HSJ Live 21.05.2013: David Nicholson to retire

6:23pm: @BenClover tweets: “Having some texts coming in putting Mark Britnell as most likely successor to #Nicholson.”

5.43pm Speculation about who will replace Sir David is predictably already mounting.Here’s a rough guide to some of the potential runners and riders (in no particular order):

• Mark Britnell: The former NHS director general left the Department of Health in 2009 to become Europe head of health for KPMG. HSJ understands he was approached over the operations director and deputy chief executive post earlier this year.
• Dame Julie Moore: University Hospitals Birmingham Foundation Trust chief executive Julie Moore is a former chair ofthe Shelford Group and widely respected.  
• Mike Farrar: The chief executive of the NHS Confederation has been an effective and constructive critics of NHS reforms and his charima has given the Confed renewed prominence.
• Duncan Selbie: The Public Health England chief executive has made a big splash since taking on the role and will be pivotal in ensuring the new local government-led public health system does better.
• Don Berwick: The man who advised President Barack Obama on his health reforms has long praised the NHS and is currently carrying a government-commissioned review on “zero harm” in the NHS.
• Sir Bruce Keogh: The NHS medical director plays a pivotal role in NHS England. Sir Bruce’s constructions – such as the NHS outcomes framework and focus on disease mortality reductions – are now at the heart of the service and near the top of the health secretary’s agenda.
• Ian Dalton: The NHS Commissioning Board’s former deputy chief executive announced he was BT Global Health in January as the company’s president of global health. He was formerly NHS North East chief executive, the national lead for swine flu, and NHS director of provider development.
• David Flory: The NHS Trust Development Authority chief executive is current role sees him oversee some the biggest and most difficult trusts in the NHS, with fiendish capacity problems, intractable financial woes, monster PFIs and dysfunctional health economies.
• Simon Stevens: The UnitedHealth Group’s executive vice President was previously Tony Blair’s health policy director while he was prime minister and has twenty years leadership experience in healthcare policy and management in the United States and internationally.  

5:25pm: Exclusive: David Nicholson tells HSJ he will leave before March 2014 if it’s in the best interests of the organisation.

Read the entire story here.

4:53pm: Jeremy Taylor, CEO of National Voices, tweets: “Should next @NHSEngland CEO be an NHS manager or not? Clinician, civil servant, industrialist, ex-McKinsey, charity leader, patient? Views?”

4:47pm: The news of NHS supremo Sir David Nicholson’s departure has been welcomed by Unite, the country’s largest union with 100,000 members in the health service.

Unite national officer for health Rachael Maskell said: “It is right that Sir David steps down as chief executive of the NHS England.

“He should have resigned earlier this year over his role in failing to tackle the abuse of patients at Mid Staffordshire, highlighted by the Francis report.

“We believe that Sir David’s job with its heavy responsibilities should not rest with a senior NHS bureaucrat – but with the secretary of state for health, Jeremy Hunt.

“What the recent disastrous reorganisation of the NHS has done is to remove the accountability from ministers and give it to a plethora of NHS executives and confusingly named ‘hands-off’ quangos.

“The public don’t want this – they want openness and transparency. And they definitely don’t want the health service privatised.

“Sir David will be remembered for the so-called Nicholson challenge of £20 billion in cuts which has brought the NHS to its knees, particularly in accident and emergency services.

“It is hoped that Sir David will not leave with a massive pay-off – as that would just be an insulting reward for failure.”

4:41pm: The Mail Online is running the story on David Nicholson’s exit with the headline: “NHS boss David Nicholson branded ‘the man with no shame’ over Mid-Staffs scandal is to retire (but not for another year).”

4:34pm: The King’s Fund has also released its resposne to the announcement of Sir David Nicholson’s retirement.

Chief executive Chris Ham said: “David Nicholson has led the NHS with passion, energy and distinction for seven years. He is an NHS man to his core - his departure will mark the end of an era.

