Michael White on NHS “fat cats”, plus the rest of today’s news and comment

  • The Care Quality Commission has denied accusations that its inspection of Hinchingbrooke Health Care Trust was ‘flawed’
  • Almost a quarter of civil servants working in the Department of Health want to leave within the next 12 months or as soon as possible, according to an internal staff survey
  • A clutch of clinical commissioning groups ended 2014-15 expecting deficits up to three times higher than planned

5.10pm The first of eight midwives accused of misconduct related to poor care and deaths at University Hospitals of Morecambe Bay Foundation Trust will appear at a fitness to practise hearing next week.

Allegations against Marie Ratcliffe, a former band 7 midwife at Furness General Hospital, will be heard before a Nursing and Midwifery Council panel, starting on Monday.

The allegations include claims she failed to adequately monitor patients, record key observations in patient notes or request assistance from doctors between 2004 and 2013.

4.30pm London Ambulance Service Trust has asked clinical commissioning groups to contribute more than £27m extra funding to help it recruit more staff and buy new vehicles.

This is on top of the amount paid to support activity, which has not yet been agreed because contract negotiations are ongoing.

3.06pm Peterborough and Stamford Hospitals Foundation Trust has still not agreed contractual arrangements with its new commissioner for older people’s services, despite the NHS owned organisation taking charge of services this month.

Peterborough and Stamford’s March finance paper outlined a series of disagreements between the trust and newly formed UnitingCare Partnership, the joint venture set up to be the prime provider for an £800m integrated older people’s services contract.

2.10pm The Care Quality Commission has denied accusations that its inspection of Hinchingbrooke Health Care Trust was ‘flawed’ or that the high profile trust was treated differently to other providers it has inspected.

 The accusation, made by private provider Circle, which ran the trust at the time that it was placed in special measures, followed the regulator yesterday publishing a report upgrading the trust’s rating from “inadequate” to “requires improvement”.

1.45pm The Mirror has today splashed with the story of Britain’s youngest ever organ donor.

Teddy Houlston died shortly after birth in April last year. His parents Mike and Jess gave permission for his kidney and heart vales to be donated, saving the life of an adult.

Paul Murphy, of NHS Blood and Transplant, said it was very rare for babies to become donor’s, and Teddy’s was “milestone moment”.

“Every donation is inspirational. It is a selfless act of heroism, he said. “But Teddy’s story is exceptional. He was the youngest organ donor in the UK.”

1.14pm The Guardian reports that being dangerously overweight is down to bad diet and nothing to do with a lack of exercise, according to a trio of doctors who have reopened the debate about what is responsible for obesity.

The authors says that while physical activity helps reduce the risk of developing heart disease, dementia and other conditions, it does not promote weight loss.

They accuse firms such as Coca-Cola as having wrongly emphasised how exercise and sport can help people becoming very overweight.

11.58am Almost a quarter of civil servants working in the Department of Health want to leave within the next 12 months or as soon as possible, according to an internal staff survey.

Eight per cent of respondents to the survey, carried out last year, said they want to leave as soon as possible, while 16 per cent wanted to leave in the next year.

The document, seen by HSJ, also reveals civil servants in the department were reluctant to raise concerns – 32 per cent said they do not believe a concern would be investigated properly. More than a quarter (28 per cent) said the DH is not a safe environment to challenge the way things are done.

11.45am Responding to the King’s Fund report published today, the Healthcare Financial Management Association’s policy director Paul Briddock said: “The [NHS] Five Year Forward View sets up a £30bn funding challenge for the NHS over the next parliament of which £22bn would come from savings and £8bn from additional cash.

“Currently both the Tories and the Lib Dems have pledged an extra £8bn, but even with this, achieving £22bn in efficiency savings is unprecedented.

“It’s going to be a huge challenge for the NHS and will mean providing a level of savings that have never been achieved in the past.

 “As such the Five Year Forward View will require radically different ways of providing care and much more integrated health and social care systems, as well as forcing different parts of the healthcare system to work more closely together.

“Whilst we welcome the £8bn pledges from parties, we haven’t heard much from the scale of the £22bn challenge that will remain.

“Given all this, it’s no surprise whatsoever that there is this level of scepticism among finance directors around the achievability of the overall scale of the challenge despite those funding pledges.

“This mirrors what we have found in the HFMA’s Temperature Checks over the last year where finance professionals have taken a pragmatic and realistic view of what’s achievable. We would certainly concur with what’s been found in the survey.”

11.30am The NHS is “facing its biggest challenges for many years” due to “mounting deficits, worsening performance and declining staff morale”, according to the latest quarterly monitoring report from The King’s Fund.

Hospitals and other NHS providers in England look set to overspend their budgets in 2014-15 by more than £800m, the report has found.

This comes in spite of nearly £900m being provided by the Treasury or switched from capital budgets to plug the the black hole in NHS finances.

Almost 60 per cent of trust finance directors said that they were dependent on additional financial support or had drawn down their reserves in 2014-15, the report has found.

