The Foundation Trust Netwok says A&E units could ‘collapse’ under pressure, the NICE conference, plus the rest of today’s news

5.21pm: Below the line on this blog, HSJ readers have been having their say on the pressures facing A&E departments. Join the debate below:

  • Umesh Prabhu makes 10 suggestions for improving A&E units.
  • “One huge headache is that the geographical siting of almost all our hospitals is historical and (at least in London) largely driven by the last World War. There is no land to rebuild where it would make sense to centralise, and no money either.”
  • “Healthcare never ‘collapses’. Even in war-torn and ravaged countries. This is because there is no definition for healthcare ‘collapse’. It is a media and political soundbite. Healthcare just slowly and often imperceptibly deteriorates.”

5.07pm: Sean Duggan, the chief executive at the Centre for Mental Health, says the post-reform NHS could transform mental health care in England, due to the requirements of the NHS mandate, but he adds: “The mandate will not on its own bring about parity between mental and physical health in the NHS. It is in the everyday actions of commissioners and providers at every level of service that the separation and inequality between the two will be tackled most effectively.”

While, on his blog, Blair McPherson argues that the government’s integration policy is not about improving care or the patient’s experience, but “money and performance masquerading as care and compassion”. He also says: “As to the claim that enforced integration is justified on the grounds of improving service coordination and communication so individuals don’t have to repeat their story, well that implies these problems don’t exist in an integrated service.”

4.40pm: On HSJ’s Commissioning channel, Bassetlaw Clinical Commissioning Group chair Steve Kell says while some GPs doubt CCGs will improve the NHS, commissioners must accept the challenge head on given the opportunities for change, engagement and transparency.

4.14pm: University College London Hospitals Foundation Trust chief executive Sir Robert Naylor has been appointed chair of the Shelford Group, which represents the 10 biggest academic teaching institutions in the NHS.

4.00pm: The latest HSJ supplement takes an in-depth look at the latest thinking on patient safety, covering workforce vetting, new approaches to tackling pressure sores (some the pictures aren’t for the squeamish) and improvements through technology.

3.44pm: HSJ ‘s man in the Midlands, James Illman at the NICE conference, is tweeting NHS director for patients and information Tim Kelsey’s speech. He tweets:

  • @tkelsey1 likes word ‘customers’ rather than patients. It signals respect #niceconf2013
  • @tkelsey1 says Francis has to be a game changer. The absence of transparency and participation led to deaths in Bristol scandal…
  • @tkelsey1 tells #niceconf2013 he wants to let patients ‘become the clerks’ do the paperwork. Like online banking. This will drive engagement.”

3.39pm: Robert Francis’ criticism of nursing leaders has also prompted some forthright opinons, both in support and arguing against him:

  • “I have not seen much evidence of the Royal College of Nursing as a professional body. I have seen plenty of evidence of the RCN as a trade union. The RCN do seem to control the directors of nursing pretty rigorously, which tends to get in the way of service redesign.”
  • “This is nonsense. The directors of nursing are not controlled or regulated by the RCN. I am very disappointed in Robert Francis’ comments. No one is taking this report more seriously than nurses.”

3.33pm: HSJ readers have been having interesting debates in response to our exclusive interview with Robert Francis QC, published yesterday. Here are some of the comments so far:

Francis presses government on criminal sanctions

  • “Would a statutory duty of candour make junior doctors imperil their careers by causing trouble? Would it help if we had to demonstrate harm according to criminal standards of proof?” Martin Rathfelder
  • “The problem with the current government is that they’re apt to present this as an NHS problem, but it’s actually much more likely to occur in smaller commercial health and social care settings. The cure doesn’t lie in more privatisation because that makes things even less safe and more chaotic.” Stella Welsh
  • “More legislation will not protect patients or accountable staff without addressing the democratic deficit in the NHS.”

