NHS England’s board has decided on 2015-16 allocations for clinical commisisoning groups, plus the rest of today’s news and comment

Live logo

3.11pm The Commons public administration select committee is today launching a new inquiry into how incidents of clinical failure in the NHS are investigated – and how subsequent complaints are handled.

The committee is considering ways that untoward clinical incidents could be investigated immediately at a local level, so that facts and evidence are established early, without the need find blame, and regardless of whether a compliant has been raised.

It is hoped that this work will reduce the need to for complaints to go to the Parliamentary and Health Services Ombudsman (PHSO), whose main role relates to administrative and service failures in the NHS in England.

The inquiry aims to:

  • examine the effectiveness of existing approaches to investigating and addressing systemic safety issues currently present within the NHS;
  • explore the relative benefits that a new clinical accident investigation body might bring to this area and how analysis of complaints could inform its work;
  • consider models of best practice within other sectors and examine their transferability to the healthcare sector; and to
  • explore the role that the PHSO might play in the functioning of any new accident investigation body.

The committee would like to hear views on:

1. The effectiveness of NHS’s current approach to investigating and addressing untoward medical incidents.

2. How lessons about best practice, procedures and human factors should be learned and disseminated.

3. The value that a new, single, clinical accident investigation branch of the Department of Health would bring to the healthcare sector and how this could improve the complaints process.

4. The current capacity of the PHSO to manage and investigate complaints relating to clinical incidents, and their ability to analyse and assess medical evidence.

5. The impact that Department of Transport accident investigation branches have had in the transport sector and the lessons that have been learnt from the establishment and use of such bodies, in the UK and in healthcare systems in other countries.

6. How any such body within the healthcare sector would support the work of PHSO.

7. The legal drivers behind increased challenges associated with the issue of medical liability, and the failure to address clinical incidents and complaints.

Bernard Jenkin MP, chair of the committee, said: “It is very unfortunate that the way clinical failures – which can be a tragedy for a person and their loved ones – are handled by the NHS and its watchdogs does not seem to foster positive outcomes or learning from mistakes that have been made.

“There seems to be a culture of blame and of responding only to complaints, rather than an environment where clinicians can come forward and lay out the facts of things that have gone wrong, or express concerns, so that they can be investigated and lead to improvements.

“Right now the only outcomes after clinical failings seem to be another excoriating report by a health watchdog, litigation or the passing of badly handled complaints further up the chain to adjudicators of last resort like the PHSO, which reports to Parliament through PASC. 

“These outcomes may be the result of ‘starting from the wrong place’. We would like to examine the possibilities of new ways of reporting and investigating clinical failures that could being about positive outcomes and change at a much earlier stage.  We are interested in the experience in other countries, particularly in New Zealand, which drew the support of a 2009 Health Select Committee Report on Patient Safety.”

The committee would also welcome views on any other matters that may be relevant to this inquiry. Please do not feel obliged to respond to all of the questions if you have a specific interest.

2.31pm The financial penalty imposed on accident and emergency departments that fail to meet the 95 per cent four hour target has been strengthened to encourage ‘radical transformation’ from struggling NHS providers.

NHS England’s draft standard contract for 2015-16, published this week, states that the penalty should “reinforce” the work the urgent and emergency care review is doing to move demand out of hospitals and improve standards.

A&E departments are required to see, treat, admit or discharge 95 per cent of patients within four hours.

2.18pm HSJ has received more information following its publication this morning of a story describing an agreement from NHS England to commission a ‘significant range and volume’ of planned care from private hospitals over the coming months.

A Monitor spokesman said that £30m of as yet unallocated money from the £250m backlog funding has been set aside to pay for approximately 30,000 procedures.

For more details, read the story here.

2.06pm Monitor has deferred a decision on whether St George’s Healthcare Trust should become a foundation trust because the trust does not yet meet all the financial standards expected by the regulator.

The trust provides a range of specialist, local hospital and community healthcare services to patients in south west London, Surrey and beyond.

Following an assessment, Monitor concluded that St George’s is well-led and the independent Care Quality Commission rated the quality of the trust’s services as good overall in April 2014.

