3.33pm NHS England chief executive Sir David Nicholson has published a blog.
“This is my latest blog”, he begins. “Thanks to everyone who has commented on my previous efforts so far. However, one of the most disappointing responses has been that I don’t write the blogs myself. Can I confirm that I do, indeed one commentator has suggested that whoever did write my last blog on culture should be starting their career in B&Q on Monday. In the circumstances, perhaps I will have to wait until April!”
After that light hearted opening, Sir David goes on to explain the true value to children and young people of the services offered by the wheelchair charity Whizz-Kidz.
3.17pm NHS England has received more than 760 valid expressions of interest applying for its £260m technology fund.
The deadline for expressions of interest closed on July 31. The total value of the bids is £650m.
The Safer Hospitals, Safer Wards Technology Fund is intended to support rapid progression from paper-based systems for patient notes and prescriptions to integrated digital care records and the development of ePrescribing.
NHS England says the level of interest in the Safer Wards, Safer Hospitals Technology Fund underlines the commitment of NHS provider organisations to play their part in helping the NHS go increasingly paperless by 2018.
2.36pm HSJ has an exclusive blog from Foundation Trust Network chief executive Chris Hopson.
How should the DH allocate the £500m winter pressures bailout, he asks.
2.28pm Another reaction to the government’s winter pressures bailout. National Health Action Party leader Dr Clive Peedell has said: “”The Government’s announcement of £500 million to prop up A&E services is no more than a sticking plaster over the massive cracks in the NHS that they have created by their disastrous reforms and spending cuts.
“This figure of £500 million over 2 years needs to be put into context. The Treasury has already clawed back £3 billion from the NHS budget in the last two financial years. There is also the backdrop of the £20 billion efficiency savings program by 2015. So in reality this money goes nowhere near to making up the massive government cuts to the NHS budget, which is putting huge pressure on the entire health system.”
2.18pm We’ve got some more responses to the A&E story. Here’s one from theAssociation of Directors of Adult Social Services:
“ADASS generally welcomes today’s announcement of the winter pressures funding, however iit s very disappointed that funding is not been directed at all localities as in previous years.
“What has been announced does not reflect the contribution that community based services - deployed through adult social care or through clinical commissioning groups - makes towards reducing pressure in the NHS acute sector.
“Our concern is, first, that this additional money is only targeted at a small number of localities, posing significant risks upon councils’ planning to respond to pressures faced across all localities. Secondly, [we are concerned that] the majority of this funding will not be utilised in the community as a preventative resource and will not stop the flow of patients admitted unnecessarily.”
2.15pm An interesting story in the context of relentlessly rising demands on healthcare: The UK’s baby boom is the biggest in the EU, the BBC reports.
Chief executive of the Royal College of Midwives Cathy Warwick said: “Births in England are continuing to boom, with the proportion of births to the oldest women growing faster than for younger women. This places considerable pressures on maternity services and we are struggling to provide high quality antenatal and postnatal care. Despite recent welcome increases in the numbers of midwives, there is still a shortage.
“England remains around 5,000 midwives short of the number required to provide mothers and babies with the high-quality service they need and deserve. Maternity care is the earliest health intervention of all and getting care right for mothers and babies is a vital part of supporting families and building a foundation for good health in later life. We need more midwives.”
2.09pm Our reporter David Williams has just got off the phone to the Department of Health, after trying to find out where the government is going to find £250m by the end of the year to pay for its A&E bailout.
He writes: “A DH spokeswoman told me the cash is ‘coming from DH underspends and efficiencies’. The department doesn’t have a breakdown of exactly what these efficiencies are, or how much any given saving scheme is expected to generate, although she did say: ‘We have quite a big drive to reduce administration spending’.
“The spokeswoman confirmed that the money would come from within the DH’s departmental expenditure limit - so isn’t new money going into the department from the Treasury. She also said it wasn’t going to come out of the NHS commissioning budget, so taking the department at its word, this wouldn’t be a reallocation of funds already being spent on NHS care to the most under pressure areas.
“The savings necessary to pay for the bailout haven’t been made yet - they are being made in 2013-14.
“And if all that sounds a bit vague, remember they’re planning to find the same amount again in 2014-15.
