The NHS trust sector finished 2013-14 £241m in deficit, the NHS Trust Development Authority has confirmed, plus the rest of today’s news and comment

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6.30pm Over in our Hospital Transformation channel, with improving the experience for women and their families when having a baby becoming a bigger priority in recent years, Jennifer Trueland explores how some trusts have made the most of the increased options available.

6.05pm A campaign has been launched to protect an eighteenth century hall after Barts Health Trust revealed it is backing the development of a modern cancer centre to be built next to the old building.

Campaigners with the group name Save Barts Great Hall are concerned that a proposed new cancer centre with a surface of translucent glass that glows in the dark would prevent the restoration of the Great Hall’s North Wing.

5.45pm The reconfiguration of services at East Sussex Healthcare Trust is now complete following the centralisation of emergency and high risk orthopaedic services at Conquest Hospital in Hastings last week.

This follows the centralisation of maternity and paediatric services after an expert team warned of the “potential for calamity”, followed by stroke services at the end of 2013.

The orthopaedics move will mean more complex elective orthopaedic operations will now take place at Conquest Hospital rather than Eastbourne Hospital.

5.25pm Concern has been raised about patients in Kent being removed from the register of their GP as part of an NHS England clean-up of lists.

NHS England regularly reviews GP registers to ensure there are no duplications or patients listed who no longer use the practice.

This includes writing to patients to ask if they still wish to be kept on their GP’s register. If they do not respond within four weeks they are removed.

5.03pm The three NHS regulators have agreed to put together a joint description of good leadership in NHS providers.

The idea is proposed in a joint document published today by Monitor, the NHS Trust Development Authority and the Care Quality Commission, which summarises the work they are doing to ensure their separate assessments of trust leadership fit together.

4.27pm There has been quite a lot of reader debate on our story about an inquiry by an influential Labour policy group concluding that markets in healthcare increase inequalities.

One reader said the report “makes sweeping conclusions from what it itself says is a weak evidence base - but when you see the identities of the academics and others involved in the study, you can see that this reflects their prior beliefs”.

The reader adds: “One obvious question for them - if they want evidence about their proposed approach, why don’t they look at the ‘success story’ that is Wales? Or would that evidence be unhelpful to their preferred conclusion?”

Another reader said: “Competition law applies in all areas where there is private sector involvement - given that this ranges from GPs to elective care to mental health, it would be very hard (as well as misguided) to undo. Conclusion: this report is yet another triumph for ideology over what’s best for patients…”

Others agreed with the findings of the report. One reader said: “There is ample evidence that competition considerations are hampering commissioners and restricting sensible service reconfiguration - as David Nicholson told the Health Select Committee last November, and as shown by the £ millions being spent by CCGs on competition lawyers.”

What do you think?  Should the Health Act be repealed? Does competition increase inequalities in healthcare? Join the debate at

4.00pm The Financial Times’ Alphaville blog discusses popular US economists from the Gary Becker school meeting with David Cameron about what to do with the NHS.

“While it’s hard to argue that the NHS doesn’t have its problems, what many American economists don’t seem to get — and yes, we’re generalising horribly here — is that most British people are incredibly proud of the universal system we have, and that any politician who even thought about bringing in a tiered scheme wouldn’t last long,” the blog states.

3.35pm Large numbers of women staying silent about incontinence after childbirth because they are too embarrassed to seek help, according to a joint poll by the Chartered Society of Physiotherapy and the Royal College of Midwives.

One in two women responding to the survey conducted by the parenting site Netmums for the two organisations, said they had never spoken to anyone about their problem and three quarters said they had never sought help from a health professional for the easily-treatable condition.

Six in ten said they felt the subject was ‘taboo’ and 56 per cent said they felt embarrassed about the problem, with 16 per cent feeling ashamed about it.

The organisations are launching a joint physio and midwife-led initiative to prevent incontinence among women following pregnancy and birth and to ensure the quick referral of women who need treatment.

Ruth Ten Hove, professional adviser at the CSP, said: “Continence issues can take a terrible toll on people’s lives, as this survey shows.

“Understandably, people find it a difficult subject to discuss and don’t seek help, which can cause the problem to worsen.

“But it doesn’t need to be this way – physiotherapists are experts in treating the condition and can make a big difference.

“We want the NHS to make it easier to access these services, but we are also working with midwives to help more women avoid developing the problems in the first place.”

Jacque Gerrard, RCM director for England said: “For women with incontinence their whole day is planned around being able to stay close to a toilet and without help these problems will only continue to get worse.

