NHS England chief executive Sir David Nicholson was not involved in the decision to award his close ally and departing HR director Jo-Anne Wass a two-year pay deal, HSJ has been told, plus the rest of today’s news and comment.

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5.10pm HSJ can reveal the first 12 clinical commissioning group areas that will be inspected under the Care Quality Commission’s new general practice inspection regime.

To find out where they are - click here

5.00pm Five hundred women every year could benefit from a new drug which has been added to the Cancer Drugs Fund to treat advanced cervical cancer, NHS England has announced.

The drug bevacizumab (Avastin) is already used in the treatment of other cancers, however this is the first time it will be available on the Cancer Drugs Fund for advanced cervical cancer.

Cervical cancer is the most common cancer in women under 35 and its incidence has risen by approximately 15 per cent in the last decade in the UK with 2,900 women diagnosed in 2010.

NHS England’s Chemotherapy Clinical Reference Group (CRG) has made the medicine available after trials showed bevacizumab could extend the lives of women with advanced cervical cancer by nearly four months compared to chemotherapy alone.

The Chemotherapy CRG is working closely with clinicians and representatives of the pharmaceutical industry to ensure a rapid review process for new drugs that may be appropriate for inclusion on the Cancer Drugs Fund list. The review process looks at the available evidence regarding a drug’s efficacy, plus data relating to its safety.

Professor Peter Clark, Chair of the Chemotherapy CRG, said: “This new addition to the list demonstrates NHS England’s commitment to achieving maximum benefit to patients from the £200 million Cancer Drugs Fund. The process of updating the list is led by cancer specialists, and should ensure that patients benefit quickly when new drugs become available that are backed by good evidence from trial data.”

Robert Music, Chief Executive of Jo’s Cervical Cancer Trust, said: “The addition of bevacizumabto the Cancer Drugs Fund is very positive as for women who receive a late stage diagnosis of cervical cancer, the prognosis can often be poor. When this is the case, any extra time that can be provided through new drugs becomes extremely valuable. We hope this will result in extended survival without impacting on quality of life for those facing non-curative treatment.”

The Cancer Drugs Fund provides an additional £200m each year to enable patients with cancer in England to access drugs that are not routinely funded by their local NHS. The national Cancer Drugs Fund list is a single national list of approved fast-track drugs giving uniform access to treatment across the country. From 1 April, NHS England took on responsibility for the operational management of the Cancer Drugs Fund, creating for the first time a single national system for deciding which drugs are available and for which conditions.

4.28pm There needs to be greater clarity around how obesity care in England is commissioned in the future, according to a report published today.

It aims to support more equitable access to obesity and weight management services, including obesity surgery, across the country.

NHS England and Public Health England convened a short-life working group, made up of a broad membership including representation from local commissioners and national health and social care bodies, to look into ways in which the pathway and co-ordination of the clinically led elements of care might be improved in the future.

The working group’s report is now published on the NHS England website.

The group explored concerns about variations in local commissioning of certain obesity services across England and in particular, concerns about access to clinician-led specialist multidisciplinary teams, commonly referred to as tier 3 services.

The working group concluded:

  • Local Authorities should retain primary commissioning responsibility for tiers 1 and 2, including population level interventions to encourage healthy eating and physical activity, as well as lifestyle related weight management  services
  • Clinical Commissioning Groups (CCGs) should have primary commissioning responsibility for tier 3, clinician-led specialist multidisciplinary teams
  • NHS England should retain primary commissioning responsibility for tier 4 services, including bariatric surgery, but should consider the transfer of all but the most complex adult bariatric surgery to local commissioning once the predicted increase in volume of tier 4 activity has been realised and once locally commissioned tier 3 services are shown to be functioning well.

Professor Jonathan Valabhji, NHS England’s national clinical director for obesity and diabetes who also chaired the working group, said: “It is clearly not acceptable that access to obesity services across the country is so variable.  This report is an important first step in providing much needed clarity about the future commissioning arrangements for all obesity care services and ensuring greater equity of access to obesity care wherever patients live in England. 

“We are now keen to hear from as many stakeholders as possible, both locally and nationally, who have views about progressing implementation of this report at a local level.”

