HSJ Live 4.4.2013: Leeds trust responds to mortality rate row

5.28pm The British Medical Association have responded to the MPS survey which raised concerns over conflicts of interest (see 12.55pm, below).

BMA chair Dr Mark Porter said: “While the vast majority of GPs have no involvement or connections with private sector companies, the BMA has repeatedly called for strong measures that guard against possible conflicts of interest during the newly formed commissioning process.

“It is not surprising that a number of GPs and practice managers are concerned about this issue given the scale of the government’s intended changes. It is important that everyone involved in the commissioning process understands clearly how to act if they are faced with any situation that could result in a conflict of interest.

“The BMA believes that any GP who has financial interests in a private sector company that might be awarded contracts in their area should consider seriously whether they should be a member of a (CCG) governing body.

“Given the tough economic climate facing the NHS, there is a widespread concern amongst GPs that the introduction of CCGs will coincide with reductions in budgets for general practice. CCGs will also inherit a situation where GPs are facing an unnecessary increase in administrative box ticking and a decline in funding following enforced and ill-advised changes to the GP contract.

“Ministers must ensure that CCGs have an appropriate level of resources so that they can meet the needs of their patients.”

4.35pm HSJ’s acute sector reporter Ben Clover has been tweeting about the statement from Leeds Teaching Hospitals (see the entry below from 4.05pm).

He says: “Leeds has put out fairly strong rebuttal to this AM’s Guardian story (see HSJ ‘s free liveblog) - sign of things to come on reconfiguration?

“Already one of the most publically-fought reconfiguration battles. Legal Q; Cardiac Paeds Review organised by a joint committe of PCTs

“It was the JCPCT decision that was overturned by a JR last week (in March). Post-March, which statutory body exists to mount the appeal?”

4.19pm NHS England has announced it will end regional variation of access to the Cancer Drugs Fund.

A press release published today says “there will be one national list of approved fast track drugs”, resulting in uniform access to treatment across the country.

The fund provides an additional £200m each year to enable patients with cancer in England to access drugs that are not routinely funded by their local NHS. It was established in 2010 and will run until the end of March 2014.

Sean Duffy, National Clinical Director for Cancer at NHS England said the move represents a “national levelling up of the number of approved treatments that are available”.

Previously entitlements were different depending on which strategic health authority area you lived in.

The single list will contain 28 drugs, to treat around 70 cancer conditions.

The announcement says: “a small number of drugs which were previously on local lists are now available more widely to patients through normal hospital treatment with no special application needing to be made”.

However the change has been queried on Twitter by Mike Birtwistle of MHP Health Mandate. He tweets: “Is new Cancer Drugs Fund list levelling access down rather than up? Indications on list down from 129 to 64. Needs explaining.”

4.05pm Leeds Teaching Hospitals Trust has made the following points about The Guardian’s front-page piece this morning (see 10.58am)

• CCAD, the Congenital Cardiac Audit Database, which pulled together the mortality rate data, has already said in strong terms that the information originally published last week was not validated and at an early stage so was completely unfit for external scrutiny.
• We have not completed resubmitting our data to CCAD or been provided with new figures and have grave doubts about the reliability of the unattributed claims made in the article about our mortality rates. Our view remains that a great deal more work needs to be done to validate the information for Leeds and all the other children’s cardiac surgery centres in England before any conclusion can be drawn on this new methodology.
• Our own detailed analysis of figures for Leeds undertaken in the last few days demonstrates that our mortality is in line with all other centres, confirming the previous information we had about our safe outcomes.
• We believe it is completely irresponsible to speculate in this way and to do so is causing unacceptable worry to the parents and families for no good reason. We are more than happy to have our surgical outcomes looked at - as they have already been on a number of occasions - but this needs to be done reliably in a fair and transparent way, rather than by innuendo in the media.
• The article also tries to imply there is some irregularity with an arrangement where a former Leeds children’s heart consultant, now working abroad, returns to the city to operate one weekend a month. This arrangement was put in place to provide us with extra capacity to address the growing demand for children’s heart surgery undertaken in Leeds, and this consultant is internationally renowned and well known to many of our patients and families.
• The article also repeats incorrect information that two consultants doing heart surgery in Leeds are locums when they are consultants on permanent contracts, and is factually wrong with its reference to the status of another consultant.
• The Children’s Heart Surgery Fund, who are also mentioned in the article, have already written formally to the newspaper expressing their concerns.

