More than a third of hospital trusts are predicting deficits at the end of this financial year, HSJ research has found, and the rest of today’s news and comment

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5.40pm NHS England’s incoming chief executive Simon Stevens has appointed a Department of Health director general to lead a new national directorate, HSJ has learned.

5.32pm In the King’s Fund blog, senior fellow David Buck looks the “increasing evidence that we have too much sugar in our diet” and the “increasing public debate on the food and drink industry and the role of tax, education and other policies to restrict consumption”. However, he questions where Public Health England’s voice has been in this debate.

5.15pm The latest from HSJ’s Hospital Transformation channel: Although frail older people are not yet the biggest group using A&E, they have specific needs which mean their care can be more resource intensive. So what is to be done, asks Jennifer Trueland.

5.00pm On 28 February, HSJ hosted a Twitter chat with Marie Curie Cancer Care, featuring their head of policy and public affairs Phil McCarvill, about issues of access and inequality when commissioning end of life care. Better education and training was one of the main themes to emerge. Have a look at the highlights of the debate.

4.39pm More on NHS’s England’s review into paediatric heart surgery at Leeds Teaching Hospital Trust, the BBC reports on parents of children treated at the unit saying the report is a “relief”.

4.14pm The chief executive of Leeds Teaching Hospitals Trust said he is “so sorry” for the poor experiences of patients at its children’s heart surgery unit.

Julian Hartley told ITV news: “We are so sorry for the experience documented in the patient experience report of 16 families… that experienced substandard care… We have and will learn from that, and we’ve already made many improvements to the unit.”

HSJ reported earlier today on the results of a two-part review of the trust’s paediatric heart surgery.

The mortality review found that services in the unit were “safe and are running well”. It confirmed that the trust was not outlier in terms of its mortality rates from surgery.

However, a family experience review, based on the views of 16 families who volunteered to give their accounts, identified a “perception of little compassion or understanding” by staff.

3.53pm Monitor has concluded that a proposal to join pathology services in Sussex is unlikely negatively affect patients.

The health sector regulator reviewed the proposal to merge the pathology services of Brighton & Sussex University Hospitals Trust and Surrey & Sussex Healthcare Trust on behalf of the NHS Trust Development Authority.

The joint venture, to be called Brighton, Surrey and Sussex Pathology is the first transaction reviewed by Monitor under its partnership agreement with the TDA.

Catherine Davies, Monitor’s executive director of co-operation and competition said: “We concluded the merger was not likely to lead to a loss of competition for pathology services, or reduce the incentives for pathology providers to improve the quality and efficiency of their services. 

“Consequently, we advised that on competition grounds the merger is unlikely to have any adverse effects for patients.”

3.41pm Accident and emergency departments have coped this winter, but next winter still looks like it will be as tough as ever, says Richard Murray, director of policy at the King’s Fund.

3.29pm Responding to the government’s announcement on NHS pay, Jon Skewes director for policy, employment relations and communication at the Royal College of Midwives, said: “This amounts to a pay cut, pure and simple, and it is not good enough.

“Midwives are angry about this. It is yet another body-blow to NHS staff facing rising pressures and working ever harder without any reward. Midwives have been struggling to cope with years of rising prices and stagnant wages.

“Morale in the profession is at rock bottom and this announcement will do nothing to help, indeed it will make it much worse.  When morale is this low and staff are disaffected, they are not able to deliver the best care. It is impossible to get the best from staff when they are treated this badly. You do not help the NHS by hurting NHS staff.”

3.20pm The BBC reports that thousands of people have been sent hoax emails warning they may have cancer. The emails appear to come from the National Institute for Health and Care Excellence (NICE).

Sir Andrew Dillon, chief executive of NICE, said: “A spam email purporting to come from NICE is being sent to members of the public regarding cancer test results.

“This email is likely to cause distress to recipients since it advises that ‘test results’ indicate they may have cancer.

“This malicious email is not from NICE and we are currently investigating its origin. We take this matter very seriously and have reported it to the police.”

