Tender is one of largest single outsourcing deals ever proposed in the NHS, plus the rest of today’s news and comment.
4.26pm Some more from the Lord Ashcroft NHS poll. Despite being more likely to think funding had risen rather than fallen, the public were more likely to think the health service had deteriorated rather than improved. Only 15 per cent thought the NHS had generally got better over the last five years, with 34 per cent saying it had stayed the same and more than half (51 per cent) saying it had got worse.
3.19pm A Conservative Greater London Assembly member has suggested “removing drunks” from A&E to “ease winter pressures”.
Andrew Boff said: “We need to urgently reduce needless admissions if we are to relieve the current pressure on London’s A&E departments. Getting too drunk is no excuse for wasting our health resources, especially when each A&E visit costs the taxpayer over £200. We should remove drunks from our A&Es in London by using specially built sobering facilities, such as alcohol recovery centres and booze buses, as suggested in the recent report On the Wagon. Recovery centres provide a place for the intoxicated to sober-up, and booze buses help treat drunken patients on-the-go, both allowing these patients to avoid emergency departments altogether, if they have no other medical complications. With 7 per cent of all emergency callouts being alcohol related this practical measure could lift the massive burden on A&Es and save over £40 million every year. It’s common sense.”
Mr Boff was due to propose the policy to Anne Rainsberry, NHS England London director of NHS England, at this afternoon’s public London Assembly health committee meeting at City Hall.
3.09pm A new study by Picker Institute Europe and the University of Oxford has found that using and understanding patient experience is a consistently high priority for healthcare professionals. However national initiatives need to go further in terms of their ability to deliver more detailed intelligence that can be used to improve care quality at a local level, researchers found.
The study found that existing approaches were better suited to accurately understanding people’s experiences of a particular health or social care service, rather than tracing someone’s individual journey through illness and treatment (i.e. the patient “pathway”).
National level undertakings to measure pathways were found to be neither plausible nor practical due to the fact that truly individual pathways “tend towards a population size of one”.
“Currently it is therefore hard to justify the development of pathway specific surveys, at a national level, nor is there the experience and resource available to enable effective service improvement based on them,” the researchers concluded.
2.52pm Monitor is consulting on draft guidance setting out the action it can take if providers block efforts to deliver joined-up care for patients.
It is the first time the regulator has produced guidance to help providers comply with the integrated care condition of the NHS provider licence. The licence contains a specific condition requiring providers not to block the delivery of integrated care when it can benefit patients.
The guidance gives examples of situations which might lead to action from the regulator, including:
- Failing to work with commissioners to identify how local services can be better coordinated;
- Refusing to discuss with other providers the use of shared care plans for patients who need to be treated by more than one NHS provider;
- Allowing unnecessary delays in the handover of patient records when a patient moves from one provider to another.
Toby Lambert, director of strategy and policy at Monitor said: “Patients want the NHS to be joined-up, with providers of health services working together to deliver the best care possible. Providers must not stand in the way of integrating care, and we’re clear that if they do, we’ll use the regulatory powers we have.
“But we know that most NHS providers want to integrate the care patients receive. That’s why today’s guidance is designed to help them deliver the care patients want.”
1.52pm The Labour Party has set out policies for unpaid family carers.
The package of measures includes:
- A new duty on the NHS to identify family carers, so they can get the right help and support, and a new right for carers to ask for an annual health check – allowing problems to be identified earlier and prevent costs escalating.
- A single point of contact with care services for families caring for people with the greatest needs, so they don’t have to battle different parts of the system.
- Ensuring the funding currently identified for carers’ breaks is ring-fenced, to make sure all the money goes to family carers.
- Consulting with employers, trade unions and carers organisations on how to improve flexible working for family carers, which could include measures such as a new period of ‘adjustment leave’ to help families cope with a short-term crisis.
- Recognising the transport costs facing family carers, by including family carers in the groups who can be eligible for hospital car parking concessions.
