Row between commissioners and a private midwifery service sparks calls for “urgent clarification” around commissioning rules, plus the rest of the day’s news and comment

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4.47pm Diabetes specialists from Heart of England Foundation Trust have taken their expertise to Ethiopia in a bid to help reduce cases of sight threatening diabetic retinopathy, a common complication from the condition that can eventually lead to blindness.

Having established the first diabetic retinopathy screening clinics at the Black Lions Diabetes Centre in the Ethiopian capital of Addis Ababa back in 2006, the team has since trained 40 healthcare professionals in Ethiopia to help run the programme, working with the Ethiopian Diabetes Association they raised enough money to purchase five digital cameras and two Pascal lasers. With a population of 90m, Ethiopia is seeing a steady increasing number of diabetic patients since the service began.

Paul Galsworthy, joint programme manager at Birmingham, Solihull and the Black Country Diabetic Eye Screening Programme, said: “It is a privilege to be able to help people living in a country like Ethiopia, who do not have access to the same standard of healthcare as those living in the UK. Through donations and raised funds, I have been lucky enough to visit Ethiopia five times to help set up the new digital camera technology and train staff how to use it, which is making a huge difference to the lives of people living with diabetes.

4.38pm The World Health Organisation has awarded a WHO World No Tobacco Day medal to a smoking cessation project in the north east.

Ailsa Rutter, director of FRESH, has been awarded the medal in recognition of her work in tackling smoking.  

3.53pm Our story on a row between commissioners and a private midwifery service has prompted a good debate:

“What I can’t understand is why the CCG’s are adamant that the quality of care given by the Local Providers is of of the highest quality? If this were true, women wouldn’t be crying out for a service like One to One Midwives! An NHS Policy has just been released to state that mental health patients can chose any provider from any area… Why has a policy for mental health been released yet pregnant women are being completely overlooked? It’s one rule for one and not for others! We are living in a country where everyone should have freedom of choice! One to One Midwives has the best maternity outcomes in the UK and is completely free… It’s unbelievable that CCG’s are not jumping onboard to promote such an outstanding service and improve maternity outcomes in their own areas.”

“One to One is… completely free… and has the best outcomes in the UK…? Can you please substantiate the claim that outcomes are best in UK, with figures. And no service is ‘completely free’… to whom? To pregnant women at point of use? Is this what you mean?”

“The GP who writes ABetterNHS has a very good explanation of that key sentence “NHS free at the point of use”. He gives the example of GP minor surgery somewhere in the North, which was free until they decided to run it as a company, after which it wasn’t. Services are free if they’re commissioned by the NHS. If not, they aren’t. I don’t have a view on the quality of the above service, other than to say the CEO should have gotten a contract in writing with agreed volumes and prices, then she’d have a stronger leg to stand on. Which gets us into AQP and tenders…..”

The review was announced in a letter circulated by the trust to NHS organisation in the region last month.

An outline business case on the proposed reconfiguration is due to be available later this year.

Avon and Wiltshire Partnership Trust, in partnership with nine local voluntary sector organisations under the consortium Mental Health Bristol, will be responsible for providing the bulk of the services as well as the system leader role.

This will involve ensuring a coordinated service between members of its consortium and the providers of a further three lots for a dementia wellbeing service, a mental health employment service and an assertive engagement service.

The new post holder, Professor Chris Harrison, has previously been interim medical director at the trust since October 2013, when Professor Cheshire began sharing the role of interim chief executive at the trust alongside his colleagues finance director Bill Shields and chair Sir Richard Sykes.

Professor Cheshire resigned from his board level position last month, a week after an investigation was launched by the trust.

2.30pm Our story on NHS England’s review of certain specialised services has attracted some interesting reader comments. If you’d like to join the debate then you can register here.

“Please please please stop devolving things to CCGs without the associated budgets, management costs and staff- things are spiralling in to PCTs and we stand to lose the clinical voice through an avalanche of delegated bureaucracy and regulations.”

“And all because someone somewhere failed to appreciate the sheer amount of work involved in chemotherapy commissioning, regimen development and audit when getting rid of the cancer network pharmacists as part of the NHS transition by not including them in the structure. I suppose now they realise there’s specialist work to do that they don’t have the knowledge to do properly- so lets dump it on the CCGs.”

