Challenge for CCGs to co-commission primary care, plus the rest of today’s news and comment

The delay followed a complaint to the regulator about the CCG’s contracting process for an unrelated cardiology contract, which had been procured alongside the ophthalmology service.

As previously reported in HSJ, the Royal Free London Foundation Trust had been chosen as the preferred bidder for the cardiology services in August 2012- a choice which sparked complaints from the two unsuccessful bidders.

4.50pm South Devon Healthcare Foundation Trust has appointed a new chairman to replace the interim David Allen.

Mr Allen was standing in after the previous chair resigned following an employment tribunal which found that the trust covered up claims of nepotism against its chief executive, Paula Vasco-Knight.

Sir Richard Ibbotson, a recently retired Admiral, is due to start at the trust on 1 June. Sir Richard’s naval career includes periods as Commodore of Britannia Royal Naval College, Commander British Forces Falkland Islands and, most recently, Deputy Commander-in-Chief Fleet (effectively Chief Operating Officer of the Royal Navy and Royal Marines).

Sir Richard is a Companion of the Most Honourable Order of the Bath and holds the Distinguished Service Cross and the NATO meritorious service medal.

Speaking of his appointment, Richard said: “I am delighted to be appointed to this role at such an exciting time in the history of the NHS. We have some real challenges in re-shaping health and social care services so that people are supported within their local communities to live well and stay well.

“It was a thorough privilege to meet so many happy and dedicated staff during my interviews and I am really looking forward to supporting them as we move forward in providing even better care for people in South Devon. I have much to learn and will be engaging with patients, staff and our partners in the coming weeks”.

Anne Harvey, Lead Governor, said: “We had an exceptionally strong field of candidates for this role, which speaks volumes about the high esteem within which people hold Torbay Hospital. The governors are delighted to appoint Sir Richard Ibbotson as our next chairman and look forward to working with him very soon.”

An investigation is still ongoing into Paula Vasco-Knight and she has been suspended while it is being conducted.

4.20pm The chief executive of Norfolk and Norwich University Hospitals Foundation Trust, Anna Dugdale, talks about her leadership style.

4.10pm In our Resource Centre, Ashford and St Peter’s Hospitals Foundation Trust has developed a programme to reduce inpatient stays and improve the discharge process, say Mark Hinchcliffe and Chris Bradley.

3.45pm In response to the challenge for CCGs to co-commission primary care Shadow Health Secretary Andy Burnham has tweeted:

“So #NHS is being re-organised AGAIN. Now the Government wants GPs to commission GP services. Lansley’s mess deepens”

3.41pm “Hunt asks CCGs to include acute trusts around the table.”

3.38pm “Hunt says the lessons we’ve learnt are at the centre there should be broad parameters but beyond that CCGs should be free”.

3.36pm “JH: delighted Simon Stevens shown commitment to revolution of out-of-hospital care. For LTCs, current model fundamentally not well-suited.”

3.34pm “Hunt says 10% of acute trusts are in special measures but it means problems are no longer swept under the carpet.”

3.31pm Back to Judith Welikala: “Hunt says there absolutely no reason to compromise the principles of NHS as free at the point of use”.

“‘The NHS remains the single reason why more people are proud to be British than anything else’”.

3.30pm This tweet from Andy Cowper: “Hunt: is NHS sustainable as it is? Not alone in reviewing. In US, also reviewing sustainability of health systems, and internationally.”

3.28pm “Hunt says the NHS reforms, which he admits were incredibly controversial when they went through, helped do so much more activity.”

“He says he has never seen people work as hard in the private sector as they do in the NHS”.

3.27pm “Hunt says ‘there is a lot of pressure out there’”

3.25pm Now Jeremy Hunt has taken to the stage at the Clinical Commissioners conference.

3.23pm Back to the conference - “Stevens says with specialised commissioning there is ‘an opportunity to do better’ and asks for CCGs help with that”.

