HSJ Live 21.01.2014 Legal challenge issued over £16m service tender

5.15pm Rob Findlay, founder of Gooroo Ltd and a specialist in waiting time dynamics, has written us a blog on the issues facing commisioners and providers ahead of the deadline for signing contracts for 2014-15. Read it here.

3.40pm In light of today’s media coverage on the care.data patient record database being created by the health service, here’s a comment piece written for HSJ last week by Geraint Lewis, NHS England’s chief data officer.

3.25pm Following our top online story yesterday about Cambridgeshire and Peterborough CCG agreeing to publish commercially sensitive documents dealing with a high profile procurement, the union Unite released this statement:

“Patients have scored a significant victory in Cambridgeshire and Peterborough against the possible takeover of elderly care by private healthcare companies. Unite, the country’s largest union, said the increasing culture of secrecy engulfing the accelerating privatisation of the NHS had received a big set-back.

“The campaign for greater openness by clinical commissioning groups to stop powerful private healthcare companies ‘cherry picking’ the most profitable NHS services in England needed to be stepped up.

“Unite, which has 100,000 members in the health service, was commenting on media reports that Cambridge and Peterborough Clinical Commissioning Group (CCG) had agreed to publish commercially sensitive documents in relation to the contract, worth up to £1 billion,  for integrated older people’s services.

“This follows a legal challenge from Stop the NHS Sell Off in Cambridgeshire. The contract has attracted interest from private healthcare companies which are interested, says Unite, in making profits from the privatisation of elderly care.

Unite head of health Rachael Maskell said: “The government has adopted a culture of secrecy, as well as legal and parliamentary ruses, to hide from the public the extent that the NHS is being put up for sale to private, profit-hungry healthcare companies.

“Openness and transparency should be the gold standard of how CCGs behave when it comes to considering contracts which are leading to the rapid piecemeal privatisation of the NHS. Pro-NHS campaigners in Cambridgeshire should be congratulated for their strong stand.

“The public has every right to know in great detail what is happening to the NHS in their local community. This culture of encroaching secrecy needs to be eradicated.”

Unite is campaigning against health secretary Jeremy Hunt’s attempt to insert clause 118 into the Care bill which would make it easier to close or privatise any hospital in England without proper public consultation.

Hunt wants these extra powers, despite the decision of the High Court, subsequently upheld by the Court of Appeal, that he did not have the authority to implement cuts to the emergency and maternity units at Lewisham hospital in south east London.

The clause is due to be debated on 28 and 30 January by the bill committee and in a letter to the committee, Rachael Maskell described clause 118 as “a dangerous move which will put thousands of lives at risk by removing local clinical decision making”.

Unite is also urging MPs to support Easington MP, Grahame Morris’ Freedom of Information (Private Healthcare Companies) bill which is due to receive its second reading on 28 February.

This bill aims to extend Freedom of Information legislation to encompass public healthcare services delivered by private companies and charities, and open up this information for public scrutiny.

Rachael Maskell said: “If you join up the dots, you can see how ministers are creating a culture that gives private healthcare companies a distinctive advantage when they bid for NHS work. This must be fought tooth and nail.”

Clinical commissioning groups (CCGs) are the NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England

2.55pm The care services minister has threatened to overrule NHS funding decisions if they undermine the government’s commitment to parity of esteem for mental health.

Speaking exclusively to HSJ, Norman Lamb attacked the “flawed and unacceptable” decision by NHS England and Monitor to cut the tariff price for mental health and community trusts’ services by a fifth more than the reduction proposed for acute providers. To read Shaun Lintern’s full interview with the minister, click here.

2.30pm Commenting on the 2014/15 National Tariff Payment System published by Monitor and NHS England today, Dr Mark Holland, vice-president of the Society for Acute Medicine (SAM) has said:

“The timing of today’s announcement by Monitor and NHS England of proposed changes to the marginal rate for emergency admissions will be welcomed by all those working in acute medicine, coming as it does at the busiest time of year. Admission rates for acutely ill medical patients continue to rise whilst at the same time there is an imperative to improve patient care, especially in light of the Francis report. 

“Allocating extra resources to acute medical care will not only fill the gaps in the current funding structure but always allow the development of better services for patients.  For example, The Society for Acute Medicine has played a pivotal role in developing seven-day hospital working.

