5.30pm More from the Labour conference in Brighton:
HSJ’s Sarah Calkin attended a session on the role of doctors after the Mid Staffordshire Foundation Trust scandal earlier today, where General Medical Council chief executive Niall Dickson was on the panel.
She emails HSJ Live to say: “I asked about the decision not to pursue fitness to practise investigations against senior doctors from Mid Staffordshire Foundation Trust and whether a doctor could ever be sanctioned by the GMC for failures in a management role under the current policies.
Mr Dickson said the GMC had introduced new guidance on leadership and management in 2011.
He added: “That’s fairly clear about the expectations of doctors in leadership roles. If they broke the guidance … they would put their licence at risk.”
He gave the example of a responsible officer under the new revalidation system “signing off doctors” as fit to practise when they knew appraisals in the organisation were “not worth the paper they were written on”. Alternatively if a medical director was made aware of patient safety concerns but failed to act that would also be a “major issue”.
Former Bristol chief executive Dr John Roylance, the last doctor to be struck off for failures in management, was prosecuted by the GMC after he failed to act when safety concerns were raised with him.
Mr Dickson said in the case of the Mid Staffs doctors they had tried to do something and the criticism was they should have done more or gone outside the organisation with their concerns. Mr Dickson said that was not enough to deprive someone of their livelihood.
4.49pm The Royal College of Nursing has sent through a statement on the pay review (see entries this morning).
Dr Peter Carter, chief executive and general secretary said: “A pay increase of 1 per cent for hard working frontline staff, following years of real-terms pay cuts, should not prevent employers from recruiting more nurses.
“We acknowledge that savings must be made in the NHS, however surely it would be better to start with the many examples of waste, in procurement and IT systems for example.
“It is demoralising for nursing staff to discover that while senior managers have enjoyed a pay increase of 13 per cent since 2009, it is frontline staff who are being asked to sacrifice their living standards to save the NHS money. These frontline staff are already suffering as a result of NHS cuts, as they face greater demand with fewer resources. Another year of pay freezes sends entirely the wrong message that this contribution is not being valued while putting staff under even more pressure, which is bad for patient care.”
4.29pm Here are some extracts from Ed Miliband’s speech, transcribed by Politics Home.
“There’s so much more our countries could be doing for our grandmas and granddads. Just putting a £50 grab rail in the home stops somebody falling over, prevents them ending up in hospital with the needless agony, and all of the money that it costs.
“The 1945 Labour government raised its sights, even in tough times. I want the next Labour government to do the same: to raise our health in the NHS. Bringing together physical health, mental health, and all the care for the needs of the elderly: a true integrated National Health Service.
“But we don’t just need to improve the health service, friends; we’ve got to rescue it from these Tories. And the Liberals too…
“Before the election I remember the speeches by David Cameron; one where he said the three most important letters to him were NHS - he’s got a funny way of showing it hasn’t he? When they came to office they were still saying how brilliant everything was in the National Health Service. Have you noticed they’ve changed their tune recently? Suddenly they’re saying how bad everything is in the National Health Service.
“…the reason David Cameron is running down the NHS is not because the doctors and nurses aren’t doing as good a job as they were before, it’s because they’ve come to a realisation, the health service is getting worse on their watch, and they’re desperately thrashing around finding someone to blame: doctors, nurses, the last Labour government - that’s what they’re doing!
“…when you heard David Cameron casting around for someone to blame for the NHS, it’s as simple as ABC - Anyone But Cameron. We know who’s responsible for the needless top-down reorganisation that no one voted for or ever wanted, for the abolition of NHS Direct, we know who’s responsible for not just an annual A&E crisis but for an A&E crisis for all seasons: this Prime Minister. It’s the same old story; we rescue the NHS, they wreck the NHS, and we’ll have to rescue it all over again - that is what the next Labour government will do.”
3.40pm Politics Home editor in chief Paul Waugh tweets: “Nhs always gets Lab conf on their feet. And worked for EdM again.”
3.33pm HSJ’s comment editor Andy Cowper, who is attending the Labour conference independently as a speaker, tweets: “The NHS clenches its buttocks at the prospect of being front stage centre for the next general election campaign. Inevitable, alas.”