3.22pm Here’s the NHS Confederation’s response to the primary care announcement:

NHS Confederation chief executive Rob Webster said: “This is a positive step towards local Clinical Commissioning Groups (CCGs) being able to commission services for their populations in a joined up way. Primary care, with general practice at its heart, must have a significant role to play in the future shape of health and care. By bringing together the commissioning of primary care services with community, mental health and acute care, we may see improvements to the care of people with multiple long term conditions, children and older people.

“We look forward to seeing how these  developments will work in practice as local leaders begin to shape the modern NHS. We hope that this work will be complemented by closer working with local authorities on the public’s health and true population based commissioning. Through this people will receive better care and local systems, including acute hospitals, could see better planned care that reduces pressure in these tough times.”

3.19pm Simon Stevens has confirmed he plans to give some clinical commissioning groups the ability to co-commission primary care with NHS England.

Mr Stevens announced today he would invite CCGs to “come forward and show how new powers would enable them to drive up the quality of care, cut health inequalities in primary care, and help put their local NHS on a sustainable path for the next five years and beyond”.

NHS England said CCGs should “describe the additional powers and responsibilities” they would like. It is unclear whether CCGs’ new powers could stretch to holding budgets or contracts for core GP services.

3.17pm “Stevens says there is no more administrative cost in the commissioning system ‘that is just the reality’”.

3.15pm “Stevens says by autumn he wants NHS to have an articulated view on how to be sustainable and improve care over the next five years”.

3.14pm “Stevens asks CCGs to stress test Better Care Fund plans with Health and Wellbeing Boards throughout May and ensure local acutes are also able to participate”.

3.13pm “Stevens asks that CCGs don’t allow mental health to lose out compared to other areas and praises IAPT.”

3.12pm A challenge to all CCGs - “SS: need you to successfully conclude 2014-15 commissioning round with attention to realistic activity levels funding for this year = pressure”

3.11pm “Stevens says this is not another top down reorganisation but saying @NHSEngland has a new role in co-commissioning”

3.10pm “Stevens will ask Ros Roughton next week to write to all CCGs to submit ideas for how they could have a role in primary care commissioning.”

3.08pm Moving into integrated care - “Stevens said to better integrate care at a time of constrained funding, it should be easier, CCGs should have greater clout”.

3.06pm Stevens says NHS England has work to do to improve data to help CCGs “SS: data and informatics clearly has some way to go - needs huge amounts of work quite soon. need fantastic actionable information.”

3.06pm “Stevens says we won’t be able to spend our way to a better future so we need to unleash some creativity.”

“Stevens says heart of CCGs’ justification is clinical leadership”

And here’s a tweet from our Comment Editor Andy Cowper (hpiandycowper):

“SS: Do CCG members feel able to shape CCG activity, and can you make a difference to what the NHS does? Is actionable data in your hands?”

3.02pm And here’s a tweet from Judith Welikala (@judithwelikala):

“Simon Stevens says he is strong supporter of CCGs and it is his job to prove sceptics they are wrong”.

3.00pm Our chief reporter Dave West has just tweeted this update on primary care commissioning:

“Stevens confirms he’ll invite CCGs to bid to be given extra responsibility commissioning primary care, he is announcing”.

2.48pm NHS England chief executive Simon Stevens and Secretary of State for Health Jeremy Hunt will be speaking at 3pm at the NHS Clinical Commissioner’s annual conference.

We’ll be giving updates and you can follow our reporters @dwilliamshsj and @judithwelikala on Twitter who are at the event.

2.37pm The National Children’s Bureau is “delighted” with measures introduced as part of the Health Education England mandate to improve paediatric training for GPs and provide expectant mothers with support on mental health.

Dr Hilary Emery, Chief Executive of the National Children’s Bureau, said:”NCB is delighted with measures announced today by the Department of Health that will result in better paediatric training for GPs on long term health issues and provide expectant mothers with additional support on mental health.”

“NCB has been at the forefront of children’s charities campaigning for better GP training. Offering GPs adequate opportunities to develop their skills, expertise and experience in working with children is a key part of improving child health. It can improve the quality of healthcare and ensure young people have a better experience of using GP surgeries. We look forward to seeing the detail of the training plans, and urge the Government to ensure that more GPs get first-hand paediatric experience within hospitals during their training.”

