The government has raided a £240m NHS technology fund to bolster financial support for hospitals struggling with accident and emergency demand this winter, senior sources have told HSJ, plus the rest of today’s news and comment

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Senior health service figures said a large amount of the money originally earmarked to help pay for projects such as digital patient records had now been diverted into the £700m winter pressures fund.

5.25pm Problems in hospitals are spreading beyond accident and emergency to other areas of performance, the King’s Fund has warned.

The latest quarterly monitoring report from the health think tank found that waiting times for treatment and other key performance indicators are deteriorating, amid “increasing demand for services and the unprecedented financial squeeze”.

The King’s Fund found that:

  • The proportion of inpatients waiting longer than 18 weeks for treatment rose to 12.5 per cent in November – the highest level since this target was introduced in 2008.
  • The target that no more than 5 per cent of outpatients should wait longer than 18 weeks for treatment was breached in November – the first time this target has been missed since 2008.
  • Waiting times for cancer treatment continued to worsen in the second quarter of 2014, with only 83.5 per cent of patients receiving treatment within 62 days of urgent referral from their GP – the lowest proportion since the current target was introduced.
  • The number of delayed discharges from hospital increased sharply to more than 5,000 per day in November, an increase of almost 20 per cent since January.
  • The number of cancelled operations during November to January was up by a third on the same period in 2013.

Commenting on the report, King’s Fund chief economist John Applebysaid: “While recent attention has focused on the problems faced by A&E units, performance against waiting time targets and other indicators has continued worsen.

“Taken together, the findings from this quarter’s report show that services are stretched to the limit. With financial problems also endemic among hospitals and staff morale a significant cause for concern, the situation is now critical.”

4.16pm Colchester Hospital University Foundation Trust has appointed a new chair, the trust has announced.

Alan Rose was appointed a special meeting of the trust’s council of governors this afternoon.

He succeeds Peter Wilson, who has been acting chair at the trust since October last year, after the previous chair Sally Irvine stood down from the role.

Mr Rose has been chair of York Teaching Hospital Foundation Trust since 2010. He was a non-executive director at the trust since 2010.

He will take up his position at Colchester on 1 April, after his maximum nine-year term at York ends.  

He has a background a strategy consultant, working with Booz Allen in London and New York. He later ran his own landscaping business for seven years.

The trust’s lead governor David Linghorn-Baker, said: “Alan comes to Colchester with an outstanding track record as a high-achieving NHS foundation trust chairman.”.

Mr Rose said: “I feel privileged to be given the opportunity to help the Colchester trust to regain the confidence of the communities it serves and that of the stakeholders in health and social care, whom I am sure also wish to see this. 

“The coming months and years will be challenging for all concerned due to the incessant pressures the health service is under, but I am confident that the staff of the Trust, backed by the huge support I sense the community still maintains in it, will provide the foundation for a new phase of good care and patient experience.”   

Mr Rose has been appointed for a three-year term of office. He will earn £45,000 for a minimum of three days’ work a week. He will take up his appointment on 1 April.

4.02pm Readers might have noticed some missing images and broken links to downloads on This is an unforeseen side effect of some work on the site’s database yesterday. We are aware of the issue and working hard to fix it. We are sorry for any inconvenience.

3.55pm NHS England chief executive Simon Stevens has acknowledged that vertical integration, one of the reform options outlined in the NHS Five Year Forward View, carries the risks of supply induced demand and unresponsive ‘like it or lump it’ care.

Mr Stevens characterised supply induced demand as “what some of the United States’ accountable care organisations are producing”.

In an interview with the Health Policy Insight website, Mr Stevens was asked whether commissioners could veto what they could perceive as “a provider cartel” created by vertical integration. His reply focused on the need to avoid two particular risks of vertical integration, whether led by acute providers or primary and community services.

3.45pm The Health and Social Care Information Centre has pledged to contact a potentially large number of patients who objected to the programme, after it emerged that their opt-outs could unintentionally exclude them from NHS services such as bowel screening.

In a letter to the Commons health committee released yesterday, the information centre admitted that patients who had objected to it sharing their data would not, under current arrangements, be approached for some direct care services.

3.28pm Commenting announcement by the Care Quality Commission today that three GP practices have been placed into special measurs, Royal College of GPs chair Maureen Baker said: “Every patient has a right to expect high quality and consistent care from their local GP practice, and it is crucial that we urgently address any variations in quality of care.

