The regulator is to investigate the CCG’s decision to award contract without tender following trust complaint, plus the rest of today’s news and comment

Live logo

4.00pm Mel Pickup, chief executive of Warrington and Halton Hospitals Foundation Trust has found an interesting use for Twitter this afternoon: 

“Here’s a bit of myth busting for today I am not applying for the CEO job at Aintree. You heard it here first straight from the horses mouth!”

— Mel Pickup (@Mel_Pickup) January 21, 2015

3.36pm The leaders of the Care Quality Commission team that rated Hinchingbrooke Health Care Trust ‘inadequate’ today issued a strong rejection of claims that their inspection was biased.

The inspector who led the team told the CQC’s public board meeting that Hinchingbrooke was “one of the worst” providers she had inspected, while the inspection chair, who has been accused of a public sector bias, denied that he was “anti-private practice”. The trust is currently run by private provider Circle.

However, the regulator said at its board meeting today that it will be revising its policy for declaring potential conflicts of interest in light of the fallout from the inspection (see box below).

1.38pm The Times reports that a Christian GP performed an exorcism on a seriously ill patient and told her “God is your surgeon” as he persuaded her to stop taking mediation, a medical tribunal has heard.

Thomas O’Brien, 56, told the severely depressed mother that he could heal her pain as she recovered from surgery and that “the devil was having a right go at her”, the Medical Practitioners Tribunal in Manchester was told.

Jeremy Hunt stepped up the pressure on health unions to call off an ambulance strike planned for next week, warning them that they would put lives at risk, The Times also reports.

The health secretary released a letter sent to union chiefs calling for striking paramedics to answer the most serious emergency call-outs.

In it Mr Hunt said NHS England had told him that the unions’ current plans for a 12-hour walkout “pose a real risk that patients with life-threatening conditions are harmed”.

He asked for a binding commitment that the staff would be encouraged to attend major incidents and other blue light callouts.

12.07pm Monitor is investigating the commissioning of community services in Devon worth more than £100 million over three years.

The regulator stepped in after receiving a complaint from Northern Devon Healthcare NHS Trust, a provider of acute and community services including district nursing and community matrons.

The complaint is about NHS Northern, Eastern and Western Devon Clinical Commissioning Group’s decision to name the Royal Devon and Exeter NHS Foundation Trust as its preferred provider of community services for the eastern part of the CCG’s area.

Monitor will review the decision-making process to ensure it was run in the best interests of patients, in accordance with the rules on procurement, choice and competition.

Catherine Davies, executive director of cooperation and competition at Monitor, said: “We have taken this case on because it may provide valuable lessons for the rest of the NHS as it tries to come up with new models of care to meet the many challenges it faces.

“Integration of acute and community services can bring about real improvements for patients. There are a number of ways to achieve better integration of care and we want to make sure that commissioners are going about it properly.”

The regulator will publish further information about the nature of the complaint and progress of its investigation in due course.

11.45am An updated briefing to help local authorities and partner organisations tackle tobacco use is published today.

The NICE local government briefing summarises its new recommendations on effective actions to reduce the harm from smoking, helping people in South Asian communities to stop using smokeless tobacco (tobacco which is chewed or sucked, such as Pan Masala), and smoking cessation help for people attending or working in hospitals.

As well as being the single biggest cause of preventable deaths in England, smoking is also the primary reason for the gap in life expectancy between rich and poor.  Workers in routine and manual jobs are twice as likely to smoke as those in managerial and professional roles. 

South Asian women (some of the main users of smokeless tobacco in the UK) are 3.7 times more likely to develop oral cancer than other women. This briefing can support local authorities in meeting their responsibility to address health inequalities linked to using tobacco. 

Professor Gillian Leng, NICE deputy chief executive and director of health and social care at NICE, said:“Tobacco use kills over 80,000 people each year, and a report from Action on Smoking and Health calculated that smoking costs local authorities more than £600 million a year in terms of social care services. 

“Local authorities are under pressure to make public health decisions that offer value for money and help people in their area keep healthy.  Most of the smoking interventions recommended by NICE are considered highly cost effective and some save money.  This briefing highlights new and existing NICE guidance recommendations that can improve the health of local people, and which make the best use of resources and provide good value for money.”

The recommendations for local authorities highlighted in the briefing include:

  • making your organisation an exemplar in smokefree policies and in the support provided to help employees stop smoking
  • planning and commissioning smoking prevention and cessation in schools with national, local and regional partners; working together on mass media campaigns for under 18s
  • ensuring that environmental health and trading standards services prioritise tobacco control
  • including tobacco harm reduction approaches when commissioning tobacco control services to help people who are not ready to give up smoking in one step
  • involving local communities and target groups in encouraging people to stop smoking. This includes working with South Asian communities to encourage people to stop using smokeless tobacco
  • promoting access to stop smoking services to pregnant women who smoke at every contact with professionals in children’s centres, teenage pregnancy services and youth services.