“Part of the huge overspend on specialised was because of the failure to clearly identify the budget associated with specialised provision and failure to forecast growth. CCGs should be very, very wary of taking on anything from NHSE without an undertaking on future review, one bite of the cherry won’t be enough on this one.”

2.17pm In our Leadership section Alison Moore looks at how the methodology for turning around a failing school could be applied to the NHS.

1.32pm The Times reports on the National Institute for Health and Care Excellence yesterday advising GPs to use NHS funds for weight loss courses at slimming companies.

Three private providers (Slimming World, Weight Watchers and a chain of health clubs run by the health and fitness guru Rosemary Conley) could make big profits, with around 25m adults in England and Wales potentially eligible to NHS subsided slimming classes.

Two hundred different bids were accepted, with many trusts successfully receiving money for several different bids.

Nottingham University Hospitals Trust was the single biggest beneficiary, securing £8.25m from the Safer Hospitals, Safer Wards technology fund, which it plans to spend on creating a digital health records programme and an electronic clinical noting programme.

Jeremy Hunt last week approved plans to replace a consultant led maternity led service at Friarage Hospital with one led by midwives and transfer its specialist inpatient paediatric services to four other hospitals.

The proposal by Hambleton, Whitby and Richmondshire Clinicial Commissioning Group had sparked controversy among local politicians, including John Blackie, the independent leader of Richmondshire District Council.

12.10pm The Times leads on a study which found that British girls are the fattest in Europe, prompting calls for the government to make large food companies reduce the price of healthy food and label food more clearly.

John Newton, chief knowledge officer at Public Health England, said the “worrying” prevalence of obesity among British girls was partly attributable to the “constant pressure” to eat fast food.

“We have to look at the environment in which people are living, and the contrast pressure to eat unhealthy food means things are particularly a problem for girls more than boys,” he said.

“Speaking as the father of a teenage daughter, girls are particularly prone to peer pressure.”

A DH spokesman told the paper that while “this is much we can do”, child obesity is now at its lowest rate in England since 1998.

11.54am NHS Shared Business Services has announced a partnership with Tradeshift, a supply chain platform, to try and encourage suppliers to its NHS clients to submit and track their invoices electronically.

The aim is to reduce the need to manually manage paper documents. 

Simon Murphy, NHS SBS director of finance and accounting, said: “We are constantly looking to make business processes as efficient as possible in order to derive maximum value from NHS resources. Tradeshift enables us to do exactly that. Implementing e-invoicing is an incredibly important step for us in simplifying and modernising supplier interactions on behalf of our clients, by allowing our organisation and our suppliers to focus on value-adding activities. We are looking forward to seeing the benefits throughout the supply chain. Tradeshift also gives us a brilliant platform for better collaboration, and will allow us to scale up and evolve with suppliers, as well as introduce innovative solutions.”

11.26am The Care Quality Commission has appointed a new National Professional Advisor for Substance Misuse.
The regulator is aiming for a “sharper focus” on the ability of health and social care providers to meet the needs of people with substance misuse issues.
Violeta Ainslie has over 25 years of experience supporting people with substance misuse issues, having started as a drugs worker and been involved in projects providing support to adults, young people and offenders at various organisations including Kingston Youth Service and drug and alcohol charity, Cranstoun.
Ms Ainslie will now be leading on the recruitment of experts from across the sector and members of the public with experience of substance misuse services, to take part in a new advisory group that will help shape CQC’s approach to the regulation of these services.
She said: “Over the coming months, we will be working to develop a framework that will inform what inspections for substance misuse services will look like. What will be most important is that these plans put people who use these services at the centre of our work.
“Having worked as a substance misuse provider, I am very much looking forward to harnessing the wealth of expertise that exists within the sector, and working with members of the public with experience in this area to develop our new approach.”
The new external advisory group will help to develop an inspection framework and handbook for service providers, and oversee pilot inspections that will take place in October 2014.
Final roll out of the new inspections for substance misuse service providers is expected to start in 2015, following evaluation of the pilot inspections.
11.10am The cost to the NHS of drugs dispensed to treat alcohol dependence topped £3m in 2013, new figures from the Health and Social Care Information Centre show.

Today’s report shows the cost increased by almost £200,000 to £3.13m in 2013, a rise of 6.7 per cent on 2012.