“So where’s this money going to be made available from? According to DH’s business plan for this year, its total budget is £110bn, but £94.2bn of that goes straight out again to NHS England, to be spent on commissioning NHS services. Most of the rest goes to other organisations such as Public Health England, Health Education England, and local councils. Just £3.9bn is identified as ‘DH programme and admin expenditure’.
“Of this, ‘admin funding’ accounts for just £230.8m - meaning that even if the DH stopped administrating altogether, it couldn’t save enough money to pay for the A&E bailout.
“‘Programme funding’ comes to £3.5bn, of which £381m is capital. Programme funding pays for the chief medical officer’s work, the external relations directorate, and the following acronyms: PHD; ERD; SCLGP; GOA; and SFNHS.”
12.52pm More HSJ news: A study of social care provision has highlighted a “clear possibility” that local government funding cuts mean vulnerable people are not receiving the help they need and are being put at “increased risk” as a result.
The study, by the sector-led improvement group Towards Excellence in Adult Social Care, is based on a detailed analysis of data submitted by all local authorities.
12.47pm New on HSJ: We have full details of the panel which will judge bids to become integrated care pioneers. It’s going be chaired by the Nuffield Trust’s outgoing chief executive Jennifer Dixon. Click here to see who else is involved.
12.42pm The College of Emergency medicine has issued a press statement about the £500m A&E bailout fund.
Welcoming the news, the college said: “We note that one of the suggestions is for consultant reviews of all ambulance arrivals in A&E. This would allow a senior level decision to be taken on what care is needed at the earliest opportunity.
“We see this as highly desirable and have consistently called for early reviews by senior decision makers. However, we have concerns about the feasibility of this in the short term, since the key crisis for emergency departments is a lack of senior medical staff. Focus on one aspect alone would potentially divert key personnel from other activities. We need a long term strategy to allow sufficient staff members to undertake the range of consultant activities in the ED.
“All departments throughout the UK face the same enormous challenges and are under the same pressures. The college is committed to and is working with the government to address cost effective, sustainable solutions. A strategic use of additional financial resources is required to resolve the problems of emergency care.”
Dr Cliff Mann, President of the College said: “This short term funding announcement for England is welcome as the pressures in the system remain acute. However the problem is one which spans the whole of the UK. Key to resolving this is getting the workforce right and this needs a fundamental review and proper funding which we hope will be an outcome of the review being led by Sir Bruce Keogh. Whilst a workable solution to this point is awaited our Members and Fellows are doing their utmost on a daily basis to provide the best possible patient care.”
11.16am In today’s Guardian Peter Wilby writes that politicians are striving too hard to adapt the NHS to the 21st century world of “consumer power”, and that this has overshadowed the central objectives of the NHS.
He suggests that the two things that have contributed to the loss of focus in the NHS are cash limits and the drive to reduce waiting times.
Wilby argues: “The first duty of the NHS is to make patients well - or, at least, less sick - not to pander to ‘consumer preferences’” He agrees with Don Berwick’s observation of the blame culture of the NHS and says: ” In other words, instead of abusing staff for their failure to meet impossible goals, politicians and commentators should support them in restoring the true aims of equitable public service.”
11.10am Ben Clover and David Williams’s story on winter pressures money has been updated.
Here’s the new bit: HSJ understands that the Department of Health, Monitor, the Trust Development Authority, urgent care boards and NHS England’s local area teams will dictate how the money is spent in each local area.
For instance, the cash could be required to be spent on hiring more accident and emergency staff, be invested in infrastructure, or to be spent on preventative primary care or social care services.
10.49am Monitor has launched an investigation into the commissioning of cancer services in Manchester, after complaints from two trusts.
The regulator announced this morning that University Hospital of South Manchester and Stockport Foundation Trust had complained that “the process adopted to select future providers of certain cancer surgery services is not based on the quality of services, patient outcomes or patient preferences.”
Jonathan Blackburn, Monitor’s legal director for Co-operation and Competition, said: “We are at the very early stages of this investigation and so it is too early for us to reach a view as to whether any rules have been breached.
“The purpose of our investigation is to assess whether the way in which cancer surgery services are being reorganised is in the interests of patients in Greater Manchester.”