2.21pm In our Comment section King’s Fund director of analysis, Richard Murray, says more money is needed – and soon – if the NHS is to avoid drifting into a financial crisis.

1.42pm The future of NHS is at risk unless a funding gap is plugged, says the British Medical Association.

Responding to the King’s Fund report on NHS funding which says a significant increase in investment is needed to prevent a financial crisis in the NHS, Dr Mark Porter, Chair of BMA Council said: “This report lays bare the severity of the financial crisis facing the NHS and the fact that the health service is, put bluntly, running out of money. This makes the billions wasted on the government’s unnecessary reorganisation even more galling.

“With the UK falling behind other countries on health spending, and many services at or nearing breaking point, we need to act now to put the NHS on a sustainable footing for the future.

“While the government claim the NHS budget is being protected, in reality it’s facing a funding shortfall of £30bn, billions of which have been made up from unsustainable cuts to services and eroding the pay of front-line staff.

“Productivity in the NHS is going up and staff are working harder than ever before, in increasingly high pressured and challenging work environments, to meet rising demand. Doctors and other staff want to be at the fore of improving how the NHS delivers the best possible patient care, but we cannot get away from the fact that many services are critically under-funded.

“Politicians need to put their money where their mouth is to address the massive funding gap in our health service, otherwise the future of the NHS as we know it will be at risk.”

1.40pm Monitor has appointed a turnaround director at University Hospital of South Manchester Foundation Trust to tackle its short-term financial problems.

The trust will also undertake a review of its leadership and how it is run. This review will include how effective the board is and how the organisation identifies and deals with challenges.

Monitor opened an investigation into the trust in December last year after concerns about the organisation’s short-term financial stability emerged during the annual planning process. It is taking action after finding reasonable grounds to suspect the trust had breached its licence.

During the course of its investigation Monitor also looked into A&E performance after the trust breached the national target to make sure 95 per cent of patients are treated with in four hours.

The trust is now taking action to improve its A&E performance. Monitor will keep this performance under review and will take further action if necessary.

1.10pm Approximately 1 in 6 children and adolescents develop post-traumatic stress disorder after being exposed to a traumatic event – with girls at higher risk than boys, according to a report by the British Journal of Psychiatry.
In this study, researchers examined 72 peer-reviewed articles which examined over 3,500 children aged between 2 and 18 years old. Most of the studies involved children living in the USA, UK and Australia, though three studies looked at children from non-Western countries – Afghanistan, China and South Africa. All the children had been exposed to a variety of traumatic events, including motor vehicle accidents, the sudden loss of a parent, life-threatening illness, war, domestic violence, and child maltreatment.
The researchers found that, overall, around 16 per cent of children and adolescents exposed to traumatic experiences went on to develop PTSD. There was considerable variation in this rate, depending on the type of trauma. About 1 in 10 children developed PTSD after non-interpersonal trauma (such as natural disasters, injury due to an accident, life-threatening disease and sudden death of a parent), while 1 in 4 developed PTSD after interpersonal trauma (such as war, terrorism, injury due to violence, or abuse).
The researchers also found that girls were more likely to develop PTSD following trauma than boys – due in part to the fact that girls are more likely to be exposed to interpersonal trauma than boys. The researchers also suggest that girls may ‘internalise’ rather than ‘externalise’ their emotions and behaviour following a traumatic event, or blame themselves for the trauma more strongly. Further research is needed in this area.
1.00pm In our Comment section, the chair of the Federation of Specialist Hospitals welcomes Simon Stevens’ focus on specialist care.

12.55pm Chancellor George Osborne has approved £420m capital funding for the redevelopment of some of the oldest hospital buildings in the NHS.

Brighton and Sussex University Hospitals Trust’s outline business case for the replacement of buildings on its Royal Sussex County Hospital site has been with the Treasury for more than two years.

This morning the Treasury announced Mr Osborne had approved the investment.

