Kate Granger, the consultant geriatrician and inspirational campaigner for patient compassion, has received a special recognition award at the 2014 HSJ Awards, plus the rest of today’s news and comment
5.30pm Responding to the CQC’s first publication of ‘intelligent monitoring’ analysis for mental health NHS trusts, Saffron Cordery, director of policy and strategy, Foundation Trust Network, said:
“It is right that the CQC plans to listen to the views of both staff and people who use mental health services. However the assessment process used to create the intelligent monitoring data must be transparent if it is to genuinely drive improvement in the quality of care. This is particularly crucial for the five mental health trusts that fall into the CQC’s highest risk category so that efforts can be targeted to ensure patients access high quality care.
“Our members acknowledge the value of a risk based approach and are keen to work with the CQC to refine the indicators in a way that accurately reflects their situation so that they can be in control of their own improvement. Working at its best, this system should drive up standards across the country. However, it’s important that the CQC use the indicators to raise questions, not make judgements, about the quality of care.
“Published results can run the risk of providing a false impression about the safety and quality of a particular service. For example, if a whistleblowing alert has been made to CQC, it automatically creates an elevated risk for that indicator, whether it is substantiated or not. It will be important for providers to challenge any unsupportable findings and unfair judgements to ensure a fair representation of the service is provided to the public.”
3.40pm There has been an 8.7 per cent rise in the number of assaultsagainst NHS staff between 2012-13 and 2013-14.
New statistics from NHS Protect show a rise from 63,199 in 2012-13 to 68,683 in 2013-14.
Richard Hampton, head of external engagement and services at NHS Protect, said: “No NHS staff should be physically assaulted and we encourage staff who are victims of violence to press charges against assailants.
“Those who work in the NHS have the right to provide care in a safe environment. Employers must do all they can to support staff in preventing incidents and pursuing offenders”.
UNISON head of health, Christina McAnea said: “It is absolutely shocking that every day more than 188 NHS workers are physically attacked. The fact this figure is rising year on year should ring alarm bells.
“The cuts and pressure on the service have caused growing patient frustration but no staff should be assaulted or feel unsafe at work. This is unfair on staff who do their best to care for patients and their families when they’re at their most vulnerable. There can be no excuse for abusing or assaulting staff and all incidents should be taken very seriously. Sadly, violence on NHS premises often go unreported and many workers are left to suffer in silence.
“The NHS must do its best to provide a safe working environment. Both employers and the police need to take these incidents seriously particularly in mental health premises where we expect full support and cooperation to guarantee the safety and security of staff.”
3.15pm 50 NHS staff are due to fly to Sierra Leone to treat Ebola patients, The Guardian reports.
They were selected six weeks ago by UK-Med, the organisation funded by the Department for International Development to recruit NHS staff for secondment,
More than 1,000 staff volunteered, but none have yet flown out to West Africa.
3.05pm The death rate for people under 75 from cancer has fallen steadily over the past decade, according to figures published today by the Health and Social Care Information Centre.
The new statistics show that across England cancer has remained the top cause of death among under-75s over the past decade, but that the cancer death rate in this age group fell by 14.7 per cent between 2003 and 2013.
For every 100,000 people in England aged 74 and younger, 142 died from cancer in 2013 compared to 166 in 2003.
The report also includes regional analysis which shows that the fall observed nationally has not been reflected across the country. Out of the 326 local authority areas used in the report, the death rate from cancer among under-75s fell in 298 areas and rose in 24.
Looking at the local authority areas, the largest fall in the death rate over the decade was 39.1 per cent (from 156.9 to 95.6 per 100,000 residents), which was recorded in Spelthorne in the South West region. The largest increase was 29.5 per cent (from 149.3 to 193.3 per 100,000 residents), which was observed in Copeland in the North West of England.
For both men and women the first and second common forms of cancer leading to death were cancers of the digestive organs and cancers of the respiratory and intrathoracic organs. For men the third most common form was cancers of the genital organs and for women it was breast cancer.
3.00pm The Financial Times reports that the amount the NHS spends on each patient would fall by between £98 and £191 - equivalent to an overall drop in real-term spending of £5.5bn - by 2020 under the funding pledges made by the main political parties, analysis of NHS England’s calculations reveal.
