Our coverage of the reaction to NHS England’s decision to postpone the implementation of its flagship data scheme, plus the rest of today’s news and comment.

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4.12pm Responding to the publication of Monitor’s advice for commissioners on the future of walk-in centres, Dr Mark Porter, Chair of the British Medical Association Council said: “The BMA has always said that the provision of walk-in centres should be based on patient need.

“Where there is a clear local demand for the services offered, walk-in centres provide important access to care in the community and so it is right that patients are involved in deciding the future of walk-in centres in their area.

“However, the blanket approach adopted by the government when setting them up meant many walk-in centres were established in areas where there was little demand, leading instead to a fragmentation of services and funding, and with little evidence they reduced pressure on emergency departments.

“Rather than the expense of setting up new centres, GP practices could have been offered extra investment to improve access and expand premises.

“With this in mind, commissioners will need to carefully assess existing service provision, local need and the interests of patients when deciding on the future of walk-in centres and how best to efficiently deliver patient care in their area.”

3.57pm Rob Findlay, founder of Gooroo Ltd and a specialist in waiting time dynamics, has written a blog on the Care Quality Commission’s efforts to improve referral to treatment monitoring.

3.45pm Michael White, in his politics column this week, argues that we sometimes don’t make a big enough fuss in the face of the well flagged problems facing the NHS – public officials should be asking awkward questions and we should be listening.

2.50pm Dr Clive Peedell, co-leader of the National Health Action Party and co-chair of the NHS Consultants’ Association has written an open letter on NHS Leadership to Sir Stuart Rose, Sir David Nicholson and Simon Stevens.

2.20pm Residents of Peterborough are being asked to consider whether their illness or ailment is really urgent before they seek treatment from the Emergency Department at Peterborough City Hospital.

The hospital today has few available beds as a result of a high number of emergency admissions as well as the number of inpatients requiring acute care. The Emergency Department is extremely busy and patients are being warned that those attending with ‘non-urgent’ conditions are in for a much longer wait than usual as patients are prioritised according to how ill they are.

The Trust is asking people who are unwell to use the Minor Injury and Illness Unit at The City Care Centre (open from 8am to 8pm), the Minor Injuries Unit at Stamford Hospital (open from 9am to 5pm). Or their GP or their local pharmacist as their first port of call for help and advice, rather than attend the Emergency Department.

Angus Maitland, chief operating officer at Peterborough and Stamford Hospitals NHS Foundation Trust, said: “We have seen a heavy volume of patients requiring emergency admissions and it is clear these patients are going to require some time in hospital to get better. As a consequence we are struggling to make beds available.

“We are working effectively with our health partner agencies across the area to help discharge those patients who are fit enough to leave hospital and perhaps be cared for in a community setting. However this is taking some time.”

This situation means there is also a lack of beds for patients due to come in for planned operations, which has led to a number of elective operations being cancelled today. However, all clinically urgent and cancer surgeries are still taking place.

Mr Maitland added: “I would like to sincerely apologise to those patients who have had routine surgery cancelled, please be assured that the Trust will do our utmost to ensure these operations are rescheduled as soon as possible.”

2.15pm A tender has been announced for a £168.1m contract to run the NHS’s email system over a five year period. Read the full story here.

2.00pm Health leaders have called for an Audit Commission-style body to perform spot checks and external monitoring of waiting times data to ensure its accuracy.

At a Public Accounts Committee hearing last Wednesday the Department of Health’s permanent secretary Una O’Brien said that the Health and Social Care Information Centre should take on the old role of the Audit Committee in monitoring the accuracy of the data. The government announced in August 2010 that the public sector auditing body was to be abolished.

1.05pm The announcement by NHS England, that the start of upload of patient data from GP records to a central database would be delayed by 6 months, comes just one day after lawyers began legal action against the scheme.

Law firm Leigh Day is representing medConfidential, an organisation at the forefront of campaigning for confidentiality and consensual data sharing in health and social care.

NHS England’s proposed care.data scheme would see GP practices being required to upload patient data to the Health & Social Care Information Centre (HSCIC) which would then be ‘linked’ to patient data from other healthcare settings, e.g. hospitals, and made available in various forms to organisations both within and outside the NHS.

In a letter before action, sent on 17th February 2014, lawyers question the legal accuracy of NHS England’s public information campaign in relation to the care.data scheme.

On 18th February NHS England announced that the scheme, due to start in April, will now be delayed until the Autumn after accepting that the communications campaign, which gives people the chance to opt out, needs to be improved.

The Royal College of GPs, the British Medical Association and patient watchdog Healthwatch England have all voiced concerns about the scheme.

The public information campaign forms the basis of the legal challenge.