“During pregnancy women are generally more receptive to health messages so this is an ideal time when midwives can be proactive in discussing prevention.”

Netmums co-founder Sally Russell said: “This is probably the last taboo subject for new mums as it can be very upsetting - but it is so easily treated.

“Women’s bodies go through such huge changes during pregnancy and birth so it’s no surprise they may not always work perfectly afterwards. However we have to get women to realise there is no need to suffer in silence, as with some gentle treatments, they can restore control and get their lives back.”

3.14pm The latest from our End Game blog, if you’re struggling to remember the six Cs of compassionate care then fear no more – there is now an allegedly catchy song to assist.

3.01pm Our sister title Nursing Times reports that universities remain locked in negotiations with the body Health Education England over cuts to funding for nursing and midwifery courses.

2.27pm Workload pressures are impinging on GP practices developing federation and network arrangements, according to a survey by the British Medical Association.

As part of its practice collaboration survey, the BMA asked more than 1,500 GPs about their their views on collaborative working.

Seven out of ten of GPs responding to the survey said workload pressures were a barrier to establishing a network or federation. A third said lack of time was also a factor.

45 per cent of GPs of respondents said they not clear or not convinced about the benefits of forming a federation or network. Nevertheless, more than a third said they are considering joining a network or federation. One in five are already part of such an arrangement.

63 per cent said they would like to develop a network to help bid for enhanced primary care services, such as sexual health and smoking cessation services, which are commissioned which are commissioned by clinical commissioning groups.

According to the survey, GPs would like more support in establishing network or federation arrangements.

Two thirds of respondents said they would find further guidance helpful, six out of ten would like to receive legal advice, and four out of ten would like HR and project management support.

Richard Vautrey, deputy chair of the BMA’s GP Committee, said general practice is “under massive strain” from “a combination of an unsustainable rising workload and fewer resources”.

“In this environment, we need to look at new ways of working that might enable practices to get the most out of limited resources and work more effectively together.

“Forming federations or networks is certainly not the solution for every practice and there is no ‘one size fits all’ model that would be suitable for every area, but it could offer real opportunities for many practices in really difficult situations.

“It is deeply disappointing that the very problems that are spurring the need for more collaborative working are preventing GP practices from putting in place proper solutions.

“As this survey shows, many GP practices simply do not have the time because of workload pressures to even explore the benefits that working in a network might offer. There is an urgent need for resources to give GPs the breathing space to enable them to plan for the future.”

Beth McCarron-Nash, the GP Committee’s lead for commissioning and service development, added: “GPs are calling for much more support and information so they are enabled to make an informed decision about whether forming a federation or network is best for them.”

You can read the full results from the BMA’s survey here.

2.04pm Also in The Telegraph, spinal chord stimulation could be used to restore the movements of stroke victims and patient patients paralysed in their arms or hands, according to researchers at Newcastle University.

Research fellow Andrew Jackson told the paper: “I think within five years we could have an implant which is ready for people. And what is exciting about this technology is that it would not just be useful for people with spinal injuries but also people who have suffered from a stroke and have impaired movement due to that.”

“When someone has a damaged motor cortex or spinal cord the problem is that the signal from the brain to the muscles isn’t getting through,” he added.

“What we have done here is restore that connection, to allow the signal telling the hand to move to reach the spinal cord.

“By exploiting surviving neural networks below the injury, we can activate natural actions like grasping using just a few stimulation sites. This is the first time that anyone has done that.”

1.45pm The Daily Telegraph has a front page story on experts warning that fear of dementia is exacerbating the condition.

A poll by the Alzheimer’s Society has found that that more than half of those diagnosed with dementia wait at least six months before seeing their doctor.

1.31pm Also in The Times, the country’s highest court is deeply divided over whether to allow doctors to assist those who are physically unable to end their lives in so-called right to die cases.

In December last year, a panel of nine Supreme Court justices heard challenges led by the widow of Tony Nicklinson, who was paralysed after a stroke. The justices have yet to produce a ruling. 

1.17pm The Times reports that NHS officials have warned that a coalition health reform could trigger a fresh cash crisis immediately after the next general election.

Doctors fear that under the better care fund, the NHS budget is going to be used to provide funding to plug gaps in social care at a time when the system is already under huge strain.

HSJ yesterday reported on the Department of Health and the Cabinet Office meeting with health and local government representatives to draw up a tougher set of tests for the better care fund.