However, the health sector regulator has decided to defer a decision on the authorisation of St George’s up until 31 March 2015. The delay will give the trust time to finalise new borrowing arrangements that would enable it to reach the financial requirements for a foundation trust. This includes putting additional financial measures in place to ensure services will be protected in the event of any financial downturn.

Miranda Carter, executive director of provider appraisal at Monitor, said: “We are deferring a final decision on whether St George’s should become a foundation trust for a short period whilst it finalises its new funding arrangements.

“When St George’s becomes a foundation trust we want to ensure it is in the strongest possible financial position.”

There are currently 149 NHS foundation trusts in England, over 60% of all trusts in the NHS. Foundation trust status gives patients a greater say in their healthcare, and foundation trusts have more freedom to shape services to match the needs of local people.

2.04pm Tougher financial penalties will be imposed on trusts that fail to meet waiting time standards and commissioners’ freedom to waive penalties will be curbed under NHS England’s draft standard contract for 2015-16, which was published this week.

NHS England proposes to raise waiting times fines by 25 per cent and to make weekly reporting from providers mandatory.

A penalty will be introduced for inconsistency “between weekly and monthly returns”.

The draft contract also includes a proposal to scrap “sanction variation”, which allows commissioners’ discretion to waive penalties in some circumstances.


1.41pm NHS England has agreed to commission a ‘significant range and volume’ of planned care from private hospitals over the coming months, following the failure of a national push to clear NHS waiting list backlogs over past months.

In a paper going to the national body’s board meeting today, NHS England chief executive Simon Stevens said the private sector work would be purchased with unspent funds from the £250m released by the government earlier this year to clear NHS backlogs.

1.40pm There is no evidence of staff being told to manipulate cancer waiting times data at Colchester University Hospital Foundation Trust, an independent investigation commissioned by Monitor has found.

A separate review, commissioned by the trust, of cancer care between April 2010 and March 2014, also published today, found “no evidence of systematic, deliberate data manipulation”.

It found 16 cases of possible deliberate and inappropriate data entry, but it could not identify intent to deliberately falsify the figures.

Both investigations were launched last year, following allegations that staff felt pressurised into changing data.

The trust was placed in special measures in November 2013 following allegations and later that month police launched an investigation into the allegations.

1.36pm Last week shadow health secretary Andy Burnham, announced Labour’s future healthcare strategy at an event to mark the first operational anniversary of the North West Coast Academic Health Science Network.

Over 400 guests were in attendance at the event in Liverpool to highlight the work that the North West Coast AHSN is doing to drive innovation across the region.

During his keynote address, Mr Burnham announced his proposed plans for the next 10 years if Labour win next year’s general election.

Some areas for change included the full integration of health and social care, and creating a more personalised healthcare system which is more focused around home-based care.

Mr Burnham said: “The problem as I see it now, we are at the very limits of a 20th century model of care. My solution is to move from that medical model, based around the hospital, to a preventative, more social model of care, that starts in the home. We should have the clear expectation that the home and not the hospital is the default setting for care in the 21st century.

“I think we’ve got to embrace something much more radical and that is the idea of a single budget, a single service, an NHS for the whole person or if you like, or another way of putting it a national health and care service.”

Other key speakers on the day included Professor Ian Greer, Provost, University of Liverpool, Louise Shepherd, CEO, Alder Hey Children’s Hospital and Professor Neil Johnson, Dean of the Faculty of Health and Medicine at Lancashire University.

12.38pm Meanwhile, over at prime ministers questions there is a tussle over numbers of nurses employed in the NHS. Labour asks why there are 2,000 less nurses than in 2010, but the prime minister replies that in fact there are 3,000 more.

12.34pm Ed Smith says he would like to understand the detailed pressures on emergency care.

12.24pm Sophie Barnes:

12.11pm Hakin: Huge increase in patients coming forward for cancer diagnostic tests so not all standards met.

12.10pm Sophie Barnes tweets:

12.10pm Dame Barbara Hakin talking about performance. 18 weeks - a lot of activity undertaken but significant number of trusts not able to deliver extra activity.

