Ministers across government are focusing on attempting to cut the rate of delayed transfers of care in a renewed effort to improve accident and emergency performance ahead of the general election, plus the rest of today’s news and comment

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5.30pm The health select committee meeting has now ended.

5.29pm Norman Lamb said end of life care has been a long neglected area, but there are developments happening around it that have the potential for achieving better.

5.28pm Martin McShane said Keith Willett has been doing a lot of work around urgent and emergency care, and aligning and co-ordinating local systems together.

He said the ambulance service has transformed from a taxi service to a mobile treatment service, and in may cases are treated by paramedics at home without necessarily being needed to be admitted to hospital.

5.19pm Martin McShane notes there are four times as many care home beds in England than hospital beds, and there is a need to work together. He pointed out the five year forward view also sets out new models of care for care homes and smaller hospitals.

4.56pm Conservative MP David Treddinnick has asked whether the NHS has considered a wider rollout of complementary therapies in end of life care.

Mr Lamb said the view in the hospice movement, whichb he supports, is that “if these therapies are seen as important to people then they can absolutely play a role.

4.51pm Sarah Wollaston has asked why pilots into free end of life social care were inconclusive.

Martin McShane clarified that the pilots were designed to understand how the money was being spent, and to get the baseline established.

4.48pm Mr Lamb said there is “ridiculous situation” that end of life hospital care is free, where many people do not want to be when they die, but end of life care at home is not.

He said it was would an “attractive proposition” for end of life social care to be free.

4.43pm Mr McShane said the tariff could be ready to roll out within the next three years.

Mr Lamb said a cautious approach was necessary to avoid any unintended consequences.

4.42pm Mr Lamb said work was underway to develop a tariff for end of life care.

He said there should be a number of areas ready to trial this new approach in 2015-16.

4.40pm Norman Lamb said the ecognition that we need to train the general healthcare workforce on end of life care is very clear.

4.39pm Charlotte Leslie also asked why comparatively few NHS staff have recieved end of life training.

Mr McShane has said there needs to be a distinction between staff gettting manditory training and training. “You can overload the system with manditory training”, which becomes “burdonsome”, he added.

4.35pm Conservative MP Charlotte Leslie has asked by the NHS five year forward view only gave a cursart mention to end of life care, and whether this means it was not a priority.

The forward view was “setting out a direction of travel” and “didn’t mention a lot of things”, Martin McShane responded.

4.30pm Mr McShane said that the conversation needs to be moved to clinicians asking patients what they would want to happen to them when they approach death.

4.26pm NHS England’s nursing directorate is working to get increased community nursing placements to support end of life care, andit has recruited a specialist advisor to assist with this, Mr McShane said.

4.24pm Mr McShane pointed to the new models of care outlined in the five year forward view, which are already beginning to be implemented.

4.23pm Martin McShane said NHS England has set out a clear steer thatthere should be more flexibility in contract and payment arrangements.

4.22pm Mr Lamb said there is a widepread recognition that the payment system needs to reform, and Monitor is doing work around that.

4.20pm At the health committee, care services minister Norman Lamb said the majority of people want to die at home and there are clearly NHS workforce implciations around that.

Mr Lamb said there is a agreement across the political system for shifting care out of hospital, but these intentions are undermined by a payment system that is distorted.

4.15pm Jeremy Hunt has responded to Andy Burnham’s letter to him about major incidents, The Guardian reports.

Mr Burham criticised NHS England guidance issued to NHS organisations in the West Midlands outlining “enhanced criteria” that should be met before a hospital trust declares a major incident.

The health secretary reiterated that “these were local operational decisions taken by NHS managers”.

He said: “For the avoidance of doubt, these decisions remain entirely a local decision for the local NHS. I was neither aware of nore have approved any new local guidance in the West Midlands.

“I am not aware of any other guidance on major incidents being issued in other regions but this would be a matter for the local NHS who take these decisions.”

Mr Hunt clarified that the guidance has been issued to CCGs in the area, not to hospital trusts.

3.51pm Care services minister is now appearing in front of the health select committee to discuss end of life care.

NHS England’s director for long term conditions Martin McShane is also speaking at the committee meeting.