3.07pm BBC health correspondent Nick Triggle argues that NHS pay is a classic catch-22 situation.

“Ministers felt on the one hand they couldn’t afford to give staff a pay rise, while on the other realising they couldn’t afford not to,” he writes.

“The result? A pay rise for some, and (arguably) none for others. But the risk is that this turns out to be a fudge that makes no-one happy.”

2.49pm With election turnouts varying wildly across the NHS organisations, Luke Ashby, senior business development executive at Electoral Reform Services, looks at how digital technology and social media can identify, inform and inspire people to vote.

2.25pm In response to the government’s NHS pay decision, shadow health secretary Andy Burnham said: “We support pay restraint, including in the NHS, but it’s unfair for NHS staff to be singled out in this way.

“The Pay Review Body has looked carefully at the issue and the Government should not have rejected its advice and gone further than a one per cent cap, which the Chancellor himself announced.

“If David Cameron hadn’t wasted £3 billion on a reorganisation nobody wanted, the NHS would have a much better financial outlook than it has today. His reorganisation resulted in six-figure pay-offs for thousands of senior managers and pay cuts for nurses. That is the reality of the NHS under David Cameron.

“It will be galling for nurses hearing this news today - they work flat out in difficult circumstances. Morale is already low and this broken promise by ministers will damage it even further.”

2.15pm On a lighter note, read about Sir David Nicholson’s leaving do on our End Game blog.

2.03pm Health secretary Jeremy Hunt has tweeted:

“Pleased all NHS workers will get more money next year, while ensuring enough frontline staff to provide compassionate care for patients”.

2.00pm Shadow health secretary Andy Burnham yesterday told The Daily Telegraph that a pay freeze would be “a kick in the teeth for NHS staff who are struggling with the cost of living crisis.”

1.51pm Chaand Nagpaul, chair of the British Medical Assocation’s GP committee, has responded to the government’s pay annoucement for GPs.

Dr Nagpaul said: “Today’s announcement from the Government on doctors’ pay is a kick in the teeth for GPs at a time when there is overwhelming evidence that GP workload is escalating to an unsustainable level while resources are continuing to fall in real terms. General practice is carrying out an estimated 340 million consultations this year, up 40 million from 2010, and are at the forefront of treating the 18 million patients in the community suffering long term conditions.

“It beggars belief to suggest that an 0.28% uplift in the GP contract will translate into a 1% increase in GP pay at a time when expenses are projected to continue to accelerate. This decision fails to recognise the expanding role and workload in general practice that shows no signs of abating.

“It will inevitably result in yet another pay cut. To add insult to injury, this decision comes on the back of several years of effective pay cuts. GPs will justifiably feel they are being unfairly treated as well as devalued. This settlement will also be a blow to patient services as it will effectively reduce resources for GP practices and frontline services.   

“Large numbers of GPs over the age of 50 are considering retiring or quitting early because GP morale is being completely undermined. Job satisfaction is at its lowest level since 2001 and we are seeing record numbers of GPs reporting high levels of stress. Not investing in general practice will make it even harder to retain and recruit more GPs. This is at total odds with the government’s stated aim of expanding the GP workforce and giving general practice the resources it needs to deliver more care in community settings.

“Today’s announcement is likely to make the morale and workforce crisis in general practice much worse.”

1.30pm In contrast to the situation in England, the Scottish government has accepted the recommendations of the NHS Pay Review Body and Doctors’ and Dentists’ Pay Review Body.

This means that NHS staff in Scotland are set to receive a 1 per cent pay uplift from 1 April.

Staff earning less that £21,000 will get an additional £300 to their pay.

Scotland’s health secretary Alex Neil said:“I was clear when Jeremy Hunt first suggested reneging on the one per cent pay offer for NHS staff in England that we would block that move here and that we would fully implement the modest increase in Scotland.

“Today, I can confirm we’ll deliver on that approach in Scotland’s NHS, ensuring our hardworking and dedicated staff rightly receive the wage increases they were promised.

