5.32pm The Department of Health has published the directions under which NHS England will transfer £859m this year to local authorities to support social care, expected to rise to £900m next year.
4.29pm Queen’s Hospital in Burton on Trent has “locked down” its A&E department after patients needed treatment for contact with an “unknown powder”, the BBC is reporting.
The unit was closed and patients were told to go to Derby instead. A&E in Burton began to reopen from 4pm, three hours after the patients were admitted.
4.04pm The FDA union has questioned today’s announcement by the Department of Health, that civil servants should spend a month a year gaining first hand experience of front line services. (see 1.13pm)
The union, which represents senior public servants,welcomed the “development opportunity” but questioned whether the initiative would be backed up by the necessary resources.
General secretary Dave Penman said: “While we are not opposed to this proposal, we question where this additional working month each year per senior civil servant will come from. DH has already been cut by 15 per cent and senior civil servants regularly work excess hours now, with around half of them working the equivalent of an extra day each week for free. Senior civil servants cannot simply absorb this sort of extra commitment.
“If this initiative is about civil servants who are developing policy having a greater understanding of the NHS front line - rather than being a publicity stunt on the back of the Francis Inquiry - it is to be welcomed, but to be taken seriously it has to be backed up by resources.”
3.57pm The integration live chat generated 46 questions and comments in all. Read the whole thing here.
3.56pm Our live Q&A on integrated care also yielded this, from Debbie Freake, director of integration for Northumbria Healthcare NHS Foundation Trust:
“In response to Don’s question about Pioneer Status: For us in the North East it provides welcome endorsement of the approaches we have been using, and encouragement to continue this work at an increased pace. We would be really delighted to have the opportunity of working alongside some really innovative teams, sharing ideas and experiences, as well as benefitting from some of the specialist support available. To be honest, this is not going to change what we are currently doing and plan to do – but it DOES help re-enforce, add weight and further impetus to our work – however, with or without pioneer status we will be ploughing ahead locally on our integration agenda with our partners!”
3.53pm Joanna Newton commented: “I think the main barriers are still cultural - until the NHS understands that accountabilities within the place based system of local authorities is different, true integration will not occur. Consistent leadership and continuity of policy key: witness our recent challenging experience here in Herefordshire.”
In response, Nicola Walsh of the King’s Fund said: “Joanna - one of the key levers this time may be the 14 national organisations committed to supporting the pioneers. At last week’s launch, Carolyn Downs of LGA was very keen to promote the opportunities of this level of commitment at a national level to support local initiatives. We would like to have seen pioneers have greater freedoms and flexibilities - but they do have the potential to submit plans and work with Monitor and others to make this a reality if chosen.”
3.51pm We asked what were the barriers to integrated care, how do we remove then and also what does Norman Lamb’s announcement of integrated pioneers mean practically for local services.
Don Redding of National Voices replied: “First, don’t forget this is about ‘person centred care’, not just integration. We’re not interested, as patients, in people joining up with each other unless they join up with and around us.
“Second, some of the crucial inputs to holistic support are to be found from the Third (voluntary and community) sector — so their strengths on patient information, advocacy, peer support, support to self-manage, etc need to be part of the mix (see Nesta on coproduction/People Powered Health).
“Third, patients and service users can help design new systems to make sure we get them right first time — if involved as equals from the start. We’re ehering of this happening increasingly in localities and it’s probably one the better predictors of whether or note there will be a change in patient experience.”
3.49pm If you’ve been visiting HSJ Live throughout the day you will be aware we hosted a live Q&A on integrated care this lunchtime.
Over the next few minutes we’ll be posting up some of the highlights from that discussion.
3.46pm New on HSJ:Na’eem Ahmed from the Faculty of Medical Leadership and Management has written an opinion piece on the need for “greater maturity” towards decisions such as the suspension of child heart surgery at Leeds General Infirmary. He says patient safety should prevail over political grandstanding.
He writes: “Presently, knee-jerk localism prevails over a wider commitment to enhance public understanding of decisions made on issues of safety. The culture in the NHS needs to change to allow open reporting and support for precautionary suspension of work on safety grounds.”
2.17pm The DH, Monitor, CQC and Trust Development Authority have today issued a joint statement on the regulation and oversight of NHS trusts.
In future, the statement says, the CQC “will focus on assessing and reporting on quality; and Monitor and the NHS TDA will be responsible for using their enforcement powers to address quality problems.
“To free up time to care, the overall regulatory burden on providers will be radically reduced but, where there are failings in quality of care, there will be a stronger response.”
Read the whole thing here, and stay tuned for analysis.
2.05pm The DH has confirmed to HSJ that Ed Jones will replace Sam Talbot-Rice as special advisor to Jeremy Hunt.
1.45pm Mike Birtwistle of MHP Health Mandate has tweeted his congratulations to Ed Jones, who he says has been appointed special advisor to health secretary Jeremy Hunt.
Mr Jones is a former colleague of Mike’s. A quick search on LinkedIn suggests that Mr Jones might also have worked for Deloitte as a consultant, and in the public affairs teams of Hanover and Kreab Gavin Anderson.
