King’s Fund report finds percentage of outpatients at its highest since 2008, and the rest of the day’s news and comment


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5.06pm Michael White’s column for this week has gathered some thought-provoking reader comments:

“Mental Health will always take a back seat until there is parity of pay and esteem for the medics. The brightest brains go to surgery in the acute sector. No emergency service, limitless waits, no family support means intolerable stress for sufferers and those around them. I question how many Commissioners have first hand experience of mental health problems with a family member, and yet I suspect most will have experienced acute services, so no surprise where the money goes.”

“Isn’t this another example of the reforms unravelling? Surely the Govt published the mandate, and NHS England responded to the mandate setting out the strategy for achieving it. What then is the status of a separate DH document? If it isn’t in the mandate it isnt something the NHS will be held to account for. Another example of MH subdued status if it missed the boat on the two key drivers of priority (The mandate, and ‘Everyone Counts’). I wonder if ministers and the DH fail to understand the new system, or simply have no confidence in it and want to act outside of it?”

“Given the disparity of ‘esteem’ and funding between mental and physical health we might need to revisit a simple question. Are psychiatry and mental health still considered integral parts of medicine? If, as I believe, the answer is ‘yes’, we might ask how and why mental health services have become professionally, geographically, managerially and financially removed from mainstream medicine in so many areas.
This wasn’t always the case; in many of the best hospitals, psychiatry was practiced in close collaboration with other medical specialties, recognising the crucial dependence of physical health on mental health and vice versa.
Psychiatric hospitals without physicians and surgeons pose a risk as do physical medicine hospitals without psychiatrists or other mental health staff but both circumstances are now worryingly common. Lack of integration in the community may be even more of a problem. In the best interest of patients, the answer must surely be to bring mental health and the rest of medicine back together in every way. When psychiatric and other medical services are properly seen as interdependent it will be easier for the whole professional establishment to help improve and maintain mental health services.
If we are, somehow, to believe that mental health is categorically different from physical health there may be an even bigger problem than Ministers think.”

4.49pm In our comment section Bill Morgan argues that the debate over the Office of Fair Trading contains several myths that will only be perpetuated by Norman Lamb’s recent intervention on the subject.

3.44pm The BBC reports that millions of people from ethnic minority groups who may be at risk of weight-related diseases are not showing up as obese under current tests, experts say.

Medical advisory body NICE says the method of calculating body mass index does not work for some groups.

And it wants the BMI “fatness” thresholds to be lowered to ensure up to 8m people of African, Caribbean and Asian descent in the UK are covered.

NICE says it would help identify those at risk of diabetes and heart disease. BMI assesses weight relative to height.

NICE says a lower BMI threshold should be used as a trigger for action in people from ethnic minority groups since they are more prone to such diseases.

1.25pm Our story on Norman Lamb intervening over mental health funding has attracted some heated reader debate:

“Don’t they realise it is only mental health and community trusts that make money nowadays and the acute sector is

“Here we go! Get ready for more Acute Trust whining. The only reason that Acute Trusts are in trouble is that community & mental health services have been chronically under-resourced so have not got the capacity to get people out of Acute trusts. The sooner that Acute trusts realise that they are not “the system” but not even the major part of the whole system, the sooner resources can go where they are truly needed and the system can be redesigned around the needs of the most important part of the system, the patients.”

“This is not about acute vs mental health and organisational winners and losers. This is about Norman Lamb boldly insisting that the system implements policy that is designed to address health inequalities, reduce premature mortality and is clearly articulated in the NHS Mandate. We’ve asked for less rhetoric & more action and the Minister should be applauded for the stand he has taken. All providers will gain if his words are heeded but more importantly patients and the public will be better off.”

“The Minister’s stance is a bit ludicrous isn’t it?! He says he’ll only act if a MH system/trust provides evidence that mental health’s finances were suffering “unduly”. HOW?! Does the Minister say Francis doesn’t apply MH trusts as NHS England claims as my reading of Francis is that it does apply MH services. Can’t the Miniter over-rule NHS England and say MH will have to do FRANCIS, and MH services in the way NHS England propose? That way, he’d have some credibility to follow through on what he says is important (MH & parity with acutes etc), rather than wait for “evidence”, while the reality is MH services will get a bigger cut despite the rectoric. Can’t HSJ journo’s ask NHS England for a response ie. will they change the forumale in light of Lamb’s views (or do they quietly press on [cutting MH on the basis Francis won’t apply when it will], and wait for “evidence” from individual MH trusts?”

The Cabinet Office has issued an information notice calling for expressions of interest in a potential deal to deliver a system, which could be rolled out to other parts of the public sector.

It will include software to deliver e-rostering and systems to either fully or partially manage bank staff to help providers reduce costs. The tender also covers “workforce management support services”, thought to include human resources systems.

