HSJ Live 20.09.13: Are US-style hopitalists the answer to 24/7 working

5:17pm: United Lincolnshire Hospitals Trust has been heavily criticised by the Care Quality Commission over concerns about low staffing, patient safety, record keeping and management, HSJ reporter Shaun Lintern reports.

The trust, one of 14 inspected as part of the recent Keogh Review, failed to meet seven essential standards at its Lincoln County and Pilgrim Hospitals, the regulator found.

Inspectors, who visited the trust on five occasions during June and July, witnessed call bells being ignored by staff walking past “without checking whether the call was urgent or not.” On one ward inspectors found the drug trolley had been left open and unattended among a high number of confused patients.

The report said: “We found all staff spoken with agreed there were staff shortages. Staff reported low staffing levels meant they could not care for their patients as they would wish to do.”

4:42pm: Latest waiting times blog from Rob Findlay is in and according to it the English waiting list is near its seasonal peak for the year, just below 3 million. Here’s more: https://www.hsj.co.uk/english-waiting-list-peaking-just-below-3-million/5063442.blog

2:42pm: A new survey has found that four in five adults want the NHS to offer levels of access to cancer treatment at least comparable with other countries.  Half believe the NHS should be a world leader in the treatments available to patients and should pay for all treatments regardless of how much they cost, going beyond international standard practice.

The findings increase the pressure on the Government to make clear its plans for the Cancer Drugs Fund, as the current arrangements are due to come to an end in early 2014.

Key findings from the survey include:

·  Half (50%) say that the NHS should be a world leader in the treatments available for patients and should pay for all treatments, regardless of how much they costs and a further two in five (39%) say that the NHS should pay for treatments that are available in other countries, ensuring that patients in the UK are not worse off than those in other countries

· One in five (20%) say that the NHS should give greater priority to treating patients who have severe illnesses, including those with terminal illnesses

· Just 5% believe that the NHS should only pay for treatments up to a certain maximum price

·  More than four in five British adults (83%) believe that decisions about which treatments are paid for by the NHS should be made at a national level

1:54pm: The Guardian reports it will take three to five years to turn around the 11 failing NHS hospitals identified in the Keogh review, according to the health secretary, Jeremy Hunt, who acknowledged that more hospitals with similar problems would soon be identified by a new inspection regime.

1:35pm: David Colin-Thomé, in his article for HSJ’s Opinion section, reflects on a roundtable discussion asking whether clinical commissioning groups should exercise sovereignty or diplomacy to realise their ambitions. Read the entire piece here.

1:26pm: Around 7,000 doctors are being asked for their views on the General Medical Council (GMC) to help gain a greater understanding of their perceptions of the medical regulator.

The National Centre for Social Research (NatCen), an independent agency, has been commissioned by the GMC to undertake the research. The doctors participating are drawn from an anonymous sample of doctors on the register.

The survey, starting today, is part of a new piece of research examining whether doctors think the GMC is regulating in a fair and objective way and whether doctors from different backgrounds have different views of the GMC’s fairness and objectivity.

The research builds on last year’s ‘Being Fair’ conference where the GMC brought together healthcare leaders from across the UK to explore the challenge of fostering greater fairness in their work.

Niall Dickson, chief executive of the GMC, said: “As an organisation we are committed to listening and improving what we do. We know that we can be controversial at times and that we must do more to understand concerns about the work we do.

“A year ago we held our first ‘Fairness’ conference bringing together leaders from across healthcare. We made a number of commitments at that event including obtaining better data, which is why we are keen to hear from doctors to understand the factors that influence their perceptions of the GMC. This will help us ensure that we are regulating as fairly and objectively as we can. This feedback will also to help to make sure we apply our standards consistently and address any concerns that doctors raise through the survey.”

“The GMC has an extensive programme of work underway to ensure that it is being fair in its work. This includes working with its Black and Minority Ethnic Doctors Forum which brings together representatives of the main associations of BME doctors in the UK; auditing the outcomes from each stage of its fitness to practice activities; reviewing the routes on to the registers; working with partners to ensure that all doctors have a chance to revalidate; producing guidance for medical schools on making reasonable adjustments for people with disabilities; and providing bespoke training to its staff and associates to help them to identify and address the equality and diversity issues that arise from their work.”

The survey will last for eight weeks and the results will be published early next year.

11:58am: The Daily Mail today picks up on the comments made by health secretary Jeremy Hunt on Thursday, reporting that “hospitals where hundreds of patients were dying needlessly received elite status under a flagship Labour policy”.

It continues: “Six failing NHS trusts were rewarded even though their death rates had been persistently high for years.

“The trusts, which include Basildon and Thurrock, Burton, Medway, Northern Lincolnshire and Goole, Sherwood Forest, and Tameside, were placed in special measures this summer after a major investigation exposed appalling levels of care.”