- Abolishing “the bedroom tax”
Shadow care minister Liz Kendall said: “Too often carers have to battle all the different services to try and get the support they need. One in three family carers who are in paid work have to give up their job or reduce their hours because they can’t get the right help to care or flexible working hours.
“Most unpaid carers don’t have enough time to pay attention to their own health, and many don’t come forward for help or get any breaks. Often people don’t even see themselves as being a carer – they’re just a son, daughter, husband, wife or partner trying to look after the person they love.
“It’s not right that people who do so much get so little in return. We need to improve support for families, and Labour’s package of measures will make a real and practical difference to their lives.”
1.38pm The NHS Partners Network has appointed Howard Freeman as its new clinical director.
Dr Freeman is a GP and has been chair of Merton CCG for two years. He has also chaired the London Clinical Commissioning Council as well as sitting on the London Health Board. He has been actively involved with the National Association of Primary Care.
Dr Freeman said: “I am delighted to join the NHS Partners Network. I have worked in the NHS for more than 30 years and I’ve seen how the independent sector can make a difference in the NHS.
“At the NHS Partners Network, the independent sector is incredibly diverse and offers a very broad range of services to NHS patients including acute elective care, community services, primary care, diagnostics, homecare and dentistry. Harnessing the knowledge and innovation of the independent sector is going to be crucial in delivering the NHS Five Year Forward View and I look forward to contributing to the sector’s important work.”
Stephen Collier, chair of the NHS Partners Network said: “I am delighted to announce the appointment of a clinical director who will provide us with real expertise and insight, particularly one with recent experience of commissioning, and insights into CCG priorities and decision making processes. The NHSPN board strongly believes that the introduction of senior clinical capacity into the organisation is crucial in ensuring that the network can operate within an increasingly clinically-led NHS.”
1.32pm The chair of Basildon and Thurrock University Hospitals Foundation Trust has stood down to represent UKIP at the general election.
Ian Luder resigned from his position with immediate effect yesterday and is running for the seat of South Basildon and East Thurrock.
He had announced in November last year that he did not plan to continue in the role after his term expires in March.
An internal report released by the trust found that 8,324 999 calls made by patients between 18 December 2013 and 22 February 2014 had been downgraded to a lower priority response by the call centre manager without formal approval. The changes contravened official Department of Health guidance. At least 57 patients died during this period.
1.21pm Three bidders have been shortlisted for a £1bn, 10 year contract to provide critical primary care support services, NHS England has confirmed.
The tender is one of largest single outsourcing deals ever proposed in the NHS.
The three shortlisted bidders are:
- Capgemini, a global consultancy and outsourcing firm, with South East Commissioning Support Unit;
- Capita with Anglian Community Enterprise (a social enterprise providing community services in north east Essex); and
- Equiniti, which specialises in finance and administration.
CSUs were understood to be interested in bidding for the services. However, HSJ understands they were barred from directly applying. This is because they are currently part of NHS England, and any decision to award the contract to them could be challenged under procurement law once the units become autonomous in 2016.
12.20pm Elsewhere, The Guardian reports on the experiences of ambulance paramedics, who’s service is now at ‘breaking point’.
The paper describes the experiences of exhausted and pressured paramedics, and the delays on those who require their help.
One paramedic describes the whole health system as having ‘ground to a halt’.
12.18pm In a comment piece for The Guardian on the findings of his NHS poll, Lord Ashcroft writes: “I found people assumed these [The Lansley reforms] had been introduced to save money; more thought they were “part of a plan to privatise the NHS” than to cut bureaucracy or give more choice and control to patients. But it is not as though these reforms tarnished an otherwise gleaming Conservative reputation on the NHS. Rather, in the absence of any clear explanation of how the changes were supposed to benefit patients, people fell back on their assumptions about Tory motivations.”
12.15pm A financially challenged clinical commissioning group is planning to use almost £500,000 earmarked by GP practices to help reduce its own deficit.