12.24pm The NHS needs to do more to tackle HIV-related stigma, lack of patient knowledge on the use of their personal data, and breaches of confidentiality, according to a survey by the National AIDS Trust.

NAT surveyed 245 people living with HIV about their experiences of disclosing their HIV status to healthcare staff and also asked them what they knew about how their medical records were handled and who had access to them.

40 per cent of respondents said they had been treated differently or badly within the NHS because of their HIV positive status. Examples included asking people how they got HIV, blaming them for having HIV, refusal or delay in operating or providing treatment, inappropriate discussions around lifestyle, and being made to feel “inferior” in some way. Such experiences were invariably not within the HIV clinic but in other parts of the NHS.

Almost a quarter (22 per cent) said they had experiences of breaches of confidentiality by healthcare staff. This often involved comments about the patient’s HIV status in a public or semi-public space or personal records being visible to others. However, only one in five of this group made a formal complaint. 

Half of respondents did not know whether or not their HIV clinic records were kept separately from the wider records of the hospital trust. Similarly, in relation to the important concept of ‘implied consent’ for the sharing of personal information with other healthcare staff, 46 per cent were unaware of this concept and a further 15 per cent were unsure about it.

When explained, most respondents seemed content with current confidentiality procedures – but there was a need for better information on these issues.  54 per cent had never received any written information on NHS confidentiality procedures and 46 per cent had never had a conversation about it.  For those who had received written or verbal information, 49 per cent and 43 per cent respectively said it did not answer their questions.  There is an urgent need for clear information on how the personal medical information of people with HIV is shared and protected in the NHS – NAT will be developing a resource for this purpose.

The one widespread concern in current confidentiality rules was the sharing of personal confidential information with NHS administrative staff – there was a call for greater differentiation and control as to who has access.

Deborah Jack chief executive of NAT said: “Most people with HIV are willing to trust the NHS on confidentiality – but the NHS now needs to show that such trust is earned and well-placed.  Explain to your patients how their personal data is used and shared; end casual, careless breaches of confidentiality which can cause havoc in people’s lives; above all else, the NHS has to become a zero tolerance zone for HIV stigma – instead of what it is now, the place where people with HIV most frequently report such prejudice.”

12.11pm Two more pairs of commissioning support units are entering into formal alliances to ensure they can offer a comprehensive set of high quality services, HSJ has learned.

HSJ has also been told that South and South West CSUs have entered into a similar arrangement to the “partnership agreement” announced by Central Eastern and Central Southern CSUs this week.

However, North of England CSU has indicated is likely not to enter into a formal alliance with another CSU.

Report co-author Tony Hockley, director of the Policy Analysis Centre, said: “It’s a lack of leadership that’s stymieing progress in moving towards a digital NHS.”

In the report, NHS Staffing: Not Just a Number, funded by IT company Kronos, the authors claim that “very conservative” estimates suggest that £71.5m could be saved through automation of staff pay, timekeeping records and real-time data on staffing levels.

10.52am Here’s an interesting story from one of our sister titles, Local Government Chronicle:

Home care contractors must pay carers the London living wage under new rules imposed by Islington Council.

From June some 800 carers will earn at least £8.80 per hour. Islington provides around 500,000 hours of home care a year, costing it £6.3m.

Personal budgets will rise by an equivalent amount so service users can pay the wage to carers they employ directly. New contracts will also include improvements to the quality and continuity of homecare.

10.50am Today HSJ has launched a new section on the website dedicated to end of life care, in association with Marie Curie Cancer Care.

Its a resource for commissioners to help plan better end of life care and will be updated regularly.


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.

Mr Lamb said the Department of Health would scrutinise trusts’ draft budgets in the coming months and would act if evidence emerged that mental health’s finances were suffering “unduly”.

10.24am The Care Quality Commission has gained a “renewed sense of purpose”, according to a Commons health committee report.

Committee chair Stephen Dorrell said “The CQC has been a case study in how not to run a regulator, but essential reforms implemented by the new management are turning the CQC around.”

However, the committee’s report had a number of recommendations for how the watchdog could be improved.

In the committee’s last report there was a recommendation for the CQC to write to care home residents and their relatives with details of their inspection findings. The CQC said it would consider this action. The committee expressed disappointment that the CQC was only “going to consider” this measure and said it should adopt and implement this policy by no later than 30 June.

10.18am Also in The Guardian, SA Mathieson senior analyst for EHI Intelligence, investigates whether Aberdeen’s new health village could provide a model for the NHS in England in how to fund new facilities and bring public and private bodies together in a joint shareholding model.

