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17.00pm Union Unite has issued a statement calling for the health secretary to deny that the NHS “will soon be forced to charge patients for care”, following publication of the Financial Times’ interview with NHS England chair Malcolm Grant today (see HSJ Live 10.00am, below).

Unite head of health Rachel Maskell said: “Jeremy Hunt must come clean at tomorrow’s health questions in the Commons and deny that a future of NHS user charges is on the cards. Nothing short of a categorical public denial and a recommitment to the `free at the point of use’ principle will do.”

16.30pm: Mike Farrar, chief executive of the NHS Confederation, has responded to today’s announcement by Monitor on Mid Staffordshire Foundation Trust.

He said: “A growing number of organisations, including Mid Staffordshire Foundation Trust, are finding themselves facing financial difficulties and tough decisions about the future sustainability of their services.

“In the best interests of patients, Monitor is right to take firm action to help the trust recover its financial footing and deliver better care. We need to consider all the options and identify their merits and flaws. 

“We need to do more to support troubled trusts at the earliest possible stage to maintain high standards of care, rather than getting to the point where trusts find themselves facing administration. This requires better integration of services and a focus on people’s care needs, rather than the location of buildings.

“There is no denying that changes to services can be controversial and they can be difficult to communicate, even when there is a good clinical case for doing so.

“Poor care costs money and, in the worst cases, lives. We know all too well about the tragic consequences for patients and their families at Mid Staffs when this was the case in the past.

“Allowing trusts to spiral in to financial difficulties is in no one’s interest. To address these issues, we need radical changes to improve outcomes and manage resources on a sustainable basis. This means having a whole-system solution that involves the wider healthcare community, rather than looking at one organisation in isolation.

“Staff, patients and the public need to be fully involved in any decisions about the future of the trust, especially given the short time frames to develop a plan. Discussions need to focus on why changes are necessary and administrators need to be open and honest about what options are on the table.”

Mr Farrar added:

“We welcome the involvement of Hugo Mascie-Taylor in this process. His involvement should reassure people of the importance given to guaranteeing the clinical sustainability of services in the area as well as financial sustainability. Hugo continues to provide hugely valuable expertise to work of the NHS Confederation as our associate medical director.”

16.05pm: Reacting to the announcement Mid Staffordshire Foundation Trust will be put into special administration Foundation Trust Network chief executive Chris Hopson said: “Mid Staffordshire NHS Foundation Trust has been under scrutiny for some time and has faced multiple challenges following the catastrophic events between 2005 and 2008 that led to the original inquiry into failings at the trust.

“Putting Mid Staffordshire into administration is a key test of the failure regime under the new healthcare system and the Foundation Trust Network hopes today’s announcement will mark another milestone in the process of successfully resolving the difficulties facing the trust.

“We support all efforts to improve the quality of services for patients in Staffordshire and welcome this recognition that on occasions issues in the local healthcare economy have to be tackled regionally rather than just locally.

“It is important, however, to highlight the work the current leadership team at Mid Staffs has done since 2008 to resolve issues at the trust including huge financial pressures.”

15.20pm HSJ reporter Shaun Lintern’s full report on the decision to place Mid Staffs FT in special administration is now live on the site.

15.01pm BREAKING: Mid Staffordshire Foundation Trust has become the first FT to be placed in special administration by healthcare sector regulator Monitor.

The regulator announced this afternoon that Dr Hugo Mascie-Taylor and Alan Bloom of consultants Ernst and Young have been appointed trust special administrators for Mid Staffs. They will take over the running of the Trust on Tuesday 16 April, with the current executive team reporting to them.

Monitor’s statement, issued at 3pm, continues: “They will work with commissioners and other local healthcare organisations to produce a plan for the reorganisation and sustainable delivery of health services.

“Monitor took the decision to make the appointment after experts in a Contingency Planning Team concluded that the Trust was neither clinically nor financially sustainable in its current form. The appointment has been made following consultation with the Health Secretary and an order authorising the appointment was laid in Parliament today.

“The Trust Special Administrators now have 45 working days to design a way of providing services to patients in the area that is sustainable in the long term. The plan will then be subject to a public consultation. Local clinical commissioners have already indicated which services must remain in the area under the new plan and the Trust Special Administrators will take this into account.

“Services at the Stafford and Cannock hospitals will continue to run as normal until a final decision is reached.”

Monitor chief executive David Bennett said: “We have taken this decision to make sure that patients in the Mid Staffordshire area have the services they need in the future. It is now the role of the Trust Special Administrators to work with the local community to decide the best way of delivering these services. There will be a full public consultation on any proposals for change.”