“But it is essential to remember that the vast majority of GP practices that have been inspected are providing excellent patient care.

“In some cases, practices can find themselves in difficulty due to factors beyond their control, such as lack of funding, significant increases in patient consultations and difficulties in trying to recruit sufficient GPs to meet patients’ needs - not because they are uncaring.

“Those that have been found to be struggling need support, not criticism, and the College is best-placed to work with them in the best interests of the practice and the patients that it serves.

“As the UK’s largest medical royal college representing nearly 50,000 family doctors, we know the pressures that GP practices are under and can provide the support and practical assistance that they need to compile and implement plans to improve the service for patients.”

3.21pm The chief executive of Buckinghamshire Healthcare Trust has she is stepping down from her positon to become the NHS E Trust Development Authority’s director of delivery and development for the South of England.

Anne Eden will take up her new role with the TDA on 1 April.

She will be replaced Neil Dardis, the trust’s chief operating officer and deputy chief executive, on an interim basis.

A statement issued by the TDA this afternoon said: “With a focus on clinically-led improvement, Anne has helped [Buckinghamshire Healthcare] to drive up its quality outcomes and is one of the best performers for surgical and hyperacute stroke services and has one of the lowest infection control rates in the country.

“She led the transformation of local health services, including a major consolidation of women, children and emergency medical services to ensure safe care and better clinical outcomes and the development of pioneering new models such as the Cardiac and Stroke Receiving Unit at Wycombe Hospital.

“In 2010, she led the bid to acquire community healthcare services, making Buckinghamshire Healthcare one of the earliest integrated acute and community providers in the country and has continued to champion greater integration and collaboration between health and social care services.”

TDA chair Sir Peter Kay said he was “delighted that Anne has decided to join our board”. 

“During her time at [Buckingham Healthcare], she has overseen significant improvement in the quality of care provided to patients and in 2014 led them out of special measures.

“I am confident that she will be a real asset to all the NHS Trusts in the South as they work towards a sustainable, high quality future.”

Trust chair Hattie Llewellyn-Davies said: “On behalf of the board I would like to thank Anne for her focus and commitment to the staff and patients at Buckinghamshire Healthcare over the past eight years. She has transformed the organisation and ensured that delivering safe and compassionate care is central to the way we work.

“Anne has been integral in establishing a new Board over the past year and we have a clear strategy with our local partners for the future.  It has been a real pleasure working with Anne and we will miss her greatly. I wish her all the best in her new post and look forward to continue working with her in the future.”

Ms Eden said: “It will be a huge wrench to leave Buckinghamshire, but I feel privileged to accept this role and the opportunity to gain a different perspective of the NHS at a national level and to share my own learning and experience is one that I could not let pass me by.

“I am so proud of the staff and all that they have achieved. They have made the Trust a strong, resilient organisation and I am confident that it will go from strength to strength. I will continue to live in the area, so they will never be far from my thoughts.”

3.03pm The NHS Trust Development Authority has announced it e appointment of Wyn Dignan as chair of North West Ambulance Service Trust.

Ms Dignan is will begin new role on 1 February.

Her appointment comes following the departure of the trust’s previous chair, Mary Whyham in December 2014. Ms Whyham had served the maximum term allowed for an NHS chair.

Ms Dignan has chaired Manchester Mental Health and Social Care Trust since 2004.

Prior to that, she was chair of North Manchester Primary Care Trust between 2000 and 2004.

She also held the positions of non-executive director and deputy chair at North Manchester Healthcare Trust.

Ms Dignan’s background is the banking and finance sectors, and she is a fellow of the Chartered Institute of Personnel and Development.

North West Ambulance chief executive, Bob Williams said: “Wyn’s appointment comes during a time of great change for ambulance services with more emphasis being placed on a model of service which aims to reduce the number of patients we take to hospital and ensure patients receive the right care, at the right time and in the right place.

“The board and I are looking forward to welcoming Wyn to the team and working with her to achieve our future objectives.”

Commenting on her new role, Ms Dignan said: “I am delighted to join North West Ambulance Service Trust. It’s an exciting time for the ambulance services across the country as they adapt to meet new challenges and new models of care.

