Three West Midlands hospital trusts are to create an alliance with catchment population of more than 1 million, plus the rest of today’s news and comment

Live logo

5.15pm To catch up on HSJ key stories today why not read our Executive Summary?

2.44pm The government has suffered a blow to its insistence on places adopting directly elected mayors in return for substantial devolution deals.

A Labour led amendment to the Cities and Local Government Devolution Bill was passed following a debate in the House of Lords yesterday.

The amendment, moved by Labour local government lead Lord McKenzie, said that an order for a directly elected mayor should “not be used as a condition for agreeing to the transfer of local authority or public authority functions”.

However, Department for Communities and Local Government’s minister Baroness Williams successfully moved an amendment which she said would “provide assurance that any future devolution arrangements will continue to uphold existing accountabilities and national standards for the NHS”.

2.40pm Monitor has launched an investigation into Oxford Health Foundation Trust to find out why it is losing money and what could be done to fix its financial problems for patients.

The regulator will examine the trust’s financial plans after it emerged that it lost £3.7m last financial year. This year, the trust is predicting that its financial position may deteriorate further.

Monitor has concerns that the trust is making fewer savings than planned, and will look at how the trust could save more money to recover its finances.

Paul Streat, Monitor’s Regional Director, said: “Oxford Health lost money last year and the losses look set to continue.

“We know the trust has already been working hard to save money, but to date it hasn’t been enough to return the trust to a healthy financial position. We want to know what more it could be doing to be more efficient, and how local healthcare organisations could help it to improve its finances.

“Our priority will be helping the trust to improve its financial position so it can continue to provide quality care to its patients.”

No decision has been made by Monitor on whether action will be needed. Monitor will announce the outcome of its investigation once it is completed.

2.23pm Nearly 600 GP practices have closed in the last five years, data seen by HSJ reveals.

However, patient list sizes have steadily risen over the same period, which suggests a shift towards larger scale providers.

Between 2010-11 and 2014-15, 599 GP practices closed, according to Health and Social Care Information Centre figures. Ninety-four practices opened during this time (see graph below).

Ninety-one practices closed in 2010-11, rising to 115 in 2011-12 and 145 in 2012-13. The figure fell to 99 in 2013-14, but jumped to 149 practice closures last year.

2.13pm Three West Midlands hospital trusts are to create an alliance with a combined turnover of almost £1bn and a catchment population of more than 1 million, HSJ can reveal.

The Black Country Alliance is being created as a joint venture partnership to make efficiency savings and improve clinical sustainability in the region north of Birmingham.

Although there will be an overall programme board to oversee its work, the alliance is not a formal merger and each trust will retain its sovereignty. The alliance intends to create a jointly owned company limited by guarantee before the end of 2015-16.

11.24am HSJ’s Will Hazell tweeting from the Specialised Healthcare Alliance’s annual conference:

11.20am Commenting on George Freeman’s speech at the Specialised Healthcare Alliance annual conference earlier this morning (see below), HSJ editor Alastair McLellan tweets:

11.17am A membership organisation of private consultant ophthalmologists has today admitted breaching competition law and agreed to pay a fine of £500,000, to be reduced to £425,000 if it continues to co-operate. Ophthalmologists (eye surgeons) are specialists in medical and surgical eye procedures.

Consultant Eye Surgeons Partnership Ltd, the membership organisation, was formed to represent the interests of 37 limited liability partnerships and their 200 consultant members based across the UK. It provides its members with a number of services including access to CESP Limited negotiated contracts with private medical insurers. Each LLP has a representative on CESP Limited’s Board.

CESP Limited has admitted to infringing competition law and the Competition and Markets Authority has today issued a statement of objections to it. CESP Limited accepts liability for a number of infringements during the period September 2008 to present, which include:

  • Recommending that its members refuse to accept lower fees offered by an insurer, and that they charge insured patients higher self-pay fees.
  • Circulating amongst its members detailed price lists for ophthalmic procedures such as cataract surgery to be used with insurers. These collectively set prices did not pass on lower local costs (such as cheaper hospital fees) and made it harder for insurers and patients to obtain lower prices.
  • Facilitating the sharing of consultants’ future pricing and business intentions such as whether to sign up to a private hospital group’s package price, which enabled members to align their responses.

Today’s fine includes a discount of £75,000 to reflect the resource savings to the CMA generated by the membership organisation’s admissions and continual agreement to co-operate.