“Whilst SAM welcomes the proposed changes as a step in the right direction, it remains to be seen if the extra resources will adequately cover the cost of future the developments that we see as essential for patient care.”

2.00pm A clinical commissioning group is facing a legal challenge over the procurement of £16.6m in services using the innovative prime contractor model.

The CCG confirmed to HSJ the award of the contract for the borough’s musculoskeletal work had been halted following a legal challenge from a local trust which runs services in neighbouring boroughs.

To find out which CCG is facing the legal action and for more details on Ben Clover’s story - click here.

1.20pm In his HSJ column this week, Michael White recounts the way in which Nick Clegg’s big speech on mental health yesterday was overshadowed by the Lord Rennard affair.

To get his analysis on what the mental health announcement actually means, click here.

12.20pm Up to 300 commissioning support unit staff are facing redundancy under a job cuts programme coordinated by NHS England.

HSJ has learned that a consultation over a new round of job losses began this month, and is being run by the overwhelming majority of CSUs. For full details read David Williams’s story.

11.08am The Guardian reports that hospitals are to receive more money for treating patients admitted as emergencies after NHS leaders relaxed a payments scheme which critics say has wrongly denied A&E units as much as £500m a year.

Under a funding rule, emergency departments receive only 30 per cent of the cost of treating any patient admitted as an emergency over and above the number of patients treated in 2008-09. As many A&E units have been hit by rises in emergency admissions, some hospital trusts have been losing up to £10m a year, according to the Foundation Trust Network.

The remaining 70 per cent was held back from hospitals and was meant to be spent by local NHS organisations to set up initiatives to reduce avoidable hospital admissions, but only a few such schemes have so far been set up.

Also in The Guardian, energy drinks such as Red Bull and Lucozade cause major behavioural problems in children and should be banned from schools and if possible from sale to the young, a government adviser has said. John Vincent, co-founder of the Leon restaurant chain and the man who compiled the School Food Plan for education secretary Michael Gove, said children could become unteachable after several cans a day of the high sugar, caffeinated drinks.

There’s also a comment piece in The Guardian by Alice Bell on the care.data patient record database. While Bell says “socialised big NHS data” could have “awesome” potential for medical research, she argues “there are legitimate reasons to be angry about this policy, which says a lot about the government’s approach to science, healthcare and the wellbeing of the people”.

11.05am The Times reports that Kettering General Hospital is refusing to publish an investigation into how a teenager bled to death after a routine operation because it would “endanger the mental health” of staff.

A coroner found that 17-year-old Victoria Harrison might have been saved if it had not been for a series of failings at the hospital.

The BBC sent a freedom of information request to the hospital to release the investigation. However, the hospital refused saying this would place extra stress on staff who might be identified by colleagues.

The Times also reports that a doctor has been struck off after failing to report suspected child abuse and saying that he did not want to read about procedures for safeguarding children.

Trevor Hudson was suspended for three months because of serious misconduct after a hearing was told that he was arrogant about the work of social services.

Dr Hudson, who has a private practice in central London, received a phone call from a woman who reported suspected child abuse. However, Dr Hudson failed to contact the local authority.  

11.00am Looking to this morning’s newspapers:

The Daily telegraph this reports that plans for a database containing the records of all NHS patients in England could be slapped down by a European Union law which could render the scheme illegal.

The paper’s health correspondent Laura Donnelly writes that the care.data scheme, which will being extracting patient identifiable data from GPs in April, may have to be scrapped due to a draft EU law – due to be voted on next year.

Board papers drawn up by senior health service officials ahead of a meeting today suggest that the proposed legislation, which seeks to harmonise data protection rules across the 27-member block, could halt the data programme as it would mean that patients would have to give their explicit consent to their data being harvested.

Currently all patients are to automatically have their data stored in this way unless they opt out through their GP.

The paper also writes a story citing a report that suggests that NHS staff are being “overpaid” by up to £60m a year because of administrative errors.

The study, published by researchers from the London School of Economics and the Policy Analysis Centre, said that audit reports showed the one trust made overpayments of approximately £1m a year.

In the same paper Philip Johnston writes a comment piece arguing that while the care.data programme may well be positive for the onward march of medical progress, patients need to be told much more clearly who will be able to see their data and what the risks are of data identifying patients.