Professor Kevin Fenton, Public Health England national director for health and wellbeing, said: “I welcome the working group report which makes a valuable step to clarifying the commissioning responsibilities, particularly for tier 3 services. We should also recognise that there remains much for us all to consider for improving and integrating the system, at all tiers, going forward. This includes the need to continue building effective partnerships across health and local government.”

The working group has now concluded and NHS England and Public Health England are inviting comments from national and local stakeholder organisations, principally concerning implementation at a local level and implications for delivery.

NHS England and Public Health England will publish a summary of any comments received and reference the organisations responding. The information provided may also be used to develop further guidance in accordance with the needs of health and Local Authority colleagues. 

3.50pm To encourage cooperation between doctors and managers early in their careers, one training initiative is having great impact on participants, says Lindsay Hadley, head of the School of Clinical Leadership at Health Education Kent, Surrey and Sussex.

3.40pm Are boards up to the challenge of delivering a paperless NHS? Experts urge them to invest in real transformation, appreciate the broad business case and seize the chance to take better informed decisions. Daloni Carlisle explains how.

3.30pm More from HSJ’s coverage of the health secretary’s ambition for a paperless NHS by 2018, information, and informatics, can play a pivotal role in delivering the transformational agenda required for constant improvement in safety, effectiveness and patient experience says Stuart Bain, chief executive at East Kent Hospitals University Foundation Trust.

3.20pm This week’s issue of HSJ magazine is now available to read on our tablet app.

This week HSJ research reveals that more than a third of hospital trusts are predicting deficits at the end of this financial year.


  • Monitor and NHS England consider setting acute providers different efficiency targets based on their varying potential to save
  • Our open letter to Jeremy Hunt urges him to address an IT skills deficit in the NHS leadership if his ambition for a paperless NHS is to be credible
  • A trust chair quits in protest after claiming the NHS pre-judged Care Quality Commission inspection results
  • Ciaran Devane says the NHS to invest in leadership training now to help commissioners provide satisfactory services
  • Using digital technology and social media online elections can identify, inform and inspire people to vote in NHS elections

To find the latest issue, simply navigate to “This week’s issue” on the app, or tap on the cover image on the homepage.

HSJ’s tablet app is free to download for both iPad and Android devices. iPad users can download it directly here, Android users will need to download it from the Google Play store.

3.05pm The Times dedicates a leader to the public sector pay restraint announced by the government yesterday.

Commenting on Jeremy Hunt’s decision not to give staff in the NHS receiving “progress pay” a 1 per cent rise, the paper says: “The suggestion that these workers are being denied a rise is bewildering – they are getting the progress pay, after all”.

2.52pm Also in The Times, every minute’s delay in treating a stroke victim reduces their healthy lifespan by more than a day, researchers have claimed.

With the difference in performance between the best and worst hospitals amounting to as much as an hour, scientists at the University of Melbourne argued that improving treatment times could give people months of extra quality life.

2.40pm Britain’s biggest care home provider has been fined £125,000, with £45,000 in costs, by Preston Crown Court over the death of woman in its care, The Times reports (paper only).

Rita Smith, 75, should have been fed only pureed food but choked on fish and chips at one of Four Seasons Health Care’s homes in 2010.

2.30pm All junior doctors in England will be forced to undertake at least four months’ community placement during their first two years in the NHS, to better prepare them for the future of service delivery, it has been announced.

2.20pm A clinical commissioning group has won a legal battle to award a contract for work that had already been given to other providers under the trust special administration process.

2.05pm By the time the Care Quality Commission finishes inspecting the acute sector under its new regime up to 30 hospital trusts could have been placed in “special measures”, the regulator’s chair suggested yesterday.

David Prior also endorsed the idea of drafting in successful operators of foreign hospital chains to turn around failing NHS organisations.

1.50pm EXCLUSIVE: NHS England chief executive Sir David Nicholson was not involved in the decision to award his close ally and departing HR director Jo-Anne Wass a two-year pay deal, HSJ has been told.

Sources at NHS England said Sir David stepped aside from the decision making process, which was handled by a remuneration committee chaired by NHS England chair Sir Malcolm Grant.

1.45pm Read HSJ editor Alastair McLellan’s open letter to Jeremy Hunt on his ambition for a paperless NHS by 2018.