1.40pm There’s been so much to talk about on HSJ Live so far today that we didn’t finish the national press roundup.
The Daily Mail devotes all of page eight to the NHS today. “Fifty hospital beds a week axed under the Coalition”, runs the main headline, worryingly for the government.
The drop in acute sector capacity is “pushing overstretched accident and emergency wards ever closer to breaking point”, the Mail argues.
An editorial also addresses the issue. “If the system is to be saved from collapse, confidence must be restored in community services”.
There’s also a downpage story about mothers getting private help “to bear midwife shortage”.
1.13pm The Department of Health has announced that civil servants will have to spend an entire month, each year, learning about patients’ experiences of the NHS.
That civil servants should spend time on the “frontline” of the NHS was announced following the Francis review. Today’s announcement sets out the policy in more detail.
A DH press release today said: “The health secretary wants his staff to lead the way… by gaining a personal understanding of life on the front line and using that experience to shape policies that serve patients and their families.”
However it appears that the announcement stops short of mandating a month’s direct frontline experience every year. Instead, the time should be spent “learning about” patient experiences.
Permanent secretary Una O’Brien and directors will “immediately” spend at least a month a year “learning about patient experiences and understanding the impact of their polices on the frontline.”
Senior civil servants will also be expected to spend at least a month a year “learning about the experiences of patients” every year, increasing their experience levels over time.
Policy staff and others “will also follow suit”, “learning about how their policy areas work out in practice, and broadening their knowledge of patient experience.”
The experience of staff will be reflected in their performance assessments, the DH says, and will become a normal part of how the department works and a “basic expectation” of the people who work in it.
Civil servants will get exposure to a “range of environments” to help them get broader grasp of how the system works in practice.
This could include accompanying hospital porters, listening to receptionists answer queries, or learning how busy nurses or health care assistants go about their business.
Department staff may also find out about how charities support patients.
“To understand more about what patients and service users need, and the issues which are important to them, civil servants need to walk a mile in their shoes… Too often, civil servants are accused of making policies from within the ivory towers of Whitehall. It is time for this perception of aloofness to end. “
Department of Health Permanent Secretary, Una O’Brien, said: “Even for myself, with seven years front line experience this type of work is important because there is so much more to learn about current realities on the front line.
“A lot of our staff have front line experience, but it’s time for all to see what life is like on the coalface to focus their minds on what we are all working towards.
“This isn’t about getting in the way of the important work that health and social care staff do. This is about connecting civil servants with life on the front line, changing the culture of the department and progressing the civil service reform agenda.”
12.45pm One final plug for HSJ’s live Q&A on integrated care. It’s at 1pm, and will take place in the comment thread of this story.
Before it starts you can use the comment thread to submit any questions you would like our expert panel to discuss.
12.23pm HSJ’s acute sector reporter Ben Clover reports that the largest single trigger for “risk summits” has been pressure on accident and emergency departments.
Summits were introduced in October, and have so far been held in relation to 26 NHS trusts.
12.21pm At 2.30pm today there will be a debate in the House of Lords about cancer deaths.
Peers will be pressing the government on the proportion of deaths caused by cancer, where the actual cause is cancer treatment. You will be able to watch online here.
12.17pm The Guardian has taken on James Illman’s story about how the Health and Social Care Information Centre is selling patient identifiable data.
The paper reveals today that the list of organisations approved to receive sensitive information includes private provider BUPA.
12.09pm Two new pieces on HSJ today:
First, Roger Russell and David Needham look at how trust boards can be strengthened to ensure the organisation is performing to the best of its ability. They write: “It goes without saying that the effectiveness or otherwise of the board is one of the most critical factors affecting the performance of any organisation. The leadership competence, style and tone set here has huge implications for the way in which an organisation performs and the kind of culture that is developed.”
And second, Debbie Guy has written an article on our Innovation and Efficiency channel about the risks involved in care handovers and how hospitals can reduce them. She says: “Introducing mobility to the handover process - not just making it electronic - is key to bringing about the shift in emphasis and focus from the handover itself to the continuous, real-time updating of the handover information… This puts patient safety first and allows for a safe handover, reducing the risk and potential for harm.”
12.02pm The chief executive of the Bristol Community Health social enterprise has responded to critical comments following Sarah Calkin’s story about mass board resignations.
Scroll down the comment thread on this story to Julia Clarke’s comment. “People’s imaginations are running rife”, she begins…
11.56am Monitor’s substantive guidance for NHS procurement is here - we’re no longer having problems downloading it. Monitor assure us the problem was with our technology, not theirs.
11.50am HSJ is hosting a live question and answer session on integrated care at 1pm today.
What barriers to integrated care still remain and how can we overcome these? How much can local leadership achieve? Post your comments in the story here for our expert panel to discuss.