The figures show that despite the ringfence applied to the NHS budget, spending using health officials’ preferred measure of estimated patient numbers has dropped by £50 per patient since 2009.
Under the Conservative party’s pledge to hold NHS spending in line with inflation, the fall per patient would be £191 from 2009 to 2020 - about the cost of one accident and emergency visit for a patient in England.
2.50pm The Foundation Trust Network has welcomed the complaints report by the Parliamentary and Health Service Ombudsman, Healthwatch England, and the Local Government Ombudsman.
Miriam Deakin, head of policy, said: “Today’s report is created from the views of patients and their families making it a true patient-centred approach to complaints handling.
“NHS providers recognise that the learning from all feedback, including complaints, plays an important role in developing an open culture of improvement for their staff, as well as for patients and the public. Our members put quality at the heart of all that they do and have focused in recent years on promoting transparency and a culture of empowerment in which staff feel supported to raise and rectify issues without fear of blame. Complaints information provides one key source of information on quality of care which provider boards use routinely to drive improvement.
“This publication provides a helpful ‘vision’ for complaints handling and its implementation will be led by trust boards and partners in primary and social care, taking ownership of their complaints processes, actively involving staff and championing change from within. Whilst we must ensure there is minimal additional bureaucratic burden to our members in providing frontline care, we look forward to working with our members and the PHSO to explore how the vision can be used at a practical level to establish and share best practice in managing and resolving complaints for the benefit of NHS staff and the public.”
2.45pm The Guardian reports that private firms are set to win about £9bn worth of NHS contracts, according to analysis by the NHS Support Federation.
2.40pm The challenged Queen Elizabeth Hospital King’s Lynn Trust has appointed a new chief executive.
Dorothy Hosein, who was previously chief operating officer at Barking, Havering and Redbridge University Hospitals Trust, will start her new role immediately.
Ms Hosein has been working at the trust on an interim basis as chief operating officer over the last few months.
2.30pm The majority of mental health trusts are of a “low concern” for the Care Quality Commission, according to analysis published today.
The information is CQC’s analysis of 59 different sources of evidence, ranging from concerns raised by healthcare staff, bed occupancy rates, to staff and patient surveys.
The CQC said that “while this is not a judgment of their performance, it is a positive indication about what the quality of their care could be like”.
Of the 57 mental health trusts in England, CQC has placed 40 of these into bands from one to four (highest perceived risk to lowest perceived risk).
Of the 39 trusts within these bands, over a third (15) of the trusts is in band four. Five are in band one.
Dr Paul Lelliott deputy chief inspector of hospitals (lead for mental health) said: “We have developed this ‘intelligent monitoring’ tool to give our inspection teams a clear indication of the aspects of care that may warrant further investigation on their inspections.
“While the bandings are not judgements of quality, we hope NHS trusts will use our analysis to reflect on where they may need to improve.
“It is encouraging that of the mental health NHS trusts within bands, over a third is of lowest concern.
“Those that give us the greatest concern will be prioritised for inspection so that we can be confident people receive safe, high-quality and compassionate care.”
Dr Catto joined the trust earlier this year as medical director and has worked in a range of clinical, managerial and academic roles in healthcare for more than 25 years.
Dr Newbold stepped down shortly after Monitor placed an additional condition on the trust’s licence on 24 October, citing poor performance on waiting times and mortality.
2.10pm Royal Berkshire Foundation Trust is under investigation by Monitor over aspects of its performance, including data problems on patient waiting times and larger financial losses than it previously planned.
Paul Streat, regional director at Monitor, said: “We are investigating because of problems with the trust’s financial position, and because there are potential concerns with the way it manages patient waiting lists.
“Since August, the trust’s new chief executive has made some progress with tackling these issues, including making the trust leadership more effective. However, we need to make sure the trust is doing enough to fix these problems and improve how the hospital is run for its patients.”
1.55pm Unite has accused health secretary Jeremy Hunt of erecting a “Berlin Wall of intransigence” over NHS staff pay.
Unite head of health Rachael Maskell said: “As ministers ponder their departmental legacies as May’s general election looms, Jeremy Hunt’s ministerial epithet will be: ‘I did not talk to hardworking NHS staff on pay’.