The CMA welcomes CESP’s proposals to implement a comprehensive compliance programme, which is a positive step ensuring CESP Limited and its members avoid breaking competition law in the future. The CMA will now review the detail of the programme and, if it is satisfactory and implemented before the CMA issues its infringement decision, grant a further reduction in its fine. The CMA intends to issue an infringement decision next month.

Ann Pope, CMA senior director of antitrust enforcement, said: “This membership organisation of private eye surgeons has admitted to anti-competitive conduct including agreeing prices, recommending that members refuse to accept lower fees from an insurer and facilitating the sharing of confidential business intentions, including future pricing intentions, between its members.

“As a result of this activity, the incentives for its members to compete on price were restricted, making it harder for insurers and patients to obtain lower fees.

“This is the first time formal competition law enforcement action has been taken against medical professionals in the UK.

“This case demonstrates the CMA’s commitment to taking action in specialised and regulated sectors including the professions and makes it clear that membership organisations and their members are not outside the scope of competition law or its penalties.

“We welcome CESP’s co-operation with the CMA’s investigation and its commitment to introducing a compliance programme and we hope that other professional membership organisations will take note of this case and take steps to ensure they operate in a way that does not infringe competition law.”

10.56am Barts Health Trust has had a new chair appointed by the NHS Trust Development Authority.

John Bacon will take up the post on 1 August.

He is currently chair of Community Health Partnerships, a private company owned by the Department of Health which works with the NHS to use the community estate more efficiently.

He was previously chair of Sussex Partnership Foundation Trust for seven years and was director of service delivery at the DH for three years.

10.54am HSJ’s Will Hazell is tweeting from the Specialised Healthcare Alliance’s 20125 conference, where life sciences minister George Freeman is currently speaking:

10.48am The NHS can be a ‘world leader’ in many areas of patient safety but only if it starts taking immediate action to improve, healthcare leaders have said in a report published by HSJ today.

The Case for Patient Safety: Financially, Professionally and Ethically, which was launched at the Patient Safety Congress event in Birmingham, features contributions from NHS England chief executive Simon Stevens and medical director Sir Bruce Keogh, and Care Quality Commission chief inspector of hospitals Sir Mike Richards.

It also includes work from Martin Bromiley, chair of the Clinical Human Factors Group and James Titcombe, national adviser on patient safety to the CQC

10.45am The Care Quality Commission (CQC) has reviewed how effectively health services in Rotherham are protecting children and young people from abuse and neglect. 

The regulator’s dedicated child safeguarding team assessed acute and community healthcare services in February and has today published its findings. 

The review concludes that there is still a lack of understanding about roles and responsibilities in safeguarding, in particular in child sexual exploitation, and that this is surprising following the publication of Alexis Jay’s inquiry last August and subsequent scrutiny on the area. 

Services must work together more closely to protect children who are vulnerable, with communication between midwives and health visitors and the capacity of the school nursing service to respond as particular areas for improvement. 

This is important as it is the ability of partners to work together that leads to the early identification and effective protection of vulnerable children and young people at risk.

The review also identifies some positive practice. For example, contraceptive and sexual health services in the area have an outreach worker who makes home visits and who has an innovative approach to using social media to keep in contact with her clients.

Rotherham NHS Foundation Trust is also developing a new emergency centre with careful consideration being given to the needs of children and young people. 

CQC has made a number of recommendations to the two NHS trusts, the clinical commissioning group and the local authority, so that it can be confident that health services in the area can keep children safe and promote the health and wellbeing of looked-after children and care leavers.

CQC’s deputy chief inspector, Sue McMillan said: “We’re disappointed that despite the intense scrutiny on child protection in Rotherham and the help packages that have been made available, services with a key role in child safeguarding are unclear about their responsibilities. While progress has been made, it is too slow and more is required. 

“This is unacceptable and we will check progress against our recommendations. These agencies need respond quickly to this report to ensure that no child is let down by the services designed to protect them.

“We know from decades of inquires that things go wrong for vulnerable children when services do not work together and this is crucial in keeping children safe.”

The review focused on the experiences of and outcomes for children and young people using a range of methods, including interviews, focus groups and visits, and by examining the performance of health providers including Rotherham, Doncaster and South Humber NHS Foundation Trust and the Rotherham NHS Foundation trust, as well as Rotherham Clinical Commissioning Group and NHS England’s local area teams. 

