HSJ readers offer their ideas and examples of good practice for improving the care of older people, plus the rest of today’s news and comment

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5.30pm The Association of the British Pharmaceutical Industry said welcomes government’s plan to fund a centralised Health Research Authority assessment and approval process, announced by Earl Howe earlier today.

ABPI’s clinical development manager Rebecca Lumsden said: “The ABPI has previously called for a streamlined research governance process to help improve UK competitiveness and the new process will greatly facilitate the process of setting up of research studies.

“Improved NHS management of clinical trials is a key driver of UK competitiveness ensuring that clinical research remains at the heart of innovation in the NHS”.

5.25pm The Department of Health has published guidance to all NHS trusts on the actions to be taken “to increase openness and clarity NHS procurement. The guidance does not apply to independent sector providers of NHS healthcare.

4.18pm And more:

£9 million of £46 million of Monitor budget is spent on consultancy. Asked about the average staff salary, Bennett doesn’t know.— Andy Cowper (@HPIAndyCowper) March 31, 2014 

4.13pm HSJ comment editor Andy Cowper is live-tweeting Monitor chief executive David Bennett answering questions at the Commons Public Accounts Committee. Here are some highlights:

3.12pm Following consultation, the Care Quality Commission has published details of the fees to be paid by providers from 1 April 2014. All services registered with the CQC are required under the Health and Social Care Act 2008 to pay fees to cover the cost of registration and inspection.

The fees scheme reflects government policy which requires CQC to recover the costs of regulation from providers. It has been approved by health secretary Jeremy Hunt.

Fees changes include a differentiated increase to fee charges, based on current levels of cost recovery, which results in:

  • No increase for providers of dental services.
  • A 1.5% increase for providers of adult social care services and
  • 2.5% for all other types of providers.

-Adjusting the fee bandings for providers of care home services to more evenly distribute fee charges.

-Differentiating fees for single location dental providers to better distinguish between smaller and larger services.

CQC chief executive, David Behan, said: “As a result of the consultation we ran last year, this is the decision we have made for the year 2014/15. We will undertake a review in the year ahead and consult again regarding next year’s fees in the autumn.

“We will continue to review fees in consultation with stakeholders, whilst ensuring that we are delivering value for money.
Our response to the consultation, our legal fees scheme and other fees documents are published on CQC’s website.”

3.00pm Thirty years after the seminal Griffiths report introduced general management to the NHS, HSJ is launching a major review into NHS leadership.

The HSJ Future of NHS Leadership inquiry will be chaired by Sir Robert Naylor, one of the most respected and longest serving senior managers in the NHS.

To get the full list of senior figures joining Sir Robert on the inquiry panel - click here.

2.53pm When HSJ launched its Commission on Hospital Care for Frail Older Peoplewe knew our readers would have ideas and experience of how care could be improved. So we asked them for their suggestions – and about 300 people contributed, highlighting areas they felt could be improved and giving examples of what they had seen working well in the UK and other countries.

For a comprehensive look at reader’s suggestions, click here.

2.21pm The co-authors of the Reform report ‘Solving the NHS Care and Cash Crisis’, have written for BBC news explaining the rationale behind their recommendations.

Labour peer Lord Norman Warner and Jack O’Sullivan, a social policy consultant, argue that the £30bn financial hole facing the NHS by 2020 combined with changing population needs and the nature of the country’s tax base make for a ‘perfect storm’.

12.46pm UCLPartners, the academic health science network, has appointed Lord Ajay Kakkar as its chair.

In a statement the organisation said: “UCLPartners is delighted to announce that Professor the Lord Ajay Kakkar has been appointed as its new Chair from 1 April 2014.

“Lord Kakkar takes up the position from Sir Cyril Chantler who will continue to work with colleagues at UCLPartners as an honorary fellow, supporting work to improve services and health in the Olympic boroughs, especially for those who are disadvantaged.”

Lord Kakkar moves into the role of Chair having provided leadership support to the partnership as chair of quality since its creation in 2009.

11.55am The Department of Health has approved an NHS Health Research Authority business plan to deliver a single approval system for all health research studies in England.

In announcing the funding, Earl Howe, parliamentary under secretary of state for quality, said: “I am pleased to announce the government will provide an additional investment of over £4.5m in 2014-15 to enable the HRA to take forward this important work.”

A statement said: The HRA welcomes the announcement of funding for our plans for HRA Assessment and Approval. This funding means that the HRA will be able to reduce duplication and bureaucracy by incorporating assessments by NHS staff alongside the independent Research Ethics Committee opinion, which will result in one application, one assessment and one approval for research in the NHS in England.
These proposals will build on recent improvements in timelines for approvals, will radically simplify the regulation of research and will remove complexity for researchers and industry.