Francis warns recommendations could be lost in ‘long grass’

  • “Let’s be honest, an organisation too used to blame and scapegoating was looking for a report where one part of the system, or one person, got blasted, so that there could be a ceremonial defrocking and execution, some blood-letting, and the exorcising of demons, then everyone could get back to business as usual. What they got instead was a report that blamed everyone and no one, looked at the system systemically and individually, and rightly found fault everywhere. Now no one knows quite what to do.”
  • “Many service leaders can’t see the wood for the trees right now, and I think some simple well crafted messages from David Nicholson would not go amiss. Please let’s not have a vacuum.” Ed McAllister-Smith

3.29pm: In her finance column, Sally Gainsbury says Jeremy Hunt has fallen foul of “his own department’s favourite trick: the ever-mutating baseline”.

She writes: “Perhaps unsurprisingly, the [30 per cent tariff for emergency admissions] policy was not properly implemented, because NHS managers do just what civil servants do when faced with an illogical policy or unworkable budget: they fiddle it.”

3.08pm: HSJ chief reporter Dave West tweets: “Just clocked that @Jeremy_Hunt was pressed on Today on HSJ’s exclusive on ‘£400m A&E fund’ emails … 2mins38.”

3.04pm: Following NHS England and Monitor’s plans to reform the NHS payment system (see 11.03am), in a new podcast Christian Fielder from Monitor’s pricing team talks about designing a new comprehensive payment system to do more to benefit patients.

2.53pm: HSJ has updated its comprehensive interactive map of the new NHS commissioning system, showing critical details about the new organisations, including their leaders, performance, budgets and size.

2.35pm: The union Unite has organised a march on 18 May in London, ending in a rally near Downing Street, “in defence of the NHS” and to protest against proposed closures of services at Charing Cross, Central Middlesex, Ealing, Hammersmith, Kingston, Lewisham and St Helier’s hospitals.

The union, which has around 100,000 members in the health service, believes efficiency savings and “privatisation of the NHS” is contributing to the A&E crisis (see 9.53am and 10.19am).

2.22pm: Another article worth reading in the debate about the potential crisis facing A&E is by Andrew Foster, the chief executive of Wrightington, Wigan and Leigh Foundation Trust. He writes in a piece that also features in this week’s magazine (out on Friday):

“Now the pressure [on A&E] is immense. Why? One theory is that it’s the weather: a long, protracted cold spell. But the emergency peak has gone on for two months and is more of a plateau. At two months’ duration, it’s the longest ‘peak’ I can remember…

“I believe we need a new strategy for primary care. The demand pressure we’re seeing is definitely part of a long-term trend of people choosing to use acute trusts rather than GPs.”

2.06pm: Is the Choose and Book system a failure or not? Does the NHS need a new system, as NHS England director of strategic systems and technology Beverly Bryant has suggested? There are plenty of comments for both arguments on HSJ’s exclusive story. Join the debate here.

1.53pm: Health minister Lord Howe has admitted the new NHS non-emergency advice line NHS 111 had a “very disappointing start”.

Health officials have launched an investigation into the advice line after a number of potentially serious incidents, including three deaths, were linked to the service.

12.54pm: Today is the last day for nominations in HSJ’s Most Inspirational Women in Healthcare. Find out more and fill in the nomination form here.

Nominees must meet one or more of the following criteria:

  • Delivering outstanding leadership
  • Sharing knowledge and expertise with others in the sector
  • Acting as a role model/mentor to colleagues
  • Driving innovation in service redesign and/or research
  • At the heart of shaping or influencing policy

12.50pm: The CBI is preparing transparency guidelines for private companies running public services, amid calls for the sector to be subject to the Freedom of Information Act, HSJ has reported.  

The CBI is in the early stages of drawing up recommendations for the approach. A source at one company involved in creating the guidelines described them as an “industry version of the FoI Act”.

12.30pm: A strategy for the future of commissioning support will be published on 12 June, it was reported this morning.

Andrew Fenton, of the Central Southern Commissioning Support Unit, has tweeted that Bob Ricketts, NHS England’s director of commissioning support strategy and market development, announced the date at a conference today.

12.25pm: NHS Confederation chief executive Mike Farrar has responded to the CEM’s and the FTN’s concerns about A&E (see 9.53am). He says:

“We strongly support the ringing of the alarm bells by the College of Emergency Medicine and the Foundation Trust Network. They are absolutely right to highlight the current pressures in emergency care.

