Proposals to make it easier to dismiss NHS executives, why the NHS needs more more middle managers, plans for winter additional winter capacity, and the rest of today’s news

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4.43pm Nursing Times news editor Steve Ford reports nursing directors at the CNO summit gave Jeremy Hunt warm applause as he exited, somewhat hastily, to catch his train.

4.40pm Jeremy Hunt says the evidence that patients suffer if the registered nurse to patient ratio is below one to eight should be used as a point of reference. He says it could be acceptable on geriatric wards.

Unison head of nursing Gail Adams tweets:

4.35pm Hunt has been asked a question about EU border changes. He says the NHS “mustn’t turn people away if they need treatment”.

4.24pm Hunt is now taking questions from the audience. He says he has a “job to do to educate media that more reporting of incidents is not a bad thing as part of a more open culture”.

4.20pm Jeremy Hunt tells the CNO summit he has to be “honest” thenew guidance on staffing in the NHS is likely to “put pressure on NHS finances”. HSJ’s exclusive analysis of variations in nurse staffing ratios suggests the cost could run into the hundred of millions.

4.08pm Hunt is now talking about nurse numbers. He says it is is not possible to have good quality care without safe staffing.

JH: Implications of Francis is that, 1yr on from trusts planning to lose 7k nurses they are plan I g to increase numbers by 4k #CNOSummit

4.05pm Hunt says that for too long in the NHS the definition of success for leaders has been achieving targets. Patient experience is as importantwhile providing compassionate care should be as important to hospitals as their finances.

4pm Hunt talks about his experiences working in hospitals as part of the “back to the floor” initiative in the wake of the Francis report, including portering patients and emptying bed pans. He says the hard work of NHS staff is why waiting times in A&E have not gone up despite growing demand.

3.57pm Hunt tells the summit it has been “difficult year for the NHS, because we have done something v brave - confronted tragedies”.

3.56pm Nursing Times editor Jenni Middleton tweets:

3.43pm Health secretary Jeremy Hunt is about to speak at the chief nursing officer’s summit.

3.21pm The British Medical Association has responded to the Whistleblowing Commission’s report. Chair of council Mark Porter said the BMA’s view was that the focus shiuyld be on application of good practice at local level rather than on anything the government can do.

Dr Porter added: “However, the Commission’s recommendation that GPs and student healthcare workers, including doctors, be covered by PIDA, is something we feel the Government should take forward, as well as their recommendation against the introduction of financial incentives for whistleblowing.

“It is vital to empower doctors and to create a supportive culture where they are encouraged to raise concerns and, just as importantly, where they know those concerns will be listened to and acted on.”

3.13pm The charity Public Concern at Work has published the report of the Whistleblowing Commission it set up to review the laws protecting employees who speak out about concerns. The 25 recommendations include strengthening anti-gagging provisions in the law, specialist training for tribunal members to handle whistleblowing claims effectively and updating and broadening the definition of worker to include groups such as student nurses and doctors and volunteers and interns. The commission was chaired by former Court of Appeal judge Sir Anthony Hooper and also included former NHS hospital chief executive Gary Walker.

2.18pm Middle level managers have a vital role to play as NHS organisations review how they operate in the wake of the Mid-Staffordshire scandal, according to researchers from the Warwick Business School.

Professor Graeme Currie and assistant professor of operations management Nicola Burgess’ from Warwick Business school found middle management play a pivotal role in patient safety at hospitals.

“These managers may have different professional backgrounds, are located at different levels of an organisation and carry varying degrees of responsibility,” said Professor Currie. “What they all have in common, though, is the ability to act as a two-way mirror; capable not just of assimilating top-down management knowledge but also of translating and transmitting ideas belonging to clinical practice back up into their organisation.

He added: “There is a common theme running through recent reports into patient safety in the NHS: the failure of organisations to pick up and act upon concerns emanating from the frontline.

“Breaks in the information chain between day-to-day clinical practice and management structures have led to sub-standard services.”

The research was published in the September issue of the BMJ.

1.54pm Sarah Amani, chief clinical information officer for Surrey and Borders Partnership NHS Foundation Trust, also talks to HSJ on how opportunities must be taken and not handed out for BME staff. Barely a year into her career as a mental health nurse, Malawian born Amani blew the whistle on the poor quality care she witnessed in her ward.