“During David Nicholson’s time in office, the NHS has delivered significant improvements in performance - a great testament to his leadership. Although initially not an enthusiast for the present government’s reforms, he has led their implementation with characteristic assurance and successfully managed the transition to the new health system - a significant feat in a challenging financial climate.

“With fundamental change essential if the NHS is to meet the challenges of the future, his successor will inherit a very demanding job.”

4pm: HSJ editor Alastair McLellan tweets: “Potential Nicholson successors (in A-Z order): Britnell; Dalton, Farrar, Flory, Keogh, Moore, Selbie, Stevens. Anyone else?”

3:52pm: NHS Confederation has commented on Sir David Nicholson’s announcement to retire.

Mike Farrar, chief executive of the NHS Confederation, said: “Despite the difficulties of recent months, today’s announcement provides an opportunity to focus on Sir David’s contribution to the NHS over the past three decades, the significant achievements over the lifetime of his career and during his time as the chief executive of the NHS.

“Sir David came into office as NHS chief executive and immediately led a major recovery from the £600m deficit that the health service faced in 2005. Over subsequent years he led the delivery of a remarkable reduction in waiting times for urgent and elective care, with access to treatment improving faster than almost any comparable health system. There have been significant improvements in patient outcomes and a huge reduction in healthcare acquired infections. In recent years, he presided over the largest structural reform in the history of the NHS.

“NHS England will now need to look forward and appoint a leader who must empower the local clinicians and managers heading up the new commissioning system so that it can deliver what is needed in the years ahead.”

3:44pm: Conservative MP and GP Sarah Wollaston tweets: “Who should lead the NHS after Nicholson steps down in March 2014?”

3:22pm: Exclusive: NHS England has announced that Sir David Nicholson has decided to retire from the NHS, and as chief executive of NHS England, in March 2014.

In a letter to Professor Malcolm Grant, chair of NHS England, Sir David said: “I have only ever had one ambition and that is to improve the quality of care for patients. I still passionately believe in what NHS England intends to do. My hope is that by being clear about my intentions now will give the organisation the opportunity to attract candidates of the very highest calibre so they can appoint someone who will be able to see this essential work through to its completion.

“Even in retirement I will always be the staunchest advocate of the NHS. I continue, and will always continue, to be inspired and moved by the passion that those who work in the NHS show. I also want to recognise the contribution of staff in the NHS and their recent efforts working in such a challenging environment have been nothing short of heroic.” 

Professor Malcolm Grant replied: “Sir David’s career within the NHS over 35 years has been exceptional, and his leadership through the radical changes in the NHS of the past two years has been absolutely fundamental to their success. In particular, the establishment, set-up and launch of NHS England has been an immensely difficult task, undertaken by Sir David concurrently with leading the NHS in its former guise. Thanks to Sir David’s leadership we are now in as good a position as we could be to take on the challenges that lie ahead.

“I should like to express my personal appreciation for all Sir David’s support and guidance to date. And I know that I speak on behalf of the whole Board when I stress how much we welcome Sir David’s commitment to continuing to lead NHS England over the coming year in delivering on our challenging agenda.”

Health Secretary Jeremy Hunt said: “Under Sir David Nicholson’s leadership, NHS waiting times have fallen, infection rates reduced, and mixed sex accommodation is at an all-time low. His job has often been incredibly complex and very difficult, and yet he has always had a reputation for staying calm, and maintaining a relentless focus on what makes a difference on the NHS frontline. I am also grateful to him for overseeing the success.”

Sir David has worked in the NHS for 35 years in over 14 organisations covering all care groups and parts of the NHS.

He was NHS chief executive for almost seven years and in October 2011 he agreed to become chief executive of the NHS Commissioning Board, now known as NHS England, and also led the NHS during the recent period of transition.

3:15pm: More reactions are coming in response to today’s news that Jeremy Hunt will be appointing a chief inspector of GPs.

The NHS Alliance has welcomed the announcement.

Its press release says: “We hope that with this recognition of the keystone function of general practice, comes an awareness that, for the service to work effectively as a whole, there is an accompanying acceptance that unless general practitioners are appointed to key senior positions, we will forever repeat the mistakes of the past with over-emphasis on hospital care. 