14.25pm The NHS Employers organisation has issued a response to the GMC’s new study on continuing professional development for doctors (see 14.07pm, below). Dean Royles, chief executive of the NHS Employers organisation, said:“There has been a lot of focus in the press on the training and education of the future NHS workforce, so it’s great to see a report that highlights the importance of the continuing professional development of the existing workforce.

“For too long doctors have seen CPD as being self-determined so I really welcome recommendations that highlight that it should be integrated with appraisal, linked to personal development plans and, importantly, aligned with organisational objectives. Doctors’ time is precious and every hour spent on CPD must be directed in the best interests of patient care.

“We welcome the GMC’s commitment to work with NHS Employers to make sure CPD is more effective for patients, employers and doctors, in the future.”

14.07pm New research by the General Medical Council suggests employers need to do more to support all doctors in their professional development, the professional regulator has reported. A GMC study based on 60 interviews with a range of organisations suggests there is “a lack of support for locums, doctors outside training grades and some of those employed in the independent sector”.

14.01pm The New Statesman carries a long piece today on the outsourcing of Suffolk’s community health services to private contractor Serco. Alan White writes that the battle over outsourcing of clinical services in Sudbury is “a warning for the rest of the country - the future of the NHS is going to be fragmented”.

13.41pm Meanwhile, health secretary Jeremy Hunt has asked the Independent Reconfiguration Panel to report to him no later than 30 April on the national “Safe and Sustainable” review of children’s congenital heart services. In a letter to the IRP, the health secretary said extending the deadline to this date would give the panel time to “take account of” the 27 March outcome of judicial review proceedings, in which the court found in favour of campaigners Save our Surgery.

13.36pm Leeds Teaching Hospitals executive director Karl Milner has tweeted that there will be a parliamentary question on children’s heart surgery at 3.30pm this afternoon.

13.23pm Macmillan Cancer Support research and policy director Mike Hobday has tweeted in response to HSJ’s latest report about the CCP review in Bristol: “Is this a challenge to coherent planning of cancer care?”

13.20pm University Hospitals Bristol Foundation Trust and North Bristol Trust are to start work to demonstrate the benefits to patients of their swapping services after the Co-operation and Competition Panel concluded it could be anti-competitive, HSJ reports today.

The panel announced last week that it was proceeding to a second-stage review of the trusts’ decision to centralise head and neck services at Univeristy Hospitals, and urology and breast care at North Bristol. The service swaps took place on 25 March.

12.30pm The Health and Social Care Information Centre has arranged an extension of the current GP Systems of Choice framework, under which clinical IT systems are currently provided to 81 per cent of GP practices.

The centre said in a statement that “thousands of GP practices around the country” would “now enjoy continuity of provision” as a result of the extension.

The statement added that the GPSoC team which arranged the extension has “also been consulting widely with both GP representatives and the supplier community on new contracting arrangements to support the delivery of GP clinical IT systems in the future”.

“The planned replacement GPSoC framework is dependent on receipt of the necessary approvals from the Department of Health, the Cabinet Office and HM Treasury,” it said. “If approved, it is likely to lead to a substantial expansion in the number of suppliers involved in GPSoC.”

12.20pm You can read more here on new King’s Fund-commissioned report that found the public may support charges for some NHS services.

12.10pm BBC Wales is reporting that figures obtained under the Freedom of Informaction Act show ambulances have spent “almost 55,000 hours waiting outside Welsh hospitals in six months”.

The station’s report adds that the figures also show that on 24,346 occasions in the six months to the end of February ambulances had to wait more than 30 minutes before patients could be admitted to hospitals.

The ambulance service told BBC Wales there had been a “high increase” in delays in admitting patients due to significant pressure on the NHS.

11.57am Bill Morgan, one-time special advisor to then-health secretary Andrew Lansley, has tweeted in response to this morning’s Financial Times interview with NHS England chair Malcolm Grant:

“I suspect we may hear dire warnings about the potential need for NHS charges from @NHSEngland in the run-up to every spending review…”

He adds:

“Still don’t understand why you wouldn’t just raise tax to fund the NHS though. User charges still come out of UK GDP so why not use tax?”

11.25am The scandal-hit Mid Staffordshire Foundation Trust is widely expected to be put into special administration later today. Sector regulator Monitor has called a press conference at Stafford Hospital at 3pm, to discuss “next steps” for the trust.

