The Department of Health has today announced a £250m elective care fund to help providers clear their planned treatment backlogs, plus the rest of today’s news and comment.


The DH also said there would in 2014-15 be a £400m fund for “winter pressures”, £250m of which was announced last year by NHS England, aimed at addressing pressure in accident and emergency departments.

The NHS has also been told to create “system resilience groups” in each area to oversee elective and emergency performance.

4.10pm The Department of Health has today announced a £250m elective care fund to help providers clear their planned treatment backlogs.

The DH also confirmed a £400m winter pressures fund for accident and emergency departments, £250m of which was announced last year by NHS England.

The elective care fund will be made available over the next few months and NHS England will work with Clinical Commissioning Groups to allocate the money based on the need of each provider.

In a move away from last year’s funding pattern, the money will be available to all trusts.

Last year, A&Es that were struggling the most were allocated £250m before a further £150m was made available for all trusts.

A news story with more detail will follow shortly.

3.35pm The news that NHS England has approved a local alternative to the QOF system for practices in Somerset, has garnered some interesting rection.

Here is a selection of comments from readers of today’s story on the British Medical Association’s warning that the move could lead the the “Balkanisation of national healthcare.”

“The BMA is wrong. By allowing individual CCGS to develop local quality outcome measures you provide true autonomy.
Secondly it will generate more ideas and innovation enabling comparisons and ultimately improved care for patients. How can a top down single set of QoF framework produce innovation?”

Another reader adds:

“The BMA is wrong. Using a large number of process measures for tick box care against a narrow band of long-term conditions is not structured care. The whole health and care system needs to work towards dealing with complexity and frailty in a very different way and harness what GPs are best placed to do with the right resources.

“Is the Balkanisation more of a threat to the BMA than to the NHS?”

A supporter of the BMA’s position, writes:

“BMA is absolutely correct.This is beyond belief. How can a local CCG agree to something like that without consultation with NHS England and the CQC. How is accountability and health care complexity especially management of long term conditions be measured?”

1.15pm Health secretary Jeremy Hunt has said that the debate over the use of private providers in the NHS is “utterly toxic”, and that poor care is still unacceptable regardless of how it is provided.

1.05pm Allowing GPs in a single clinical commissioning group to break away from the nationally agreed quality and outcomes framework could lead to the “Balkanisation of national healthcare”, the British Medical Association has warned.

Yesterday HSJ revealed that NHS England had approved a local alternative to the framework for practices in Somerset.

Details of the Somerset Practice Quality Scheme agreement - seen by HSJ - state practices which choose to take part will only have to report against five of the 67 indicators in the 2014-15 framework.

1.00pm Small district general hospitals can survive and thrive but the way services are provided to local patients must change to guarantee quality care, the regulator Monitor has said.

Economists from the watchdog analysed a comprehensive range of clinical and financial indicators to test whether any special factors affected the performance of hospitals with fewer than 700 beds (typically in trusts with an income of less than £300m).

The research by the health sector regulator found no clear evidence that smaller acute hospitals performed any worse clinically than larger counterparts.

However, the analysis showed that there is evidence that smaller providers may be starting to face greater financial challenges, with performance worsening more than the sector as a whole in the last two years.

The report concludes that size is likely to become more of an issue as hospitals face greater pressures to recruit staff to further improve the quality of care. Monitor recommends that the sector should:

  • Identify new models of care for patients, for example re-designing services to improve the integration of care and move it closer to home
  • Come up with creative ways to address the scale challenges, such as sharing staff with nearby trusts, using new technology, or building networks between smaller hospitals and major centres
  • Make sure that the right balance is struck in local communities between redesigning services and making sure patients are treated near to where they live

David Bennett, chief executive at Monitor, said: “People value their local hospitals and we wanted to understand the challenges that they face as the NHS takes on a potential £30 billion funding gap over the next decade.

“We found that smaller hospitals are facing increasing challenges but with the system’s support can continue to play an important role in the nation’s health service.

“Bigger isn’t always better and just merging or taking a ‘one size fits all’ approach to local health services is not the answer. We need to achieve the right balance between risks to quality and risks to access, and consider other constraints such as the impact of clinical specialisation to make sure patients continue to benefit from the local hospitals that they value so much.”

11.43am The Daily Telegraph reports that NHS hip operations have claimed more than 40 lives despite the health service being warned of the dangers they pose five years ago.