10.35am Acute sector reporter Ben Clover has uncovered more financial bailouts for struggling NHS trusts.
10.29am An NHS trust has been given permission by the Court of Protection to carry out medical treatment on a woman who suffers from a learning disability and has a long-standing fear of hospitals.
A judge declared today that “K”, who cannot be identified, “lacks capacity” to make decisions for herself and it is in her best interests that she attends hospital and undergoes assessment and treatment.
10.27am New news on HSJ this morning: The Mid Staffordshire Foundation Trust reconfiguration row rumbles on.
The proces is “critically flawed”, it has been claimed, after it emerged several key managers have never been consulted over their views.
In a heated public consulation meeting, a number of leading local clinicians said they had never been approached for their opinions and claimed some of the data the proposals relied upon was “not accurate”.
10.13am The Daily Telegraph reports the government’s announcement that: “The NHS is to be given a £500m bail-out for accident and emergency departments across England after warnings that the system is on the brink of collapse.”
It quotes Age UK director general Michelle Mitchell saying: “We need to tackle the root causes, we have got a national health services that is too often fractured and unresponsive to its main client group of older people.”
10.09am More from the A&E story comment thread. In response to Heatherwood chief Philippa Slinger’s comment (9.56am), one of her main commissioners Adrian Hayter, chair of Windsor Ascot and Maidenhead Clinical Commissioning Group, has weighed in.
His comment says the trust is “suffering from the sins of the past”, and praises Ms Slinger’s leadership. He also namechecks HSJ’s most recent Local Briefing about Berkshire, which details the various financial and performance pressures.
“Some of the immediate issues related to quality and patient experience can be addressed by an injection of capital resource,” he says. “However our CCGs are limited by their recurrent allocation and increasing bed capacity is not the long term answer. More importantly if we are allocated Winter Pressure funding it allows our economy to bring forward plans to enhance the primary care and community response for this winter.
“If this is successful we shall be better placed to absorb the smoke within enhanced community and primary care structures and for the wind to not blow it towards Wexham.”
Interesting how both commissioner and provider are going with the “smoke” metaphor.
9.56am The chief executive of a troubled acute trust has openly posted a comment on our story about the accident and emergency bailout fund.
A number of readers were unhappy that struggling trusts would get more money. “So the price of failure and incompetence is - A TREASURY BAILOUT!!” was one fairly typical comment.
In response, Philippa Slinger, chief executive of Heatherwood and Wexham Park Foundation Trust, wrote yesterday evening:
“I have never commented on an article before but feel I must. As the CEO of one of the Trusts mentioned I accept full responsibility for the delays we cause internally and we are working hard to change this.
“However, as a Trust that has been in deficit for a number of years for many reasons we simply have not had the cash to address the capital need for expanded capacity, or to increase revenue costs at risk.
“We have improved but if we are to ensure that patients are treated with dignity and in timely fashion we need help. I am grateful to our neighbours for their support over last winter, there were times when we were all in the mire. My aim if we receive funding is to ensure we can consume our own smoke and support others if they need.”
As one of the worst performers on A&E in the country in late 2012-13, her trust potentially stands to gain from the fund. Heatherwood and Wexham Park urgently needs investment, as it is currently subject to an improvement notice from Monitor, following a damning Care Quality Commission report which pointed to failings in accident and emergency care at Wexham Park Hospital.
9.40am HSJ is hosting a live question and answer session about Liverpool’s integrated care model at 12.30 today.
At 12.30pm on 8 August, Liverpool Community Trust chief executive Bernie Cuthel and the city’s assistant mayor Roz Gladden will be answering your questions about their plans on LinkedIn.
9.37am The story we broke yesterday morning about the government’s £500m winter pressure investment was picked up in the national media late yesterday.
8.48am: Good morning, researchers are finding they are left to negotiate excess treatment costs, with multiple providers and commissioners, and this is creating a barrier to gaining timely research approval. If a treatment that started as research continues beyond the study end, these are attributed as excess treatment costs.
Commissioners want transparency of expenditure and are reluctant to provide funding when the final liability is unclear says Dr Greta Westwood, head of nursing, midwifery and allied health professional research at Portsmouth Hospitals Trust. On HSJ’s commissioning channel today she writes on how a new funding model could help solve the problem.