“One early manifestation of this would be in agreeing the criteria that the so-called Ofsted inspection would use. We would want to be assured that they are based on patient-centred measures in a manner that would make sense to the public, rather than a management set of metrics measures that are concerned more with bureaucracy rather than people. We would call for patients to be central to their construction.

“We also hope that these initiatives will be applied in a practical manger sense that is joined up with other elements such as CQC registration.  We would not want for practices to be distracted from their core aim of responding to patient and population’s needs through having to address lengthy administrative processes.”

2:36pm: NHS Confederation has released its statement on out of hours care and the impact on urgent and emergency care.

Following his evidence to the health select committee inquiry into emergency service and emergency care, and comments about the GP contract, Mike Farrar, chief executive of the NHS Confederation, said:

“With specific regards to the contractual arrangements for GP out of hours care, we do not see a correlation between the changes to the 2004 GP contract and the NHS four-hour waiting standard for A&E departments. In fact for the vast majority of the last decade, A&E waiting time standards have been improving. It is in recent years where the pressures have started to bite, and there have not been any discernable structural changes to out of hours GP contracts during that time.

“It is clearly evident that there are rising pressures on the whole system. We agree there is a need to improve the coordination of out of hours care, and see how it can help take the pressures off A&E.

“We believe real and lasting improvements to out of hours care are possible, but only if we put a greater level of investment in to primary, community and social care.”

2:23pm: An update is due on Wednesday on the two orthopaedic theatres closed at North Cumbria University Hospitals Trust in the wake of the mortality rates review carried out by Sir Bruce Keogh. The review team had concerns about air quality at the units.

In a statement NCUH said: “Orthopaedic operating theatres use very specialist ‘ultra-clean air’ ventilation equipment to ensure the air flowing around the open wound is as clean as possible in order to reduce the risk of infection.”

The wards were shut on Friday. The trust said yesterday evening the total number of patients affected by the closures was 23.

Jeremy Rushmer, director of clinical transformation at the trust said: “We apologise again wholeheartedly to those patients whose operations have been affected by the temporary closure at Whitehaven but would like to reassure people that we took this action as a precautionary measure in the interests of patient safety.

“As soon as the air quality issue was highlighted, we took immediate action in the very best interests of our patients and we are now working hard to ensure that the two affected theatres in Whitehaven can be reopened as soon as possible.  We will continue to keep all stakeholders updated.”

The review team were due to begin their work at NCUH on May 7 and it is not know how the air quality issue came to light on Friday.

Review teams from the Keogh investigations were due to start work at George Eliot Hospital trust today and Tameside Hospital and Burton Hospitals foundation trusts on Thursday.

2:03pm: Pressures on general practice and emergency care are complex, says British Medical Association.

Responding to comments made by the Secretary of State for Health on the issues facing general practice and emergency care, Dr Laurence Buckman, chair of the BMA’s GP committee said: “It is right that the Secretary of State has acknowledged that GPs are struggling to cope with rising patient demand and a proliferation of administrative box ticking.

“Unfortunately, the government’s own recent decision to impose a series of politically motivated changes to the GP contract will only increase the pressure on primary care. Many practices are coping with a fall in funding despite a sharp increase in workload that has been exacerbated by a wave of new targets which divert valuable time away from treating patients. The government is partly to blame for taking GPs away from the front line to deal with these targets.

“The issues facing emergency care are also complex. The government’s own analysis shows that the current pressures have a series of interconnected causes, including reductions in bed numbers and staff shortages in key departments. The botched introduction of NHS111 has created additional problems for already over-stretched services.

“The BMA believes that much can be done to better integrate GP services with out-of-hours care, NHS 111 and emergency hospital services. Clinical commissioning groups have just taken over responsibility for commissioning out-of-hours care and their pivotal role could find a way forward.

“We hope the government will work with doctors and other health care staff to find a solution that helps the NHS tackle these challenges. Recent attacks on hard working NHS staff and specific services have been neither helpful nor productive.”