3.24pm Isabel Hardman of the Spectator tweets: “Standing ovation for the ‘we’ll rescue the NHS’ line.”
3.23pm Kaye Wiggins: “Ed: We know who’s responsible for cuts to social care and fragmentation of services. It’s this PM #lab13”
3.22pm Sarah Calkin: “EdM: even in tough times we can raise our sights, like govt of 1945, and brig together physical health mental health & social care”
And: “First whooping of Ed’s speech when he mentions levels of satisfaction with NHS when last labour govt left office #hsjlab13”
We assume the “whooping” is from the audience, not from Mr Miliband himself.
3.21pm In contrast to Randeep Ramesh’s tweet (3.18pm) right-leaning commentators are more sceptical of Miliband’s claim to have saved the NHS.
Tim Montgomery, former editor of Conservative Home and now comment editor on the Times, tweets: “Tell the people of Mid Staffs that Labour rescued the NHS.”
3.19pm Sofia Lind of Pulse tweets: “Last Labour government solved an A&E crisis… [Ed Miliband says] “We did rescue the National Health Service!”, he now shouts #lab13”
3.16pm: LGC’s Kaye Wiggins: “Ed endorses Andy Burnham’s plan for “fully integrated” physical, mental and social care #lab13”
3.14pm: Patrick Leahy again: “Miliband reiterates that Labour govt will bring in an integrated physical, mental and social care service in the future”
3.10pm Kaye Wiggins, reporter on our sister title LGC, tweets: “Ed’s onto care for the elderly. “A £50 grab rail prevents a fall and all the money and agony it costs” #lab13
3.07pm Patrick Leahy, public affairs official for the Royal College of Surgeons tweets:
3.05pm Our reporter Sarah Calkin, who is in Brighton for the Labour conference now, tweets:
3.04pm Labour leader Ed Miliband is talking about the NHS in his speech to the party conference in Brighton. Quotes to follow…
2.56pm An exclusive story from our workforce reporter, Shaun Lintern: Next year’s pay rise for NHS staff could be linked to changes in their working practices to help force more seven-day working.
NHS Employers will argue for the second year running that pay for the 1.4 million strong NHS workforce should be frozen, claiming a 1 per cent rise would add £500m to the NHS pay bill.
But the body will also try to persuade its members to back an idea to make any future pay rise part of possible contract reforms.
1.44pm Monitor inform us that the NHS Futures Summit will not be held in public, but “the content of the summit will be made public and open to public debate”. That means the regulator will invite public debate in the run up to the event, which takes place in November, and will produce a report afterwards.
1.36pm Monitor’s call for papers for its Futures Summit encourages contributors to be radical, but asks submissions to make the following assumptions:
1. Scenarios should describe a health service that continues to offer universal access, and is tax-funded and free-at-the-point-of-need. They should assume those objectives will continue to shape the NHS payment system.
2. Funding for major infrastructure and capital projects is unlikely to be available for the foreseeable future. However, scenarios may propose more innovative ways to use available capital, both infrastructural and financial.
3. Demand for health services will continue to increase at levels roughly equivalent to the historical rate of about 4 per cent a year.
4. The population in England will rise by between 8.4% and 12.2% in total between 2010 and 2020/22, and continue to age.
5. There will be no centrally-mandated NHS re-organisation between now and 2021 although local reconfiguration and restructuring will be possible.
6. NHS settlements over the next ten years will be flat in real terms. Inflation means that nominal NHS spending will be £115 billion by 2023, but this will equate to the same spending power as the current NHS budget of £95 billion.
1.29pm Here are some extracts from Monitor’s call for papers on the future of the NHS.
“….what should the future NHS look like?
“To consider this question, Monitor, NHS Trust Development Authority and NHS England are convening the NHS Futures Summit on 21 November. Health system leaders and experts, patient representatives, commissioners and providers will debate future scenarios for the NHS, chaired by David Bennett from Monitor, Malcolm Grant from NHS England and David Flory from the NHS TDA.”
“We will consider any well-developed, practical idea for the future of the NHS from any contributor, be they a patient, health care professional, academic, or from outside the sector, although we recognise that practical ideas are likely to be based on experience.”