Services included in this review are accident and emergency, maternity services, child and adolescent mental health services, health visiting services, school nurses, sexual health services and GPs.

Other findings include;

  • Children who are brought into the care of Rotherham Social Services were not receiving timely initial health assessments (IHA) and when they did take place, they were not always effective and not always followed up.  IHAs are important because they include an assessment of whether the child is or has been abused and also, it is well recognised that the health of children who are looked after is often worse than those who are not. This is unacceptable. 
  • Rotherham’s contraceptive and sexual health services and Genito Urinary Services do not understand their roles or responsibilities in relation to safeguarding and in particular, CSE. 
  • There have been cases with young people receiving inpatient mental health services who have been discharged back to Rotherham without local mental health services knowing. This is unacceptable and puts vulnerable children at serious risk of harm. 
  • Rotherham NHS Foundation Trust’s community based service, The Family Nurse Partnership was well established and successful in working with young mothers who are traditionally difficult to engage and have complex and chaotic lifestyles.
  • Children and young people attending the emergency department of Rotherham Hospital have their safeguarding needs assessed with action taken to keep them safe where appropriate. The hospital is also rebuilding its Emergency Department adding a specialist paediatric unit.

CQC has recommended NHS England and Rotherham Clinical Commissioning Group (CCG) should work with GPs to ensure they understand local child protection processes and their responsibilities therein. 

Both trusts, NHS England and the CCG should ensure that pharmacists, doctors and nurses in Rotherham Walk-in Centre are aware of their role in referring young people for screening for sexually transmitted infections or in raising safeguarding concerns. 

The CCG and Rotherham NHS Foundation Trust should make sure children or young people who attend the emergency department should have their previous attendances considered as part of the safeguarding assessment. Other recommendations can be found in the report. 

CQC’s safeguarding children and young people team carried out this inspection as part of a two-year programme to review health services in 50 local authority areas across the country. 

In addition to this programme, CQC is now enhancing it Child Sexual Exploitation work, building it into all inspections carried out under its new approach. Safeguarding special advisors will attend all planned hospital inspections in future. 

The safeguarding team inspected Rotherham NHS Foundation Trust in conjunction with inspectors from CQC’s hospitals directorate. 

Separately, CQC carried out a comprehensive inspection of Rotherham NHS Foundation Trust to assess whether it was providing patients with care that is safe, caring, effective, responsive to their needs, and well-led. CQC has rated the trust as Requires Improvement overall and the report is available on CQC’s website:

10.32am It seems highly likely that there are other units that show some of the same care failings found at Morecambe Bay. Assuming that all is well without investigating would be a significant missed opportunity to improve, writes Bill Kirkup.

10.31am Three West Midlands hospital trusts are to create an alliance with a combined turnover of almost £1bn and a catchment population of more than 1 million, HSJ can reveal.

The Black Country Alliance is being created as a joint venture partnership to make efficiency savings and improve clinical sustainability in the region north of Birmingham.

The trusts involved are:

  • Sandwell and West Birmingham Hospitals Trust;
  • The Dudley Group Foundation Trust; and
  • Walsall Healthcare Trust.

10.29am The Daily Mail reports that health regulators yesterday announced an investigation into the safety of the cervical cancer vaccine amid mounting concerns over severe side-effects.

Every girl at secondary school is offered the human papilloma virus jab against the disease.

Many experts say the programme is essential as it is the most common cancer among the under-35s.

But the European Medicines Agency will now carry out an official review which will focus on possible links to two rare conditions.

These are complex regional pain syndrome – a chronic pain condition affecting the limbs – and postural orthostatic tachycardia syndrome, which causes abnormal heart rate.

10.22am Looking to this morning’s newspapers, The Daily Telegraph reports that a top cancer surgeon under police investigation over patient death rates has been sacked by an NHS Trust.

Sudip Sarker was dismissed as a specialist in colon and bowel cancer treatments, Worcester Acute Hospitals Trust has announced.

He has been suspended from practising medicine in the UK by the General Medical Council since June last year.

7.00am Good morning. Financially, ethically and professionally, patient safety should be the core business of healthcare. Yet despite big improvements reducing healthcare-associated infections and venous thromboembolism, why does patient safety still feel like something we are yet to crack? Where are the main areas to focus? And what are the first steps to improve?