11.25am Lord Warner, the co-author of a report calling for a  £10-a-month ‘membership charge’ to fund the NHS, has strong links to the private healthcare companies that would benefit from such a fee, a trade union has said.

Unite said that the link between ex-health minister, Lord Warner, the co-author of the report by the right-wing think thank Reform, and the private health sector demonstrated an unacceptable conflict of interest.

Unite said that the £10-a-month membership fee would be ‘the death knell’ of a health service free at the point of delivery to those in need.

Unite head of health Rachael Maskell said: “The Reform report needs to be kicked out completely. If such a proposal were ever adopted, it would be the death knell for the NHS. It would be the end of a health service free at the point of delivery for all those in need.

“It would be very discriminatory against the poor who would struggle to pay such a charge. It would create a two-tier NHS in favour of the well-off. It would fundamentally undermine the principles and ethos of the NHS.

“Lord Warner, the co-author of the Reform report, is a stalking horse for the interests of the private healthcare companies to which he has strong links – and this should be borne in mind in any discussion of this divisive ‘membership charge’ idea. This is an unacceptable conflict of interest.

“Immediate savings could be made to the NHS by stripping out this obsession with turning the health service into a market place for private healthcare companies, when the £30 billion funding crisis is looming.”

Lord Warner works as an adviser to Xansa, a technology firm, and Byotrol, an antimicrobial company, which both sell services or products to the NHS and was “paid by DLA Piper, which advised ministers on the £12 billion IT project for the NHS” projects that he was responsible for when he was a government minister.

11.10am Responding to Lord Warner’s call to introduce charging patients a monthly fee to use the NHS, Dr Ian Wilson, Chairman of the BMA’s Representative Body, said:

“Lord Warner’s conclusion that the NHS is being driven into a worsening funding crisis will ring true with all who work in it.

“Whilst some of his proposals merit closer examination, resolving under-funding should not be at the expense of the most vulnerable in society nor at the fundamental principle that the National Health Service needs to be free at the point of use and the BMA firmly believes that charging for patients is not the solution.

“The Government has so far failed to provide a fair and sustainable solution to the funding crisis, with its efforts instead focusing on attempting to balance the books on the back of frontline staff through year-on-year pay freezes.”

11.05am Responding to the NHS Confederation’s survey of politicians, which highlights that seven out of 10 MPs believe there is insufficient political will to meet the challenges facing the NHS, Dr Ian Wilson, Chairman of the BMA’s Representative Body, said: “The government must not risk the NHS’s core value of being based on need, not ability to pay, purely because they are unwilling to take action and make the changes they admit are desperately needed. 

“It is unbelievable that while eight out of 10 politicians agree change is essential, almost seven out of 10 say there is insufficient political will to allow this to happen.

“The reality is that the NHS is under intense pressure from a combination of rising patient demand and declining funding. Politicians must confront these challenges head on in order to ensure we can continue to deliver a high standard of care while remaining free at the point of use.”

10.52am Meanwhile, politicians have expressed concern that a free NHS may be unsustainable if challenges facing the health service are not addressed.

A cross-section survey of 100 MPs, conducted on behalf of the NHS Confederation, reveals that 48 per cent fear an NHS ‘free at the point of need’ could soon be consigned to the history books if no action is taken.

10.45am The Nursing and Midwifery Council failed to properly investigate 17 former nurses at the Mid Staffordshire Foundation Trust according to an audit by the Professional Standards Authority.

The PSA, which oversees professional regulators, has reviewed 100 instances where the NMC closed cases at an early stage of investigation.

10.35am A former Labour health minister has called for British citizens to pay a £10 per month “NHS membership charge”, as part of a suite of proposed reforms intended to prevent the health service “starving the rest of the public sector of resources”.

In a report published by think tank Reform, Lord Warner (pictured) argues NHS funding from general taxation should rise only in line with inflation to ensure health does not drain funds from other public services.

The Labour lord, who was minister for health reform in Tony Blair’s government, claims there needs to be a £10 per month NHS membership charge and other patient contributions if the NHS is to survive the next five years of austerity.

10.30am The Daily Mail has also covered the Reform report’s suggestions for NHS reform.

10.20am The Guardian has a front page story on former health minister Norman Warner suggesting everyone should pay a monthly £10 membership charge for the NHS.