Submitted papers “should set out a scenario for the NHS ten years from now. Each scenario should include the types and mix of services that could emerge, as well as the types and mix of providers of those services, based on a set of common assumptions about future health needs and policy, economic constraints and demographics.”
1.26pm The reason Monitor is hosting a Twitter chat on the future shape of the NHS (see 1.07pm today) is that it is launching an “open call for papers” ahead of something called the “NHS Futures Summit”. We’ll be trying to find out what that is this afternoon.
1.07pm That Monitor Twitter chat (see 11.57am) is getting underway now. Use the hashtag #nhsfutures to get involved.
1.05pm Candace Imison, acting director of policy at the Kings’ Fund, has written this piece for us about primary care reform. The drumbeat for reform is getting ever louder, and culture must trump the rules, she says.
1.01pm There are a couple of new opinion pieces on HSJ this afternoon. First, this, from Vita Sinclair - a final year medical student at King’s College London.
Flexible hours and more support from seniors would improve care for patients and the educational value of being on-call, she argues.
But, “it is critical that junior doctors and trainees have a voice in the discussions. It is they who have the most current experience of on-calls and for whom seven day care could mean unsociable hours for significantly longer than initially imagined.”
12.12pm Here’s some more south west merger news from Sarah Calkin: Two Dorset foundation trusts who are awaiting a decision on their merger plans have started work on plan B, HSJ has learned.
The Competition Commission has asked that no further work is done on integration until their assessment process comes to a conclusion. This effectively prohibits the work of the joint programme board and the proposed board.
12.01pm Our reporter for the south west, Sarah Calkin has the latest on an acute service reconfiguration in Bristol. Monitor has expressed concerns over a service swap between North Bristol Trust and University Hospitals Bristol Foundation Trust on the grounds of a loss of choice for patients.
Quality improvements, they judge, are not sufficient to outweigh the loss of patient choice resulting from the “merger”.
11.57am Monitor are taking to Twitter to find out what people think the NHS provider landscape should be like in ten years’ time. The chat begins at 1pm - to take part use the hashtag #nhsfutures.
11.50am More news courtesy of James Illman, this time in his capacity as our reporter for the data and technology beat: The Information Commissioner’s Office met with NHS England last Thursday to discuss legal concerns to the “care.data” project, particularly about the speed with which it was being implemented.
The intervention comes amid mounting GP opposition to the project.
11.45am HSJ’s east of England reporter James Ilman has an interesting story about money troubles in one of the largest clinical commissioning groups in the country.
Cambridgeshire and Peterborough CCG, which covers a population of 831,000, has reported a £787,000 year to date programme budget deficit, £1.1m behind a planned year to date surplus of £333,000.
This was partially offset by an underspend on running costs - the CCG spends most of its running cost allowance in house rather than using a commissioning support unit - leaving the group with an overall deficit to date of £5,000, still £338,000 worse than plan.
11.38am More from the nationals: The Daily Telegraph’s Laura Donnelly has a story on how 4,000 care homes have been allowed to break the law, with no registered manager in charge of residents. “The Care Quality Commission has turned a blind eye to the failing”, the story says.
11.16am Another new story for today on HSJ: Extra government funding will be used to treble the number of junior doctors at the accident and emergency department of a trust affected by the closure of services at Mid Staffordshire Foundation Trust.
The University Hospital of North Staffordshire Trust will increase their number from four to 12, in addition to the unit’s existing 17 consultants, thanks to an extra £1.8m of funding the trust has received to improve A&E performance.
11.14am A new story on HSJ this morning: A panel of experts is set to reveal its findings on divisive proposals to overhaul hospital services in west Wales.
Hywel Dda Health Board’s plans on accident treatment and specialist baby care were sent to health minister Mark Drakeford after patient watchdogs took exception. He will deliver the independent panel’s verdict on Tuesday.
The health board claimed the proposals would result in “first-class healthcare”, but critics are concerned about service cuts.
10.31am The Daily Mail has the story about Herceptin this morning, too.
“A new jab is set to revolutionise breast cancer treatment, and save the NHS millions of pounds”, their story goes.
The Mail also reports that an investigation by Pulse magazine has found one in five GPs in clinical commissioning groups has a financial link to private firms that stand to make money treating NHS patients. Of the 251 GPs who sit on CCG boards, 50 have a financial link to a private firm that holds a contract with their organisation.