“The past few months have been the toughest many of us in the NHS can remember, and credit must go to A&E staff who have been working tirelessly to manage patients safely.

“The key thing is to understand that A&E doesn’t stand alone − pressure in our A&E departments is a visible symptom of a whole system under great strain and tackling it requires a whole-system solution.

“We urgently need to look at the alternatives. This includes fundamentally reviewing how we organise and fund our services outside traditional hospital settings, the way staff work throughout the whole week, and how we provide effective alternatives to hospital-based emergency care.”

“If we don’t take action now, we will all lose out - the pressures will continue to grow as people continue to use A&E because of a lack of viable alternatives.”

12.22pm: @kayewiggins tweets: “Grand plan to ‘fully join up’ health & care by 2018 will draw heavily on #localgov community budgets.”

12.14pm: HSJ reporter James Illman is tweeting from the NICE conference, where Robert Francis and David Prior have been speaking. He tweets:

  • “Robert Francis tells #niceconf2013 he’s been encouraged by response to his report. Nor too much political point scoring.”
  • “Prior says there is a close parallel between CQC and Ofsted. ‘Hospitals more complex but key to Ofsted is they’re taken seriously’.”
  • “Francis tells #NICECONF2013 hospital ratings will have some value but not stop another Mid Staffs.”

11.55am: YouGov chief executive and Data Strategy Board chair Stephan Shakespeare has released an an independent report that outlines recommendations for how public sector information can be better used to improve government services and unlock economic growth.

The “Shakespeare review” calls on government to devise and implement a national data strategy. See the full report here.

11.38am: Yesterday, HSJ reported that Rotherham Foundation Trust is planning to save £5m from its “corporate overheads” as it battles to deliver £50m cost cuts in the next three years.

Rotherham, which has faced performance, finance and governance problems over the past six months is the subject of this week’s in-depth HSJ Local Briefing.

11.32am: Further to the Foundation Trust Network’s claim today that accident and emergency departments could “collapse” under current pressure, FTN chief executive Chris Hopson wrote in his blog earlier this month: “The four-hour target is a good barometer of the overall health of the A&E system. Missing the target isn’t dull and managerial − it shows that care quality and patient safety may be at risk, despite the best efforts of all concerned.”

11.19am: Shadow care minister Liz Kendall has published what she says are the “con tricks” of the government’s social care proposals.

She says the proposals in the Care Bill will not stop people from having to sell their homes to pay for care or cap the costs elderly people actually pay for their residential care.

11.03am: We have updated HSJ’s report on NHS England and Monitor’s plans to overhaul the NHS payment system. Read the latest details here.

10.51am: NHS England has published its latest bulletin for clinical commissioning groups.

10.19am: HSJ is also tracking the performance of A&E departments in England’s hopsitals. The most recently published accident and emergency figures show the English hospital sector is still missing the national target for 95 per cent of patients to be seen within four hours.

We also reported last week on the panic over an attempt to create extra funds for A&E.

9.53am: The row over pressure on accident and emergency units escalated further today. The Foundation Trust Network said units could “collapse” under pressure unless action is taken, while the College of Emergency Medicine warned of serious workforce pressures. HSJ has covered both stories.

The FTN’s main demand is for a change to the marginal emergency tariff − something we have covered in depth.

9.45am: In his column this week, Michael White takes a look at the Queen’s Speech, which contained two bills of note for healthcare: the Care Bill and an immigration bill; though the MPs’ debate was “a disappointment”.

He writes: “Jeremy Hunt was positive about the NHS’s “heroic” achievements and challenges, but said little that MPs have not heard before. When he abruptly sat down after just 19 minutes the speaker said: ‘I’m not clear if the secretary of state has completed his speech.’”

8.20am: Good morning, the wide-ranging government reforms of the NHS have been introduced on the basis that commissioning of local healthcare services is clinically led. However, local commissioning decisions − particularly those relating to treatment thresholds and other criteria − have the potential not only to increase unexplained variation but also to create tension and even disagreements between commissioners and secondary care clinicians.

Today on HSJ’s commissioning channel, Nigel Beasley and colleagues write about a pioneering project which is establishing clear, consistent and credible value-based commissioning guidelines for a wide range of surgical procedures.