He writes: “Aberdeen health village, which opened last month, also houses other parts of the public sector: Police Scotland’s local sexual forensic unit; a branch of Carerspoint, run by NHS Grampian health board, Aberdeen city council and voluntary organisations, to support unpaid carers; and a healthy living advice service.

“This joint working extends to the way in which the village has been financed. It is the first healthcare project to open with the support of the Scottish Futures Trust, a company set up and owned by the Scottish government to provide public sector infrastructure projects with an alternative to the controversial private finance initiative (PFI)”.

10.17am The Guardian reports that Professor Sir Bruce Keogh, NHS England’s medical director, said private companies would be asked to conduct planned operations in hospitals “when the going gets rough in winter”.

He told the health select committee: “We’ve started to look at how the private sector might be engaged in the event of a surge through hospitals, coming through A&E. One of the issues under consideration is when the going gets rough in winter, often one of the impacts is on elective care, so waiting lists start to drift out, so could more elective care be shifted into the private sector?”

10.15am The Times reports that thousands of patients may not be getting the drugs they need from the NHS. One in three patients suffering from conditions such as kidney cancer and motor neurone disease is not getting treatments recommended by NICE, the NHS drugs rationing organisation.

As part of an agreement signed last year between the government and the pharmaceutical industry, data has been collected by the Health and Social Care Information Centre to examine whether a sample of medicines was being prescribed to all patients who met the criteria for them.

Alice Thomson has written an opinion piece emphasising the importance of institutional care, especially for those with mental health problems.

10.11am The percentage of outpatients waiting more than 18 weeks for NHS treatment is at its highest level since 2008, according to a new report, which also says more hospitals are falling into deficit.

Analysis by the King’s Fund shows 3.6 per cent of outpatients waited more than 18 weeks for treatment in November 2013, the highest level since October 2008, when the figure was 3.7 per cent.

In addition, almost one in 10 (9 per cent) of inpatients waited more than 18 weeks for treatment, the highest since November 2011 when the proportion was almost 10 per cent.

10.08am The scale of mental ill health in London is costing the capital around £26bn a year, a new report commissioned by Boris Johnson has revealed today.

In any given year, an estimated one in four Londoners will experience a diagnosable mental health condition. A third of these will experience two or more conditions at once. According to a Department of Health report, the impact of mental ill health is greater than cancer and cardiovascular disease. It represents around 22.8 per cent of the total, compared to 15.9 per cent and 16.2 per cent respectively.

Close to £7.5bn is spent each year to address mental ill health in London. This includes spending on health and social care to treat illness, benefits to support people living with mental ill health, and costs to education services and the criminal justice system.However, these costs are only part of the total £26 billion lost to London each year through such issues as reduced quality of life and productivity.

The Greater London Authority report provides a range of data, highlighting the direct and indirect costs of mental ill health to the city’s economy. For example, at least one in 10 children is thought to have a clinically significant mental health problem, and the impact of childhood psychiatric disorders is estimated to cost the capital’s education system approximately £200m per year.

In social care costs alone, London boroughs spend around £550m a year treating mental disorder, and another £960m is spent each year on benefits to support people with mental ill health.

The report shows how London’s businesses are also affected - it is estimated that £10.4bn is lost each year, including £7.2bn due to increased worklessness. £920m alone is lost annually to sickness absence, and a further £1.9bn is lost to reduced productivity.

The mayor of London Boris Johnson said: “This report is a rallying cry to increase yet further our response to this very pressing and pervasive issue. There are still many misconceptions about what mental ill health is, how it happens and what can be done about it. The result is that those struggling with mental ill health often go unnoticed and unsupported. It affects our relationships with others, limits educational achievement and increases sickness absence and worklessness. Indeed, the effects of mental ill health impact upon each and every aspect of our lives.”

9.56am NHS England medical director Sir Bruce Keogh has revealed “great scepticism” that the £3.8bn Better Care Fund will be wrongly used by councils for “filling in potholes and other significant things”, according to The Independent.

Sir Bruce said there was a need to be “absolutely clear” how that money would be spent.

9.45am Magnetic pulses that can control migraines have been approved for use on the NHS reports The Independent.

The device sends magnetic pulses through the skull to combat severe headaches and could save the economy £2.25bn a year in absenteeism.

9.40am The Independent reports that staff morale in the health service is appraoching an all-time low and may be affecting the care that clinicians are providing patients according to a report by the King’s Fund.

The report also found that one in five hospitals expect to be in deficit by the end of the financial year.

7.00am Welcome to HSJ Live. This morning Ian Mills, director of SMSR and a visiting lecturer in marketing at Hull Business School, writes that A&E will always be many people’s first port of call for care, and working with this reality would allow the NHS to relieve overloaded emergency capacity by directing visitors to suitably ‘marketed’ services.