Sir Liam Donaldson, the former chief medical officer, and a team from Imperial College London, found that 62 people had died or suffered harm following a toxic reaction to the bone cement used in their hop operations.

Patient safety and drug watchdogs first warned about the cement in 2009, but it continues to be used in hop operations.

Also in The Telegraph, doctors and nurses will be told in new guidance that they must apologise to patients if they are harmed or distressed.

The General Medical Council has set out guidelines for NHS staff, warning them they must respect the dignity of patients, act with honesty and admit when they have made mistakes.

11.30am English waiting lists narrowly avoided two rotten headlines in April, and improved where it matters most. But trouble is still building in the longest wait specialties, writes Rob Findlay, founder of Gooroo Ltd and a specialist in waiting time dynamics.

11.25am The Guardian reports that alcohol firms are adopting contentious tactics pioneered by the tobacco industry by funding charities to gain influence inside government, researchers claim in a new study.

Drink manufacturers, retailers and grant-making trusts have given five alcohol charities donations of up to £1m each in recent years, according to research by academics at the London School of Hygiene and Topical Medicine.

11.11am This week’s issue of HSJ magazine is now available to read on our tablet app.

11.09am Clinical commissioning groups that commission elective and trauma musculoskeletal services separately risk destabilising their local health economies, the British Orthopaedic Association has warned.

The alert came from Tim Briggs, the association’s president and a consultant surgeon at the Royal National Orthopaedic Hospital Trust.

11.00am Colchester Hospital University Foundation Trust has begun a disciplinary investigation and suspended a member of staff in relation to alleged wrongful manipulation of cancer patients’ waiting time data.

The move follows whistleblowers reporting allegations of “bullying and harassment and the alleged manipulation of endoscopy and dermatology waiting lists”, which has been highlighted in an independent report.

10.50am The NHS Confederation has released a statement responding to the AMRC report ‘Guidance for Taking Responsibility: Accountable Clinicians and Informed Patients’

Dr Johnny Marshall, GP and director of policy at the NHS Confederation said: “It is important that patients know who is ultimately responsible for their care.

“Displaying the names of the accountable doctor and nurse is a good building block to developing positive, trusting relationships between clinicians and their patients.

“This is vital to ensuring patients receive good quality care. Everyone involved in the management or delivery of NHS services has a personal responsibility for the quality of care they provide and ensuring the safe transfer of that responsibility when patients leave hospital.

“As Dr Kate Granger told health service leaders at our annual conference last week, it is ‘the little things’ that make a big difference to patients. As healthcare professionals, we can play our part in making sure that every patient has a good experience, every time.”

10.45am NHS England has still not worked out how to present trusts’ nurse staffing data on NHS Choices, less than two weeks before it is due to publish the information for the first time.

Health secretary Jeremy Hunt announced all trusts would have to collect and publish ward level staffing data, as part of the government’s response to the Mid Staffordshire Foundation Trust public inquiry.

10.40am Guidance from the Academy of Medical Royal Colleges published today will for the first time make doctors responsible for the whole of a patient’s care during their stay in hospital.

The so-called ‘name over the bed’ initiative will make it clear to patients, their carers, nurses and relatives, which doctor is ultimately responsible for all aspects of their care. The guidelines also say a ‘Named Nurse’ should be available to provide patients with information about their care and should be a primary point of contact.

The move follows one of the Francis Report’s key recommendations that if a named clinician were accountable throughout a patient’s treatment in hospital then patient safety and the overall quality of care could be improved. It will help make sure that patients are only discharged if it is in their best interests, with appropriate support from friends, family or carers and when it is safe and clinically appropriate to so, particularly if a patient is vulnerable.

The guidelines have been produced by the Academy following a request by health secretary Jeremy Hunt MP to examine ways to improve the accountability of clinicians and communication with patients and families.

The Academy has worked closely with patient groups, employers and nurses’ representatives and NHS England throughout the process.

The General Medical Council is also issuing advice today which consolidates its previous guidance to doctors on their responsibilities for patients.

Jeremy Hunt said: “Patients tell us that, too often, their care isn’t joined up. That’s why every patient should have a single responsible clinician whose job it is to help them with anything that goes wrong and make sure they get the care they need. This guidance will make that a reality - it has been developed by clinicians, for clinicians, and is a huge step forward for patient safety.