Dr Buckman further said:

“We will need to see the details of the government’s plans, but a great deal of today’s proposals have already been announced, including more regular inspections by the Care Quality Commission. The new Chief Inspector of Primary Care must be closely linked to the CQC to ensure that the post operates in a coordinated fashion with the body undertaking the inspections.

“GPs are committed to providing high quality care to their patients and will work with the new regulatory framework to ensure that patients continue to have confidence in their local practice. 

 “It is important that the new system takes a pragmatic approach to general practice inspections and understands GPs do not work in a sterilised operating theatre, but a busy consultation room where patients should not be inconvenienced.

“Proposals to provide a named healthcare professional responsible for patients in regular contact with community services could produce benefits for vulnerable individuals. It is important this move is carefully planned and fully integrated with local services so that patients feel a real benefit.”

1:25pm: Earlier during the day, Mike Farrar, chief executive of the NHS Confederation, said that a blame game about which parts of the health service are at fault do not help.

Ahead of his appearance at the health select committee, he said: “Like many hard working frontline staff in the NHS, we have been ringing the alarm bells about urgent care services struggling to meet the demands of patients. The recent headlines do not lie - the pressures are growing and we are getting closer and closer to the cliff edge.

“In the last ten years, emergency admissions through A&E have increased by 51 per cent; that’s an extra 1.25 million more patients going in to hospital on an unplanned basis.

“If we continue with this trend we will see another extra half a million patients cramming into our A&E department in the next three years. This will be simply impossible for our hospital services to cope with, despite the heroic efforts of staff to date.”

He added: “There is no use in pointing the finger at patients, or any one part of the system when in reality it is a perfect storm of different mounting pressures causing our problems - GPs, hospitals, NHS 111, the ambulance service and social care.

“These pressures have been compounded by three years of major structural reforms, a lack of honesty about the situation we face, and the service not being able to respond quickly enough to the financial pressures it faces.

“The problems that longer waiting times in A&E highlight are an inability of the service to manage the flow of patients across and between our organisations. In particular, it reveals the imbalance of investment in primary, community and social care compared to hospital care.”

12:50pm: HSJ reporter Ben Clover is covering the health select committee proceedings in Parliament. Follow him at @BenClover for the live updates.

“Burnham asks Jeremy Hunt in Parliament how his primary care strategy will help with A&E.”

“JH claims the 95 per cent target is being hit at the moment at 96%, reiterates the GP OOH line.”

“‘GP contract is a significant part of the issue’ JH says, and also blames the failure of the IT contract for slowing things up.”

“JH says ‘for 1st time’ hospitals will have say on how 30% marginal rate is spent. Doesn’t represent how comm/prov have worked on the ground.”

12:16pm: Data out today shows that there are over 1,000 more health visitors working in the NHS now compared to 2010.

Health Minister Dr Dan Poulter said: “Health visitors are essential for giving every child the best start in life. Recruiting and training more is a priority for us and it’s good that we’re already at over 1,000 extra health visitors since May 2010, and well on our way to achieving our target of an extra 4,200 in 2015. There are over 2000 health visitors currently in training, with more places planned for next year.

“For every pound we spend on health visitors we receive many times more in return, the support they offer parents and babies in providing the best start in life is invaluable.”

11:59am: The Independent reveals that heads of 20 emergency departments have warned that they “can’t guarantee safe care for patients anymore.”

It reports: “A combination of ‘toxic overcrowding’ and ‘institutional exhaustion’ is putting lives at risk, according to the letter to senior NHS managers from the leaders of 20 emergency departments. They warn that the rising number of patients presenting themselves for treatment has created a ‘state of crisis’ in casualty departments.

“The letter will heap more pressure on the health secretary Jeremy Hunt, who is due to respond to the troubles facing emergency units in a speech on Thursday.”

11:41am: HSJ Exclusive: Department of Health permanent secretary Una O’Brien explains why she is sending DH civil servants to work on the NHS front line for four weeks a year.

