders here.

9.45am: The Times says thousands of lives could be saved as a result of a database containing millions of patient records with details of individual cancers and it was treated.

The newspaper is reporting cancer specialists will have instant access to the database including the clinical data and the way tumours responded to treatment.

It will expose variations in the quality of care in different trusts and between units and oncologists.

The Times says the database will lead to highly personalised treatments with doctors targeting specific genetic mutations with new drugs.

Jem Rashbass, from the Cancer Registration Service at Public Health England described the development as “game changing”.

8:40am: Good morning, the approach to managing and delivering healthcare in Wales is underpinned by three principles:

  • the NHS should remain a wholly public sector service, supported, where appropriate, by not for profit providers;
  • its direction of travel should be determined by a strong central steer; and it
  • it is best organised in large fully integrated units that are charged with the responsibility of taking the central steer and applying it in the context of local circumstances and need.

The quality of care given to people who are dying is one measure of how much a country values its population. Simon Jones looks at the principles and processes of Wales’ plans to improve end of life care.