The public accounts committee casts doubts over QIPP and the rest of today’s news

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4.16pm: A statement has been published on the future of the National Clinical Assessment Service. It says:

“National Clinical Assessment Service to become part of the NHS Litigation Authority on 1 April 2013.

The National Clinical Assessment Service (NCAS) will become an operating division of the NHS Litigation Authority (NHS LA) on 1 April 2013.

NCAS joins the NHS LA from the National Institute for Health and Clinical Excellence (NICE) where it has been hosted from April 2012.

Sir Andrew Dillon, Chief Executive of NICE, said: “Hosting NCAS has been a pleasure. I’m glad that the organisation now has a permanent home and I wish it great success in the future.”

Catherine Dixon, Chief Executive of NHS LA, said: “We are looking forward to NCAS joining us. The NHS LA and NCAS have a shared purpose to help improve patient safety in the NHS and in healthcare more broadly. We believe that our complementary expertise will benefit the NHS.”

3.28pm Health minister Dan Poulter has written to NHS trusts asking them to sell off surplus land for housing. It is part of a long-term push from the government designed to cut NHS costs and stimulate growth in the economy.

The pan-public sector initiative is intented to provide 100,000 new homes, and is described as a “top priority for this government”.

“It is encouraging that initial analysis of the latest annual data return of NHS surplus land indicates an increase in surplus or potentially surplus land suitable for housing”, Dr Poulter writes.

The Homes and Communities Agency are currently contacting NHS trusts to discuss their estate, Dr Poulter says. “I would ask the NHS to respond to them”.

“The government would like to see a further acceleration of the release of surplus public sector land.

The letter reminds recipients - including all NHS chief executives, estates directors and finance directors - that £290m was made available in the 2012 autumn statement to speed up surplus NHS land sales.

The full letter is attached to this live blog, on the right hand side.

3.08pm A round up of today’s news so far:

  • The CQC has exclusively revealed to HSJ the details of its new inspection regime, involving the return of star ratings.
  • The public accounts committe has published a fairly damning report about the NHS efficiency programme.
  • The Office of Fair Trading will have to assess any merger involving an NHS foundation trust.
  • A Patients Association report has found low levels of confidence in out of hours primary care.
  • Critical care bed occuppancy rates have hit a record high.
  • NHS Employers has warned the Department of Health it risks creating a “tick box culture”.
  • Matt Tee made animal noises at David Frost. Seriously.

2.59pm Healthcare sector regulator Monitor has confirmed the Office of Fair Trading will in future have responsibility for assessing any merger involving an NHS foundation trust, HSJ’s finance reporter Crispin Dowler reports.

The decision means that mergers between FTs and NHS trusts – which until now had been reviewed by the NHS Co-operation and Competition Panel – will now be subject to review by the OFT, the national general competition watchdog.

Read the whole story here.

1.41pm A Patients Association survey about primary care has had a lot of pick up in the nationals today.

The main findings were that more than half of patients reported having to wait more than two days to see a GP, while 79 per cent were not confident in the quality of out of hours care.

Here’s the Guardian’s story, which includes some lines about the public accounts committee (see posts on this blog from early this morning).

Here’s the BBC’s take, and here’s the Daily Mail’s.

1.25pm A new post has just gone up on the HSJ End Game blog all about the time NHS communications man Matt Tee - who is about to become the NHS Confederation chief operating officer - was interviewed by David Frost.

12.50pm Health Education England has drawn up proposals to authorise 13 Local Education and Training Boards which will collectively deliver a £5.5bn healthcare training budget.

At a meeting of HEE board members next week the new education quango is expected to give the 13 regional organisations the go ahead.

The local boards will take on their responsibilities on April 1 and will include a much greater involvement of NHS providers in the education and training of the future NHS workforce.

12.40pm Someone has taken the trouble to translate the NHS Commissioning Board’s website into young person’s vernacular.

“Da NHS Commissionin Board (NHS CB), skits a key role up in tha Posse’s vision ta modernise tha game steez wit tha key aim of securin tha dopest possible game outcomes fo’ patients,” it says.

If this is the sort of thing you find amusing, and as it’s Friday, there’s a link below. But be warned, it does increase the swear factor considerably.