The stricter assurance programme is expected to come out of a what will be a series of meetings could allow for direct Whitehall intervention in areas where plans are deemed not to have been properly developed.

1.03pm Great Ormond Street Hospital Foundation Trust has appointed a new chief executive with a background in children’s healthcare management in Australia.

Dr Peter Steer is currently the chief executive of Children’s Health Queensland Hospital and Health Service for five years. He will join Great Ormond Street in January next year.

He is also a professor in the School of Medicine at the University of Queensland, and is a board member of the Australian Provincial Council on Children’s Health.

12.56pm EXCLUSIVE: An inquiry by an influential Labour policy group has concluded that markets in healthcare increase inequalities and that the Health Act 2012 should be repealed.

The review by the Parliamentary Labour Party health committee, whose findings have been shared exclusively with HSJ, was chaired by Debbie Abrahams, who is the parliamentary private secretary to shadow health secretary Andy Burnham.

12.40pm In its leader column, The Times argues that the use of private expertise in the NHS is its saviour, not a betrayal of its values. Citing the example of Circle-run Hinchingbrooke Hospital the paper suggests that ‘top-class management’ can improve care at the same time as saving money.

12.25pm Back to today’s papers, The Times writes of a “dysfunctional” NHS hospital that was crippled with debt has come top in the country for patient care two years after being taken over by a private firm. (newspaper only)

Hinchingbrooke Hospital was taken over by Circle two years ago and has been rated the best in the country for quality of care by independent consultants CHKS.

11.55am The Department of Health has defended the national review system for NHS reconfiguration proposals after a local councillor claimed the foreign secretary had lobbied officials involved in the controversial plan.

John Blackie, the independent leader of Richmondshire District Council claims William Hague had intervened by speaking to both the health secretary and an official panel that is considering whether to conduct a full review of a planned shake up of hospital services in North Yorkshire.

11.39am The NHS trust sector finished 2013-14 £241m in deficit, the NHS Trust Development Authority has confirmed.

The year-end position is substantially worse than the £76m net deficit planned at the start of the year.

11.25am The body representing clinical commissioning groups has warned not including CCGs in primary care commissioning will put patients at risk.

In a statement, NHS Clinical Commissioners said it has been “calling for to the way that primary care is currently commissioned since 2013 as members tell us that the current primary care arrangements do not allow them to truly transform local health services”.

The statement reads: “Leaving CCGs out of primary care commissioning decisions puts their clinically led and clinically designed strategies for local health improvements at risk, which ultimately means it’s putting the health outcomes of their patients and populations at risk.  Simon Stevens announcement in May 2014 that he was giving CCGs the opportunity to exercise more powers to co-commission primary care was a welcome move in the right direction.

“Building a successful NHS for the future that delivers high quality care for patients, will need to have strong and effective out of hospital community based services. Achieving this requires highly effective commissioning that integrates care across primary, acute and community services. This will not happen while different people are commissioning different part of the system.

“With GPs and other clinicians who lead CCGs already taking a strong partnership approach with NHS England and local authorities, it means they are ideally placed to join up the system to make informed decision on behalf of their populations, and are the right people to look across a whole care pathway and recognise the health impacts and outcomes for patients that each part of the system has.”

The statements points to examples where “clinical leadership is bringing big benefits for patients and the wider health economy”, such as  Northumberland CCG’s frail elderly services, which brings together primary care, the community and hospital services at Northumbria Healthcare Foundation Trust and at Northumberland County Council  social services.

“Since the programme started there has been a steady reduction in emergency admissions of frail elderly patients as they are identified as a risk before they even get to A&E, and then assessed and monitored regularly.”

The statement continues: “Getting primary care co-commissioning with CCGs right is not going to be easy, but by not using the clinical leadership which is at the centre of local healthcare systems we risk fragmenting the NHS even further, causing even greater healthcare variation.

“CCGs are statutory bodies who already have to produce clear and transparent plans on their governance, delivery and strategic direction and this would not change with an expanded role into primary care. The strong oversight role that lay members already play in CCGs, working across the system with Health and Wellbeing boards and NHS England area teams, as well as others, means that any perceived conflicts of interests within CCGs can be managed and the public can be reassured that primary care decisions are being made in the best interests of the patient.

“Criticisms that this signals a move towards the old PCT model are also unfounded as CCGs are membership organisations driven by local clinical experts, who use their expertise, relationships and clinical experience to ensure that patients are always at the heart of their decisions.”