“This means that all NHS staff groups in Scotland covered by the remits of these bodies will receive a one per cent pay increase, and we will supplement the pay of those currently earning under £21,000 to ensure they receive a total increase of £300.

“I have also taken steps to ensure that no NHS Scotland worker can be paid below the Scottish Living Wage.

“Our commitment to this pay increase, and to the living wage, for NHS workers underlines our commitment to frontline staff delivering services for the people of Scotland.

“The new rates of pay will be payable from 1 April 2014.”

Tom Waterson, Chairman of Unison’s Scottish health committee, said:

“We are delighted the Scottish Government has decided to implement the recommendations of the pay review body in full.

“We would urge the UK Government to also commit to paying health service staff the recommendations in full. We went into these negotiations in good faith and we expect the clear recommendations of the pay review body to be delivered. It is good news for NHS staff that the Scottish Government have committed to doing that.”

1.15pm The British Medical Association said the government’s announcement on NHS pay “highlights its abject failure to find a fair and sustainable solution to the funding crisis imposed on the health service”.

BMA chair Mark Porter said: “NHS doctors have now seen their real terms pay cut for the fifth year in a row. Despite how the government have tried to present it, doctors are being left worse off, year on year.

“This comes at a time when demand but also productivity across the NHS is rising, and demonstrates just how little the Coalition Government values its NHS staff given the fact they seem determined to balance the NHS budget on the backs of those working on the frontline.

“While the BMA understands the economic constraints the NHS faces, the continued erosion of pay undermines the excellent work and dedication to patient care from doctors and other NHS staff, and only goes to highlight the Government’s failure to find a meaningful and sustainable solution to the funding crisis imposed on the health service.

“At a time when doctors are working harder than ever before to meet rising demand, it is not surprising that doctors’ morale is going down when today’s announcement means that staff are once again bearing the brunt of the Government’s cuts.

“Overstretched doctors are covering for a recruitment crisis. In hospital emergency departments, severe doctor shortages combined with underfunding has produced the perfect storm – a crisis in patient care.

“The continued chipping away of pay means consultant pay is now, in real terms, lower than it was over a decade ago. GPs will also be unfairly hit. Despite delivering substantial efficiency savings while at the same time facing ever increasing workload pressures and patient demand, today’s announcement will continue to see practice income eroded as practice expenses increase disproportionately to income.

“How can the Government expect to engage constructively with doctors on pay and conditions when it continues to devalue them year on year?

 “The Government has set itself the target of reducing the NHS budget by £20 billion but has so far found no realistic plan to achieve this except for punishing those on the frontline by chipping away at their pay and dressing this up as ‘efficiency savings’. Jeremy Hunt has said that the continued erosion of staff pay is ‘not sustainable’ yet he has chosen to ignore his own advice.

“What message does it send to our hard-working doctors, nurses and other frontline staff when NHS managers have enjoyed a rise of 13 per cent since 2009 and yet doctors’ pay is being outstripped by inflation year after year? If we are going to meet the challenges the NHS faces head on the Government should be working with, not against, those doctors on the ground with the values, knowledge and professional judgement best placed to drive innovation and deliver real savings while all of the time protecting patient care.”

1.10pm The Royal College of Nursing has also criticised the government’s decision not to increase pay for all NHS staff by 1 per cent.

Its chief executive and general secretary Peter Carter said: “The Government is once again ignoring the independent pay review body, holding the Agenda for Change pay system to ransom, while expecting NHS staff to be grateful while their contractually agreed terms of employment are torn up.”

“The argument that the NHS cannot afford to honour the recommendations of the independent pay review body simply does not stack up. What the NHS cannot afford to do is continue a policy of treating hard working and loyal staff with contempt, at a time when morale is at an all time low and trusts around the country struggle to retain and recruit enough nurses to maintain safe staffing levels.

“Today’s decision means that less than half of nursing staff at the top of their pay increment will get a 1% rise. Other nursing staff get what they are contractually entitled to, if they can demonstrate they have developed their skills in the previous year.