In a letter sent to all GP practices in its area yesterday, Bedfordshire CCG said it would keep £460,000 earned by GP practices as part of the 2012-13 and 2013-14 prescribing incentives schemes. The schemes encourage practices to bring down their prescribing costs.
10.58am The Cambridgeshire and Peterborough health economy is likely to submit a joint expression of interest to develop a new integrated model of care, HSJ has learned.
HSJ understands Hinchingbrooke Health Care Trust was signed up to the project before Circle decided to withdraw from its franchise agreement to run the trust. Cambridgeshire and Peterborough Foundation Trust, Cambridge University Hospitals FT, Cambridgeshire Community Services Trust, and Peterborough and Stamford Hospitals Trust are also understood to be involved, along with Cambridgeshire and Peterborough Clinical Commissioning Group.
It is the largest example of a proposed vanguard application HSJ has seen in terms of number and size of the organisations involved. Expressions of interest must be submitted by 2 February.
10.49am Lesbian, gay and bisexual people seeking therapy will be better protected from harmful ‘gay cures’f ollowing commitments made today by NHS England, and medical and psychological professional groups.
Gay conversion therapy (sometimes referred to as ‘gay cure’ or ‘reparative’ therapy) is the umbrella term for a type of talking therapy which attempts to change sexual orientation or reduce attraction to others of the same sex. There is no good evidence this works and instead it is potentially harmful.
The UK Council for Psychotherapy with support from the Department of Health has brought together 14 signatory organisations, including the Royal College of GPs and the Royal College of Psychiatrists. These organisations are meeting today at the DH to launch an agreement on actions to end the practice of conversion therapy in the UK, to bolster psychological professionals’ training and improve the emotional support available to LGB clients who seek therapeutic help.
The memorandum makes clear that NHS England, the organisation which has day-to-day responsibility for running the NHS, “does not endorse or support conversion therapy and will make this clear to Clinical Commissioning Groups.” This commitment, signed by Sir Bruce Keogh, the NHS medical director, will effectively end the possibility of conversion therapy being provided on the NHS.
Care minister Norman Lamb said: “We have always been clear that being lesbian, gay or bisexual is not an illness. Any therapy that claims to change a person’s sexual orientation is not just unethical – it’s potentially harmful. I welcome this commitment from NHS England, the royal colleges and professional bodies to help tackle any such practice in the UK.”
10.38am The Financial Times reports that the EU’s Transatlantic Trade and Investment Partnership deal with the US is unlikely to be concluded this year, following negative responses to a public consultation.
The TTIP accord has been the subject of fierce debate in the UK about its potential impact on the NHS.
The European Commission received almost 150,000 responses to its survey on the deal - 100 times more than any previous consultation on trade - with the majority of respondents expressing fears that the deal’s investment clauses would undermine national sovereignty.
The deal includes clauses giving foreign investors rights to sue governments in international tribunals, bypassing national courts.
10.26am The former strategic health authority director who led the franchising of Hinchingbrooke Health Care Trust has defended the decision.
Stephen Dunn, currently West Suffolk Foundation Trust chief executive, was a director at NHS East of England SHA from 2007-11 then NHS Midlands and the East until 2013. In these roles he led decisions on Hinchingbrooke’s future and the tender process.
He told HSJ NHS East of England started considering the approach in 2008 when the NHS’s circumstances were very different.
Mr Dunn said: “At the time of working through the solutions to Hinchingbrooke’s problems nearly six years ago, we needed to find a solution for [the trust’s] debt, and to bring in the best placed partner with a plan to secure sustainability for the medium term.
10.18am Clifford Mann is asked whether the £700m winter pressure funding has been useful. He says: “We’re not convinced that the money has been invested in the schemes that were envisaged in the winter planning guidance. We are so concerned that we’re in the process of doing an FOI request to chief executives of every trust to ask how much money they received and what it went towards.”