“I look forward to working with the board to build on the excellent work of my predecessor Mary Whyham and develop the service still further as a byword for excellence across the North West.”

He term is expected to last 31 January 2017. She is entitled to receive of £35,000 per year for the role, the TDA has said. 

2.38pm Ambulance services across England are looking overseas to fill gaps in their paramedic workforce as trusts grapple with vacancy rates as high as 25 per cent, HSJ research has found.

2.23pm EXCLUSIVE: Medical directors from England’s 10 biggest teaching hospitals have written to their counterparts at NHS England and Monitor to warn that controversial new tariff plans will damage patient care and lengthen waiting times.

The letter, from the most senior clinicians at the Shelford Group trusts, said the imposition of a 50 per cent cap on specialist work above 2014-15 levels could see patients “excluded from optimal or timely treatment”, HSJ can reveal

2.15pm Clinical commissioning groups were asked to decide by early January if they wanted to take on full, delegated responsibility for general practice in their area. Those wishing to take on lower levels of co-commissioning have until the end of January to decide.

HSJ today reveals that 77 groups, or 36.5 per cent, have applied for full delegated responsibility.

Take a look at our exclusive map, which shows which groups are known to have applied to take on full delegated powers and, as of 22 January, which have decided on other co-commissioning options. Seventeen groups have not yet decided or not revealed their plans - one of these has applied to NHS England for delegated responsibility, but its identity is not known to HSJ.

2.12pm Around a third of clinical commissioning groups are bidding to take over responsibility for performance management and budgets of their member GP practices from April, HSJ can reveal.

Seventy seven CCGs (37 per cent of the total) have submitted proposals to NHS England to take on full delegated commissioning of primary care from April, which also includes managing complaints about practices and GPs.

Primary care is currently commissioned by NHS England’s area teams, but its chief executive Simon Stevens announced last spring he wanted to hand the responsibility to CCGs. They were asked late last year to choose between three “levels” of co-commissioning (see box, below)

They had to tell NHS England by 9 January if they wanted full “delegated” responsibility, and by 30 January if they had chosen other options.

A comprehensive survey of all CCGs by HSJ has identified the choices made by 193 groups, the remainder saying they had not decided or would not say. Forty-two per cent (89 groups) have applied for “joint commissioning” and 12 per cent (25 groups) have applied for the lowest option of “greater involvement”. Five CCGs have said they do not want any co-commissioning role.

1.44pm Responding to Monitor’s report “Commissioning better community services for NHS patients”, NHS Clinical Commissioners co-chair Steve Kell said: “We know from our members that CCGs are not automatically rolling over community services contracts but are actively improving local services by finding and developing local solutions.

“The last thing we need if we are to deliver the better care fund is competition where it is not in the best interest of patients.”

“This report from Monitor highlights the significant gap between their rhetoric and reality, and it is essential that CCGs are allowed the freedom to deliver integrated care and that this is not prevented by unnecessary enforced competition”

1.23pm The Academy of Medical Royal Colleges has issued a statement on the Medical Innovation Bill, which is due to go through its third reading to the House of Lords tomorrow.

It says: “The intention to promote innovation is supported by the medical profession and we welcome the opportunity that the Medical Innovation Bill has provided for this to be debated.

“However, the view of the Academy and Medical Royal Colleges, reaffirmed at the end of last year, is that we do not believe that the Bill will actually achieve this worthwhile intention.

“When it was first presented Royal Colleges and other professional medical bodies had concerns about potential unintended implications of the Bill. The amendments made to the Bill to date have certainly addressed a number of those concerns and have been welcomed.

“There still, however, remains a danger of the unintended consequences of the Bill in diverting efforts away from properly conducted clinical research trials.
In addition, even as amended, we remain unclear as to what value the Bill will add to the current position.

“We do not therefore believe that this legislation is necessary and efforts could more helpfully be directed at removing some of the practical barriers that can impede real innovation in the NHS.

“Medical Royal Colleges would be pleased to discuss with the Bill’s supporters and Government how this could best be achieved.”

12.52pm Monitor has said commissioners should not “automatically roll over community services contracts”:

“The regulator believes that clinical commissioning groups, responsible for much of the £10 billion the NHS spends on community services, should explore how best to improve the care available to their patients as these contracts come to an end.

“Monitor heard from 147 clinical commissioning groups in England and found that, of contracts expiring in 2015, half of CCGs plan to extend at least one of their community services contracts with their current provider.