Dr Carter added: “To suggest that incremental pay is the same as a pay uplift, or that NHS staff are simply being rewarded for time served is to either deliberately mislead or to fundamentally misunderstand how NHS pay works. Incremental pay is used in the private and public sectors and is only awarded to NHS staff when they can demonstrate that they have developed their skills.”

1.01pm The health union Unison has described the government’s rejection of proposals to increase NHS staff pay by 1 per cent across the board as “no way to treat our dedicated NHS members”.  

General secretary Dave Prentis said:“Today’s pay award for our NHS staff is even worse than we expected.  Not only is this coalition government freezing pay for 60 per cent of staff, but those who get the paltry 1 per cent lose it at the end of the pay year.

“This wretched government has treated the NHS, our members and patients with contempt. 

“I don’t know about you, but I was disgusted with the pathetic attempt by coalition politicians to justify why, at a time when they claim the economic recovery is at hand, they cut the pay of the majority of health staff.

“Most people understand that increments are about paying you more for getting better at your job, gaining new skills and becoming more efficient.  If the government wants to play that game, everyone should be paid the rate for the job.

“But let’s look at this one per cent increase – for this year and next – only for those at the top of their grades.  At the end of year one, your next year’s 1 per cent will be based on the pre-2014 rate – so even more is cut.

“This is no way to treat our dedicated NHS members. 

“They had to cope with massive cost of living increases, like everyone else, and they are worse off by an average 10 per cent. 

“This shabby coalition has once again demonstrated its real colours and should be swept from power for the sake of our NHS, if nothing else.”

12.54pm Jeremy Hunt has responded to the report of the NHS Pay Review Body, on behalf of the prime minister.

The health secretary said:  “We thank the NHS Pay Review Body for its 28th report and note its recommendations and observations.

 “We are clear that in the wake of the public inquiry into Mid Staffordshire NHS Foundation Trust, our first priority must be to ensure that the NHS can afford to employ the right number of frontline staff needed to ensure the safe, effective and compassionate care that patients have a right to expect.

 “The NHSPRB’s recommendations for a 1% consolidated rise for all staff, on top of automatic increments, are unaffordable and would risk the quality of patient care. Without a pay rise, incremental pay increases already commit nearly £1billion every year for all NHS employees and add 2% each year to the NHS pay bill for Agenda for Change staff. The PRB proposals suggest a pay rise that would risk reductions in front line staff that could lead to unsafe patient care. It is not possible to maintain appropriate numbers of front line staff, give a general pay rise of 1% and pay for incremental progression.

 “The Government is therefore adopting an approach by which all staff will receive at least an additional 1% of their basic pay next year. All staff who are not eligible to receive incremental pay will be given a 1% non-consolidated payment in 2014/15. Other staff will receive an increase of at least 1% through incremental progression.

 “It is our intention that in 2015/16 the same approach will apply and staff who are not eligible to receive incremental pay will receive a non-consolidated payment of 2% of pay, whilst other staff receive incremental progression. As this will be a two year pay award, the NHSPRB will not be asked to make recommendations on a pay award for Agenda for Change staff in the 2015 pay round.

“NHS staff are dedicated and hard working and the Government would prefer all NHS staff to receive a consolidated 1% increase. This would be affordable if incremental progression was frozen for one year in 2015/16. If the NHS Trade Unions were prepared to agree to this then the Government would be prepared to reconsider the position and make a consolidated award as other public sector workforces are receiving.

“The Government agrees with NHSPRB’s observation that a thorough review is required of the Agenda for Change pay structure, including the operation of incremental scales, so that it might better support the challenges facing the NHS in terms of both patient care and affordability.

“We note its offer to look into this, given an appropriate remit and evidence and we will consider whether to ask them to look at contract reform issues in next year’s report.”

12.40pm Children’s heart surgery at a Leeds trust, suspended last year following concerns over mortality rates, has been found “safe” in an NHS England review.

12.36pm Most of the “significant” drop in spending on social care has come from cuts to services, particularly for the elderly, according to the National Audit Office.

