New NHS Litigation authority rules have major impact on North West trust’s finances, plus the rest of the day’s news and comment

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3.16pm In response to the CQC’s report today on mental health Health Foundation senior policy fellow Felicity Dormon said: “While the findings of CQC’s report today on people’s experiences of services for crisis care are disturbing they unfortunately do not come as a surprise.

“Our analysis shows variation in the quality of care across a range of mental health services. For example, inpatient provision for children and young people varies enormously, with some areas in 2014 having no inpatient beds available within a 50 mile radius for children and young people needing some forms of support.  

“National information shows rising numbers of people in contact with community mental health services – and suggests that it is not only crisis care services that are struggling to provide high quality, safe and accessible care.

“It is encouraging that the report identified successful innovative approaches. National and local Crisis Care Concordat groups must now take up the challenge of moving from plans to delivering actions that improve the accessibility and quality of crisis care – learning from those that are doing it well.”

1.35pm We’ve got an update to our story earlier this week that the provision of more than 50,000 extra GP appointments in Greater Manchester last year brought a 3 per cent reduction in accident and emergency activity.

Following the work within four “demonstrator” sites, it has been confirmed that seven day access to GP appointments and other primary care services will be rolled out across the city by the end of 2015.

An evaluation report by the National Institute for Health Research has assessed the impact made by the project in central Manchester, Bury and Heywood and Middleton last year, and health chiefs deemed the results to be encouraging enough to roll out the work.

Dr Ivan Benett, clincial director for Central Manchester Clinical Commissioning Group, said the overall results had matched expectations.

1.14pm Shortening the training of junior doctors alongside a greater level of generalist training ‘won’t work’, according to the president of the Royal College of Physicians.

Jane Dacre has criticised proposals in the Shape of Training Review on the future of medical education and training, which suggest shortening the length of time it takes for a junior doctor to become a consultant.

The independent review was commissioned by the General Medical Council.

The aim of the review, chaired by Nottingham University vice chancellor David Greenaway, was to produce proposals to adapt UK medical education to the changing needs of the population.

12.15pm People who are having a mental health crisis are not always receiving care and support when and where they need it, the Care Quality Commission has said.

The regulator raised its concerns in a report published today. As part of its review, CQC surveyed people who have experienced different types of mental health crisis care.

It found that while 86 per cent of those who had received care and support from charities and volunteers felt that their concerns had been taken seriously by them, only 37 per cent said that they felt this from accident and emergency staff.  In addition, people reported poor attitudes from staff towards their injuries caused by self-harm. Only 14 per cent of thought the care they received provided the right response and helped them to resolve their crisis.

The CQC found a “clear need” for better 24-hour support for people having a mental health crisis, particularly during the hours of 11pm-5am, where availability and accessibility to services poor. This had led that people going to accident and emergency departments or even to police cells while a “place of safety” could be found for them.

The regulator also found:

  • Many people will go to see their local GP as their first point of contact when they are having a mental health crisis. The majority (60 per cent) of people said they were satisfied with the experience.
  • Most people said that they came into contact with at least three different services when they had a mental health crisis. 12% said that they had come in to contact with between six and ten services, which indicates a need for them to work more closely together in areas.
  • There has been a “significant” reduction in the use of police custody as a ‘place of safety’ for people in crisis, but are still problems with people under 18 being able to access a suitable place of safety. In 2013-14, nearly a third (31 per cent) of under 18s who were detained were taken into police custody.

The CQC’s lead for mental health Paul Lelliott said: “It is not acceptable for people with mental health problems to be treated differently to those with physical health problems.

“We know that people can experience a mental health crisis at any time of day or night, and so the NHS and our other public services must make sure they are equipped to provide the specialist and urgent care that is needed around the clock. Sadly this is not what we have found from our national review.

“What’s more, we found that when people do receive help, hospital and mental healthcare staff are not always compassionate and caring. Worryingly, many people told us that when they were having a crisis, they often felt the police and ambulance crews were more caring and took their concerns more seriously than the medical and mental health professionals they encountered. 

“In particular, people who have inflicted harm on themselves as a result of their mental distress deserve the same respect and compassion as those whose injuries are sustained by accident.

“These findings must act as a wake-up call to our public services. We found some excellent examples of services in areas joining-up and providing effective care, with staff committed to working to make sure people in a crisis received the help they needed. These examples must become universal.”

He added: “NHS trusts and other commissioners of care must make sure that they place a bigger focus on training staff to look after those having a mental health crisis, no matter where they are or when they need help. I feel that no NHS leaders can consider themselves to be a success while these issues go unanswered.”