3.24pm Social care spending for people over the age of 65 fallen by a fifth in a decade, according to BBC analysis.

2.56pm Labour must resist the urge to dictate and mandate in its 10 year plan, says NHS Clinical Commissioners co-chair Steve Kell.

Mr Kell, who also chairs Bassetlaw Clinical Commissioning Group, argues with the NHS as a key election battleground, parties need to give us clarity, not mere aspirations.

2.35pm Care services minister Norman Lamb is due to appear in front of the health select committee, which has just begun, discussing end of life care.

2.34pm Following the launch of Labour’s ten year health plan yesterday, The Guardian reports that Ed Miliband is facing a backlash by Tony Blair supporters, who have warned that it risks playing into the hands of the Conservatives.

Former Labour health secretary Alan Milburn said the party was running “a pale imitation” of the 1992 general election campaign in it was defeated, in an interview with BBC Radio Four’s World At One yesterday.

Mr Milbrun warned it would be a “fatal mistake for Labour to go into this election looking as though it is the party that would better resource the NHS but not necessarily put its foot to the floor when it comes to reforming it.”

2.22pm East Kent Hospitals University Foundation Trust has appointed an interim chief executive to succeed Stuart Bain when he retires in March.

Chris Bown will take on the role for a year. He was most recently interim managing director of County Hospital in Stafford, before Mid Staffordshire Foundation Trust was dissolved in November.

Previously he was chief executive at Poole Hospital Foundation Trust and prior to that he ran West Suffolk Trust for 10 years.

Mr Bain was diagnosed with lymphoma two years ago and announced his retirement from in August last year.

1.58pm Ministers across government are focusing on attempting to cut the rate of delayed transfers of care in a renewed effort to improve accident and emergency performance ahead of the general election.

HSJ understands that the weekly “Monday meetings” between health secretary Jeremy Hunt and the leaders of national organisations, which previously had a strong emphasis on A&E, have expanded to include communities and local government secretary Eric Pickles and minister for government policy Oliver Letwin.

Several senior sources with knowledge of the meetings have told HSJ that they have been running in their new form since the beginning of the year. The meetings are understood to address whole system improvement in the context of A&E performance, with delayed transfers as a significant area of focus.

1.18pm The NHS trust sector’s financial position has deteriorated to an overall deficit of £414.2m, providing new evidence of the pressure trusts are under.

Papers presented at the NHS Trust Development Authority’s board meeting last week show that for the eight months to November last year the trust sector is £38m further into the red, compared to the £376.2m deficit it reported in the six months to September.

1.07pm Labour MP Rosie Cooper has said hospital executives in her consistuency were too concerned to declare a major incident because of concerns about the political consequences.

12.56pm Birmingham Edgbaston MP Gisela Stuart said the guidance has not be felt as if it is merely operational guidance by NHS staff on the ground in the West Midlands, who are feeling very pressurised.

12.54pm Mr Hunt said sensible local guidance, as that issued by West Midlands, should be supported by ministers and not used a political football.

12.49pm Health committee chair and Totnes MP Sarah Wollaston said ministers should never lean on operational decision making, and should allow the NHS to make local decisions.

12.46pm Mr Hunt again stressed the decision to issue the guidance was an operational decision, and nothing to do with ministers.

He accused Labour of “sinking to new depths” to weaponise the NHS, and again brought up the Mid Staffordshre scandal.

12.43 Mr Burnham quotes the document, saying: “Major incidents should be agreed with from the director on call from NHS England”.

12.41pm Jeremy Hunt said any decision to declare a major incident is taken locally.

He said document referred to by Mr Bunrham was from the local NHS in West Midlands to help CCGs work with local NHS organisations to deal with pressures felt this winter.

He quotes NHS England’s Barbara Hakin, who today stressed it was local decision, and neither the responsbility of minister or came as a result of from pressure from ministers.

13.29pm Andy Burnham has now asked an urgent question askingthe health secretary about NHS England guidance on hospital trusts declaring major ic

12.29pm Liberal Democrat MP Julian Huppert has asked the prime minister whether the future of Hinchingbrooke Hospital should remain with the NHS in Prime Ministers Questions.

12.22pm Royal United Hospitals Bath Foundation Trust has taken over Royal National Hospital for Rheumatic Diseases FT after its proposal was approved by Monitor.