The paper suggests that the health secretary announced plans to “effectively strip them of the coveted ‘foundation trust’ status, endowed by Labour”.

You can read HSJ’s report on Mr Hunt’s comments here.

11am: The Guardian has revealed that nearly 50 NHS England professionals earn more than the prime minister.

It reports: “Sir David Nicholson, the NHS’s embattled chief executive who is due to retire next March, earns the most – £211,249. Five executives earn over £180,000, including Prof Sir Bruce Keogh, the high-profile national medical director, who takes home £190,000-£195,000.

“A total of 291 earn over £100,000 a year, meaning that almost one in 20 of the organisation’s 6,115 staff earns at least a six-figure sum. The 291 ‘very senior managers’, who are a combination of managers (62%) and doctors (38%), represent 4.7% of its overall workforce.”

Matthew Sinclair, chief executive of the TaxPayers’ Alliance, said: “It is astonishing how many NHS England staff are earning more than the prime minister and that nearly 300 are on six-figure salaries. At a time when budgets are so tight, people expect the NHS to be concentrating its scarce resources on delivering frontline medical care, not lining the pockets of managers.”

10:45am: GPs need to be freed from increased bureaucracy, box ticking and administration so they can spend more time meeting the needs of their patients, sccording to a survey by the British Medical Association.

The key findings include:

• 97% said that bureaucracy and box ticking had increased in the past year while 94% said their workload has increased.
• 82% felt that some of the new targets were actually reducing the number of appointments available to the majority of patients.
• 89% said that more targets will not improve patient care.
• 90% said their practice’s resources are likely to fall in the next year.
• 45% of GPs said they are less engaged with the new clinical commissioning groups (CCGs) because of increased workload.
• 86% of GPs reported a reduction in their morale in the past year.

The findings are contained in the largest survey of GP opinion since changes to the GP contract took effect in April 2013. In total, 3,629 GPs completed the survey, just over 10% of all GPs in England.

Dr Chaand Nagpaul, chair of the BMA’s GP committee said: “The results of this survey demonstrate that an increase in bureaucracy, box ticking and administration has damaged GP services and patient care, mirroring a government funded report into GP’s working lives that made similar findings.

“GP practices are already struggling with declining funding and rising patient demand, especially from an ageing population. Recent changes to the GP contract have created additional and unnecessary workload that is diverting valuable time away from treating patients. Worryingly 8 in 10 GPs report a reduction in morale, and nearly half of GPs are less engaged with their Clinical Commissioning Groups due to workload.

“Recently introduced targets included encouraging GPs to carry out a large number of lengthy and clinically dubious questionnaires that ask how many hours patients spend on gardening, cooking   and DIY. They are also offering appointments to all healthy 35-40 year olds simply to check their blood pressure. GPs are very worried that the time taken for this programme and questionnaires is resulting in fewer appointments for other patients who are in need of care.

“The BMA wants to work with the government to deliver real benefits to patients and remove the administrative burden that is putting pressure on already overstretched GP services. We particularly need to see how we can free up more time to deliver the personalised care that patients deserve and meet the challenges from an increasing number of older patients who need coordinated and effective care.”

10:31am: Richard Murray, currently chief analyst at NHS England, has been appointed as a new director of policy for The King’s Fund.

Chief executive professor Chris Ham said: “We are delighted that Richard will be joining The King’s Fund. He has a deep understanding of the health and care system, which, coupled with his skills in policy analysis and development, will be a great strength for the Fund.

“Richard joins a team already making a significant contribution to developing the evidence, ideas and tools that can help those in health and health care meet the very considerable challenges we face. In Richard we have appointed someone who I know will bring the energy and intellectual rigour needed to make a real impact and make the most of this role.”

He replaces Anna Dixon, who left in April to join the Department Health as their director of Quality and Strategy and chief analyst.

Mr Murray said: “I am thrilled to be joining The King’s Fund. It’s great to become part of a team with such a strong track record in shaping policy through research and analysis and using the evidence to foster understanding and debate. Now more than ever, the combination of this work with the Fund’s strength in developing organisations and leaders provides a unique environment in which to contribute to improving health and care.”

8:30am: One of the key points that emerged from HSJ and Clever Together’s discussion around 24/7 working was the creation of a new role of a “generalist”. A generalist is a doctor who can act as an interface between all traditional care settings, helping to facilitate early discharge. 

The idea might be a new one for the NHS, but it is already an established practice in the US. Its pioneer is Dr Robert Wachter who coined the word “hospitalist” and is considered the pioneer of the hospitalist system. Today on innovation and efficiency channel, he tells Shreshtha Trivedi what he thinks needs to be done if a similar system were to be adopted for 24/7 care in the NHS.