The work will be a mixture of replacing the oldest buildings, many of which date back to the 19th century, and refurbishing some of the newer buildings. An additional 100 beds will be created as part of the work which is due to start this year and be complete by 2024.

12.11pm Papworth Hospital Foundation Trust has finally secured its long-awaited move to Cambridge University Hospital Foundation Trust’s biomedical campus.

The Treasury has today announced its approval of a £165m deal for a new hospital adjacent to Cambridge’s Addenbrooke’s hospital, in a move that shores up the trust’s future after years of uncertainty.

The new 310-bed Papworth hospital will be delivered through a 30-year PFI deal. Construction of the new facilities is projected to begin in 2015 and complete by 2017 to 2018.

12.03pm The Department of Health has responded to The Times front page story, which reported that the Royal College of GPs feared that thousands of patients could lose their family GPs in a “catastrophic meltdown” caused by funding reforms.

A Department of Health spokesperson said: “We want to ensure that patients have access to high quality GP services, no matter where they live. The system needs to be equitable so GP practices are paid fairly according to the number of patients and the services they need.

“The MPIG was introduced in 2004 to support practices moving to a new GP contract, and was never intended to be in place for the long term. The NHS will be supporting the most affected practices to adjust as these payments are gradually phased out over seven years, and the money will be reinvested in general practice.”

11.51am The NHS Confederation has also responded to the FSH report.

Dr Mark Newbold, chief executive of the Heart of England Foundation Trust and chair of the NHS Confederation’s Hospitals Forum, said: “The Federation of Specialist Hospitals’ report articulates some of the concerns and recommendations voiced by our members.

“There is widespread consensus that clinical outcomes should guide any decision about reconfiguring specialised services, and evidence needs to be gathered of any efficiency gains resulting from centralising these services in fewer, larger centres.

“Any specialised services’ reconfiguration planned by NHS England must consider and address the full range of consequences. For instance, smaller providers may be destabilised if they lose specialist services, and this could impact on their ability to provide other, non-specialised, services to their communities.

“In each locality, the whole health and social care system must co-create a strategy which is appropriate for the area, and is both sustainable and capable of delivering the best outcomes for patients.

“One size does not fit all, and this ‘place-based’ approach will ensure local need is taken fully into account.”

11.50am The Foundation Trust Network welcomes the Federation of Specialist Hospitals report as evidence of “impressive and welcome evidence” of high quality care delivered by specialist trusts.

Miriam Deakin, head of policy at the Foundation Trust Network, said: “Today’s report provides impressive and welcome evidence of the high quality care delivered by specialist trusts across the country.

“Driving innovation and developing the skills and expertise required to treat rare diseases is essential in ensuring the NHS operates a 21st century service which delivers its best for patients – as is providing integrated care to those patients receiving specialised services alongside other care.

“But as the report rightly highlights, there is more to do to ensure that payment systems and the quality inspection regime is tailored to, and supportive of, specialist provision whether provided in a specialist centre or a large teaching hospital.

“We look forward to working with all of our members and partners including the Federation of Specialist Hospitals to enable England to develop and implement a new strategy for specialised commissioning.  While ensuring efficiency in the system is important, this must be based on a clinical case for change in the interests of safe and compassionate care.”

11.40am The NHS Confederation has welcomed the King’s Fund’s latest report into NHS finances.

Chief executive Rob Webster said: “This is a helpful addition to the overwhelming evidence that the health service is facing the most challenging period in its history. Continuing to do things in the same way as we have always done is clearly no longer an option. It is essential that the NHS has both the space and the permission to change what it does and how it does it.

“Our 2015 Challenge is about securing commitment from politicians of all parties that they will go into the next General Election with manifestos that let the health and care system deliver the reforms essential for its future. Without this, it is very possible that the current basis of the NHS, free for all at the point of need, will become a thing of the past.”

11.20am A financial crisis in the health service is “inevitable”, a leading health charity has warned.

There is a “looming” financial disaster in the NHS which will arrive by 2015-16, the King’s Fund predicts.

This would have “damaging consequences” for patient care such as rising waiting times, cuts in staff and “deteriorating” quality of care, it said.