“We understand that MPs from all parties have been urging Hunt to start talks, but, so far, he is cowering behind a Berlin Wall of intransigence.
“The 1.35 million NHS workforce has been forced, reluctantly, to take strike action on Monday as they have seen their incomes eroded by 15 per cent since the coalition came to power in May 2010 – and we expect a strong turn-out buoyed up by very welcome continuing public support, following the four hour action last month.”
1.30pm Clinical commissioning groups will take on responsibility for commissioning at least two of the six specialised service areas whose growth has placed the greatest strain on the specialised services budget, NHS England has confirmed.
The commissioning of renal dialysis and some parts of neuroscience services are being transferred back to CCGs.
These areas, alongside chemotherapy, secure mental health services, neonatal intensive care and neurosurgery have driven half of the annual growth in NHS England’s specialised services budget.
1.20pm The NHS Confederation has responded to the CQC guidance on transparency.
Chief executive, Rob Webster, said: “We must ensure that we retain the confidence and commitment of the public to the NHS. This means we support anything that will enhance transparency and build a more open culture - while making sure those responsible for neglect, abuse or poor care are held accountable for their actions.
“Our members tell us that recruitment practices for both executive and non-executive roles are of a high standard, with most of the fit and proper person requirement already covered so we hope a proportionate and risk-based approach has been developed. The Duty of Candour guidance must be seen as an enabler in the development of a culture of openness when things go wrong and when reputations and lives are at risk. I believe there is already a strong and shared set of values for cultural change in the NHS and with supportive leadership and training, NHS staff should be able to raise patient safety concerns. This will also require a balanced and clear leadership approach by each of us. Alongside the CQC, we will always support transparency, candour and openness as a lever towards excellence and must constantly reinforce the purpose of this approach.”
1.10pm The Care Quality Commission has published guidance for NHS organisations to help them meet the requirements of the new duty of candour and fit and proper persons for directors regulations that come into force next Thursday.
The guidance shows how CQC will decide if NHS organisations are meeting the two new regulations.
The CQC has also published the response to the consultation that helped shape its guidance.
Professor Sir Mike Richards, chief inspector of hospitals, said: “The guidance marks an important milestone to encourage a more open and transparent culture in the NHS.
“It is essential that CQC uses these new powers to hold providers and directors to account when care fails people, so that standards continue to improve.
“All registered providers must demonstrate that they are meeting these requirements to register with CQC and then continue to provide regulated services.
“This guidance will help us to determine whether there is a breach of regulations and if so, what action to take. In some cases, this will mean we will use our powers to prosecute.
“We will expect all providers to comply with them when they come into force in the NHS from next week.”
Sue Covill, director of employment services at the NHS Employers organisation, said: “The new regulations present an opportunity for providers to show the robust processes that they have in place for recruiting and employing their Board level directors. To achieve the desired intention it important that the requirements do not just become another set of tick boxes but create the platform in which values-based leadership is encouraged and open, honest conversations are the norm. These are vital if we are to support NHS leaders in creating the right culture for high quality care to thrive.”
CQC will assess whether systems and processes are in place to support the duty of candour, and will review evidence of what happened after a sample of incidents which resulted in significant harm to a patient. They are likely to ask if the provider told the relevant person about the incident, whether they provided a true account of what happened, and if they offered an apology.
The fit and proper person’s requirement – which applies only to NHS board members – is to make sure that providers have robust systems in place to carry out appropriate checks before a job offer or appointment is made. This would include whether the person is of good character, is physically and mentally fit and has the necessary qualifications, skills and experience for the role.
The event, held last night, is the largest celebration of healthcare excellence in the UK. It was attended by figures from across the NHS, including health secretary Jeremy Hunt.
Dr Granger is a consultant in elderly care medicine at Leeds Teaching Hospitals Trust and in 2011 was diagnosed with a rare, aggressive and terminal cancer.
Speaking at the Foundation Trust Network conference this week, David Bennett said he accepted the differential tariff deflator imposed on mental health services in 2014-15 was “unfortunate”.