Health minister Alastair Burt said: “We asked CQC to do this investigation so we could shine a light and better understand the perspectives of people who have experienced a mental health crisis. It is clear that there is still a long way to go to make sure everyone is treated compassionately in the right place and at the right time.

“We’re tackling historic underfunding and have increased investment in mental health by £300m last year. 

“We have also introduced the first treatment targets to make sure people get the prompt support they need and mental health is treated on the same terms as physical health.

“More people than ever before are receiving talking therapies, we are working hard to tackle mental health stigma, and work continues to improve early intervention services to make sure that people get the care they need to prevent crisis situations happening.

“Street triage schemes joining up police nursing are proving to be successful and we have halved the number of people going through a mental health crisis going to police cells.

“Improving mental health care is my priority. I am clear that there is so much more to achieve and we all need to work together to achieve it.

“The CQC will now inspect crisis care arrangements in every service and I have asked them to continue to help stamp out poor care and help us to make sure that people with physical and mental health conditions are treated with equal importance.”

Paul Farmer, chief executive of the mental health charity Mind, said: “This is an important review that looks in detail at a vital part of NHS mental health services. We welcome its findings and the thorough, person-centred way in which it has been conducted.

“The report will not come as a surprise to anyone who has found themselves in crisis or who is involved in supporting people when they are at their most unwell. We know that, while excellent services do exist, the emergency response for mental health in many parts of England is just not good enough.

“We take for granted that when we have a physical health emergency, we will get the help we need urgently. It should be no different for mental health, yet far too many people are just not getting the help they need.

“This report is a clear call to action. Mental health services are the victim of years of neglect and funding cuts over the last few years have taken their toll, at a time of rising demand. National and local commissioners must now make mental health a priority and invest in the future of our mental health services.”

11.35am The Times reports that weekend GP appointments have been scrapped in one of David Cameron’s key pilot schemes after doctors said no one was turning up. Patient campaigners called the decision “ludicrous”.

Barely one in ten Sunday appointments was filled in Yorkshire surgeries testing out-of-hours care and only half of Saturday slots were taken up, doctors said.

Patients were also reluctant to go to surgeries other than their own, in a setback for a scheme reliant on groups of practices teaming up to share evening and weekend care.

11.00am The National Institute for Health and Care Excellence spent nearly £1m on its work to develop nurse safe staffing guidelines for the NHS, HSJ has learned.

NICE was told to suspend its work by NHS England chief executive Simon Stevens last week.

There has been widespread concern over the decision to suspend work by NICE, which was a key recommendation of Sir Robert Francis following his public inquiry into poor care at Mid Staffordshire Foundation Trust.

An interim report on NHS efficiency by Lord Carter, published yesterday, also said NICE should be used to improve guidance on appropriate staffing levels and skill mix.

10.18am A quick recap of yesterday’s top stories:

Plans were announced for Monitor and the NHS Trust Development Authority to work much more closely together, under a single chief executive, who will not be Monitor’s David Bennett. A new chief executive is being sought with the intention to appoint by the end of the summer. Rather than a formal merger, which still seems likely in the long run, the organisations said the move will create a “much closer relationship”.

There was also a general welcoming of Lord Carter’s interim findings on NHS efficiency, which predict that improved management of workforce, medicines, estates and procurement can save up to £5bn a year by 2019-20.

10.10am The NHS - which is critically reliant on its staff - needs a comprehensive workforce strategy to meet all its challenges and meeting these successfully will need close cooperation across multiple organisations, writes King’s Fund policy director Richard Murray.

7.00am Good morning and welcome to HSJ Live. We start the day with changes to the clinical negligence scheme for NHS organisations.

More than 40 trusts have lost their maximum discounts for premiums for 2015-16 now that changes to the way clinical negligence premiums are calculated have come into force.

The changes, implemented in April, will have an especially heavy impact on Liverpool Women’s Foundation Trust. The new rules brought in by the NHS Litigation Authority give more weight to an organisation’s claims history when setting its premium. They were first agreed in 2012-13.

Along with trusts now being liable for large claims from previous years, the changes also remove discounts for those that had achieved higher risk management standards. The changes have also been applied retrospectively, meaning Liverpool Women’s has to pay for claims related to cases dating back to 2001.

This makes the £102m turnover trust liable to a group action expected to cost £35m. It relates to claims made by around 360 women who said mistakes by urogynaecologist George Rowland between 2001 and 2008 had made their incontinence worse.