10.35am Lord Victor Adebowale CBE, Chief Executive of Turning Point and Chair of the NHS England Parity of Esteem Programme Board has responded to ‘Closing the Gap: Priorities for essential change in mental health’, announced yesterday by Nick Clegg. He said:

“’Closing the Gap’ brings a much needed re-focus to the mental health priorities as outlined in the national strategy, ‘No Health without Mental Health’.  The action plan is another step towards addressing the challenges still abundant within the health service for anyone with a mental health issue.

The lack of parity of esteem that continues to exist for those with mental health issues, compared to people with physical health conditions, is simply unacceptable. Crisis services, especially, need reform to ensure people can access and receive the care they need in a timely and safe way – something not currently guaranteed.

Significant challenges exist if we are going to achieve parity including:

-          The discrimination people with mental health issues face at every level of the system, particularly those from BME communities

-          The undermining impact of funding cuts on equality of provision

-          Challenges around data collection and use which informs decision making, and

-          Measurement by system leaders to prove that change is happening and improving people’s lives.

Words must now urgently translate into tangible actions on the ground if this inequity is to be resolved.”

10.30am More than a tenth of clinical commissioning groups have lost at least £10m of the fundsoriginally earmarked for them for this year, HSJ has discovered.

To find out where they are and how this has happened, read Will Hazell’s story here.

10.20am Coroners could help save the lives of hundreds of people by telling bereaved family members to get themselves screened for inherited heart conditions, a charity has said.

New guidance which calls on coroners in England and Wales to recommend that family members of those who die of genetic heart conditions get themselves a check-up could “save hundreds of lives”, the British Heart Foundation said. For more on this story - click here.

10.00am Analysis showing the extent to which the NHS is prescribing NICE-recommended medicines is published today.

Use of NICE-appraised medicines in the NHS in England – 2012, experimental statistics is published by the Health and Social Care Information Centre (HSCIC) and reports on the use of medicines that have been appraised by the National Institute for Health and Care Excellence as an option for the treatment of a disease or condition.

This is the fourth in a series of reports which covers five years in total. Today’s report also contains additional analysis to allow the inclusion of medicines for which an expected level of usage cannot be calculated, for instance because it is not possible to reliably estimate the number of eligible patients or average dose. This additional analysis provides data on 36 medicines in 18 therapeutic groups presenting variation in usage over time by Area Team or Clinical Commissioning Group.

The report contains an analysis which compares expected with actual use2for 18 medicines in ten groups3. It showed usage to be lower than expected for four groups of medicines, higher than expected for two and around the expected level for three. For one group, treaments for Hepatitis C, it was not possible to develop an appropriate estimate. However, use of all these groups of medicines in the NHS has risen over the last few years. When interpreting these figures it is important to note that higher or lower usage may occur for a variety of reasons and is not necessarily a sign of ‘under’ or ‘over’ prescribing.

The drugs whose use was higher than expected were:

• Donepezil, galantamine, rivastigmine, memantine - for Alzheimer’s disease
• Temozolomide- licensed for the treatment of newly diagnosed brain cancer in adults. It is also licensed for second-line treatment of brain cancer in adults and children over three.

The drugs whose use was lower than expected were:

• Carmustine implants - for the treatment of recurrent glioblastoma multiforme, a form of brain tumour
• Sunitinib and pazopanib - for the treatment for renal cell cancer
• Riluzole - a treatment to extend life in patients with amyotrophic lateral sclerosis, a form of motor neurone disease.
• Ranibizumab - a treatment for age related macular degeneration

The drugs whose use was around the expected level were:

• Insulin glargine and insulin detemir – for diabetes
• Exenatide and liraglutide – for the treatment of diabetes (type 2) in combination with other drugs
• Trastuzumab - used for the treatment of early and advanced breast cancer and gastric cancer

The report is commissioned by the Department of Health and produced in collaboration with NICE and with the involvement of the pharmaceutical industry.

7.00am Welcome to HSJ Live. This morning, David Buchanan, professor of organisational behaviour at Cranfield University School of Management, writes that new research into the role of hospital middle managers contradicts many of the negative stereotypes and highlights their value to clinical and organisational outcomes.

“Managers maintain order while leaders drive change. Although they perform both roles, hospital middle managers are primarily change leaders,” he argues.