HSJ welcomes NHS England’s ambition but urges it to go much further to address the problematic culture in the NHS in which technology is viewed largely as a sideshow to the main event

1.33pm The health union Unite has written to Jeremy Hunt saying it could engage in talks with the government over NHS pay, but it will continue to consult with its members over possible strike action.

In the letter, Unite’s head of health Rachael Maskell said: “We have never met such anger at a pay announcement in the NHS, and our members are clear that they want us to progress to consult over taking action against your proposals.

“Unite would agree with you that dialogue is preferable to strike action, and whilst we will continue to follow the mandate of our members to demonstrate the strength of feeling against your actions and use industrial means to change your response to the NHS Pay Review Body recommendations, we would engage in talks should they be meaningful and with the intent of progressing the pay arrangements.

“It would be helpful if you could outline how you have envisaged talks taking place, and their scope.”

13.10pm Are boards up to the challenge of delivering a paperless NHS? Experts urge them to invest in real transformation, appreciate the broad business case and seize the chance to take better informed decisions. Daloni Carlisle explains how here.

12.45pm Senior managers’ lack of knowledge about the clinical and cost benefits of improved IT systems is hindering progress towards the health secretary’s ambitions for a paperless NHS, an HSJ survey suggested last week.

HSJ reporter James Illman analyses the results of our first technology survey and why healthcare leaders believe the sector will struggle to achieve Jeremy Hunt’s target of a completely digital health service by 2018.

11.36am People suffering from serious illnesses including cancer and dementia will be able to try new medicines years earlier thanks to a new scheme, the health secretary has announced.

Jeremy Hunt published details of a “fast track” plan to get drugs into the NHS before they have even been granted a licence for use.

Paid for by the pharmaceutical industry, the scheme means experts will carry out a rapid assessment of a drug before labelling it a “promising innovative medicine”.

11.35am A heart surgeon who has not returned to work since five of his patients died after becoming infected with an antibiotic resistant bug during valve replacements has lost a High Court case against his employer.

11.15am “The NHS is at a crossroads,” says Monitor chief executive David Bennett in HSJ today, adding, “We need to adapt or face the consequences.” 

Monitor, NHS England and the Trust Development Authority have been working together to look into how the NHS can change to meet the challenges of rising demand and costs while continuing to provide a service free at the point of use. The recent NHS Futures Summit provided a forum for health policy makers, academics and NHS staff to exchange ideas on how healthcare can be delivered and debate how they could be adopted. 

At www.hsj.co.uk/nhs-futures we have more from the summit – including video interviews with Malcolm Grant and David Bennett; while delegates offer their views on how the NHS should change.

11.08am Finance and quality are not at opposite ends of a spectrum, but they are in a state of tension, writes HSJ editor Alastair McLellan in this week’s leader.

Regulators and government need to face facts about the realities for individual trusts, and this will involve frank discussions about priorities, he says.

10.55am The Daily Mail reports on 600,000 NHS staff being denied a 1 per cent pay rise. The paper contrasts this with a number of “hospital fat cats” who beat the freeze on wages.

In its leader column, the paper comments: “With dreary predictability, outgoing NHS boss Sir David Nicholson – aka ‘The Man With No Shame’ – says the answer to the behemoth’s problems is to throw even more billions at it.

“This from a man who presided over Mid-Staffs hospital neglect scandal, allowed millions to be spent gagging whistleblowers, and claimed lavish expenses himself, while ordering deep cuts in front-line spending.

“What the NHS needs is not ever more cash, but vastly better management and a change of ethos based on greater financial discipline

“Drastically reforming the ludicrous GP contracts would be good start.”

The Daily Mail also reports on thousands of people being sent a hoax email, purporting to be from the National Institute of Health and Care Excellence, telling them they may have cancer.

10.49am Responding to the report,The Early Benefits and Impact of Medical Revalidation, Niall Dickson, chief executive of the General Medical Council, said: “This is an encouraging report. It suggests that revalidation has begun to have an impact on the number and quality of annual appraisals of doctors and it suggests the new system may be helping to spot concerns at an earlier stage.

“At the heart of this, there are signs that healthcare organisations are taking their responsibilities in this area more seriously both in supporting doctors and in identifying where there may be problems.

“But we are at the start of this process and there is plenty for all of us to learn as the system beds in. We are committed to listening to those who run the system, as well as those who have been through it, and this combined with an independent ongoing evaluation will help us develop and refine the model, including how we gather patient and colleague feedback.    