Royal National Hospital for Rheumatic Diseases FT jointly applied with the Bath trust for the takeover.

12.13pm Ed Miliband has brought up NHS England’s guidance on declaring major incidents at Prime Ministers Questions today.

David Cameron said: “The NHS in the West Midlands without any instruction from the Department of Health, without any instruction from ministers, issued a statement about major incidents.

“The head of NHS England was asked about it this morning and she [sic] said this: ‘I haven’t been under any political pressure. This document was issued in the West Midlands’.”

12.08pm EXCLUSIVE: Two commissioning support units have not made it on to NHS England’s procurement framework, placing their viability and the futures of around 2,200 staff in doubt, HSJ has learned

North West CSU - which serves clinical commissioning groups in Cheshire, Merseyside and Greater Manchester - and Yorkshire and Humber CSU were unsuccessful in their bids for accreditation to provide the full range of “end to end” support services.

Staff at the CSUs were briefed on the issue last week.

10.55am Following Mr Burnham’s letter, the health secretary has tweeted:

10.52am Here is the full letter from Andy Burnham sent to Jeremy Hunt:

Dear Jeremy

NHS England guidance on ‘major incidents’

As you will recall, in the first week of January, at least 14 Trusts in England declared major incident status due to pressure on A&E services.

Official figures show that hospital A&Es were under similar pressure during the second week of January:

  • Only seven out of 140 hospital A&E departments hit the 95 per cent target
  • Four hospital A&E departments saw less than 70 per cent of patients within four hours
  • There were 14 ‘A&E diverts’ and one ‘A&E closure’

However, it would appear that there have been no further major incidents declared or reported since the first wave in the first week.

It has now been brought to my attention that new guidance was issued to some of England’s largest trusts in the West Midlands area setting out the ‘enhanced criteria’, covering 17 detailed points, which must be met before a major incident can be declared. It would appear from correspondence I have seen that this guidance was developed by an office of NHS England earlier this month and issued to CCGs shortly afterwards.

Procedures for declaring major incidents are long-established in the NHS and it is a highly unusual move for new guidance to be issued in the middle of a difficult winter. This had led some in the NHS to question the motives behind it. I have been shown correspondence from NHS staff referring to the guidance, in which the Head of Operations at a major Trust says:

“This is the enhanced criteria that have been introduced by NHS England (to effectively stop trusts from calling a major incident). Worth sharing with the ED consultants as our hands will be tied in most cases if they wish to all a major incident for capacity reasons.”

As I am sure you will agree, this is a very serious matter and raises a number of important questions:

  • Has the same guidance been issued in other English regions?
  • Were you aware or NHS England at national level aware of this change to the criteria and did you/they approve it?
  • Can you explain why a decision was taken to introduce it so abruptly in the middle of January?
  • Do you acknowledge the risk that trusts could perceive this as an attempt to stop them declaring major incident status even though it might be necessary?
  • Are you fully satisfied that this new guidance will not make it harder for trusts to declare a major incident and put patient care at risk?

It is clear from the emails I have seen that clinicians and managers at the front-line have interpreted this guidance as a move to keep A&E pressures out of the news. I am sure you will agree that is a worrying perception and will want to take steps to answer the questions I have set out as a matter of urgency.

I look forward to your response.

Best wishes,

Rt Hon Andy Burnham MP

10.48am Andy Burnham has written to health secretary Jeremy Hunt criticising new guidance issued byNHS England on acute trusts declaring major incidents.

 The shadow health secretary said it was brought to his attention that new guidance was issued to some large West Midlands setting out the ‘enhanced criteria’ that must before a trust can declare a major incident.

 He pointed out that at least 14 trusts declared major incidents in the first week of January because of accident and emergency pressures, but there have been no further major incidents declared since.  

 Mr Burnham said: “Procedures for declaring major incidents are long-established in the NHS and it is a highly unusual move for new guidance to be issued in the middle of a difficult winter. This had led some in the NHS to question the motives behind it.

He also said he was shown correspondence from the head of operations at a major trust, stating: “This is the enhanced criteria that have been introduced by NHS England (to effectively stop trusts from calling a major incident). Worth sharing with the ED consultants as our hands will be tied in most cases if they wish to all a major incident for capacity reasons.”