What’s more, Two-thirds of hospitals are concerned about staying within budget in 2015-16. Forty per cent of clinical commissioning group finance leads are also concerned about being able to balance the books inthe next financial year.

Other findings from the report include:

  • for the third consecutive quarter, staff morale tops the list of concerns raised by trust finance directors
  • fewer than half (45 per cent) of trusts feel confident that they will achieve the productivity targets for 2015-16
  • 90 per cent of trust financial directors and 85 per cent of commissioners are concerned about the financial state of their local health economies
  • there is a mismatch in expectations about demand for services between providers and commissioners; for example, 80 per cent of trusts expect emergency admissions to rise this year, while 60 per cent of CCGs expect them to fall
  • around three quarters (75 per cent) of trusts and two thirds (68 per cent) of CCGs think there is a high or very high risk of failing to achieve the productivity gains over the next five years outlined by the NHS Five Year Forward View.

Commenting on the report, King’s Fund policy director Richard Murray said: “The health service enters the new financial year facing some of the biggest financial and performance challenges in its recent history.

“If last year was the most difficult for some time, this year promises to be much worse, with little confidence that the alarming deterioration in NHS finances can be arrested.

“Looking further ahead, while there is still significant scope to improve productivity in the NHS, efficiencies are becoming harder to generate and there is considerable scepticism that the £22bn in productivity improvements outlined in the NHS Five Year Forward View can be achieved.”

11.11am West Hertfordshire Hospitals Trust has suspended midwifery obstetric services for private patients at Watford Hospital, following feedback from the Care Quality Commission.

The change will take effect next month, after the CQC inspected the hospital last week. Twenty-seven women due to give birth in the coming months were expecting to use the service.

10.40am Times columnist David Aaronovitch writes that despite the NHS being the top concern for nearly half of all voters not one of the main parties has explained how they will meet the stand-still cash needs of NHS England up to 2015, let alone their party aspirations for improvement.

He writes that the new government faces an “immediate NHS cash crisis” in a situation where there are already deteriorating outcomes in waiting times and in A&E.

10.34am The Times reports that Labour promised yesterday to divert cash from expensive cancer drugs to pay for an upgrade of ageing equipment used to treat the disease.

Campaigners warned that patients would lose access to life-extending medication, while experts said more lives could be saved if money was spent on modern radiotherapy methods, which are more likely to cure cancer.

10.25am The Daily Mail has picked up HSJ’s story that more than a third of clinical commissioning groups are considering introducing limits on access or eligibility for services this year amid huge financial pressures, according to our latest CCG barometer survey.

The Mail leads with the line that obese patients could be denied routine operations in order to save money.

10.12am Here’s something else you may missed yesterday: With two weeks to go until the general election, the NHS is a top priority for voters, and all the main parties have set out their key health policy pledges in their manifestos.Therefore, HSJ has created two diagrams above show where the parties’ health policy promises do and do not overlap.

With the election on 7 May likely to result in a hung Parliament, any common ground on the NHS may be a vital factor in post-election negotiations between parties, and in what policies emerge.

The graphics focus on two possible scenarios. The first explores the common ground between Labour, the Liberal Democrats and the Scottish National Party – a triumvirate many experts believe will have to work together in some form after 8 May. The second examines Conservative policies compared with those of their current coalition partners the Liberal Democrats.

The diagrams are based on pledges published as part of each party’s manifesto. Bear in mind that they are not exhaustive - not all policies are listed.

Click here to view the diagrams and take a look at the common ground between parties’ health policies.

10.07am Social media can have a significant impact on debate around the NHS. HSJ has investigated online discussion around the hot topic of accident and emergency performance to reveal the top influencers, when debate kicked off and why.

9.50am In case you missed it yesterday, the Care Quality Commission has upgraded Hinchingbrooke Health Care Trust’s rating from ‘inadequate’ to ‘requires improvement’ but it remains in special measures.

The improved rating is based on a follow-up inspection the regulator carried out shortly before it published a highly critical report on the trust in January.

Hinchingbrooke was, until the beginning of this month, the only trust in the country to be operated by a private company – Circle. It returned to the NHS on 1 April.

7.00am Good morning and welcome to HSJ Live. We begin the day with Michael White’s weekly politics column.

This week one of the stories which Michael discusses is the revelations in the Daily Mail about pay for “NHS fat cats”.

“Speaking for myself, I was mightily offended by the Mail’s revelations about excessive pay and perk packages for trust chief executives whose hospitals seem to be underperforming one way or another. Not to mention the ingenious ways in which remuneration, including pensions, was maximised and tax liabilities apparently diminished.”

However he adds: “I say ‘apparently’ because you have to be careful reading this stuff. Not content with uncovering substantial evidence that senior management pay is underregulated in much of the public service (aping habits in city boardrooms), the Mail gilds its lily with gratuitous, perhaps misleading, detail.”