In total almost 184,000 prescription items were dispensed in primary care and NHS hospitals in 2013. This is a rise of 3.1 per cent on the previous year and a 78.9 per cent rise on ten years ago.

The report also found that:

  • In 2012-13 there were over one million alcohol-related hospital admissions based on primary and secondary diagnoses and almost two in three of these were male (65 per cent).
  • The North East Region recorded the highest rate of alcohol-related admissions (2,500 per 100,000 population) and the South East Region recorded the lowest (1,500 admissions per 100,000 population).
  • In 2012 there were 6,490 alcohol-related deaths, a fall of 4.2 per cent on 2011 (6,770) and of these almost two thirds were caused by alcoholic liver disease (4,080)

10.50am The Royal College of General Practitioners has awarded its first Prison Quality Practice Award for excellence in general practice to healthcare services at New Hall women’s prison in Wakefield.

RCGP President, Professor Mike Pringle, visited the prison yesterday afternoon to present the award – a gold standard in excellence in general practice - to Spectrum Community Health CIC, the prison’s health service provider.

The RCGP Quality Practice Award aims to improve patient care through assessing practices against a set of 130 criteria across six categories, through written evidence and a practice visit. It has been granted to more than 200 GP surgeries across the UK since 1996 but this is the first time a prison health service has received it.

Dr Ken McLean, RCGP Lead for pQPA, said: “There is a principle that those patients in secure environments should receive equivalent care to those in general practice, so it follows that the best level of care in prisons should equate to the best level of care in general practice.

“I applaud the enthusiasm of the prison service at HMP-YOI New Hall and Spectrum Community Health CIC team to apply for, work for, and achieve the College’s very first QPA for prisons. At the end of the visit the QPA assessors left with the feel good factor that a QPA assessor has when they have just visited a great team.”

The review – in its very early stages – is considering which services currently commissioned by the organisation should no longer be classified as specialised. Chemotherapy and renal dialysis are understood to be two of the services whose classifications are currently being reconsidered.

The review comes after NHS England chief executive Simon Stevens told MPs on the Commons health committee that specialised services were currently “overdefined”.

10.21am The Daily Mail reports that doctors have admitted they are prescribing antidepressants too freely as figures show a huge variation in prescription rates across the country.

Overall the number of prescribed pills have more than trebled since 1998 - from 15m to 50m.

But this varies in different areas, ranging from 71 items per 1,000 patients in Brent, North London, to 331 per 1,000 in Blackpool.

The dispute has arisen between three clinical commissioning groups – Leeds South and East, Leeds West and Leeds North – and One to One Midwives, a private provider currently commissioned by four CCGs in Merseyside and Cheshire.

While the Leeds CCGs said that they have not commissioned the firm, One to One told HSJ that the CCGs had told them in writing they would fund referrals from GPs.

9.39am The Foundation Trust Network has launched a new publication reflecting on ten years of foundation trusts, Seizing the opportunity: ten new perspectives from healthcare leaders.

Chris Hopson, chief executive of the FTN, said: “The tenth anniversary of the creation of the first foundation trusts is a great time to reflect on the achievements of the FT movement and to consider how this model of delivering health and care should develop in future. The FTN is therefore delighted to publish this document which combines the content of Alan Milburn’s original inaugural FTN lecture with nine perspectives from others who have been involved in the FT movement over the last decade.

“The publication highlights the patient benefits that have come from the twin pillars of the FT concept – provider autonomy and local accountability. It also recognises that there is much still to do to fully embed the model and reduce variability between FTs. The emphasis should now, therefore, be to build on the undoubted success to date and ensure the FT model develops and adapts to meet the changing needs of the NHS. FT status is not a fixed, final, destination – it’s a set of principles based on provider autonomy and local accountability that can and should  adapt to meet new challenges. As Alan Milburn himself said in his FTN lecture, ‘NHS Foundation Trusts are more relevant now than they were a decade ago’ ”.

7.00am Good morning and welcome to HSJ Live. The “scoping report” states the commissioners’ ambition to provide practical tools for senior NHS leaders to encourage the adoption of best practice.

The commission was launched last October, and will publish its main report next November. The scoping report published online today says the commission’s focus will be on how to ensure older people are cared for in appropriate settings, and making hospitals better places for older people.