Former NICE chair criticises NHS commissioners for ‘poorly implementing’ body’s guidelines. plus the rest of today’s news

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5.00pm HSJ’s Shaun Lintern tweets:

4.12pm Alison Moore, top health journo and HSJ contributor asks:

3.34pm Mr Titcombe adds:


3.33pm The Care Quality Commission patient safety advisor James Titcombe tweets:

3.30pm HSJ’s Shaun Lintern tweets:


2.35pm Ministers have launched a series of pilots exploring ways to help carers balance work with their caring responsibilities.

Carers could soon be using smart phones, email alerts and pop-up care centres to help them plan and co-ordinate formal and informal support, the government has said. The ideas will be trialled as part of £1.6m of pilot projects announced today by minister for women and equalities, Nicky Morgan, and Norman Lamb, minister for care and support at the Department for Health.

There will be nine pilot sites across the country: North Tyneside; Northamptonshire; Cheshire West; Gateshead; Bury; North Somerset; South Gloucestershire; Staffordshire and Stoke; and Sefton.

The nine pilot areas will explore how technology can be combined with professional support from the local authority and the assistance of informal networks of friends, neighbours and Time Bank volunteers to ease the pressure of caring.

For example, one pilot will monitor cared-for adults by telephone every day at an agreed time, then contact the carer by email or text to confirm that they do not need assistance.

The pilots will also explore how businesses can give employees with caring responsibilities more help, for example by promoting flexible working patterns and setting up carers ‘surgeries’. One pilot will also set up a pop up business school to help carers set up in self-employment.

Minister for Women and Equalities, Nicky Morgan, said: “Women often find themselves caring for both older relatives and children; juggling work and caring can be enormously stressful. These pilot projects are designed to test how that pressure can be eased and allow people to balance their caring responsibilities with their jobs and families.

“Carers who feel forced to leave their jobs are a real loss to the workforce and economy. We want to give people the peace of mind about their loved ones that helps them keep their jobs.”

The start of these pilots coincides with the announcement of a new pledge to support carers under the Public Health Responsibility Deal’s health at work Network.

The Network has broadened its existing pledge on chronic conditions to include an element that supports unpaid carers.

The pledge sets out to improve the workplace support employers provide for people with long-term/chronic conditions (such as diabetes, cancer and heart disease) by asking employers to embed some basic principles for managing these conditions within their standard HR procedures.

The pledge will also now aim to improve the workplace support that employers provide for carers so that they can care more effectively; look after their own health and wellbeing; fulfil their employment potential; and have a life of their own alongside their caring responsibilities.

Care and Support Minister, Norman Lamb, said: “Too many carers find it difficult to balance their important caring roles with their work commitments. This has costly implications not only for them, but for our businesses and economy too.

“Our Care Act will provide more support to carers than ever before by working with people, their employers and communities. This project will help us to build a stronger economy and a fairer society.”

1.50pm NHS England’s most senior GP leaders have criticised the national GP pay for performance framework as ‘bad for health’. Clinicians should instead be incentivised to work more closely with other parts of the health system, they said.

Speaking at a Westminster Health Forum event in London yesterday, NHS England deputy medical director Mike Bewick said he thought “[the quality and outcomes framework] is becoming bad for health”.

He said the framework, known as QOF, had “reached the point” where it needed to change from “looking at how to use indicators for incentives” to “using indicators for improving care”

1.05pm Norfolk and Suffolk Foundation Trust has today announced its withdrawal from the government’s Mutuals in Health pathfinder project.

It is the second Norfolk trust to withdraw from the mutuals project in recent days. Norfolk and Norwich University Hospitals Foundation Trust also confirmed to HSJ that it was no longer involved with the initiative.

Norfolk and Suffolk was last week rated “inadequate” by the Care Quality Commission, which recommended it be placed into special measures.

12.54pm An ambulance trust chief executive has warned that the lack of a national funding scheme for training paramedics could only exacerbate workforce shortages if it is not tackled.

Ken Wenman, a board member of the Association of Ambulance Chief Executives, also said the urgent and emergency care review by NHS England medical director Sir Bruce Keogh was the “solution” to the workforce problem in the ambulance service.

HSJ reported last month that ambulance services across England were looking overseas to fill vacancy rates in their paramedic workforces as high as 25 per cent.

12.36pm A social enterprise consortium will replace Serco as the provider of out of hours GP services across Cornwall.

Devon Doctors, a GP led social enterprise, and Kernow Health, a community interest company run by member practices, have been chosen by Kernow Clinical Commissioning Group to provide the county’s service from June. The consortium will operate under the name Cornwall Health.

The contract, worth £8m a year, will cover an initial two and a half year period with an option to extend for another two and a half years.

The consortium won a competitive tender process after Serco’s controversial out of hours contract was ended by mutual agreement 17 months early.

12.33pm The National Institute for Health and Care Excellence’s former chair Sir Michael Rawlins has criticised NHS commissioners for ‘poorly implementing’ the body’s guidelines but said making them mandatory would be ‘counterproductive’.

Asked by HSJ about shadow health secretary  Andy Burnham’s suggestion that he would consider making NICE’s guidelines mandatory if Labour won the general election, Sir Michael said some flexibility was necessary.   

Sir Michael, who chaired NICE from its formation in 1999 until April 2013, said: “The guidelines are guidelines, not tramlines.

10.44am NHS England has set out guidance for how access and waiting time standards for mental health services are to be introduced.

In October, NHS England and the Department of Health announced the measures in Improving better access to mental health services by 2020.