NHS England had said that they had distributed a leaflet ‘Better information means better care’ to every household in England.

The leaflet purports to inform the public of their right to ‘opt out’ of the scheme and other ‘secondary uses’ of their information.

The legal action centred on the use of the term: ‘And you can change your mind at any time’ on the final page of the leaflet.

Lawyers argue that the ordinary meaning of this phrase suggests that, if an individual has not opted out of having their data uploaded by HSCIC, then if at any time in the future they change their mind they will be able to exercise an opt-out that completely removes any information relating to them from the database and prevents any further uploading from the GP.

However lawyers on behalf of medConfidential argue that their understanding of the scheme is that once data has been uploaded to the HSCIC, that process is irrevocable and the data can never be retrieved, including from third parties who have been passed the data, or deleted.

Merry Varney, the lawyer from Leigh Day representing medConfidential explained:

“We are pleased that NHS England have realized that the public awareness campaign has not been appropriate. Any future campaign needs to be not only distributed personally to every NHS patient but it must accurately inform people of what ‘opting out’ truly means.

“If they are simply going to resend the same information leaflet and/or reiterate the ‘you can change your mind at any time’ then we will continue with this legal action as the public must be correctly informed about how information from their GP records will be processed.

Phil Booth from medConfidential said:

“If you can’t have your medical information deleted once HSCIC has extracted it from your GP, then it’s utterly misleading to tell people they can just opt out at any point after uploading begins.

“It is imperative that no patient-level data is passed on or sold to any company or organisation that won’t agree to delete it if anyone decides they want to opt out further down the line.”

1.00pm The Medical Protection Society responds to the decision to delay care.data

Dr Pallavi Bradshaw, medicolegal adviser at the MPS says:

“[We are] pleased to see that the launch of care.data is being postponed by six months, which will give NHS England the opportunity to address the concerns that have been raised.

“An MPS survey of over 600 GP members and a YouGov survey commissioned by MPS of 1454 members of the public revealed a lack of information about care.data. 67 per cent of the public have stated they had not received the leaflet from NHS England and 80 per cent of GPs do not believe they have a good understanding of how patient data will be used in the care.data system.

“This roll back will enable NHS England to fully inform the public and GPs about this fundamental change to use of personal data, which is hoped will transform our health services.”

12.10pm About 2,500 lives a year are being lost due to a “postcode lottery” in how ambulances respond to heart attack patients, a former service boss has claimed.

Roger Thayne, former chief executive of the Staffordshire ambulance service, told the BBC that figures on response times and ability to resuscitate patients were “frightening”.

Data obtained by the BBC shows significant variations in the performance of England’s 12 ambulance services.

10.51am In response to the news that NHS medical records sharing programme care.data is being delayed for six months, Professor Sir John Tooke, president of the Academy of Medical Sciences said:

“Sharing patient records through the care.data programme would bring enormous benefits for the coordination of healthcare and research into the understanding and treatment of disease.

“A national conversation is paramount to ensure the programme is implemented with the support of the public. The stakes are high given the potential future impact on healthcare, so I urge everyone with an interest in the scheme to engage in this conversation to ensure the benefits of sharing patient data are achieved”.

10.47am The Guardian reports that synthetic chemicals used in the processing, packaging and storing of food might be damaging people’s health over the long term, according to environmental scientists.

The scientists, writing in the Journal of Epidemiology and Community Health, claim that tiny amounts of synthetic chemicals leach into food. While these minute quantities do no harm, no one knows how safe people are from a lifetime’s exposure to the chemicals.

The Guardian has a comment piece by Ian Birrell, a former speechwriter for David Cameron, speculating that Jeremy Hunt could be a “dark horse” in a post-Cameron Conservative Party leadership contest.

He argues that after a “lacklustre” stint as culture secretary, Mr Hunt has “salvaged his high-flying reputation in possible the trickiest post for a Tory politician”.

10.43am The Daily Telegraph reports on the care.data programme being delayed by six months following sustained criticism and days of crisis talks.

NHS England has compiled a list of the risks and benefits of care.data in The Daily Telegraph, which is has now halted until Autumn 2014.

The Daily Telegraph also reports on data obtained by the BBC, which has significant variations in the performances of ambulance services across England.

Former ambulance service chief executive Roger Thane told the BBC the figures were “frightening” and he estmimated that 2,500 lives a year are being lost because of this “postcode lottery”.

10.40am General practice remains overwhelmingly dominated by providers on single sites with small lists, providing little beyond “core” services, HSJ analysis reveals.

To read all the details of HSJ analysis higlighting the scale of the challenge involved in cultivating the landscape of large and extended GP provider models, click here.

