HSJ Live rolling news 14.2.2013

16.11pm: Monitor have released their license conditions. This replaces the terms of authorisation foundation trusts must currently satisfy.

The licence is here with more information here.

Chief executive David Bennett said in a statement: “Our goal is to have a licence which will allow us to operate as an evidence-based and patient-focussed regulator in partnership with the Care Quality Commission and NHS Commissioning Board and enable licensees to focus on patient care.”

Foundation Trust Network chief executive Chris Hopson said: “It’s not often that the regulated praise the regulator but we’d like to acknowledge the time and effort Monitor has taken to listen carefully to the views of public providers and shape the licence accordingly.

“The reality is that none of us will really know how effective the new licencing regime will be until it’s been working for a year. That’s why we particularly welcome Monitor’s commitment to review the licence after a year of operation.”

14.56pm: Professor Edward Peck from the University of Birmingham says trusts and clinical commissioning groups looking for a new template for care of long-term conditions should start by looking at the successful transformation of mental health services elsewhere.

14.42pm: Noel Plumridge takes issue with the claim that NHS hospital care is “free at the point of delivery”, arguing it isn’t for patients and especially their visitors: “NHS hospitals in England outsource their car parking, catering and other services in return for hard cash to businesses keen to sell to a captive audience,” he says.

Reminds me of a point made at a conference recently that if trusts had had to pay the transport costs of patients to-and-from hospital would hospitals be in the same locations they are now?

14.26pm: Some very interesting comments under the Gary Walker story, both anonymous.

One said: “If Gary had been dismissed appropriately for gross misconduct for swearing, which is what the trust and strategic health authority maintained, then why did his employment tribunal for unfair dismissal not go ahead with rigorous defence from his former employer? Could it be that he had called Barbara Hakin and David Nicholson as witnesses to the tribunal and pressure was then put on the trust to settle with him in order to make him go away and save them from embarrassment?”

Another point from a poster at 13:09pm: “High mortality ratios in a hospital with an apparant inability to treat patients within 18 weeks alongside meeting the A&E four-hour target are not necessarily a sign that the chief executive’s concerns were justified. It could reflect a wider basic lack of competence in the hospital. It’s striking how trusts in this situation never seem to acknowledge that there are very good reasons why its also uinacceptable for elective patients to be waiting for very long periods of time.”

14.22pm: A speech given by shadow minister for care and older people Liz Kendall at Reform’s conference on NHS reform this week has been published. Ms Kendall identifies the two major priorities for health and care as “ensuring patients, users, families and the public are not just at the heart of services but in the driving seat of change”, and “how we radically shift the focus of services out of hospital, into the community and towards prevention”.

14.11pm: The BMA have responded to the GMC report on junior doctors and the European Working Times Directive.

Dr Ben Molyneux, chair of the BMA’s junior doctor committee, said: “The BMA has been raising concerns about the poor implementation of the working time directive for many years. Badly designed, understaffed rotas can leave junior doctors doing long stretches of night shifts with fewer training opportunities. There is clear evidence that tired people are more likely to make mistakes and so it is essential that this problem is addressed.

“The BMA is currently taking part in exploratory talks with NHS Employers about government proposals to change junior doctors’ terms and conditions. Tackling the problem of potentially dangerous working patterns will be an important part of these talks.”

May I take this opportunity to again point you in the direction of Shaun Lintern’s analysis and predictions on the issue.

12.24pm: Waiting times expert Rod Findlay, also known as NHS Gooroo, has analysed the latest Department of Health waiting list data for December 2012. It shows a small increase in the number of patients waiting over 18 weeks, from around 135,000 to 140,000. However, the number of patients waiting longer than a year has continued to fall. Nationally, the NHS is comfortably meeting the target to treat 90 per cent of admitted and 95 per cent of non-admitted patients within 18 weeks.

NHS Gooroo blogged on HSJ last week on what changes to the penalties for missing the target in the NHS Standard Contract mean for trusts.

12.13pm: NHS Employers has said the research published today on doctors’ working hours reinforces the case for a renegotiation of junior doctors’ contracts.

NHS Employers director Dean Royles said: “A renegotiated junior doctors’ contract could simplify processes, increase the focus on patients, enhance training opportunities and achieve less rigid shift patterns.”

HSJ’s in-depth analysis of this issue is here.

11.30am: Here is our story on the Gary Walker case.

11.22am: NHS Midlands and East (the successor organisation to East Midlands Strategic Health Authority) jas just released a statement.

I have not changed it as per the HSJ’s house-style because it is interesting to note how much like a legal document it reads.