Our panel will be:
- Dr Nicola Walsh, integrated care programme lead and assistant director of leadership at The King’s Fund
- Don Redding, director of policy, National Voices
- Debbie Freake, director of integration, Northumbria Healthcare NHS Foundation Trust
- Anthony Gardner, NHS Cumbria CCG network director for South Cumbria
11.42am You can read Monitor’s “enforcement guidance” for NHS procurement here.The “substantive guidance” is here, but when we tried to download it, we got a notice saying the file was damaged beyond repair, which some may find amusing, given the politically contentious nature of the the issue.
11.37am More on that procurement guidance. Monitor’s release this morning says that over the next two months the regulator will be formally consulting to make sure it is “a clear reference point” for commissioners.
Monitor chief executive David Bennett said:”It is for commissioners to decide what services to purchase and how best to secure them for their local population. Monitor’s role is limited to ensuring that commissioners have operated within the legal framework established by the regulations. Our guidance is intended to be a practical tool that helps them improve the quality of services, and that is why we are consulting clinical commissioning groups and others on this draft.”
“The guidance makes it clear that the regulations do not force commissioners to go out to tender for every service, but equally commissioners should not simply roll-over existing contracts without first asking how good the service is, and whether it could be improved to give patients a better deal.
“If so, the next steps might be evaluating alternative providers if there are any and if not negotiating a better arrangement with the existing provider. These are matters for commissioners to consider in exercising their duties. As a sector regulator, Monitor will be able investigate complaints about procurement decisions in England as an alternative to bringing cases before the courts.”
11.33am Monitor has this morning published draft guidance for commissioners procuring patient services.
The guidance is designed to help commissioners comply with new procurement, patient choice and competition regulations, and to ensure decisions are consistent with the controversial Section 75 regulations published earlier this year.
More to follow….
11.24am Another story from the weekend: 38 of the UK’s leading care charities are warning that the government’s Care and Support Bill could shut a million people out of state funded care.
The warning came in a letter to the Sunday Telegraph. Signatories included Alzheimers UK, Scope and the British Red Cross.
11.16am Karen Lynas, deputy managing director of the NHS Leadership Academy, has written an article for HSJ setting out why now is the right time to invest in leadership development programmes.
She says: “This work isn’t a distraction from solving the problems we are all currently facing - it is a big part of the solution. We have a whole new architecture being led in many parts by people new to the role and struggling to find their way through what they have inherited - they need support, wisdom, knowledge and experience.”
10.54am The BBC is reporting that a third of calls to a confidential phone line for NHS staff in Scotland are coming from “other parts of the UK”.
The line was established in the wake of the Francis report to enable NHS staff to raise concerns about care.
The National Confidential Alert Line has received 53 calls since its launch last month, the BBC says. Of those, 19 were from NHS workers in parts of the UK other than Scotland.
10.47am Here’s the Health and Social Care Information Centre’s press release on their new chair. Mr Manning reveals he is “delighted” at his appointment.
10.43am New on HSJ this morning: the accident and emergency row escalates.
Steve Kell, co-chair of NHS Clinical Commissioners’ leadership group, said: “There is little doubt that a fire-storm has being whipped up over what is happening in accident and emergency departments, with primary care provision, the GP contract and out of hours care being dragged into the mix.”
10.36am Ex-McKinsey consultant Kingsley Manning has been appointed as chair of the Health and Social Care Information Centre, HSJ editor Alastair McLellan tweets.
Alastair said Mr Manning was “knowledgeable and well connected” In his guise as Health Policy Insight editor, Andy Cowper added that Mr Manning “founded Newchurch, sold to Tribal who sold to Capita”, and “famously” sent a list of “pro-reform GPs” to former health secretary Andrew Lansely’s aides.
Mr Cowper also tweeted this, which is Mr Manning’s response to the Lansley NHS reform white paper in 2010. The reforms eventually became the 2012 Health and Social Care Act.
10.30am The Independent has a story based on a Care Quality Commission report on Harmoni’s management of out of hours care in north London.
The story makes the second slot on the front page, under the headline: “Privatised service is failing NHS patients - official”. The story claims it is “the first evidence from an official body that cost cutting by private companies may be harming patient care.”
10.23am In case you missed it, health secretary Jeremy Hunt was on BBC’s Andrew Marr show yesterday morning. Much of the interview focused on the Conservative Party’s existential crisis over Europe, but presenter Jeremy Vine also asked him about the pressures on accident and emergency services.
Mr Hunt linked the issue to out of hours primary care, saying that he wanted GPs to be responsible for everyone on their list, but didn’t want them on call at 2am on a Saturday. He also acknowledged that NHS 111 might have contributed to the problem “in the short term”.
You can watch the whole thing here: Mr Hunt is on from about 30 minutes.
8.37am: Good morning, on HSJ today we will be hosting a panel discussion on integrated care with Nicola Walsh from The King’s Fund, Don Redding from National Voices and Debbie Freake from Northumbria Healthcare NHS Foundation Trust.
Health minister Norman Lamb last week invited health economies to bid to become integration “pioneers” running large-scale experiments in integrated care. What barriers to integrated care still remain and how can we overcome these? How much can local leadership achieve, and are further changes in national policy needed? Join the debate today from 1-2pm http://bit.ly/14sjr5E