“’Da NHS belongs ta tha people.’ Da NHS Constipation.”

12.11pm After yesterday’s blog on the growing waiting list gap, Rob Findlay, the NHS Gooroo, has published his complete analysis of NHS waiting times.

The most recent data, for January, came out yesterday.

Click here to find out where the longest waits are, and to see performance against the 18 week target mapped.

11.55am The NHS has hit a record high in its critical care beds occuppancy rate, the DH reports this morning. There were 3,770 adult critical care beds available with 3,309 occupied, giving an occupancy rate of 87.8%. Previously the highest was 87.4% in December 2010. Data started being recorded in August 2010.

But, performance is improving on cancelled operations. The number of urgent operations cancelled was 293, which compares to 338 in January 2013 and 352 in February 2012.

While overall performance on delayed transfers of care hasn’t changed much over the past year, delays attributable to the NHS have increased by 1,800 days since February 2012, the DH says. Delays occurring in acute care settings have increased by 1,895 days over the same period.

11.34am An exclusive from HSJ’s workforce reporter Shaun Lintern. A letter sent to the Department of Health from NHS Employers has warned the government that it risks creating a “tick box culture” if it focuses too much on the recommendations by Robert Francis QC.

Creating new laws with the threat of criminal sanctions in the NHS would be the wrong response to the Mid Staffordshire scandal, they say.

Read the whole thing here.

10.56am An interesting tweet from NHS London chief Ruth Carnall. On the subject of CQC star ratings for NHS providers, Dame Ruth said under the old star rating system: “lots of effort [was] spent on gaming.” In future, a “more sophisticated approach” will be needed.

10.50am More activity from Monitor. The foundation trust regulator is “supporting” talks between Frimley Park Foundation Trust and Heatherwood and Wexham Park Foundation Trust. If successful, Frimley Park would take over its financially troubled neighbour. If they fail, it is thought likely locally that the regulator will take steps towards appointing a special administrator.

HSJ’s story also includes an update on the Shaping the Future for East Berkshire reconfiguration. Commissioners will next week be considering plans to move services out of Heatherwood hospita, in Ascot into the community. The site’s minor injuries unit would close and be re-provided in an urgent care centre in Bracknell. That’s interesting for two reasons: first, the site is owned by the Royal Berkshire Foundation Trust but is losing about £4m a year; and second, the local clinical commissioning group are have said they’re going to go to tender for the urgent care services.

10.40am Today’s Daily Mail carries an almost complete double-page spread on pages 30 and 31 about two grieving parents whose son died at University Hospitals Morecambe Bay Foundation Trust.

It is headlined “Who will the Man With No Shame blame this time?”, in another attack on Sir David Nicholson.

The paper says: “What is compounding the tragedy for bereaved parents is the fear that UHMBT covered up the deaths while chasing foundation trust status – an initiative set up by the Labour government to give trusts a greater degree of independence and more financial freedom”.

The seriousness of the spread is undercut by a short unrelated story in the top-left corner about a new design of ketchup bottle.

10.37am Monitor have said that services for patients have improved significantly at Cambridgeshire and Peterborough Hospital Foundation Trust. The regulator also said that the trust’s board has made important improvements in the way it runs the organisation. As a result, Monitor has decided it is no longer in significant breach of its terms of authorisation as a foundation trust.

Read the full report from Monitor here.

10.35am Elsewhere this morning, The Times is reporting on a study by the University of Glasgow  which suggests at least half of women with breast cancer are putting their lives at risk by failing to take their full course of medication.

Women prescribed a five-year course of anti-hormone treatment either stopped taking the drugs or took less than their suggested dose after the third year of treatment.

Those women who collected at least 80 per cent of their prescriptions for only three of the five years were three times more likely to die from breast cancer than women who collected at least 80 per cent over the five years.

By year five half of the women were collecting just 51 per cent or less of their prescriptions.

10.30am Bill Morgan of MHP Health Mandate tweets of the CQC: “Key insight in #ratingsreview: CQC needs to have resource to do job properly. But CQC will always lose out to NHS in bunfight for DH budget”.

On that point, Alastair McLellan adds: “CQC chair David Prior very kind w/ his time. HSJ interview took place in MIDDLE of teleconf with DH over CQC funding!”