3.59pm There are now two new entries on the HSJ End Game blog.

First there’s this, on the alarming speed with which the NHS has returned to “business as usual” after the transition.

And there’s this, on a remarkable piece of candour from a hospital reconfiguration programme on the likely impact of their planned service changes.

2.04pm HSJ readers have been quick off the mark to comment on the story that NHS England, CCGs and CSUs are currently not able to handle patient identifiable data.

One anonymous commentator says: “Unfortunately most of the datasets arrive with NHS number, and presumably no-one is (legally) able to access the data to delete the identifiable information, so even non-patient level work is grinding to a halt if based on datasets that have NHS number attached. Total mess.”

“How many more preparation tasks have been neglected,” asks another. “Shouldn’t some explanation be provided - seems quite important!”

A third commentor writers: “It was raised in my presence at a DH meeting in December 2011. A service had been transferred to the private sector and the Trust involved was told it couldn’t just give the patients’ records to the private provider. They wrote to every patient to get permission, but the wider issue was raised then (if not before).”

Join the debate here.

1.57pm Almost 900 medical consultants in England and Wales have been awarded clinical excellence awards for 2012, HSJ’s workforce reporter Shaun Lintern writes.

The Advisory Committee on Clinical Excellence Awards’ announcement had been delayed by the government ahead of a report by the  Doctors’ and Dentists’ Remuneration Review Body, which has recommended significant changes to the process and level of awards.

In total the Department of Health will spend £204.4m on CEAs in 2012-13.

1.52pm New on HSJ: West Cumberland Hospital is facing a corporate manslaughter probe.

Cumbria Police has begun a gross negligence and corporate manslaughter inquiry into the death of Cockermouth resident Michael Parke at West Cumberland Hospital in Whitehaven on December 6, after concerns were raised about his care.

1pm HSJ commissioning reporter David Williams reports that NHS England, CCGs and commissioning support units are currently unable to handle patient identifiable data.

As previously reported by HSJ, NHS England applied for a special exemption to enable it to legally handle sensitive information. No decision has yet been made, meaning commissioners are unable to carry out research or analysis that isn’t directly related to NHS commissioning.

This means, for example, that NHS England and the 19 CSUs it hosts cannot process information containing patients’ NHS numbers in order to analyse health outcomes for patients with a particular condition.

12.55pm A survey of members by the Medical Protection Society has revealed that 59 per cent of GPs and practice managers see conflicts of interest as their main concern.

The medical indemnity provider says the survey reveals concerns that clinical commissioning groups will expose doctors to accusations of conflicting interests as the role of GP changes.

The survey covered more than 1000 GPs and practice managers across England.

12.45pm The openDemocracy group has today published 15 quotes from health policy commentators condemning competition regulations published by the government earlier this year.

The section 75 regulations were rewritten last month. However, openDemocracy says, “Health figures highlight that they still explicitly contradict repeated ministerial promises that “it would be for commissioners to decide when to use competition” and that there was “absolutely nothing in the [Health and Social Care] Act that promotes or permits the transfer of NHS activities to the private sector”.

Among the objectors are known critics of the act Lord Owen, Lord Hunt, Royal College of GPs chair Clare Gerada, Dr Kambiz Boomla, Tower Hamlets GP and member of Tower Hamlets CCG, Frances O’Grady, Trades Union Congress general secretary.

Yesterday HSJ reported that Monitor chief executive David Bennett said it would be “mad” to force unecessary tendering. Read senior correspondent Crispin Dowler’s story here.

11am A new online today: As many as 6,500 bowel cancer patients could be denied access to life-extending drugs when a cash pot to pay for them ceases to exist at the end of the year, Beating Bowel Cancer has warned.

The Cancer Drugs Fund, worth £200 million a year, was set up for patients in England to access drugs approved by their doctors but not given the go-ahead for widespread use on the NHS.

