There is dwindling interest among commissioners in using ‘any qualified provider’ to increase competition and extend patient choice, an HSJinvestigation has found, plus the rest of today’s news and comment

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4.50pm There may be wide variances in the diagnosis and treatment of rare cancer Mesothelioma, a report from the Health and Social Care Information Centre suggests.

The cancer is most common in older men and closely associated with exposure to asbestos.

The report’s findings are based on data for 8,740 patients in England and Wales first treated in secondary care for the disease between 2008 and 2012.

Despite this being one of the largest case series ever published in the world, the relatively low number of cases for each area means the data should be interpreted with caution. However, findings suggest wide variation in the approach to diagnosis and treatment. For example looking at Cancer Networks, average intervals between referral to diagnosis varied from 15 to 44 days and proportion of fit patients receiving chemotherapy varied from 61.3 per cent to 19.9 per cent. 

4.30pm Our exclusive story revealing that Simon Stevens told Andy Burnham EU regulations would prevent a ban on NHS tendering has gathered some interesting reader debate:

“Scotland and Wales reject compulsory tendering and do not breach EU competition law. England has chosen its procurement policy. EU law permits flexibility in the procurement of public services: ‘In principle, the activities classified as public services are determined exclusively by the State, and more specifically, the legislator.’” 

“Yes, by Section 75 in particular, tho also the other issues Debbie Abraham’s highlights. We had this row at the time of s75. Blaming the EU for ‘privatisation is here to stay’ is false, just a figleaf for the broken promises of those tories and lib dems who said there was nothing in the act to promote privatisation.”

“And TTIP - the free trade agreement between North America and the EU will be another nail in the coffin unless the EU can secure exemptions for ‘national health services’ The Canadians helped shape the exemptions last time. England has been supine about this and the 2012 changes particularly to the commissioning landscape does not help. The provider procurement game was lost a long time ago. Simon Stevens is right on that. The DH did not think EU legislation applied to patient choice, the trojan horse that let the rules apply.”

“The new system in England gives a lot of support for commissioning (CSUs etc) but none for tendering. If you are an NHS provider running hard to keep the wheels on your current service, trying to achieve18 weeks etc you will find it very difficult to find the resource and time to write a sexy tender document to compete, whereas AQP and the independent sector have the time and resources to put together comprehensive tenders, at least on paper (usually glossy) to try to win new work. What we end up with are pre-existing NHS services, that may be reasonable, finding it hard to put their case across in a tender, easily criticised as they are the current providers that are providing a real service that exists - the potential new boys on the block put together a plan for a service that does not exist and sells the CCG a dream of what might be. CCGs and patients beware! NHS organisations either need to be supported in their tendering or their management be instructed to put aside time and resource to tender properly or the NHS as we know it will fragment and disappear. Tendering is not a level playing field where resource is concerned and seriously disadvantages existing NHS services with the current commissioning arrangements.” 

3.30pm The BBC reports that staff at Southampton General Hospital have received abusive calls and emails in the wake of the Ashya King case.

Chief executive Fiona Dalton said that staff had also been questioned about the case “sometimes in a very aggressive way”.

2.45pm The Academy of Medical Royal Colleges has welcomed the 2015 Challenge Manifesto.

Chair, Professor Terence Stephenson, said: “Healthcare faces a number of serious challenges which must be addressed. Overcoming these challenges is going to take political courage from all parties to ensure an honest debate and proposed solutions.

“I believe it is hugely significant that clinicians, patients groups and healthcare managers working across health and social care have worked together to set out a clear vision of a future health and care services.

“We hope all politicians will look at this seriously, address the issues we have outlined and commit to this vision for 2015.”

A letter to Andy Burnham from NHS England chief executive Simon Stevens, released under the Freedom of Information Act, suggests it is European regulations set down well before the current parliament that prevent a blanket ban on competitive tendering for NHS services.

The letter was sent in response to Mr Burnham’s request that NHS England suspend the signing of “any further contracts for NHS clinical services”, except where there was urgent clinical need, until after the 2015 general election.

1.40pm Also in The Times, dementia patients have urged the government to spend more money on researching a cure, as new figures show there are 46 times as many trials under way into cancer drugs as into dementia.

In a letter to the health secretary, Jeremy Hunt, 27 families affected by the condition said: “While a drive to improve diagnosis and care and support will help people live well with dementia today, greater investment in research and ring-fenced funding could help us find a cure for dementia tomorrow.”

1.05pm The Times reports that making fat people feel bad about their weight only makes them heavier, according to researchers who say that weight discrimination should be treated like sexism or racism.

The study found that overweight people who felt discriminated against put on almost 1kg over four years, while those who did not lost weight.