Lord Warner, who served as a health minister under Tony Blair, and healthcare consultant Jack O’Sullivan propose in The Guardian that a £10 a month NHS membership fee is “one of several new funding streams urgently needed to renew impoverished parts of our care system but preserving a mainly tax-funded NHS that is largely free at the point of use. We have to escape the constraints of general taxation if we want a decent system.”

He adds: “We need our political and professional leaders to help us face uncomfortable truths rather than presiding silently over the current miserable decline.”

The Guardian also reports on the discovery of a link between obesity and a gene that breaks down carbohydrates by scientists at King’s College London and Imperial College London, which lead to obesity patients’ diets being better tailored to their metabolism.

10.15am The Telegraph reports that people should be charged a £10 monthly membership fee for using the NHS alongside hotel-style charges for hospital stays, a report suggests.

The study, published by the think tank Reform and co-authored by former Labour health minister Lord Warner, called for radical changes to how the NHS is funded.

Elsewhere in the paper it’s reported that thousands of patients, doctors and charity chiefs are calling on the Department of Health to back Maurice Saatchi’s Medical Innovation Bill, which would give legal protection to doctors who want to try new treatments for patients whose survival chances are poor.  

More than 6,000 people have responded to a public consultation by Jeremy Hunt, the Health Secretary, following his statement to MPs that he will enact the Bill at the “earliest opportunity” if the public supports it.

10.10am Flicking through this morning’s newspapers:

The Times reports that half of British politicians think a free NHS could be a thing of the past unless challenges are met to ensure that it meets future patient needs, according to a poll published today.

More than eight out of ten MPs said that in their constituency the NHS had to change, yet almost two thirds said there was not sufficient political will to implement reform.

Interviews with 39 Conservative, 48 Labour and five Liberal Democrat MPs plus five from other parties found that 48 per cent feared that a free NHS might be unsustainable.

10.00am NHS England’s chief technology officer Alex Abbott is leaving the organisation, the latest of a series of senior departures, HSJ has learned.

Mr Abbott, who was part of NHS England’s patients and information directorate, is leaving this week. He is taking up a position in the private sector which is yet to be announced.

9.49am The leaders of England’s health and social care representative organisations from the NHS, Local Government and Social Services have written a joint letter to their members supporting the Better Care Fund as “the catalyst for a once-in-a-generation opportunity to transform the lives of people who use health and social care services”.  The organisations behind the letter are:

  • The Foundation Trust Network
  • The Local Government Association
  • NHS Clinical Commissioners
  • The Association of Directors of Adult Social Services
  • NHS Confederation
  • Solace

The letter has been sent to the leaders of all members belonging to the six organisations representing the entire NHS and Local Government in England.  The letter states:

“The Better Care Fund is the catalyst for a once-in-a-generation opportunity to transform the lives of people who use health and social care services. The vision is the right one for our society and the goal is both a better quality of life for people with health and care needs, and a more balanced and sustainable health and care system for the future.

“This requires a significant transformation in the way in which we deliver services, and brings real challenges for every part of the local system, from local authorities to clinical commissioning groups, acute trusts and NHS providers. Key among those challenges are the financial pressures, the complexity of local systems and the time pressure that health and social care partners are under to deliver both credible and ambitious plans.

“Clearly, for a programme whose aims include the redistribution of service demand and associated resources in a short period of time, working together is absolutely vital. Early evidence from the first draft of local BCF plans shows that strong collaborative working across a local health and care system has resulted in an effective plan that mitigates many of the risks. Equally, where such collaborative relationships are less advanced, the planning process has been less successful with significant risks for some or all parts of the local system left outstanding.

“The Local Government Association, ADASS, the Foundation Trust Network, NHS Confederation, NHS Clinical Commissioners – representing councils and social services directors in England and Wales, NHS providers, and CCGs respectively – believe there are three key issues at this point in the BCF process that will help each local area meet the challenges:

1. Ensure all parts of the local system are fully involved in the planning process, including NHS providers as well as commissioners and local government.

2. Capture explicitly within the BCF plan the risks for each part of the system along with appropriate mitigation strategies that are developed and agreed collectively.

3. Recognise that all local areas should do everything they can to agree an ambitious plan by 4 April but at the same time be mindful that this is just the start of an iterative process to deliver truly transformational change over five years and beyond.

“We know that the scale of the transformation required means that it will not be easy, but it is absolutely crucial that we continue to work together to deliver real and lasting change for the better, transforming not only the health and social care system but helping to change lives for the better.”

7.00am Good morning and welcome to HSJ Live.

Following the Care Quality Commission’s overhaul of the way it inspects and rates providers of NHS services, HSJ reporter Will Hazell takes you through some of the key changes relating to quality ratings and explains how the system works in our latest data video.