10.58am The Guardian carries a front-page story on the Leeds child heart surgery story.

It seems to have been given access to new information on the mortality rates at the unit run by Leeds Teaching Hospitals Trust.

Earlier this week a consultant at the trust had criticised the data on which Sir Bruce Keogh advised the trust to suspend activity at the unit, and the British Congenital Cardiac Association said the data released had been “premature”.

But The Guardian’s report said adding in the outcomes of the 130 children whose data was not submitted because a recording of their weight was missing “had not made a difference” and “Leeds is a statistical outlier with a mortality rate outside the expected and acceptable range”.

It also said a Dutch surgeon had been flown into the trust one weekend a month to cover a senior consultant who was on leave.

The trust made no comment to The Guardian.

In a comment piece accompanying the article health editor Sarah Boseley called the situation “a new low for the NHS” and decried “turf wars involving doctors, celebrity campaigners and MPs trying to keep their seats”.

The paper also carries an opinion piece from academic Allyson Pollock headlined: “The latest casualty of health reform: casualty itself”, discussing the recent rises in breaches of the A&E targets and the proposed closure of some A&E units.

10.55am Mike Birtwistle of MHP Health Mandate has written a blog, asking: “Is (education secretary) Michael Gove is legislating to pilot Labour’s health policy?”

“Okay, the title of this blog is bizarre”, he admits.

“The Children and Families Bill currently being considered by Parliament offers some interesting clues as to how integration could be given a push,” the blog says. “Part 3 of the Bill would introduce a duty for local authorities and clinical commissioning groups to make joint commissioning arrangements for the education, health and care provision of children and young people who have special educational needs”. 

10.08am The Times is reporting research by Japanese scientists which suggests balding men could have a higher risk of heart disease.

Researchers looked at studies linking heart disease with baldness and data on 40,000 men.

Men who lost most of their hair over more than a decade were a third more likely to develop heart disease, the study suggests.

10.07am The Daily Telegraph reports that “GPs are making addicts of us”, according to minister Anna Soubry. Ms Soubry said the willingness of GPs to dispense drugs had led to some people becoming hooked on them.

She said in the paper: “I think there have been some GPs who have simply not been following the guidelines from their own professional bodies”.

The Telegraph also carries the “health tourists” story. It refers to David Cameron’s promise last month to introduce new curbs on health tourism by tightening the criteria that make people eligible for free care.

10.04am The Press Association agency is reporting that thousands of disadvantaged young mothers are to get more support from specially trained family nurses while bringing up their babies.

About 5,000 more families will benefit from the extension of a programme to give first time mothers one-to-one support, health minister Dr Dan Poulter has announced.

The family nurse partnership scheme sees specialist nurses or midwives regularly visit first-time mothers under the age of 20 during their pregnancy and until their baby is two years old.

The nurses help new parents to prepare for labour; offer advice on looking after babies and toddlers, and help plan for the future.

Dr Poulter said ministers plan to extend the current programme to include 16,000 families by 2015.

9.56am The Daily Mail is leaving Sir David Nicholson alone for the time being, and has turned its attention to the effect of foreign nationals on the NHS.

Its splash headline today reads: “Epidemic of healh tourists ‘costs us billions’”.

The story is based on the account of a single doctor - cancer specialist J Meiron Thomas of the Royal Marsden Hospital - who has written two pieces on the subject for the conservative Spectator magazine. The story claims that the NHS is becoming the “world’s maternity wing”, as well as attracting cancer, HIV and kidney patients.

There is no data backing up the “billions” claim.

It is accompanied by a special investigation across pages 22 and 23 which includes examples such as Shrewsbury and Telford Hospital Trust, whcih is owed £61,000 for HIV treatment given to an American national, and Kingston Hospital, which is owed £62,000 by an Egyptian national who underwent a complex hernia treatment.

8.17am Far from sapping their time and energy, nurturing the healing relationship at the heart of medicine sustains clinicians’ vitality, write Suzanne Shale and Murray Anderson-Wallace on HSJ today.

According to them, it’ll make a big difference if organisations learned to treat complaints as laments for the loss of something important, rather than viewing them as criticism, feedback, or an administrative task.