11.59am Sir Malcolm Grant, NHS England Chair says: “The important consideration on allocations for CCGs is pace of change - fair shares or acceleration?”

11.53am Ciaran Devane says he is concerned by NHS England’s budget cut, bearing in mind the amount of change required for next year. The Department of Health has said it will cut administrative budgets by 10 per cent across the board.

11.50am Allocations will be published on Friday, says Baumann.

11.48am Baumann: both NHS England and the government are interested in multi year allocations.

11.46am Sophie Barnes:


11.37am Baumann: Broadly we want to stick to the clinical commissioning group allocation rules that we set out last year.

11.35am On the subject of specialised commissioning, Paul Baumann said that thespecialised commissioning budget will not balance with the allocation NHS England has given it without the changes proposed in next year’s tariff.

11.33am He adds thatover target CCGs will get small increases in recurrent funding.

11.30am Paul Baumann informs the board that 17 out of 18 deficit clinical comissioning groups are under target.


11.25am Baumann adds that they have doubled the size of the prime minister’s challenge fund for primary care.

11.23am Paul Baumann tells the board there won’t be any additional resilience money. Part of the deal of getting the £2bn is it covers everything, according to HSJ reporter Sophie Barnes.

11.20am This NHS England paper gives some detail as to how the extra money pledged in the Autumn Statement will be spent.

11.18am HSJ’s Sophie Barnes tweets:

11.16am NHS England’s finance chief Paul Baumann jokes that he will be avoiding colourful language on the basis it landed him in the Daily Mail last time with a particularly bad photo accompanying it.


11.11am Stevens says that the cancer drugs fund is on track to overspend by another £100m.

11.08am Stevens says NHS England wants to make faster progress in bringing under target CCGs up to their ‘fair share’ allocation. He aims for a two-year elimination of under target budgets.

11.06am Simon Stevens says that this money can be called a down payment on year one of the Five Year Forward View

11.05am Sophie Barnes:

11.04am Sophie Barnes:

10.56am Lord Adebowale asks how do we measure the change is happening for the five year forward view.

10.52am Sophie Barnes:


10.45am NHS England tweets:

10.44am NHS England have added a preview of the 2015-16 planning guidance to their board paper pack

10.40am Sophie Barnes:

10.39am Ian Dodge: I’m confident that working with our partners we can develop a national support programme that can particularly help the vanguard economies and those areas where we will need to take a more particular approach.

10.36am Tim Kelsey emphasises the focus on delivery of a safe, sustainable digital service across the health and care system. He says 2015-16 planning guidance encourages adoption of people’s access to their own data across primary care.

10.35am Ian Dodge: Our challenge in the planning guidance is to be able to provide a compelling offer of support for ‘vanguard sites’

10.31am Sophie Barnes:


10.28am Ian Dodge says in 2015 NHS England will be introducing a national indicators for reducing sepsis.

10.25am Sophie Barnes tweets:

And the meeting has started. Simon Stevens says one principal duty today is to decide how the extra £2bn will be allocated— Sophie Barnes (@sophieevebarnes) December 17, 2014 

9.57am Many media outlets this morning report on an exclusive HSJ investigation which has revealed that a shortage of registered nurses to fill an increasing number of posts has driven nearly three-quarters of hospital trusts to recruit overseas.

Analysis of data from all 140 English acute hospital trusts shows that 103 recruited a total of 5,778 nurses from overseas in the 12 months to September 2014.

The numbers illustrate the scale of the shortage of UK based nurses and mean that overseas recruits constituted a substantial proportion of the total hired by hospitals.

9.51am HSJ’s Dave West tweets:


9.47am Issues for discussion by the national agency’s govening body include imminently expected planning guidance, the urgent and emergency care review, winter pressures, and how to spend the extra £1.5bn of newly pledged money from the Treasury.

9.45am NHS England’s board meeting is due to start at 10.15am this morning - watch it streamed live here.

7.00am Good morning and welcome to HSJ Live.