In a new report, the NAO found that around three-quarters of the reduction in spending by local authorities has come from cuts to the amount of care provided, while a quarter has come through slashing costs.

12.26pm The Chartered Society of Physiotherapy has sharply criticised the government’s decision not to implement the recommendations of the Pay Review Body in full.

Pete Finch, its assistant director for employment relations and union services, said: “We are appalled, as will our members be, by the government’s decision to reject the recommended pay rise for all NHS staff that they have worked so hard for.

“Physiotherapy staff are committed to providing vital, quality services to patients.

“Yet with this decision, the Department of Health shows a complete disrespect for the very people who have somehow continued to deliver outstanding patient services under extremely difficult circumstances.

“The principle of working together in partnership with the Pay Review Body to produce a fair deal for NHS staff and the taxpayer also now appears to be in tatters.

“The CSP has always supported the PRB, but the DH has badly undermined its independence and for reasons that don’t add up.

“There is no evidence that NHS pay restraint creates more jobs to deliver patient services, and staff in England agreed last year to make increments performance-related.

“This very disappointing decision will further damage morale, which could then affect patient care at a time when the NHS is asking its dedicated staff to work harder than ever.”

12.20pm HSJ reporter Nick Renaud-Komiya is tweeting throughout the day from the The Economist Events’ Pharma Summit 2014.

Follow @NickRenKom on Twitter for any updates.

12.10pm David Cameron has told the BBC the decision over NHS staff pay rises was difficult, but the right one.

12.04pm PoliticsHome’s Paul Waugh speculated on Twitter whether chancellor George Osborne and chief secretary to the treasury Danny Alexander overruled Jeremy Hunt, fearing even bigger backlash over NHS pay, saying the health secretary opposed a flat rate rise.

Ed Jones, special advisor to Jeremy Hunt, replied “no”.

11.49am The Mirror has examined how different public sector workers’ salaries will look after the 1 per cent pay rise.

11.26am There are significant updates to HSJ’s earlier story on the government rejecting proposals to increase NHS staff pay by 1 per cent across the board. It will instead impose a two-year deal in which staff who receive incremental pay awards get no further rises at all.

11.15am The health union Unite is considering takiing industrial action, following the government’s rejection of a one per cent pay rise for all NHS staff.

Unite described it as “divide and rule” tactic that “will see about 45 per cent of the NHS workforce getting no cost of living pay increase at all from 1 April”.

The union’s head of heath, Rachael Maskell, said: “Jeremy Hunt has adopted a divide and rule tactic which calls into serious question the relevance of the so-called independent PRB.

“He is deliberately muddying the waters by trying to imply that the annual increment that staff receive, as they gain more skills to benefit patients throughout their careers, is part of the annual pay increase – it is not. It is despicable that Hunt has adopted such an underhand tactic. 

“The PRB’s role is defunct, if ministers continue to steam roller its copious evidence gathering process which leads to its considered recommendations on pay.

“Our members are being hit by the escalating cost of living crisis – their pay packets are shrinking year by year. Their hard work and dedication appears to count for nothing in an NHS which is being parcelled up for privatisation at an accelerating pace.

“We will be consulting with our members about the possibility of industrial action.

“Hunt has created a parallel pay universe where 2,400 top NHS bosses are earning more than David Cameron – this is a gravy train for the elite, while nurses, health visitors, paramedics and speech and language therapists are treated with contempt.

“The bosses in the Yorkshire ambulance service are swanning around in top of the range Mercedes and BMWs – this is a prime example of the pay hypocrisy currently afflicting the NHS.”

10.53am A few tweets from HSJ reporter Shaun Lintern, who has been covering the NHS Pay Review Body report:

“NHS staff eligible for incremental pay rise will get nothing. Those at top of pay bands will get a 1% non-consolidated rise #nhspay

“This will be imposed again in 2015-16 when staff at top of their band will get a 2% non-consolidated pay rise #nhspay

“Non-consolidated rise means not added to their substantive pay or pensions. This is to avoid widening pay gap between bands #nhspay

“Government claims its decision on NHS pay will save over £200 million in 2014-15 and over £400 million in 2015-16”

“400 “very senior managers” in the NHS will not recieve any pay rise this year. #nhspay

“Doctors and dentists not on Agenda for Change will get a minimum 1% rise. #nhspay

“Gov has told NHS unions if they agree to an incremental freeze for 1 year in 2015-16 then it might be prepared to consolidate pay #nhspay

Follow @ShaunLintern on Twitter for further updates.