NHS England’s guidance, out today for clinical commission groups, makes the case for change in four areas and sets out the expectations of local commissioners for delivery during the year ahead working with providers and other partners.

It sets out how commissioners and providers can begin to prepare for implementation of the new early intervention in psychosis and liaison mental health standards.

It says plans need to be submitted about how local commissioners will meet the new IAPT standard for people with depression and anxiety disorders. It also updates on funding for eating disorders services.

Dr Geraldine Strathdee, NHS England national clinical director for mental health, said: “It marks an important milestone for mental health services.

“This will change the lives of young adolescents and adults with psychosis and they will no longer face an almost inevitable future of 20 years premature mortality from poor physical and mental health.

“The guidance is the first step to working with commissioners and providers, community leaders and workforce education bodies to make this happen.”

She said the new access measures are “a major step” towards the Five Year Forward View commitment to integrating physical and mental health care. 

“These services will support patients in mental health crisis who come to A&Es, patients on acute wards, and in long term conditions outpatient clinics,” she added.

In October, a wide range of measures were announced including a new standard whereby 50 per cent of patients experiencing their first episode of psychosis will, from 1 April 2016, access NICE concordant care within two weeks of referral.

Also from April 2016, 75 per cent of patients with depression or anxiety disorders needing access to psychological therapies are to be treated within six weeks of referral, and 95 per cent in 18 weeks. By 2020 all hospitals are to have effective liaison mental health services in place across acute settings.

It has been announced that £80m for mental health will fund the measures for 2015/16. It will be split with £40m to support implementation of the early intervention in psychosis standard, £10m to support the IAPT standard and £30m targeted to support the development of liaison mental health services.

A commitment of £30m for the next five years was made in the Autumn Statement to improve timely access to evidence-based community eating disorder services.

The guidance out today backs this announcement firstly with the case for change.

For example, it states that when treatment is delivered according to the NICE standards for people experiencing a first episode of psychosis, their experience of care and their outcomes are very significantly improved.  Timely access to NICE concordant care has been shown to have a significant impact on reducing the risk of suicide. People with psychosis who receive effective early intervention services are also far more likely to get a job.

Within IAPT services for people with depression and anxiety disorders, at least 50 per cent of those completing treatment move to recovery and most experience a meaningful improvement in their condition.

A number of national resources in each area will help commissioners with implementation of each of the four standards. These are to be developed in partnership with the National Collaborating Centre for Mental Health.  The NCCMH is the body responsible for developing mental health guidelines on behalf of the National Institute of Health and Care Excellence (NICE).

The guidance also shows the draft Referral to Treatment (RTT) pathway for first episode psychosis which will form the basis of monitoring performance against the new standard.

10.21am Norfolk and Suffolk Foundation Trust has today announced its withdrawal from the Mutuals in Health Pathfinder Project. 

Michael Scott, the trust chief executive, explained that following feedback from staff the board last week reviewed the provider’s part in Pathfinder.
The pathfinder programme, which has awarded 10 trusts £100,000 each, forms part of the government’s response to a recent review into NHS staff engagement.

Mr Scott said: “There has been a level of misunderstanding about the project and the aims of our Trust in taking part. We can see that this has led to concern among our staff about a risk of ‘privatisation of the NHS’.

“We are clear that our Trust’s priorities are improving the quality of our services and improving staff morale, by making the Trust a better place to work. Anything that might create a distraction to these priorities is not for us at this time. 

“As a result the Trust has decided to withdraw from the project,” he said.

Michael went on to explain that the Trust had a responsibility to inform and discuss its decision with the Cabinet Office, which leads the scheme, and with its regulator, Monitor, before it could make its announcement to staff today. 

“We also understand that this week UNISON representatives took a vote to establish its position on ‘mutual status’ and voted in opposition to it. So, collectively we believe we are all now on the same page in discontinuing our involvement in the project.”

10.12am The full scale of neglect at a dangerous and filthy care home that had to be evacuated in the middle of the night has been laid bare in a critical report, The Daily Telegraph writes.

The Merok Park nursing home in Surrey was closed in December last year and residents moved in freezing conditions after officials concluded that they were “at a significant risk of harm.

In the report published by the Care Quality Commission (CQC), inspectors noted that the smell of urine was “overpowering when we arrived and continued throughout the day” and that mould was growing on the home’s walls.

Some nursing staff were found to be unqualified and unvetted by police, with one described as having “very little knowledge of people”.

10.02am Looking to this morning’s newspapers, The Guardian reports that doctors should give clear messages to patients about the benefits of 30 minutes of exercise five times a week – which can be a “miracle cure”, according to a report.

Medical practitioners are being urged not to avoid awkward conversations about lifestyle, as the report from the Academy of Medical Royal Colleges says regular exercise is often more effective than pills.

10.00am The total value of trust bailouts paid out by the Department of Health so far this financial year has already outstripped last year’s total, HSJ research shows.

Data from the DH shows it has paid £840.8m in the first three-quarters of 2014-15 to help trusts that were running at a deficit, compared to the £759.8m in 2013-14.

HSJ’s analysis highlights the increased pressure faced by NHS provider organisations over the past nine months

7.00am: The top 100 organisations will be revealed in a special supplement in July, produced in association with NHS Employers,HSJ can reveal.

Our intention is to celebrate those organisations that are working the hardest for their staff across the country - those that know how to create environments where people can enjoy their work.

Identifying and recognising outstanding workplaces will be carried out by HSJ and independent workplace research firm Best Companies Group.