11.12am NHS organisations are being encouraged to ‘twin’ with hospitals in countries like China as part of an effort by Healthcare UK to help them secure international business deals.

Healthcare UK’s chief executive Howard Lyons has also pledged to draft new guidelines to help hospital trusts open up new income streams by offering advice to their counterparts oversees.

11.01am Thousands of NHS staff are being paid through off-payroll deals that can cut tax payments, The Daily Mail reports.

A Department of Health review found that more than 2,400 staff are paid as contactors rather than receiving their salary directly from the public purse.

Officials only investigated staff who earn more than £58,000 a year and who have been employees for at least six months.

10.48am The Daily Mail reports that a heart attack test that could save thousands of lives is due to be rolled out on the NHS within months.

The test detects small increases in a protein released when heart muscle is damaged.

As many as 50,000 patients a year are wrongly sent home from hospital with a diagnosis such as indigestion or back pain because current methods do not pick up they have had a heart attack.

10.35amThe Guardian’s financial editor Nils Pratley argues that Pfizer failed its bid its bid to take over British drugs company AstraZeneca because it was overconfident.

He says “the story of the bid battle itself is very simple: Pfizer was over-confident and never offered enough to win”.

He adds the “naked aggression” of Pfizer chief executive Ian Read was “counter-productive”.

“Pfizer never attempted to address AstraZeneca’s worry that valuable research projects would be binned if the company was carved up to fit the US group’s operating model.

“Nor did Pfizer ever go public with the size of the cost and tax savings […] it’s hard to inspire a rebellion in AstraZeneca’s ranks if you don’t tell investors the size of the prize they are meant to be chasing. Pfizer looked suspiciously defensive on the tax point.”

10.19am Turning to this morning’s papers, The Guardian leads on US pharmaceutical firm Pfizer walking away from its £69 bid to take over British rival AstraZeneca.

The bid had been widely criticised for being motivated by tax purposes. There were also concerns that the takeover could lead to cuts in British jobs and research.

10.04am Trusts bidding for a share of NHS England’s latest £240m tranche of its technology fund will come under increased pressure to prove proposals deliver significant economic benefits.

This emphasis on outcomes follows the loss of a £60m chunk of the £260m originally earmarked for its first funding round, which HSJ revealed last week had been clawed back by the Treasury.

NHS England sees the creation of a strong evidence base as critical to the future of the fund.

9.45am There are some interesting reader comments on our story yesterday about the Department of Health and the Cabinet Office meeting with health and local government representatives to draw up a tougher set of tests for the better care fund.

Have a read of some of them below:

“These centrally allocated funds lead to dysfunctional behaviour whereby much effort is diverted to applying, but finance directors grab it for the general pot. Much more effective to hand the totality of money to CCGs and measure them against outcomes”

“This is classic NHS/Gov at its best. Introduce an ill conceived scheme, then develop metrics that are undeliverable, then a buracratic planning approach which is completely unworkable, and then introduce an assurance process to prove that it is the idiots completing the plans that are at fault, not those that came up with a thinly disguished method to shift funds from the NHS to fill the growing hole in social care funding….. brilliant!”

“A 15% reduction in emergency activity - what planet are they on. The likelyhood of this happening flies in the face of historical increases year on year as the demographics of the population clearly indicate.”

“The unrelenting rise in emergency admissions is driven by an ever ageing, frail population with complex medical needs and a significantly under-resourced and staffed primary care/general practice infrastructure which is unable to cope safely with the demand. It isn’t caused by a huge lack of health & social care integration and expecting emergency admissions to fall by 15% as a result of the impact of the Better Care fund is plain mad and condemns the scheme to fail from the start. Once again, a classic example of a good idea in principle being ruined by the combined ineptness of health ministers and the DOH/NHSE.”

9.35am Data on the repeat use of the Mental Health Act has been published for the first time by the Health and Social Care Information Centre.

The information, released today, concerns the number of adults subject to repeat use of detentions and short term orders under the Mental Health Act.  It looks at the number of adults subject to more than one detention or short term order during 2012-13.

It accompanies the HSCIC’s monthly Mental Health Minimum Data Set publication on adult mental health services.  

The full report can be read here.

7.00am Good morning and welcome to HSJ Live. We begin the day with an article from our resource centre on how one clinical commissioning group has sought inspiration from the retail sector.

Sandwell and West Birmingham CCG created a single point of contact for compliments, comments, concerns and complaints, influenced by John Lewis’ approach to customer service.