The health charity said that a “significant” boost in funding for the NHS is needed to prevent the impending crash.

11.18am The Department of Health has approved a £420m new hospital in Brighton.

The development will replace old buildings at the Royal Sussex County Hospital.

The hospital’s capacity will expand by 100 beds and the neurosciences and cancer centres will both also be improved.

The works at the Royal Sussex County hospital site will be fully financed from public funds and as part of the Department of Health’s capital investment budget.

Redevelopment works at the hospital site are expected to start later this year and complete by 2024. Plans will be finalised over the coming months.

11.10am Specialist hospitals which fear they could lose their independence under NHS England’s plans to centralise specialised acute services are calling on the body to rethink its “one-size fits all” approach.

The intervention is a sign NHS England will face fierce opposition from some of the country’s leading medics and most prestigious institutions if it presses ahead with large-scale reconfiguration.

In a report highlighting the superior clinical and patient experience outcomes of many specialist hospitals compared with national averages, the Federation of Specialist Hospitals calls for more consideration to be given to networks or “chains” of services rather than consolidation of services into between 15 and 30 centres as proposed.

11.05am A significant increase in funding is needed to prevent a financial crisis in the NHS, according to a new report from The King’s Fund.

The report finds that there are still significant opportunities to improve efficiency within the health service, for example by improving procurement and changing clinical practice. However, with more than a quarter of trusts already in deficit, the report warns that a financial crisis is now inevitable by 2015/16 and could arrive sooner than this, with damaging consequences for patient care.

The report highlights the progress made in improving efficiency in the face of the unprecedented slowdown in NHS funding since 2010. But it warns that the main ways of reducing costs - holding down salaries, reducing the prices paid to hospitals and cutting management costs - have now almost been exhausted.

Analysis conducted for the report shows that the NHS budget is under huge pressure. This will be exacerbated by the introduction of the Better Care Fund in 2015/16, which will divert a further £1.8 billion in NHS funding to support joint working with social care. In the long term, the report finds that on current projections, NHS spending as a proportion of GDP will fall to 6 per cent by 2021, its lowest level since 2003.

The report argues that new funding should not be used to disguise the need for change by propping up unsustainable services. Instead it should be used for two distinct purposes:

  • to establish a health and social care transformation fund to meet the costs of service changes and invest in developing new models of care outside hospitals
  • to make emergency funding available to provide temporary support for otherwise sound NHS organisations experiencing difficulties as a result of the unprecedented pressures on their budgets.

John Appleby, chief economist at The King’s Fund and lead author of the report, said: “There is still scope to improve efficiency in the health service, and efforts to release savings should be re-doubled. However, it is now a question of when, not if, the NHS runs out of money. Without significant additional funding, this will lead to rising waiting times, cuts in staff and deteriorating quality of care. It is essential that politicians from all parties are honest about the scale of the financial pressures facing the NHS and initiate a public debate about the long-term sustainability of the health and social care system before, not after, the general election.”

11.01am Nominations end at midday for our project to identify the 50 most influential people in the integration of health and care services.

To nominate someone for inclusion in the list, please send an email to Local Government Chronicle features editor Rachel Dalton at with ‘Integration 50’ in the subject line, or on Twitter by using the hashtag #integration50.

Within your email, please include your nominee’s name, the organisation they work for, and a short explanation (100 words or fewer) of why you believe they should make the list.

11.00am A report by the Federation of Specialist Hospitals looks at the achievements of England’s specialist hospitals. The authors hope the report will be an important contribution to the debate on hospital configuration in the NHS following NHS England’s announcement that it plans to reduce the number of providers of specialised services. 

The FSH is concerned that plans to reorganise these services should recognise specialist hospitals’ unique expertise and class-leading outcomes. The FSH is calling on NHS England to clarify its intentions regarding the reconfiguration of specialised providers in England. The Federation cautions against a one-size-fits-all approach and emphasises the need for change to be driven by clinical considerations.