10.43am NHS Employers has said the pay rises announced by the government today “will further test NHS finances and inevitably impact on staffing levels”.

Its chief executive Dean Royles said: “These are really tough calls for the government to make. We know staff have worked incredibly hard in some very challenging circumstances when the NHS has been subject to exceptional scrutiny.

“For many staff a pay increase would of course help ease some financial pressures and for others a pay award would be a welcome recognition in a difficult year. We know how tough this decision will feel and how disappointed staff will be.

“The evidence we gave to the review body said any rise would add to already significant cost pressures. Employers are recruiting more front line staff with no additional money and this is not sustainable.

“The simple fact is that the decision to have no annual pay increase for those already eligible for increments will help ensure more that staff remain in employment than would otherwise be the case.

“More than two-thirds of NHS spending is on staff and increasing all staff pay by one per cent would have cost about half a billion pounds, equivalent to around 14,000 nurses. Even with limiting the increase to staff at the top of their pay scales, employers still face a £150 million pay bill pressure this year. This is bound to have an impact.

“The announcement will however give employers some certainty over pay for the next two years and we can now turn our attention to how we can come out of this period of pay restraint in a mature way. I know trade unions will be angry but hope they will recognise a shared desire to maximise job security for staff and work with us on creative solutions.

“More immediately, I hope that the doctors’ union will now see the urgency in concluding negotiations on changes to their terms and conditions of employment. Nurses, therapists, scientists, cleaners, porters and other NHS staff have already agreed some changes to their national terms and condition of employment. We now need doctors to do the same.”

10.37am The Department of Health’s overall financial position appears to be tighter in 2013-14 than it has been for a number of years, HSJ’s Will Hazell reports.

10.25am BREAKING: The government has rejected proposals to increase NHS staff pay by 1 per cent and instead impose a two-year deal in which staff who receive incremental pay awards get no further rise at all, HSJ understands.

10.16am In his leader column, HSJ editor Alastair McLellan writes that more than 10 years since the search for an effective failure regime for trusts began, the NHS’s policymakers are still looking.

10.06am The Telegraph leads on a story that statins have virtually no side effects, a major study claims.

Imperial College researchers looked back at 29 trials involving more than 80,000 patients taking the drugs.

They concluded that the chance of experiencing debilitating symptoms were slightly less among people taking statins than for control groups given a placebo.

9.58am The Times reports that the High Court has ruled that two paramedic volunteers “seeking only to do good” at the scene of accidents must be convicted of a criminal offence.

The two paramedics used vehicles with two-tone sirens and blue flashing lights to get to accident scenes quickly. The judges held that they acted in breach of road traffic regulations.

Sir David Nicholson, who steps down at the end of the month after eight years in charge and 36 years in the health service, warned that without the money the NHS will struggle to survive on recent austerity-driven budgets.

In an interview with The Guardian he appeared to call for a “change fund” on top of the health service’s annual £110bn budget to help pay for its reformation.

Data collected from trusts shows 54 of the 141 non-specialist hospital trusts in England are expecting to end 2013-14 in the red.

Hospitals appear to be in a significantly worse position than they were last year. At the end of 2012-13, 22 trusts reported deficits with Monitor or the Department of Health.

The net total forecast deficit of the 141 hospital trusts for this year is £373.1m – a deterioration of nearly £700m from the net surplus recorded in the previous year.

7.00am A very good morning and welcome to HSJ Live. We begin with an opinion piece by Andrew Street and Adriana Castelli of the Centre for Health Economics at York University, who have found that considerable variation exists in the productivity of health organisations.