“The regulator’s report, published today, identifies a number of ways that commissioners are already improving community care provision, which may help other commissioners. These include involving patients in selecting community services providers, working in partnership with local government to co-ordinate services and using patient outcomes to incentivise improvements in care.”

Catherine Davies, executive director of cooperation and competition at Monitor, said:

“Improving community services for patients is critical to helping make sure the NHS continues to provide high-quality care and can meet the current and future challenges it faces.

“We do not think that commissioners should automatically roll over community services contracts. As the arrangements run out they should take the opportunity to explore ways of improving the community care available to their patients.

“Looking to improve services for patients does not mean necessarily putting contracts out to full competitive tender, but it may be the best option in some cases.”

12.36pm The Royal College of Physicians has commented on the news that the government is to hold a vote on plain cigarette packaging before the next election. RCP president Jane Dacresaid:

“We warmly welcome this announcement. Evidence is clear that 600 children begin smoking every day in the UK, and we know that they are susceptible to branding of cigarettes. This announcement provides real progress in the fight to reduce children’s exposure to tobacco branding, making the marketing of tobacco products much less effective.

“Along with the vote earlier in the year in favour of legislation to introduce a ban on smoking in cars with children, which the RCP called for as long ago as April 2010, this news will start the process of taking smoking completely out of children’s lives.

“Supported by the strong evidence from the introduction of plain pack in Australia, the RCP has spoken for a number of years on the potential public health benefits plain packs could have in the UK.

“This is an important public health measure and MPs now need to vote in favour of plain packaging on tobacco products. Smoking related diseases still kill thousands of patients each week in our NHS – that is why there can be no further delay on this vitally important decision.

“We are one step closer towards a tobacco-free UK.”

12.32am Medical directors from England’s 10 biggest teaching hospitals have written to their counterparts at NHS England and Monitor to warn that controversial new tariff plans will damage patient care and lengthen waiting times.

The letter, from the most senior clinicians at the Shelford Group trusts, said the imposition of a 50 per cent cap on specialist work above 2014-15 levels could see patients “excluded from optimal or timely treatment”, HSJ can reveal.

The 10 trusts provide much of the country’s most advanced treatment for specialised conditions and are in many cases internationally renowned.

11.44am Mike Bewick, deputy medical director, NHS England, said:

“General practice is the bedrock of the NHS and it’s pleasing that the majority of practices inspected are rated good, with some rated outstanding. These inspections are about ensuring that every patient, anywhere across the country, receives consistently high quality services by identifying issues so improvements can be made. And for those in special measures that need extra support, we are working with the GPs, local medical committees and CCGs to help turn the affected practices around, including the offer of additional support from the RCGP.”

11.32am Steve Field, chief inspector of general practice, said:

“So far we have published ratings on 143 practices – of which the vast majority have been good or outstanding. It is disappointing that we have found any to be inadequate, but it is important that those practices are offered help at the earliest opportunity to improve.  

“In each case, we have found significant areas of concern. Patients should be able to expect high quality and consistent care from their GP which is why I have put the three practices into special measures. Two practices have already begun to show signs of improvement but we will monitor their progress closely, returning to inspect in the near future.

“We will only cancel the registration of a GP practice if we think it is absolutely necessary – and in any case our priority will be to help the practice improve, if that is appropriate. In these situations we will work closely with NHS England who will ensure that people registered at that practice continue to have access to safe and high quality general practice.”

11.31am Commenting on the publication of the new reports, Nigel Sparrow, CQC’s senior national GP advisor said:

“We know that the vast majority of England’s GPs are providing a service which is safe, effective, caring, responsive and well led. If that is what we find on inspection - we give it a rating of “good”, and I congratulate the GPs and staff in these practices.

“Patients should be able to expect high quality and consistent care from every GP practice. Where we have required improvement, we will expect the practice to take the necessary steps to address the issue, and we will return at a later date to check that those improvements have been made.”

11.25am The Care Quality Commission has published a further 75 reports on the quality of care provided by GP practices that have been inspected under its new approach, with give practices being found “inadequate” and three going into special measures.

Three practices have been rated “outstanding”, 57 have been rated as “good”, 10 have been rated “requires improvement”.