Professor Tim Briggs, Chair of the Federation of Specialist Hospitals, said: “The Federation’s report highlights the excellent clinical and patient-reported outcomes achieved by specialist hospitals in both routine and complex services.  In an NHS where the experience of the patient comes first, hospitals that deliver the best outcomes for their patients should be at the heart of the service.

“The FSH supports the reorganisation of specialised services, where there is a clear clinical rationale focused on providing high quality care.  Reconfiguration of services, should concentrate provision in centres with the best outcomes for the relevant medical specialty, with appropriate sharing of this expertise through networks, rather than seeking to concentrate more services in just a few large hospitals.”

10.47am The Guardian reports that people should be rewarded with tax rebates for giving up smoking, staying slim or drinking less to relieve pressure on the NHS, a think tank has urged.

20/20 Health says incentive scheme that reward healthy lifestyles would encourage more people to look after themselves and avoid damaging habits. Incentives should also be available for those who do not become ill or prove good at managing conditions such as diabetes, it suggests.

10.45am Also in The Times, two out of three infertile men do not know about their condition because of the “plumbing, sporting or car mechanic” metaphors used by GPs when breaking the news to patients, a new book by medical sociologist Liberty Barnes claims.

Dr Barnes says male infertility is “culturally invisible” and there are gap in services for men.

10.42am Public Health England is considering banning electronic cigarettes in public places, The Times reports.

10.37am The Times leads on claims by the Royal College of GPs that hundreds of thousands of patients could lose their family doctor due to a “catastrophic meltdown” caused by funding reforms.

The RCGP has called for an emergency, saying almost 100 practices could be forced to close because of changes to the way money is allocated.

10.35am The Guardian reports that pneumonia will become a feared killer, surgery risky and diarrhoea is not taken to preserve the power of current antibiotics as well as develop new ones, the World Health Organisation has warned.

In its first investigation of the extent of antimicrobial resistance, the WHO said the world is facing a huge threat to public health, which could affect anybody of any age, with no country immune as bacteria and viruses resistant to drugs cross national borders with ease.

10.12am The NHS Clinical Commissioners’ member event will take place this afternoon, where Simon Stevens is expected to give detailed plans for primary care commissioning.

We will be giving you live updates from the event at 3pm today. Follow our reporters David Williams @dwilliamsHSJ and Judith Welikala @judithwelikala for twitter updates.

10.08am The Independent reports that antibiotic resistance is no longer something to fear in the future but is happening “right now”, the World Health Organisation has warned.

10.05am Trusts could see a significant reduction in penalty payments for breaching NHS targets in 2014-15, according to new analysis.

The study by software company Checklist calculated the potential size of this year’s fines by applying the new system of penalties and caps to trusts’ performance data for last year.

This showed that they would face less than £87m of fines in 2014-15 if the new rules and cap were applied. A similar study by Checklist in 2013 put the total penalties bill at £227m.

Checklist examined trust performance against targets for referral-to-treatment waits, 12 hour trolley waits, emergency admissions and cancelled operations, among others.

9.55am A troubled foundation trust is to be placed into special measures after inspectors reported a catalogue of repeated failings, including unsafe staffing levels and missed accident and emergency targets.

The Care Quality Commission has today said that the quality of care provided at Heatherwood and Wexham Park Hospitals Foundation Trust was inadequate, leading the watchdog to recommend the move.

This is the third time in two years that the watchdog has found evidence of inadequate care at the trust, which is expected to be acquired by neighbouring Frimley Park Hospital Foundation Trust.

9.46am A combined health and local government drive to help people with learning disabilities move out of hospitals by next month has been an “abject failure”, Norman Lamb has said in a scathing assessment.

With just one month to go before a key milestone was due to be reached, the care minister has branded progress “distressing”, “frustrating” and “utterly hopeless”.

Set up in the wake of the Winterbourne View scandal, the programme’s first major deadline on June 1 would now be completely missed, Mr Lamb admitted.

7.00am Good morning and welcome to HSJ Live. We start the day with the news that the NHS has been given a reprieve from an estimated £500m tax bill after HM Revenue and Customs backtracked on its attempt to standardise VAT rules on contracted out services across all government departments.