10.24am HSJ reporter David Williams notes that there will be chief inspectors of primary and integrated care, social care, and hospitals, but not one for mental health, which will be the inspected according to the care setting. “[the] beginning of parity of esteem?” he ponders.

10.18am The final story on the CQC this morning. Chair David Prior tells Sarah Calkin that “we are not in a position, at the moment, to really assess the safety and quality performance of hospitals.”

The CQC’s current model was “fundamentally flawed”, he explains, leaving “our inspectors [doing] a bloody good job in difficult circumstances”.

HSJ editor Alastair McLellan tweets: “CQC chair admits to @sjcalkin that CQC can’t - with confidence - spot poor hospitals. I wonder what CQC staff think.”

Another of his tweets reads: “Those of you as long in the tooth as me will remember controversy over hospital star ratings. Looks like they’re back”

10.11am Here are anonther two reports on the CQC inspection overhaul.

In this one, CQC chair David Prior outlines how his “one strike and you’re out” approach could tip providers into the failure regime after just one breach of core standards.

The regulator wants to move away from simply assessing whether organisations are complying with its standards to making and publishing an overall judgement about them.

10.05am On to the main business of the morning: HSJ reporter Sarah Calkin has a package of exclusive stories about the Care Quality Commission’s coming overhaul of the hospital inspection regime.

The best hospitals would go five years without an inspection and the worst face intense scrutiny, Sarah reports.

Under the new regime, to be introduced from next month, the quality regulator will abandon annual inspections for NHS organisations and ditch its generic approach to health and social care.

Instead, inspectors will work under one of three newly created chief inspector posts responsible for hospitals; social care; and primary and integrated care. The current inspection workforce, many of whom come from the CQC’s predecessor, the Healthcare Commission, will be split into specialist teams depending on their area of expertise. It is expected mental health will be spread across all three, depending on setting.

10.00am Dame Mary Archer “would run the NHS beautifully”, the Daily Telegraph reports today. The former chair of Addenbrooke’s Foundation Trust should replace Sir David Nicholson, according to Lord Jeffrey Archer, her husband.

Click here to read the full interview, and to gawp at the incredible view the Archers enjoy from their flat on the Thames.

9.44am Here’s another response to the public accounts committe report on QIPP.

British Medical Association chair Dr Mark Porter said: “We share the committee’s concerns about some of the things that are happening as a result of cost pressures on the NHS.  Doctors base their practice on the care of individual patients, and every day see that many of the services deemed to be of low clinical value can be immensely valuable.

“The committee is right to raise concerns about staffing cuts.  The Francis report made clear the potential consequences of reducing staff levels under financial pressure.

“We agree that focusing on quality and safety of care, rather than knee-jerk cost-cutting, is the best way forward in the long-term. Clearly the challenge of dealing with financial pressures is huge, and it will be best addressed if clinicians are involved in decision-making.  There needs to be wide engagement on how to tackle the decisions facing many parts of the NHS.

“We would also argue that the wage restraint which the committee seems to welcome is an example of short-term thinking.”

9.43am Responses are coming in to today’s public accounts committee report into NHS efficiency savings.

John Appleby, chief economist at The King’s Fund said: “While the NHS has coped well up to now, our feedback suggests that the financial squeeze is beginning to have an impact on quality and access to services in some parts of the country.

“Efficiencies are becoming harder to deliver as one-off savings such as cuts in management costs start to slow. Pay restraint and holding down prices paid to hospitals are no substitute for delivering genuine productivity improvements.

“As the report points out, major changes to hospital services are needed to improve the quality of care and increase financial sustainability, yet the decision-making process remains complex and is often undermined by resistance to change, even when a strong clinical and financial case for change has been made.

“We echo the committee’s concern about the lack of strategic responsibility in the new health system for leading large scale reorganisations of services and the adverse impact this could have on attempts to improve the quality of care to patients.

“The NHS and social care face huge challenges - addressing financial pressures and improving quality of care in the short term, and meeting the challenges posed by demographic change and changing health needs in the long term. This demands new thinking and radical changes to services.”

9.39am The Public Accounts Committee report contains a transcript from an oral evidence session with Sir David Nicholson.