He said it was a “very serious matter” which “raises a number of important questions”, including whether similar guidance was issued elsewhere and “why a decision was taken to introduce it so abruptly in the middle of January”.

“It is clear from the emails I have seen that clinicians and managers at the front-line have interpreted this guidance as a move to keep A&E pressures out of the news,” the shadow health secretary added.

“I am sure you will agree that is a worrying perception and will want to take steps to answer the questions I have set out as a matter of urgency.”

10.32am We need to recalibrate our view of what we expect from the NHS and what we wish to pay for. Patient expectations and NHS budgets do not match, writes Serco’s strategic development director John Myatt.

10.19am Ambulance services would take over the running of the non-emergency 111 telephone service under a Labour government, Andy Burnham has revealed.

Unveiling the party’s 10 year plan for the NHS at the King’s Fund yesterday, the shadow health secretary said ambulance services would become an “integrated provider of emergency and out of hours care”.

“As NHS 111 contracts expire, we will look at ambulance services taking them on, so that in time they can handle all 111 and 999 calls from the same call centres,” Mr Burnham said.

He said this would result in “more experienced staff on the phones and better classification of calls”.

10.07am Here’s another announcement you may have missed yesterday: NHS England will continue to commission specialist renal and morbid obesity services in 2015-16 after concerns were raised by organisations including NHS Clinical Commissioners who said patients could be put at risk if the services were transferred this April.

NHS England said it will keep under review whether to transfer responsibility to clinical commissioning groups, but any changes would not happen before April 2016.

Director of commissioning specialised services Richard Jeavons said: “We all want what is best for patients, and we have listened extremely carefully to their views and those of CCGs. For the time being we will continue to directly commission these services, which will give us head room to work through the proposals in more detail and address the issues that have been raised with us.”

NHS England has launched a consultation into how it will prioritise which specialised services and treatments to invest in.

It directly commissions around 145 specialised services. It is now going to decide which of these it will continue to fund.

The consultation will last for 90 days.

The NHS England board voted to extend the length of the consultation at their last board meeting in December.

Mr Jeavons said: “We want to ensure patients have access to the very best innovative, evidence-based treatments and services that are being developed all the time. We need to get the most out of every pound for the benefit of patients. They asked us to consult on the principles and process behind making these decisions, which is exactly what we are doing.”

This process is looking at the specialist treatments and services that will be routinely available for groups of patients on the NHS. Clinicians, on behalf of their patients, will continue to be able to make a request (an Individual Funding Request) to NHS England for treatment that is not routinely available.

NHS England is also seeking views on which specialised services should be prioritised for ‘service reviews’ as part of a rolling programme of reviewing how each specialised service is delivered. NHS England is writing to all providers of specialised services, Clinical Reference Groups and associated patient groups seeking their views on where to concentrate efforts over next 12 – 24 months. 

9.58am The Daily Telegraph’s lead story this morning mentions HSJ’s exclusive interview with Ed Miliband, in which the the Labour leader refused to confirm that he would Andy Burnham the post of health secretary if Labour won the next election.

The paper writes: “Mr Burnham has been in the shadow post since 2010, but has repeatedly come under fire for his handling of the NHS when he was health secretary before that – most notably for refusing a public inquiry into the Mid Staffs hospital trust scandal.

“While praising Mr Burnham’s current work, Mr Miliband told the journal that his policy was “never to nominate anybody for government” because it suggests he is presuming victory or “measuring the curtains”

9.45am In case you missed it when the story broke yesterday, NHS trade unions have suspended a 12 hour strike planned for Thursday, with the government appearing to give in to demands for a 1 per cent pay rise to all non-medical staff.

Unions will now consult their members on the offer, which follows several meetings with Department of Health officials and health secretary Jeremy Hunt in recent days.

7.00am Translating models into practical delivery is fraught with dangers, as any health or social care provider will tell you, writes Joe McCrea, managing director of JB McCrea and a course tutor for the NHS Leadership Academy

Recent history is littered with examples of “local reconfiguration” going awry when it comes to getting on board local patients, carers, service users, stakeholders and decision makers.