10.30am The Daily Mail reports that NHS officials’ have postponed the controversial Care.data project’s harvesting of patient data to ensure the public is first made aware what their details will be used for and how they can opt out.

The paper claims the move as a victory following its work in ‘repeatedly highlighting concerns amon GPs and patients’ of the data project, which was due to begin uploading patients’ data next month.

The paper also reports that tougher checks will also be made on firms wanting to access the data amid fears it will be used by insurers to raise premiums.

10.13am The Times reports that a quarter of miscarriages could be prevented if women had babies earlier, drank less in pregnancy and made other lifestyle changes, according to Danish scientists.

They said that women who weighed too much or too little, worked nights or did regular heavy lifting were also at higher risk.

The researchers called for policies that helped women have children younger and provide better protection for pregnant women doing shift work.

The University of Copenhagen team looked at the records of 91,427 births of which 3,177 ended in miscarriage before 22 weeks. Women were asked about their habits around week 16 of their pregnancy. The researchers concluded 25.2 per cent of miscarriages could be avoided.

10.10am This morning’s newspapers are dominated by NHS England’s announcement that it will be delaying plans to harvest patient data for use in the nationwide care.data patient database by six months.

The Independent sees the announcement that the programme’s implementation will be put back until autumn as a victory for privacy.

The paper’s health reporter Charlie Cooper writes: ‘Controversial plans to trawl patient records from every GP surgery in England have been put on hold, amid concerns from doctors and ministers that the public have not been properly informed about how their private data will be used. The care.data programme, which was scheduled to begin collecting the confidential information from GPs in April, will now be delayed until the autumn, NHS England has announced.’

10.05am General practice remains overwhelmingly dominated by providers on single sites with small lists, providing little beyond “core” services, HSJ analysis reveals.

The findings highlight the scale of the challenge involved in cultivating the landscape of large and extended GP provider models, which is currently being sought by national officials and policy experts. Click the link above for full analysis on the situation around the country.

9.50am Hospital admissions for anxiety increased with age and were highest among older women, new figures from the Health and Social Care Information Centre show.

In the 12 months to November 2013 almost three out of ten anxiety admissions were women aged 60 and over (2,440 out of 8,720, or 28 per cent), with 65 to 69 the most common age group of female patient admissions (8 per cent of all female admissions). The most common age group for male patient admissions was 45 to 49 (8.5 per cent of all male admissions).

Today’s report also looks at hospital admissions for stress which were highest in girls aged 15 to 19 years (295) and men aged 40 to 44 years (343) and three quarters of patients were under 50 years old (74 per cent or 3,580 out of 4,840).

The pattern of admissions for anxiety or stress by age and gender was similar to the previous 12 months, however total admissions fell by over 2 per cent for anxiety (from 8,930 to 8,720) and almost 14 per cent for stress (from 5,610 to 4,840).

The overall trend in admissions by age showed that anxiety admissions increased with age and stress admissions amongst adults aged 45 years and above decreased with age.

The report published today focuses on a special topic which is part of a wider monthly publication of all NHS-commissioned provisional inpatient, outpatient and A&E activity in England. For all hospital admissions for anxiety or stress between December 2012 and November 2013:

  • Women accounted for three in five anxiety admissions whereas more than half of stress admissions were men (55 per cent) and this was similar to the previous 12 months (63 per cent and 55 per cent respectively).
  • Almost nine out of ten anxiety cases and eight out of ten stress cases were emergency admissions.
  • One in five anxiety cases were diagnosed with high blood pressure and one in four stress admissions had a personal history of self-harm.
  • Merseyside Area Team had the highest rate of admissions for anxiety and stress and Thames Valley Area Team had the lowest rate of admissions for both conditions

Alan Perkins, HSCIC chief executive, said: “Today’s report shows striking age patterns in admissions for anxiety, and some interesting age and gender patterns for stress cases.

“Hospitals have dealt with fewer admissions for anxiety and stress compared to last year but the higher rates of anxiety in the older generation could be an area for concern.”

7.00am Good morning and welcome to HSJ Live. To start the day, according to a report published today by the King’s Fund has called for GPs to take responsibility for out of hospital community services for patients under their registered lists.

In comment piece for HSJ, King’s Fund chief executive Chris Ham, outlines the “radically new approach to commissioning and funding general practice” that the organisation proposes.

The new approach “starts from the premise that GPs are both providers and commissioners of care, and their role as providers is the more important of the two”.

Professor Ham adds: “Strengthening the role of GPs as providers requires practices to collaborate in federations to deliver services at scale.

“It also means practices working closely with community nurses, health visitors, allied health professionals, pharmacists, paramedics and social workers in “family care networks” to deliver most forms of care other than specialist expertise best provided in hospitals.”