The local government briefing on tobacco is available at

11.40am There are only four days left in phase one of our campaign to Challenge Top-down Change in the NHS. Huge thanks to everyone who has joined in so far – 1,035 of you have got involved and made over 4,500 contributions, all in less than two weeks.

Up to now, you and your colleagues have told us that the following things are important for enabling bottom-up change:

Inside Organisations:

  • Focus on collaboration in place of competition. 
  • Listen to and act upon ideas from everyone in the organisation. 
  • Develop an organisational appetite for appropriate risk.

Across Organisations:

  • Provide platforms to enable easier collaboration & co-creation across organisations. 
  • Remove or improve boundaries between organisations.
  • Encourage organisations to share risk and outcomes.

What do you think? Do you agree with these ideas? Do you disagree? Can you think of something else that we need to be talking about? 

Head over to our Change Challenge page now: to have your say.

If you have contributed already, we invite you to come back and see how the ideas and comments have developed. If you haven’t, then it is not too late to join the conversation and make your voice heard.

At the end of the first phase of this campaign, we will analyse your ideas and suggestions to create a list of the top things that help or block bottom-up change. Once we have identified what helps or blocks people from delivering change from the bottom-up – we will then seek your help again to develop workable solutions for individuals and organisations to use, to deliver bottom-up change.

At the end of this campaign we will use all your ideas to develop a tool to empower all NHS staff to contribute change ideas effectively.

All your contributions will be anonymous, you can get involved from any computer, tablet or smartphone and you can visit as many times as you like to develop the ideas and help shape this important conversation. 

Your knowledge is essential for this conversation to work. Thanks again for taking part. For more information about the campaign please visit 

10.55am A mass referral of more than 20 senior NHS managers has been made to the Care Quality Commission in what will be the first test of the new ‘fit and proper person’ regulations, HSJ can reveal.

A group of whistleblowers and campaigners has made seven formal submissions to the regulator, alleging that several managers are unfit for board level positions because of their past actions or behaviour.

Among those named are current and former NHS chief executives, medical directors and senior board level executives.

Under the regulations, directors can be deemed “unfit” to sit on boards if they have been involved in “serious misconduct or mismanagement”. The CQC can, through the provider registration process, require the removal of directors found to be unfit.

10.53am Miriam Deakin, head of policy, NHS Providers, said: “We welcome the committee’s continued focus on the effective handling of complaints and concerns which are one key source of intelligence on quality of care which provider boards use to drive improvement.

“We have been pleased to provide evidence to the Committee’s Inquiry into complaints handling and welcome recognition of the progress providers have made to date. We have also been pleased to support the development of a national service user-led vision for complaints handling.

“Our members know that in order for complaints handling to work efficiently, it is important that the process is streamlined and accessible so that patients, service users and their families know how to raise concerns, and receive nothing less than an excellent response to issues they may raise. 

“NHS providers are committed to working with colleagues across the system and learning from all forms of feedback, including complaints, and recognise their importance in developing an open culture of improvement for staff, patients and the public.

“NHS providers continue to focus on promoting transparency and on empowering staff so that they feel supported to raise and rectify issues without fear of blame, to develop cultures of continuous learning throughout their organisations.”

10.30am A proposed new law on patient safety would open the door to tougher regulation of health and care providers by the Care Quality Commission, legal experts have told HSJ.

The Health and Social Care (Safety and Quality) Bill is a private members bill put forward by Stafford Conservative MP Jeremy Lefroy in response to the poor care at Mid Staffordshire Foundation Trust. It has moved closer to becoming law after being passed in the Commons last month

The bill, sometimes referred to as the “zero harm bill”, imposes a duty on the health secretary to introduce regulations “to secure that services provided in the carrying on of regulated activities cause no avoidable harm”. This harm could be caused directly or indirectly, but excludes harm that cannot be “reasonably avoided”.

7.00am Independent sector providers could take a 50 per cent share of the market for NHS community services by the end of the decade, according to market analyst LaingBuisson.

NHS trusts accounted for 69 per cent of the total £9.75bn spent on community services in 2012-13.

The report, shared exclusively with HSJ, predicts this share could drop to less than half by 2020, due in part to a growth in home healthcare spending and increased opportunities for non-NHS providers to bid for larger “pathway” based contracts.

The Primary Care and Out of Hospital Services report said: “Provided the emerging outsourcing culture in the NHS is not eliminated by any politically driven reversion to ‘NHS first’ policies, it seems very likely that with continued retendering the share of the broadly defined community health services market provided by the NHS will drop to around 50 per cent or below by the end of this decade.”