Here it is: “The East Midland SHA (“the SHA”) totally refutes all the allegations made by Gary Walker and his account of the specific conversations with Dame Barbara Hakin, the then SHA Chief Executive. During her tenure as SHA Chief Executive, Dame Barbara Hakin acted at all times in the interest of patients, ensuring that they received high quality and safe services.

“The SHA’s concerns about United Lincolnshire Hospitals Trust (“the trust”) from 2009 are well documented. They included too many cancer patients waiting for treatment and too many patients acquiring C Difficile whilst being cared for by the trust.
“Contrary to these allegations from Gary Walker, the SHA’s concern to ensure patient safety was such that it initiated an investigation in April 2009 which looked at quality and safety in the Trust.

“A number of senior doctors and nurses formed part of the review team which interviewed patients and visitors, as well as a range of Trust clinical and managerial staff.
The review confirmed that there appeared to be a lack of strategic direction at the Trust and that clinical governance arrangements were weak. The SHA worked closely throughout that period with commissioners and key regulatory bodies, but in the final analysis, the SHA had
to take action in order to assure quality care for patients.

“In July 2009, the SHA asked the Appointments Commission to suspend the chairman of the trust, and on the range of evidence presented, they agreed to do this. Since that time, a series of unfounded allegations have been made about whistleblowing.

“In response to Mr Walker’s allegations, the Department of Health in October 2009 commissioned an independent investigation which found that the SHA had acted appropriately and properly and that the allegations were wholly without merit.
In late 2011, the trust and Gary Walker reached an agreement which amicably resolved the differences between them. The SHA was not a party to this agreement.”

11:14am: A tweet from my (multi-award winning) colleague Shaun Lintern: 12 years ago! - Health Service Circular 1999/198stated: “NHS trusts should prohibit use of “gagging” clauses in contracts of employment.” Shaun Lintern ‏@ShaunLintern

10.45am: In other news, the DH has published new rules on procurement, patient choice and competition.

10.41am: A reminder of some of the other ripples caused by the Walker case. Last year HSJ established that the GMC were investigating a complaint abut Dame Barbara Hakin relatingto the case.

10.33am: Union Unite has called on Jeremy Hunt to set up “robust whistleblowing procedures immediately” in the wake of the Francis report and this morning’s news.

Unite head of health Rachael Maskell said: “The chickens are coming home to roost for those that presided over a culture of fear and bullying across the NHS.”

10.25am: The King’s fund report A&E waits are at their highest level since 2003.

The thinktank said as financial pressures continued to “bite hard” on the health service there was growing pressure on emergency care.

9.58am: This story from 2010 details Gary Walker’s standing as a candidate in the general election of 2010.

9.53am: The DH has responded to Mr Walker’s claims in a statement. A spokesman said: “It is absolutely critical that all staff working within the NHS are able to speak up and raise concerns and that every organisation takes concerns raised seriously and acts upon them.

“The Government and the NHS have taken a series of steps to encourage an open dialogue about concerns and Sir David Nicholson has written to NHS organisations reminding them of their responsibilities.

“In relation to Mr Walker’s specific comments, we know that he is unhappy about his personal case. Allegations made by Mr Walker regarding behaviour at the SHA have been independently investigated and found to be without merit.

“It is important to stress that allegations of this nature are taken extremely seriously. Following Mr Walker’s initial concerns raised in 2009, Sir David commissioned a rigorous independent review, following which it was concluded that no evidence whatsoever was found of bullying and harassment by the Trust or SHA. A copy of both the findings of the review and Sir David’s response have also been sent with this statement.”

9.46am: The BBC and Daily Mail have given major coverage today to the story of Gary Walker, who was sacked as chief executive of United Lincolnshire Hospitals Trust in 2009-10.
He has given interviews which appear to breach a confidentiality agreement made with the trust when he left. Mr Walker has also published a lawyers’ letter, sent on behalf of the trust this week, threatening to take action if the agreement is breached. Mr Walker told the BBC and Daily Mail he had tried to raise patient safety concerns with then NHS East Midlands chief executive Dame Barbara Hakin and NHS chief executive Sir David Nicholson but was ignored. NHS East Midlands has rejected the claims.

7.33am Good morning, within the NHS, the transparency agenda has seen more data than ever before made public. Clinical commissioning groups are beginning to contract bespoke data extraction services to help them gain a better and deeper understanding of local health services. But this data has to be translated into knowledge and, finally, integrated into clinical workflows if it is to make a difference on the front line. Sean Riddell explains how it can be used to deliver real change.