10.17am Andrew George MP says we have substantially less acute beds than other European countries and the “assumption is this is not a moveable feast”. He says there has been a conscious effort to reduce the number of acute beds.
The King’s Fund’s Chris Ham says he agrees there has been a reduction of acute beds in recent years, but he says it’s not the number of beds but how they’re used that matters. He says there are wide variations between hospitals in how they used beds. He says not only should we look at the number of beds but we need to look at facts outside of hospital such as cuts to social care.
He adds, however, that two-thirds of delayed transfers of care are due to blockages within the NHS itself.
10.11am The College of Emergency Medicine’s Clifford Mann is asked if he thinks the changes to the ambulance target eight minute target for ‘Red 2’ patients is sensible. He says it is, because the Red 2 category is now very broad and includes patients who might not be an emergency. He cites the example of a patient having a stroke in the moment compared to a person who has suffered from a stroke hours ago, which therefore means an ambulance arriving in eight minutes wold be irrelevant. He says it makes more sense to give call-handlers a few more minutes to ascertain more details about whether the case is an emergency or not.
10.10am The health select committee is currently holding a one off hearing on accident and emergency services, in response to the well reported pressures on A&E departments and spate of “major incidents” which have declared since the start of the year. Appearing before the committee in the first session are Clifford Mann, president of the College of Emergency Medicine, and Chris Ham, chief executive of the King’s Fund.
You can follow the session live here, but we’ll keep you updated on what’s being said here on HSJ Live.
10.04am The author of a major government review on provider sector reform has rejected the suggestion that the collapse of the Hinchingbrooke contract should spell the end of franchising in the NHS.
Sir David Dalton’s health secretary commissioned review described management franchises as one of a series of organisational forms with “the potential for wider adoption across NHS providers”.
Publication of the review came just a month before private provider Circle announced plans to pull out of its franchise to manage Hinchingbrooke Health Care Trust, the only such deal in operation in the health service.
But speaking after the news broke, Sir David said it was “a big step to say one failure equals the concept being dead and buried”. He added: “[Problems with] one contract with one provider in one locality in Cambridgeshire does not mean, in itself, that there is a problem with one organisation managing another.
9.57am An MP has called for an urgent review of an NHS helpline after it was revealed yesterday that patients are being asked nonsensical questions, The Daily Mail reports.
Liberal Democrat Andrew George claimed the non-emergency helpline NHS 111 went into ‘meltdown’ in his St Ives constituency over the Christmas period.
In one case a pensioner was asked if he was conscious.
9.56am Browsing through this morning’s papers, The Daily Mail reports that ambulance chiefs were accused last night of risking patients’ lives to meet response time targets.
One trust downgraded emergency call-outs to non-urgent to free them from hitting a response time target of eight minutes. Critics said this may have hastened the deaths of 57 people.
East of England Ambulance Service admits that 8,324 patients had their cases reclassified in this way in a two-month period last year. At least 57 were not taken to hospital and died.
9.50am In the poll 42 per cent said “improving the NHS” was in the top three most important issues facing Britain, rising to 54 per cent when respondents were asked what were the most important issues facing “me and my family” (only second to “tackling the cost of living”).
9.46am The Conservative peer, Lord Ashcroft, has published the results of a wide ranging poll on people’s attitudes to the NHS.
He found that 29 per cent of voters think that the Conservatives have the best approach to the NHS, compared to 47 per cent for Labour and 12 per cent a piece for the Lib Dems and UKIP.
There’s lots in the data - we’ll pick out the most interesting bits throughout the morning.
Hilary Cass issued the warning after a major study by the RCPCH, shared with HSJ, found the NHS has failed to centralise paediatric inpatient units despite mounting pressures.
The college believes reconfiguration of paediatric services is necessary to help ensure high quality care for children and to help tackle UK child mortality rates, which are significantly higher than those in Europe.