If the trust is placed in administration, it would be the first time a foundation trust has been subjected to the “failure regime” powers granted to Monitor under the 2012 Health and Social Care Act.

An expert team sent in to assess the trust’s sustainability concluded the trust was neither clinically nor financially sustainable in its current form in the long term.

The Contingency Planning Team report, jointly written by Ernst & Young and McKinsey, concluded the trust’s catchment area of approximately 200,000 was far below the Royal College recommendation of 450,000 and that it did not have enough specialists to run an emergency service.

Mid Staffordshire received a Department of Health bailout of £20m in 2012-13 and the investigation found the trust would need to find £53m in savings and £73m in subsidies over the next five years to break even.

11.00am The chairman of private hospitals group Spire Healthcare also joins in the debate on rationing of NHS care this morning. In an interview with the Daily Telegraph, Garry Watts says it is “a self-evident truth that the NHS can’t do all things for all people at all times regardless of cost and demand”.

He adds: “There has to be some public agreement that the NHS can do so much and the gap that’s left can and should be filled by private provision.

“Any individual attempt to apply rationing of course is very contentious but I would argue that we’re better off having that rationing debate in the open in public.”

10.45am The Daily Telegraph carries a story today about locum GP Dr Thomas O’Brien who reportedly convinced a Staffordshire patient to stop taking depression medication and instead took the woman to a church for an exorcism.

Dr O’Brien has been handed conditions on his registration for 18 months by the General Medical Council after it ruled “his professional and private boundaries became blurred” and that he imposed his religious beliefs on the woman.

The Telegraph reports the woman, from Stoke-on-Trent, was given lifts to a Pentecostal church in Stoke-on-Trent where she was told “God is her surgeon and God will heal her.”

It was also claimed Dr O’Brien sent the patient books about the church where she underwent the four-hour “testimony” where the exorcism took place in January.

10.40am NHS Clinical Commissioners, the representative body for clinical commissioning groups, has called for the roll-out of NHS 111 services to be halted until the system is safe for patients.

In a statement issued this morning, the group said: ” Local commissioners have raised concerns about the roll-out of NHS 111 and that top-down imposition has overridden local worries. Local commissioners are keen to ensure that patients have access to high quality, accessible urgent care, and it is clearly not acceptable that patients may be put at risk and their calls may not be answered.

“There is an urgent need for issues surrounding 111 to be resolved.

“NHS England must call a halt to the further roll-out of NHS 111 until each region has been rigorously tested and assurances can be given that the system is resilient and patients will received appropriate advice.”

The statement follows a meeting of the NHS England board on Friday. As HSJ reported, NHS England chief executive Sir David Nicholson told the meeting that patients had been “let down” by “unacceptable” failures of some 111 services.

10.15am Yesterday’s Observer reported on a DH commissioned survey raising concerns about the friends and family test. However, Ipsos MORI – which wrote the report - has since criticised the newspaper’s interpretation of it. The report was published by the DH two months ago.

10.07am Meanwhile the King’s Fund think tank has today published the results of research with polling experts Ipsos MORI which found that the public remains “firmly wedded to the fundamental principles underpinnning the NHS but under certain circumstances could support the introduction of charges for some treatments and services”.

The report is based on two day-long events with members of the public to explore their views about how to pay for health care in the future. Researchers found that participants were “reluctant to consider fundamental changes to the current funding model, even when confronted with the scale of the funding challenge facing the NHS”. They strongly supported the principle that “access to health care should continue to be based on need rather than ability to pay”. However, the think tank reported “some support” for charging patients in certain circumstances, namely:

  • where treatments are “not perceived as clinically necessary”, such as cosmetic surgery or elective caesarian sections;
  • where people were thought to misuse services, for example by missing appointments or arriving drunk at emergency departments;
  • where patients required treatment as a result of lifestyle choices, such as smoking or obesity;
  • where people wished to pay ‘top ups’ for non-clinical aspects of care, such as private rooms.

10.00am NHS England chair Malcolm Grant has predicted that a future government will have to consider introducing user charges for the NHS unless the economy strengthens, the Financial Times reports this morning.

The paper reports Professor Grant as saying: “It’s not my responsibility to introduce new charging systems but it’s something which a future government will wish to reflect [on], unless the economy has picked up sufficiently, because we can anticipate demand for NHS services rising by about 4 to 5 per cent per annum.”

8.20am: Good morning, the combination of scale, politics, bureaucracy, public interest and managed competition makes the NHS an unpredictable field to navigate in says Craig Barratt. He looks at how the latest leadership literature applies to the NHS.