The three practices which have been placed into special measures are:

  • Dr Srinivas Dharmana, Queens Drive, Liverpool.  The service was rated Inadequate for being Safe, Effective, Caring, Responsive and Well-led. 
  • Dr Michael Florin, Norris Road, Sale, Trafford.  The service was rated Inadequate for being safe and well-led, Good at caring for patients but required improvement to be responsive and effective.
  • Priory Avenue Surgery, Priory Avenue, Caversham, Reading. The service was rated Inadequate for being safe, effective and well-led, and required improvement to be caring and responsive.

The two practices which have been told they will be put into special measures if they fail to improve are:

  • Dr Sunil Srivastava, Richmond Medical Centre, Upper Accommodation Road, Leeds.  The service was rated Inadequate for being safe, effective, responsive and  well-led, and required improvement to be caring.
  • Widdrington Medical Practitioners, Grange Road, Widdrington, Northumberland.   The service was rated Inadequate for being safe and well-led, and Good for being caring, responsive and effective.

11.15am The chief executive being seconded to turn around Heart of England Foundation Trust has said his appointment is an example of the recommendations of the Dalton review into the provider sector being put into practice.

Andrew Foster, the chief executive of Wrightington, Wigan and Leigh Foundation Trust, is to join Heart of England as interim chief executive in mid February.

He will work there four days a week for a maximum of six months, during which the trust will also receive other support from Wrightington, Wigan and Leigh.

Mr Foster said his secondment was “in line” with Salford Royal Foundation Trust chief executive Sir David Dalton’s recommendations for new organisational forms in the NHS provider sector.

Speaking to HSJ, Mr Foster said the Dalton review, published last month, discussed both a “wide range of models for different organisations working together” and “how one trust might help another to get out of poor performance”, including by “credentialing” high performing trusts to give support.

“This is where I see it as being highly consistent, because it’s not just that I’m going to go and be interim chief executive; we’re going to take a number of ‘products’… or things that we’ve done at Wigan, and we’re going to do something similar [at Heart of England].”

10.43am Here’s an extract from Andy’s interview:

Health Poilcy Insight: “One of the most exciting opportunities within the 5YFV is to find new organisational forms bringing primary, secondary and social care together. Assuming that this is essentiallyabout how care is provided, how can you stop commissioners vetoing what they see as a provider cartel?”

Simon Stevens: “We will need to safeguard against two particular risks with vertical integration. One is the risk that, rather than getting smart use of resources across services, you end up Balkanizing primary and community care and pulling funds into acute care settings: the danger of supply-induced demand. That is what some of the United States’ Accountable Care Organisations (ACOs) are producing.

“The second risk is that you could see a lack of patient responsiveness: ‘like it or lump it’ care.

“So to prevent these risks, we’ll have various tests – starting with a default assumption of a partnership of equals between GPs, community services and hospitals if health economies want to form a primary and community system (PACS). And to address supply-induced demand, PACS will have to be capable of taking delegated funding decisions for their accountable population, to get them to internalise the need to make good decisions about how they’ll care for their population as a whole.”

10.16am Simon Stevens has given an interview to Health Policy Insight, the website run by HSJ comment editor Andy Cowper. Among interesting points to Mr Cowper, Mr Stevens acknowledges some of the major risks in vertically integrated providers, as advocated in the NHS Five Year Forward View. He also directly states that some accountable care organisations, integrated forms created in the US as part of its health reform programme, are “producing… supply-induced demand”. This suggests they may be unnecessarily driving up costs – which is the opposite of the intention of the policy. Mr Stevens was based in the US at global health insurance firm UnitedHealth until his move to NHS England last year.

We’ll provide you with a few extracts from the interview throughout the morning.

9.55am Ambulance services across England are looking overseas to fill gaps in their paramedic workforce as trusts grapple with vacancy rates as high as 25 per cent, HSJ research has found.

The number of paramedics recruited from overseas has already rocketed to 183 in the financial year to date, compared with just one in 2013-14, according to information provided by ambulance trusts.

Nearly all of this increase is attributable to London Ambulance Service, which told HSJ more than one in five of its full time equivalent paramedic posts are vacant. The trust said it had recruited 175 paramedics from Australia, who started joining it this month.

7.00am Good morning. Jonathon Carr-Brown calls on people to think about how and where they would like to die, and record their choices while they are able to.