“I am very grateful to the Academy of Medical Royal Colleges for their work which will help to make sure patients experience the best care during their hospital stay.’

Professor Terence Stephenson, chair of the Academy said, ‘Doctors recognise that we need to have clear lines of responsibility when it comes to the way patients are treated during their stay in hospital.

“Some hospitals have already implemented a ‘name over the bed’ process and where they have, patients say they have more confidence that someone is taking overall responsibility for them. They also know who to go to if they have questions or if they think something needs to be done differently. This is vital if we are to drive up standards of care and continue to safeguard patient safety.’

10.30am HSJ’s exclusive about Somerset GPs being given permission to move away from the national quality and outcomes framework prompted some reaction from senior figures in the British Medical Association on twitter last night.

They feel that it shows NHS England is not giving priority to long term conditions in Somerset and that what the Somerset practices will be paid for is things practices everywhere are doing anyway, such as improving integration with other services and reducing avoidable hospital admissions.

Richard Vautrey, deputy chair of the BMA’s GP committee tweets:

10.30am Health secretary Jeremy Hunt has said that the debate over the use of private providers in the NHS is “utterly toxic”, and that poor care is still unacceptable regardless of how it is provided.

Mr Hunt added that the public suspect that both Labour and Conservative politicians can be more inclined to pay private providers because it is “logical”, rather than for reasons of patient care.

10.20am NHS England have released a statement explaining the development:

An innovative new scheme developed jointly between Somerset CCG, Somerset LMC, local GP practices and NHS England is aiming to improve Primary Care services for patients across Somerset.

GP practices are being given the opportunity to either trial the new locally designed Somerset Quality Practice Scheme or continue with the existing national Quality and Outcomes Framework.

Practices participating in the SQPS will work closely and collaboratively with other health organisations in Somerset, sharing highly skilled staff between practices to provide more advanced care of long term conditions, such as diabetes, and in the care of the frail and elderly.

The one year trial starting Summer 2014 will be closely monitored by NHS England and independently evaluated by the South West Academic Health Science Network upon completion.   

Linda Prosser, director of primary care for the Bristol, North Somerset, Somerset and South Gloucestershire Area Team, said: “NHS England is pleased to be supporting this locally designed, innovative approach.  It’s responding to patient needs by giving GPs greater flexibility and potential to work closer together to improve primary care services for people locally.”

Dr Matthew Dolman, chairman of Somerset clinical commissioning group, said: We are very pleased that NHS England has agreed to the proposed pilot of a local quality scheme focusing on integration of care around the patient and sustainability of primary care. We have listened to our members, to patients and to other stakeholders and look forward to testing out this new way of working.

“The one year pilot will be subject to rigorous evaluation and we hope the results will be of interest, not just locally but nationally as well. The majority of Somerset’s GP practices will be taking part in the pilot, which will run until the end of March 2015.”

Dr Sue Roberts, chairman of Somerset Local Medical Committee, said: “Somerset LMC has been delighted to work closely with the Area Team, Somerset CCG and practices to enable this pilot project to come to fruition. 

“We are fortunate in Somerset to have a unique opportunity to do this based on the relationships that have developed between the organisations and building on the high quality of care that Somerset GPs have always delivered. Hopefully the results of this Pilot can begin to show how GPs, when given the opportunity, can really make a difference to the care of patients.”

Practices taking part in the scheme will continue to provide the care set out in the QOF as clinically appropriate and will continue to report on this care. However, funding will be issued on the basis of contribution to providing proactive, multidisciplinary and integrated care for patients, rather than by QOF performance.

Evaluation will include analysis of how greater integration of health care services can lead to improvements in patients’ confidence in managing their long term conditions, and what impact this has had on the use of secondary care services and health outcomes.

No local alternatives to the QOF will be offered by NHS England in any other part of the country during 2014/15

10.05am Dr Chaand Nagpaul, chairman of the BMA GPs committee, and his deputy Dr Richard Vautrey, have tweeted their opposition to the move:

10.00am The British Medical Association has come out strongly against the decision to allow GPs in Somerset to ditch reporting against the majority of quality and outcomes framework indicators in favour of a locally developed approach, in a move seen as a “significant departure” for NHS England.

7.00am Good morning and welcome to HSJ Live. We begin the day with a piece from former Primary Care Trust and trust chief executive Robert Creighton on how the NHS needs to ditch cynicism to make new leadership a reality.