Sarah Jackson, of University College London, who led the study, said: “There is no justification for discriminating against people because of their weight”.

Andy Burnham was speaking at a conference on NHS leadership, where he also conceded that the payment by results system introduced under Labour had “caused a problem” and indicated support for a care model in which acute trusts employed GPs and social care staff.

He told delegates: “Given what’s happened in recent years… the old way of doing things certainly won’t work now, and it shouldn’t have happened anyway.

All CCGs are given annual allowances for running costs separately from their programme allocations, which are intended to fund health and care services.

The proposal by South Devon and Torbay CCG would involve funding an annual cost of around £300,000 for clinicians sitting on “pathway groups” and leading individual service design work from its programme budget.

11.40am With just seven days to go until people in Scotland vote on independence, their feelings towards the NHS will be one of the factors to have a massive impact on the referendum result, argues James Tout, a former Scottish government communications officer, in our Comment section.

11.15am The Healthcare Financial Management Association has responded to the 2015 Challenge Manifesto.

Director of policy, Paul Briddock, said: “We are proud to be part of the 2015 Challenge Manifesto and its aim to highlight the very real challenges facing the NHS and social care. We believe that an open and honest debate is needed between the public and all political parties about the future of health and care services; the scale of the financial challenges; what these mean for service provision and care and the actions required.

“The current model is simply not fit-for-the-future and we urgently need to change the way we provide services so they are better focussed on the needs of patients and offer the best care possible.”

Len McCluskey, general secretary of Unite, said there had been an orchestrated campaign of “disinformation” over the Transatlantic Trade and Investment Partnership (TTIP), and claimed it would lead to privatisation of health services in the UK.

The government has denied the claim, insisting a deal would boost trade, create jobs and help small businesses.

10.45am The Independent reports that Jeremy Hunt has a “great deal of sympathy” for the idea of charging drunks money if they end up in A&E units.

He acknowledged that there were practical difficultues in introducing a charge, but insisted that people should be made to take responsibility for their actions.

Taxpayers should not have to foot the bill for some people who had one “over the top” on a night out.

Minister of state for care and support Norman Lamb said the draft Legislative Reform Order sought to amend the NHS Act 2006 to allow clinical commissioning groups to form a joint committee when exercising their commissioning functions jointly.

But Labour accused the coalition of trying to fix “yet another problem” thrown up by its controversial health reforms, which passed into law in 2012.

10.30am Ashya King, the five-year-old now waiting for radiotherapy in Prague following brain tumour surgery, will suffer the same side-effects and have the same chances of recovery as if he had been treated in the UK, NHS experts believe.

The Guardian reports that the type of tumour Ashya has, medulloblastoma, is not on the list of cancers approved by the NHS specialist board for proton beam therapy. Proton beam therapy uses beams of protons which can be targetd to hit the tumour, which is useful for tumours that can be targeted by medulloblastoma leftover cancer cells can be anywhere.

10.20amThe Guardian reports that children of mothers who drink as little as four units of alcohol a day even once while pregnant are at greater risk of developing mental health problems and doing less well at school, new research has found.

The study of 4,000 children found that the 11-year-old offspring of women who consumed the equivalent of two medium-sized glasses of wine in one session during pregnancy are more likely to suffer from hyperactivity and inattention.

10.12am Dementia patients and their families are being hit by a ‘care tax’ of more than £20,000 a year, research by the London School of Economics has revealed, reports the Daily Mail.

Families are forced to cover the costs of extra basic help because it is not provided by local authorities.

It is estimated that of the £26bn a year cost of dementia to the UK, patients and their families are picking up two-thirds of the amount - about £17.4bn.

10.05am The Daily Mail reports that patients have a ‘human right’ to be told if they have dementia, Simon Stevens has said.

GPs should always seek to diagnose the illness and not make the assumption that sufferers would rather stay in the dark, he said.

He warned that there was an ‘attitude of fatalism’ about dementia in the NHS, with both doctors and patients thinking ‘nothing could be done’.

Data gathered from 183 clinical commissioning groups under the Freedom of Information Act shows that a minority have opened new services up to any qualified provider in 2014-15, despite the government’s intention that the policy would be extended to an increasing range of services.

AQP was a key policy for extending patient choice and introducing competition between providers at the time CCGs were being established. It enables commissioners to set up “zero based” contracts, meaning providers have no guaranteed income but are paid based on how much activity they attract.

7.00am Good morning and welcome to HSJ Live. We begin the day with an opinion piece from Rob Webster and Chris Hopson. They argue that the next Francis report on how the NHS treats whistle blowers will be required reading for people across the health service.