Read the full article here.

11:24am:  NHS foundation trusts deliver £30 bn in economic value annually, according to new research examining how they boost local economies.

The report, Providing Value: The economic and social value of foundation trusts, published by Barclays and the Foundation Trust Network sets out, for the first time, the economic benefits regionally.

Paul Birley, head of healthcare at Barclays, said: “Foundation trusts are at the heart of their communities and this research, for the first time, values this contribution at £30 billion annually to the UK economy. Showcasing the foundation trust as a vital component of local lives, from the number of people they employ, to local community initiatives.

“Any changes to the healthcare system must therefore acknowledge not only the clinical impact, but also the wider implications such changes could have. What is very clear is that the foundation trust model is about more than delivering care, it is also about the broader responsibility it has to its local community.”

The research has developed a tool that foundation trusts can use to help benchmark social value, which is designed to support trusts in measuring this social value and reporting it transparently to the public and commissioners.

Chris Hopson, chief executive of FTN, said: “In the current economic climate, it has never been more important to capture and share the full value of the foundation trust model in local communities, including the economic investment made in local areas, the employment generated and the wider social benefits created by their services.

“The research demonstrates that every trust in the NHS plays a vital social function by helping people improve their health and wellbeing, and by treating illness and injury safely and effectively. I am delighted that this report celebrates and shares the added value trusts can play in every region by acting as responsible employers, reducing the environmental impact of the organisation and by delivering a range of long-term social benefits.”

11am: ‏@branwenjeffreys has tweeted: “Just heard @andyburnham has been granted urgent question to Jeremy Hunt on A&E in commons at 1230.”

10.56am: The National Audit Office has today published a memorandum to the Public Accounts Committee examining the availability of clinical trial information when medicines are licenced and appraised for use in the NHS, and the decision to stockpile Tamiflu for the treatment of pandemic influenza.

The memorandum is intended to provide background information for the members of the committee for its hearing on Monday 17 June 2013.

10:30am: HSJ’s reporter Sarah Calkin is reporting (and live tweeting) from the Patient Safety Congress. Some of her tweets:

“Keogh takes to stage at #psc2013 to give a talk entitled ‘Acceptance is our biggest enemy’. Acceptance the greatest barrier to improvement.”

“Keogh gives the example of his previous acceptance that 3% of heart surgery patients would die: acceptance by default #psc2013.”

“Keogh’s 2nd form of acceptance is by commission, such as failure to regularly risk assess for VTE despite evidence for 30 years #psc13.”

10.25am: The Guardian has a story this morning about how a series of care failings led to the death of a disabled woman in Basildon in Essex.

A report by the NHS ombudsman has found that mistakes were made by out of hours GP services and at Basildon hospital, leading to the death of Tina Papalabropoulos. Her mother, Christine, Papalabropoulos, and the charity Mencap are claiming that the inadequate care was the result of clinicians’ attitude to people with disabilities.

10.19am: Health Select Committee is taking evidence now on the crisis in emergency care.

@politicshomeuk tweets: Chief executive of NHS Confederation Mike Farrar tells the committee that “cuts” in social care may have led to greater pressures on A&E.

10.13am: Several media outlets are reporting that later this week health secretary Jeremy Hunt will announce proposals for a new Chief Inspector of General Practice who will subject GPs to a “rigorous” inspection and check if they are providing effective care.

The Telegraph reports: “Mr Hunt will also promise to bring back the family doctor - one GP responsible for all the patient’s care - as part of plans to make care more personal.

His speech, to be made at an event hosted by the King’s Fund on Thursday, comes in after concerns over ever-increasing pressure on the A&E departments and other NHS services.

8.40am: Good morning, faced with engaging one of the largest organisations in the world, it took the power of social media to harness support for NHS Change Day − the biggest improvement event to date for the service.

Today on HSJ’s innovation and efficiency channel, Joe McCrea, social media strategist for NHS Change Day, looks at the lessons which can be learnt from the event’s effective social media strategy.