He added that pouring extra money into mental health treatments could ease pressures on acute services but said the way mental healthcare provision was measured had to change.
Roger Taylor, co-founder of the data analysts Dr Foster, said: “If you asked any surgeon whether they thought there were only three in the country who were significantly worse than the rest of them, I think they would laugh.
“What is being said is that this will help people to identify good and poor-performing individuals. This actually looks like it has been designed to avoid identifying good or poor outcomes.”
The Times reports that NICE has published draft guidelines for GPs based on recent evidence of which symptoms best predict cancer.
The move came as it emerged that NHS England had missed one of its cancer care targets for the third quarter in a row, meaning that more than 15,000 patients had waited two months or more for their treatment to begin.
Simon Stevens’ prognosis for the state of the NHS finances was delivered to MPs on the parliamentary accounts committee yesterday, which also heard that most foundation trusts expected to end 2014-15 in the red.
Monitor chief executive David Bennett told the committee that 81 of the 147 foundation trusts in England expected to end the financial year in deficit, the vast majority of which were hospital trusts.
Ministers want to bypass traditional clinical trials by using patients as a “test-bed” for promising new drugs, linking their health service data to pharmaceutical company records to discover much more quickly how effective treatments are.
Firms would be paid different prices depending on how well the drugs work for individual patients.
Medicines are increasingly being tailored to the genetic make-up of patients. Ministers argue that the system of assessing new treatments is no longer up to the job and that NICE needs to catch up.
10.20am The NHS Confederation has welcomed the report into expectations for good complaint handling.
Deputy director of policy Elizabeth Wade said: “The NHS is a healthcare system which can change lives with every single interaction, whether it’s delivering state-of-the-art medical care or holding a hand by the bedside. Hundreds of millions of these interactions take place in the NHS each year. While only a small number of these ever give cause for a complaint, we know that responding well when things do go wrong is crucial. This ‘golden thread’ – apologising, being open and honest about what happened, and describing what is being done to ensure it won’t happen again – is vital for patients and their families to feel their issue has been handled properly and resolved well
“The work by the Parliamentary and Health Services Ombudsmn, the Local Government Ombudsman and Healthwatch England has distilled the views of patients and their families into a ‘gold standard’ for dealing with complaints. Organisations in the health service can usefully draw on the ‘I statements’ to ensure their own procedures and practices for handling complaints and other feedback genuinely deliver the outcomes that patients and their families say are important.
“In the 2015 Challenge Manifesto, we call for an open culture in the health and care system which encourages complaints as learning opportunities. Our members are committed to learning from patient feedback and complaints - that is why we will work with our members, the Ombudsmen and Healthwatch England to help share best practice and improve how the NHS responds, so that patients now and in the future get the response that is right for them and which helps the whole NHS improve the service it delivers for individuals and for the country.”
10.05am Patients and service users have described their expectations for good complaint handling across health and social care in new research published today by the Parliamentary and Health Service Ombudsman, the Local Government Ombudsman and Healthwatch England.
The report, ‘My expectations for raising concerns and complaints’, describes people’s views of what good complaint handling should be like at each stage of the complaints journey. This includes, knowing they have a right to complain, where to complain, being kept informed and feeling their complaint made a difference so the same thing does not happen to anyone else and feeling confident to complain again.
For the first time health and social care providers, from GP surgeries to hospitals and home care services to residential care homes in England, will be able to use this work to measure people’s experiences of complaints and help them improve.
Parliamentary and Health Service Ombudsman Julie Mellor, said: “For the first time patients and service users’ expectations and experiences of raising a concern and complaint can be measured and used to drive improvements in complaint handling.
“Ultimately we want all patients and service users to be able to say: ‘I felt confident to speak up and making my complaint was simple. I felt listened to and understood. I feel that my complaint made a difference’.
“We will now work with regulators, commissioners and providers to develop measurement tools to establish areas they need to improve, take actions to get there and see if they have succeeded in delivering an experience the public say is better.”
10.00am Good morning. Jenny Wilde at Ridouts argues that delivering health and social care services is not easy.
Providers have to be able to balance the needs of service users, their families, staff members, commissioning bodies and the regulators while ensuring that the care and treatment they provide is of a consistently high standard.