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16.58pm: The Foundation Trust Network’s chief executive has waded into the A&E row, describing the situation facing providers as an “omnishambles”.

The DH claimed in response claimed the national position on A&E was that trusts were now meeting the 95 per cent target, contradicting the latest publically-available data on waiting times.

16.07pm: Chief economist at the King’s Fund John Appleby tweets that UK NHS spending fell in real terms in 2010-11 and 2011-12.

The Treasury’s public spending statistics can be found here.

14.27pm: We have published a collection of our articles by Nick Seddon, who has been announced as health and social care adviser to the prime minister - who is Nick Seddon?

14.25pm: NHS Employers chief executive Dean Royles has replied to the HEE announcement mentioned below.

He says: “We are extremely pleased to be a part of this scheme… It’s very useful to have this pilot period first, as employers will want to ensure any proposals improve patient care and are workable and affordable.

“The Government’s call was for all student nurses to have that experience. We need to test that old adage that, in theory, there’s no difference between theory and practise - but in practice, there is.”

13.41pm: Patrick Leahy, healthcare public affairs professional, tweets: “I understand the Care Bill will be published on Friday. And @LordPhilofBrum says 2nd reading on 20 May. First 3 Cttee days on 4,10,12 June”

13.18pm: Health Education England has announced the next steps for in the proposed “pilot scheme for student nurses to spend timeworking as a healthcare assistant before taking up their degree”.

It announced (see attached) a national steering group to oversee the policy, which was announced by the government in the wake of the Francis report.

A statement says: “The group will be chaired by Sir Stephen Moss, a non-executive director at Derby Hospitals NHS Foundation Trust and former turnaround chair at the Mid Staffordshire NHS Foundation Trust.The group includes nursing leaders from the Royal College of Nursing, the Nursingand Midwifery Council, the Care Quality Commission, NHS England, the Department of Health, Public Health England, NHS Employers and the NHS Trust Development Authority.”

12.15pm: The Keogh review of 14 hospital trusts who are outliers on mortality indicators has published its first four reports.

NHS England medical director Sir Bruce Keogh’s team have now publiushed data on the Dudley Group Foundation Trust, Basildon and Thurrock University Hospitals Foundation Trust, Medway Foundation Trust and North Cumbira University Hospitals Trust.

11.38am: The Francis inquiry has left hospital trusts reluctant to sign off further reductions in their staffing bills, an HSJ analysis shows.

A survey of hospital savings plans has found the proportion of efficiencies scheduled to come from pay budgets falling beneath half, despite pay typically forming 70 per cent of a provider organisation’s costs.

The difference has been made up trusts planning on earning more money, at odds with government policy and considered unrealistic by some commentators.

11.34am: The College of Emergency Medicine has issued its response to the A&E story.

It gives a list of causal factors, not all of which are the same as NHS England’s.

They are: “Rising numbers of patients presenting to emergency departments. Reasons for this include particular pressures due to inadequate social care beds, a frail elderly population with multiple co-morbidities and challenges with out of hours services.
“An ‘access block’ caused by hospital wards which do not have sufficient capacity to allow patients in a timely way to be moved from the emergency department into wards. This causes particular difficulties for ambulances who sometimes are queuing at emergency departments at a result. Any further closure of hospital beds needs to be considered only when there is sufficient community based care to cover the needs of patients.
“Our workforce recruitment is at crisis. We have had three successive years of only 50 per cent fill rates for senior emergency medicine trainees. As a consequence emergency departments have a significant shortfall in senior trainees and consultants which adversely affects service delivery and patient safety. Retention of doctors in the specialty is also proving difficult due to the pressures on the service.
“Our experience of NHS 111 is that this is increasing demand in some areas but not universally. We expected some teething problems as the new system beds in but a key issue is having sufficient capacity in primary care for NHS111 to access as an alternative to the emergency department.”

The statement added: “Approximately 22m patients were seen in emergency departments last year and we believe 15-30 per cent of them did not require emergency department services. Redirecting patients away from emergency departments only works if reliable alternatives are available.”

11.03am: NHS England have announced there will be a review of the “causes of problems” in A&E.

A press release issued this morning promised “co-ordinated action” with the NHS Trust Development Authority to address the problem but made no mention of financial support. The reasons for this could be contained in the story below.

HSJ has reported on the continuing problems in A&E over the past month in stories here and here - each with a trust-by-trust breakdown of performance.

10.38am: Further to HSJ’s exclusive below on the mismatch between departmental understanding of the situation with A&E and what commissioners and providers are doing on the ground, read the story here.

Here are some other extracts from the emails: “DH calculate that the [total] 70 percent [reduction on payments for] non-elective activity [above 2008-09 levels] is equivalent to 3-400m nationally. The Secretary of State would like to announce tomorrow that 3-400m is being invested to solve A&E problems. We have spent most of the day trying to hold him off doing this.

“We can only see 70-80m for the 70 percent [non elective penalty] in plans.

“Why is only £70m been removed from provider contracts? This seems extremely low given the level of non-elective admissions compared with 08/09. SoS is expecting figures of £300 - £400m so we need to respond urgently on this.”

10.25am: In an HSJ exclusive, Dave West reports on the panic in NHS England over plans by Jeremy Hunt to announce a multimillion pound fund to “solve” continuing problems in A&E.

10.20am: A survey carried out by a organisation that offiers insurance to doctors has found that 87 per cent of medics think online medical records will “raise patient expectations”.

The research is in a report from the Medical Protection Society.

10.11am: The Telegraph also leads its coverage of the Queen’s Speech on health related matters.

It proclaims that plans for health care restrictions on migrants – one of the most heavily trailed policies in the speech – are already unravelling.

10.03am: CQC chairman David Prior has told a King’s Fund conference there are too many elderly people presenting to A&E, the Telegraph reports.

HSJ has reported over the past three weeks on the deterioration of A&E performance since the start of the financial year.

See the stories and accompanying data here and here for where the pressure has been concentrated.

9.51am: The Daily Mail carries a page-17 lead headlined “Poor NHS care makes 160,000 patients every year even more unwell”.

The paper says “For the first time the NHS has released data on the numbers of patients suffering any of four conditions linked to neglect”.

It said the 160,000 incidents represented eight per cent of all those treated in the NHS.

Most measures show healthcare systems do avoidable harm to around 10 per cent of patients.

HSJ has previously reported the results of the NHS Safety Thermometer, the figures used by the Mail.

8.27am: Government plans to place a statutory duty of candour on providers fail to recognise the need for cultural change to achieve real openness when things go wrong writes Stephanie Brown at the Medical Protection Society. The group carried out a survey on the importance of openness amongst doctors and patients. You can see the results of this and a timeline of the health service’s attitudes to patients on the HSJ Leadership channel.

8.15am: Nick Seddon, deputy director of right-leaning think tank Reform, has been appointed 10 Downing Street’s new health and social care policy adviser. The story broke yesterday evening. There’ll be more on the HSJ site on this story later today.

Related files/tables