And, there’s a story about the GMC and Mid Staffs: “Now all the doctors at Mid Staffs escape scot-free over deaths” is the headline.
10.10am NHS trade unions have collectively made their submission to the Pay Review Body today.
The fifteen unions that make up the staff side of NHS Employers have argued that pay has failed to keep pace with inflation, leaving NHS staff without a real-terms pay increase since 2006 and suffering a real terms cut of between 8 per cent and 12 per cent by 2014.
Christina Mcanea, joint chair of the NHS staff council said that real terms pay cuts, together with cuts in staffing and services, increased demand and, structural reorganisation, has led to “low morale and high stress levels”.
“We’re asking the PRB to investigate the impact of successive pay freezes and ongoing pay caps on NHS workers, because this is important for patients. The evidence is clear - supporting and investing in staff makes a real difference to patient outcomes.”
Josie Irwin, joint secretary of the NHS staff council said: “Frontline staff continue to work hard providing patient care throughout a period of uncertainty, and on top of this are struggling to cope financially as pay continues to fall behind inflation.
“Claiming that fair wages cannot be afforded, while the latest figures show senior managers have enjoyed substantial pay increases, sends the message to frontline staff that their contributions are not valued, which is bad for staff and bad for the NHS.”
10.07am NHS England’s press release about the new form of Herceptin treatment has just arrived (see 9.58am).
It says: “NHS England has today sanctioned a faster, more comfortable method for giving Trastuzumab (Herceptin) to breast cancer patients. From the 24th of September a new subcutaneous (SC) form of the drug will be commissioned. Herceptin SC will primarily be used to treat women with early breast cancer who currently get the drug with chemotherapy before or after surgery.
“Until now Herceptin has been delivered intravenously which means patients receive the drug by intravenous drip and each treatment takes between two and three hours. The revolutionary new subcutaneous formulation of Herceptin is given by an injection under the skin which takes just two to five minutes to administer. Patients will need to stay in hospital for around an hour and a half after the injection to be monitored, but it will half the time for the patient and be a considerably more comfortable treatment.”
There’s also a quote from Peter Clark, chair of NHS England’s chemotherapy clinical reference group and an oncologist at Clatterbridge Cancer Centre NHS Foundation Trust: “The new subcutaneous formulation of Trastuzumab will mean that women who are being treated for early breast cancer can have a much less invasive treatment than the current intravenous treatment. This will be of benefit to patients as less time is spent receiving treatment and it is a more comfortable form of receiving this drug. The faster treatment also frees up the time of highly trained cancer nurses to give care to patients on the ward.”
The new treatment will save time for nurses and hospital pharmacies in both preparation and administration of the drug, the release says. This will free up specialist cancer nurses and hospital pharmacists.
The sub cutaneous form of Herceptin is also expected to save costs to the NHS as the drug is given as a fixed dose not dependent on patient size or weight, minimising waste and reducing overall drug costs.
10.01am The Telegraph also carries a report at the top of page 17 on the GMC’s decision over Mid Staffs doctors. Victims’ families have said they are “bitterly disappointed” over the move.
9.58am The Daily Telegraph reports this morning that NHS authorities have agreed to fund a new breast cancer treatment. The two-minute injections of the drug Herceptin will replace existing treatments which take hours.
9.48am The Guardian has also done a short piece about the General Medical Council’s decision not to take action against Mid Staffordshire Foundation Trust doctors. The GMC’s legal advice found there was insufficient evidence against Dr John Gibson, Dr Valerie Suarez, Dr David Durrans and Dr Diarmuid Mulherin.
9.42am The Guardian has followed up our reporter David Williams’s story about falling accident and emergency performance in London. “Demand soars at busiest hospital casualty units”, is their lead story on page 6, which combines HSJ’s exclusive with reports of demand rising at the Royal London hospital.
8.40am: Good morning, replicating successful programmes implemented in the US, is not just a copy and paste job commissioned from the top down argue the Health Foundation.
With the health service under immense pressure to deliver improvements, a recently published report from the organisation explores the reasons why shortfalls in redesigns might occur. They say engagement of clinical leaders and on-the-ground staff is crucial.