HSJ Live 14.06.2013: A&E data suggests poor out-of-hours not driving attendances

5.27pm: NHS England has published some guidance on the vexed question of how commissioners can carry out risk stratification in light of compex rules and legal restrictions on use of patient identifiable data. Problems with commissioners accessing data - which have emerged in the establishment of the new NHS system - have irritated commissioners. Its guidance acknowledges, “The Health and Social Care Act 2012 has complicated the legal landscape relating to risk stratification”.

5.05pm: NHS Clinical Commissioners co-chair Steve Kell, also Bassetlaw CCG chair, has written a blog about why shadow health secretary Andy Burnham is wrong to propose giving NHS commissioning budgets to local authorities, and making CCGs advisory bodies.

2.28pm: The General Medical Council, the doctors’ regulator, has issued a statement on the discussion surrounding publication of surgeons’ performance.

Niall Dickson, GMC chief executive, says: “We expect doctors to put their patients first. We’re living in an increasingly transparent age where doctors are expected to be open about their practise. We would encourage all doctors to be as open and public as possible with information about the care they provide.

“All doctors are now subject to annual appraisals - we would expect surgeons who do not join a national scheme such as this to be prepared to discuss their decision as part of that process.”

2.33pm: The A&E statistics from this morning have sparked an interesting twitter debate between Homerton FT medical director John Coakley, King’s Fund chief economist John Appleby, and NHS policy expert Joe Farrington-Douglas.

2.30pm: We have published a story on the latest developments at troubled Leeds Teaching Hospitals Trust. An interim chief executive and turnaround director have been appointed, who are a husband and wife team.

2.29pm: Campaigning comedian GP Phil Hammond tweets: “Well done the Royal College of surgeons. They’re researching ‘never events’ & want patient & staff input http://t.co/8PUaGKqueO”

2.03pm: Healthwatch England has announced two senior appointments - of Claire Pimm as director of communications and engagement, and Marc Bush as director of policy and intelligence.

A statement said: “Claire joins Healthwatch England from the Department of Health where she was Head of Brand Management with responsibility for NHS and Department of Health brands. She is a highly experienced communications expert with considerable experience within local and national government and charitable sectors, where she has worked at Mind, Bliss and Contact a Family.

“Marc joins Healthwatch England from the disability charity Scope, where he was the Head of Research and Public Policy. He has a background in autism research, extensive experience of developing public policy and has acted as an advisor for statutory bodies, Government departments, local authorities and charities. “

11.21am: We’ve published an important piece of analysis by our reporter David Williams of the workforce in the new commissioning landscape. Among the findings are a more than a 100-fold variation in the numbers of people employed by clinical commissioning groups. The revelation has prompted concern over the viability of smaller CCGs.

The research also gives major insight into the balance of workforce and roles between CCGs and commissioning support units.

It includes infographics describing the findings.

11.07am: NHS England’s latest weekly A&E performance data is published here,appearing to show a continued improvement in performance from serious problems in March.

NHS England ‏tweets: “A&E - Over 95% of patients seen in under 4 hours every week for 10 weeks http://bit.ly/120028f

“A&E - 96.8% of patients seen in under 4 hours in all A&E types http://bit.ly/120028f”

11.04am: NHS England has published official hospital activity data for April, and A&E performance data.

Hospital activity data shows a large year on year increase in GP referrals, and a smaller increase in emergency admissions.

The statement says: “GP referrals made for April 2013 show a 12.4% increase, compared to April2012 (1.7% adjusted for working days). These referrals had shown a 7.7% increase (2.0% adjusted for working days) at the same stage last year. “

“Non-elective admissions for April 2013 have increased by 4.1% compared to April 2012. As non-elective admissions occur throughout the week we have not adjusted for working days.”

10.59am: Hackney GP Jonathan Tomlinson tweets in response to the Information Centre statistics on A&E attendance - particularly the disparity between attendance rates among rich and poor. He says: “With nowhere else to go, patients end up in A&E or GP surgeries”, with reference to his blog on the issue from last year.

10.29am: We’ve published coverage of the latest development on publication of individual surgeons’ outcomes. It follows news that they will be able to opt-out. Our story says: “Doctors who decide not to disclose details of their performance will be “named and shamed” by the government, it has emerged.Jeremy Hunt, the health secretary, said there was “no valid reason” why consultants should not make their figures available.”

10.19am: We have published the news that the Department of Health has set aside £600m to pay up to 22 NHS trusts to procure a patient records system branded “completely useless” by a senior MP. The coverage from the public accounts committee is the latest development in the national programme for IT saga.

10.06am: The Times reports on a report into alcohol abuse by the National Confidential Enquiry into Patient Outcome and Death charity. The report calls for all patients attending hospital to be screened for alcohol abuse and for all hospitals to have a seven day alcohol specialist nurse service. The Department of Health backed charity examined the notes of 385 patients who died from alcohol related liver disease across England, Wales and Northern Ireland and found there were “missed opportunities” to help influence the patient’s health outcome in 135 cases. Researchers estimated as many as 32 of these deaths could have been avoided, the paper reported.

10.01am: The HSCIC release (see below) is an interesting contribution on the controversial issue of A&E pressure.

In a statement its chair Kingsley Manning said: “As the authoritative and trusted source of national health and social care information, the HSCIC is providing this timely and robust analysis to inform current debate.”

9.57am: The Health and Social Care Information Centre has published an analysis of provisional official statistics on accident and emergency attedances, which will fuel the debate on the large surge in A&E waiting times earlier this year.

A HSCIC stateemnt says: “While the number of patients attending A&E has increased each year for the period analysed (from 2007-08), the pattern of their arrival times has remained largely unchanged, with about three in five attendances during “working hours”.

“In the 11 months to February 20134, 58.5 per cent of patients (9.8 out of 16.8 million) arrived between 9am and 6pm. This figure has varied between 56.8 per cent and 58.5 per cent of patients from 2007-08 to 2011-12.”

This raises questions about the assertion - made by the health secretary - that the quality of out of hours primary care is to blame for growth in A&E pressure.

The statement continues:

“Considering A&E attendances in England in the 11 months to February 2013:

• “20.0 per cent of patients were discharged from A&E requiring a GP follow up. This figure has steadily increased from 17.0 per cent in 2007-08. In contrast, 39.0 per cent of patients were discharged with no follow up required, a decrease from 41.2 per cent in 2007-08.
• “The most deprived 10 per cent of society accounted for more than double the number of attendances (14.4 per cent, or 2.4 million) compared to the least deprived 10 per cent (6.7 per cent, or 1.1 million). This compares to 15.7 per cent and 6.4 per cent respectively in 2007-08.”

8:49am: Good morning, like any organisation, the NHS is driven to deliver on objectives and the role of management is critical to success. However, leadership andmanagement skills must be distributed throughout any organisation for it to be truly successful.

Today on HSJ’s leadership channel, Jeannine Mortlock writes that empowering every NHS employee with leadership skills is the best way to bring about a culture change following the Francis report.