The dialogue dates back to January, and Sir David’s tone is remarkably strident and combative compared with the more humble tone he has used since the publication of the Francis report.

It includes two mentions of HSJ, both of which refer to an interview we published in January. You can read parts of it here, here and here.

The dialogue reads:

Stephen Barclay: As you said in your interview, when you were quoting Lenin, you are sitting there on the commanding heights.

Sir David Nicholson: Who said I quoted Lenin? I have never quoted Lenin.

Stephen Barclay: There was a paper circulated to the committee ahead of this.

Chair: The Health Service Journal.

Stephen Barclay: The Health Service Journal.

Sir David Nicholson: Can I say that I never quoted Lenin. I quoted Harold Wilson, who is slightly different from Lenin.

Stephen Barclay: Harold Wilson was quoting Lenin.

Sir David Nicholson: He was talking about the commanding heights of the economy.

Stephen Barclay: It is in the piece. All the Committee Members have read it because it was circulated.

Chair: I always think that Sir David is more of a Stalin figure than a Lenin one.

Stephen Barclay: A communist.

Then, later on:

Sir David Nicholson: What I cannot be held accountable for is the way in which individual foundation trusts manage their own financial affairs. I can absolutely be held to account for the service transformation required.

Stephen Barclay: I was not suggesting that you were being held accountable for that. Their structure is that they have an accounting officer in their own right to Parliament, as you and I know. What I am driving at is, in the Health Service Journal, you said—

Sir David Nicholson: I haven’t seen this. I don’t know what you are quoting.

Stephen Barclay: They were quoting you in this.

Sir David Nicholson: It must be true then. Go on. I will bury my head in my hands.

Stephen Barclay: This was circulated to members of the Committee.

Sir David Nicholson: Not by me, in some festive self-publicity.

Stephen Barclay:I feel almost reluctant to quote your own words back to you.

Sir David Nicholson: Please feel free.

Stephen Barclay:“It’s hard to imagine a service change that’s going to take place over the next few years that the Commissioning Board is not directly involved in.” That suggests it is pretty centralised.

Sir David Nicholson: No, not at all.

Stephen Barclay: So you accept that those were your words?

Sir David Nicholson: They are absolutely my words, but I want to explain the context in which I said them….

8.21am The House of Commons public accounts committee has this morning published a report on the NHS’s efficiency programme.

The committee disputed the data that the Department of Health based its efficiency claims on, and found that savings had mostly come from freezing wages.

Only 60 per cent of the £5.8bn reportedly saved in 2011-12 could be substantiated using national data.

Chair Margaret Hodge has expressed concerns that other savings are being achieved through rationing access to procedures such as cataract surgery or hip replacements.

She said: “Furthermore, the finances of some trusts are fragile, and there is a risk they may resort to simple cost-cutting rather than finding genuine efficiency savings.”

Ms Hodge linked the issue to the Francis report on Mid Staffordshire, adding that financial pressures could be causing trusts to cut staff, to the detriment of quality and safety of care.

The report raises questions over the quality, innovation, productivity and prevention programme. While the NHS must change the way healthcare is provided, such as moving services out of the acute sector, the committee said it is not satisfied that the Department of Health and NHS Commissioning Board is doing enough to support service transformation through the use of financial incentives and making the case for change.

“Unless this is done urgently, the Department will continue to face resistance to change and the NHS will struggle to deliver the savings it needs,” said Ms Hodge.

QIPP reporting by primary care trusts is inconsistent, the public accounts committee said. For instance the costs associated with generating savings were not always taken into account in PCT savings figures.

While performance on waiting times and infection rates was maintained, the committee expressed concerns that the need to make savings could be affecting aspects of care which are less rigourously measured.

Over the four years to 2014-15, transformational change is expected to generate 20 per cent of the total savings, but the DH expects that by the halfway stage—the end of 2012-13 - just 7 per cent will have been made that way.

8.19am Good morning. Since Innovation, Health and Wealth there has been substantial interest in the first tranche of academic health science networks now being established across England.

Fifteen aspirant networks submitted prospectuses to the Department of Health in October 2012 and, following panel interviews, successful applicants will start to become operational from April. As the first of these prepare to launch, Lucy Reynolds reflects on the experiences from the application process and shares emerging lessons.