1.26pm As part of our celebration of BME Pioneers working in healthcare Roger Kline examines Tony Blair’s 2003 prediction that “in 10 years’ time, ethnic minority groups should no longer face disproportionate barriers to accessing and realising opportunities for achievement in the labour market”. Has austerity and the combination of government policy resulted in us moving forwards on equality?

1.12pm The government’s additional £250m funding for accident and emergency this winter will be spent on more than 2,000 extra beds and extra staff, Jeremy Hunt has said. In an announcement press released yesterday the Department of Health said the extra staff is the equivalent of up to 320 extra doctors and 1,400 extra nurses, as well as up to 1,200 other NHS staff including physiotherapists and occupational therapists. Read the full story on HSJ here.

1.08pm HSJ’s Crispin Dowler reveals a group of clinical commissioning groups in the North of England are lobbying for direct access to the national database of provider patient safety incidents, the National Reporting and Learning Service. However, there are concerns providers would be reluctant to report events if they knew commissioners could access them.

12.59pm England’s hospital sector will have largely completed a reconfiguration of surgery for abdominal aortic aneurysms by April, HSJ’s Ben Clover reports. Read the full story for detail of what is going where.

12.49pm HSJ’s Shaun Lintern reports on plans to link very senior managers contracts to their organisation’s Care Quality Commission rating. The proposal forms part of the government’s response to the Francis report but there is skepticism about whether it would actually work in practice.

11.00am: This evening HSJ will be unveiling who is on our BME Pioneers list. The list forms part of our efforts to examine what can be done to create a more diverse mix at the top of NHS leadership.

The list will be announced at 7.30pm tonight on our BME Pioneers site here.


10.50am: Another story receiving a great deal of attention in the papers this morning is the NHS call for 100,000 so-called ‘good Samaritans’ to sign a pledge saying they will look in on an elderly friend or neighbour this winter. The campaign, backed by both the Daily Mail and the Daily Telegraph, comes amid concerns that too many older people are being admitted to hospital because they have been ignored.

The Telegraph reports that those who sign up to be “Winter Friends” online will receive cold weather alerts when the temperature drops, and advice about how to look out for vulnerable older people.

10.35am: Commenting on the NICE guidance on smoking in and around hospitals, Sir Richard Thompson, president of the Royal College of Physicians said:

‘As doctors we are especially aware of the harm that smoking causes to health, and the benefits of stopping smoking. Admission to hospital is a particularly important time and opportunity to stop smoking, and hospital, of all places, should be ready and able to help smokers to do so. We welcome this guidance and the RCP will do all it can to ensure that our hospitals become smoke-free.’

10.25am: HSJ will be holding a free webinar today at 12:30pm, in association with Norgine, to explore how to balance clinical efficacy of treatments with quality of life. The webinar is free, so to watch it click here and register.

Specific areas for discussion will include:

  • How can we decide where the balance should lie between clinical efficacy and quality of life?
  • How can we ensure that patients are sufficiently involved in the development of medications, and in health research and development more generally?
  • Will academic health science centres and networks make a difference in this area?

10.15am: A number of newspapers are reporting on NICE recommendations that smoking should be banned on hospital grounds for both staff and patients. The regulator added that smoking has been “tacitly endorsed” by the NHS for decades, the Times reports.

NICE also suggested that NHS staff should not be allowed to smoke during working hours or while in uniform. Professor Mike Kelly, director of NICE’s centre for public health said the NHS needed to end the “contradiction” of spending £2.7bn a year treating smoking-related illnesses while letting patients smoke and not helping them to break their habit, according to the Guardian.

The paper also writes that police have begun a criminal investigation into “alleged manipulation” of cancer waiting lists at Colchester general hospital. The news comes three weeks after Sir Mike Richards, the chief inspector of hospitals in England, said he had referred the matter to police afters concerns that lives might have been put at risk for the sake of waiting time figures.

9.41am: Welcome to HSJ Live. The Department of Health has published outline details of what the health service is doing to prepare for winter, in part funded by additional fundign of £250m. We have an overview report.