“We are the first country in the world to attempt such a comprehensive system which is designed to make sure every doctor practising in the UK is competent and fit to practise safely and effectively. It should be seen as part of a wider commitment to make patient safety and the quality of care the number one priority – we are confident that, over time, revalidation will make a significant contribution towards realising that ambition.”

10.47am Medical revalidation, a process by which UK-licensed doctors show they are still fit to practice, is taking doctors longer than expected, according to a review into the process carried out by the NHS Revalidation Support Team.

The team reports that one year into implementation, medical revalidation is delivering value, but more needs to be done to maximise benefits in the future.

Evidence that revalidation is delivering value include:

  • A continued increase in appraisal rates (which increased from 63% to 76% between March 2011 and March 2013)
  • An increased focus on the quality of appraisers and the appraisal process
  • Indicative signs that concerns about a doctor’s practice are being identified at an earlier stage
  • Strong support for the system among responsible officers and appraisers
  • Strong support from doctors, appraisers and responsible officers for medical appraisal, a key element of revalidation.

However, the report also highlights a few areas where further work is needed:

  • While doctors continue to value appraisals and continuing professional development, some feel that revalidation is not yet relevant to their needs.
  • Doctors, appraisers and responsible officers are, on average, taking slightly longer than expected in this first year, to participate in appraisal and revalidation.
  • Patients and the public need clearer and more powerful roles in revalidation in the future.

The Early Benefits and Impact of Medical Revalidation report summarises research carried out in 2013-14 on the early benefits and impact of medical revalidation in England. The findings are based on an analysis of 3,500 responses to surveys on the impact of revalidation from doctors, appraisers, responsible officers and designated bodies.

10.20am The Guardian reports that a scheme to fast-track new medicines to patients without waiting years to get a licence will be announced today by the government.

Under the scheme any severely ill patient with a life-threatening condition will be able to get new drugs that are still under development even if they are not within the strict parameters for a specific clinical trial.

10.18am The Financial Times reports on the Commons public accounts committee criticising government failures in dealing with private providers and demanding tighter outsourcing controls.

The committee noted that whistleblowers, rather than civil servants, were the first to draw attention to the outsourcer Serco misreporting of performance figures on its out-of-ours GP services in Cornwall.

10.15am Let’s look at this morning’s papers:

The Daily Telegraph writes that health workers could go on strike after the government yesterday rejected a proposed pay rise for NHS workers.

Trades unions have accused ministers of taking a “scalpel” to the pay of NHS workers after the government imposed an effective pay freeze on 600,000 health workers.

The government has defended its “difficult” decision not to give nurses, paramedics and other NHS workers a blanket pay rise by saying that more money can be spent on hospitals and “vital treatments”.

9.46am State-of-the-art medicines and advanced treatments will be fast-tracked to patients thanks to a new approach that will make the UK one of the best countries in the world to capitalise on breakthroughs in medical care, the government has said.

The Department of Health has this morning announced the launch of a scheme designed to make innovative drugs available as soon as the regulator has signalled that the benefits outweigh the risks following an initial scientific assessment.

The Early Access to Medicines scheme will see doctors working with patients to make promising drugs available as soon the Medicines and Healthcare Products Regulatory Agency has made the assessment.

The DH has said that the scheme is an important addition to the pharmaceutical sector, providing a platform for drugs to be brought to patients at a much faster rate than ever before.

The companies will be able to gain experience of their medicines being used in the NHS and work with regulators to look at the value of the drugs, gaining guidance and advice much earlier in the regulatory process.

Health Secretary Jeremy Hunt said: “Making Britain the best place in the world for science, research and development is a central part of our long term economic plan. This ground-breaking scheme will provide cutting edge medicines earlier, give hope to patients and their families and save lives. And as part of our strategy for Life Sciences it will create more jobs and opportunities for people, helping secure a better future for our country.”

Alongside the Early Access to Medicines scheme, the Department of Health has launched a bank of nearly 75,000 medical research volunteers to make it much easier for researchers to recruit people with specific conditions and a family history of conditions into research and trials.

7.00am Good morning and welcome to HSJ Live. To start the day, the results of HSJ’s ‘paperless NHS’ survey are in - and they make sobering reading for Jeremy Hunt writes Claire Read.