Health minister Dan Poulter has rejected warnings from a leading think tank that the NHS could experience a funding crisis before the next general election, plus the rest of the day’s news and comment

2.41pm More than three quarters of acute NHS providers have missed their own targets for the number of hours worked at their hospitals by registered nurses, HSJ analysis of latest published data has revealed.

Of 139 acute trusts that reported staffing data for May 2014 to their boards, a total of 105 failed to meet their own targets for total nursing hours worked during both day and night in at least one hospital site.

More than four out of five providers, 86 per cent, failed to meet their targets for registered nursing hours worked during the day, while 112 trusts, 80 per cent, missed their targets for nursing coverage at night.

2.35pm NHS England has asked Sir Stephen Bubb, the Chief Executive of charity leaders network ACEVO, to head a new group of experts and advisors to develop a national guide for how we provide health and care for those with learning disabilities.  

The group will also include healthcare, charity and voluntary sectors, as well as with people with learning disabilities and their families. It aims to design more innovative and integrated local commissioning of healthcare and housing to best support people with learning disabilities at home and in their communities, reducing reliance on hospital care.

Jane Cummings, chief nursing officer for NHS England, said: “People with learning disabilities, autism or challenging behaviour, often have complex health needs and it is vital that they have health and care support in their homes and communities.

“Too often we see people being admitted to an inpatient setting and staying for long periods of time purely because this support is lacking. This is not good for patients and through the Winterbourne Joint Improvement Programme, we are addressing this by ensuring local areas improve their discharge and care planning arrangements. 

“But many areas need wider service redesign, greater integration and longer-term, sustainable solutions. We are seeing more co-commissioning with local authorities but this needs to be expanded and accelerated. We need to ensure that funding follows the individual. The new group will drive this, drawing on essential expertise from the third sector and importantly from patients and carers. I am pleased that we have the experience and expertise of Sir Stephen Bubb to lead this process.”

Commenting on the launch of the group, Sir Stephen Bubb said: “The Government made a brave pledge to improve the quality of care for people with learning disabilities in the Winterbourne View Concordat. While I am delighted that Simon Stevens has asked me to help create a plan to support the Government meet that pledge, I am also determined to bring the experience and strength of the third sector to help transform care for people with learning disabilities.

“Co-commissioning with charities and social enterprises in this way is unprecedented in the NHS and offers new solutions to these problems. I believe that the third sector will bring the innovation required to create a sustainable ‘national framework, locally delivered’.”

The key objectives of the group are to:

  • develop models for local implementation that meet the needs of people with learning disabilities and autism
  • develop funding models for new services
  • identify potential sources of social investment
  • identify the best way for funding to meet individual needs
  • seek input and guidance from partners working in this field.

The group will provide a final report by the end of October to inform commissioning and the Everyone Counts planning guidance refresh.

2.25pm Health minister Dan Poulter has rejected warnings from a leading think tank that the NHS could experience a funding crisis before the 2015 general election.

The junior health minister dismissed the conclusion of last week’s Nuffield Trust report, Into the Red, saying think tanks had been mistaken about similar issues in the past.

Dr Poulter told HSJ: “I don’t [agree with the Nuffield Trust report], no.”

He added the Nuffield Trust had “from time to time” come out with reports that had been proven wrong.

2.10pm Professor Sir Mike Richards, chief inspectors of hospitals has urged the organisations overseeing the moving of services from Mid Staffordshire Foundation Trust to other providers to develop a clear transition plan without delay.

Professor Richards has written to Monitor, the Trust Development Authority and the Trust Special Administrator following an urgent inspection of the trust carried out at their request. The CQC’s full report on the inspection will be published next month.

The inspection took place between 30 June and 2 July. It looked specifically at whether the trust’s clinical services were safe. The inspection team, chaired by Mr Andy Welch, Medical Director of Newcastle upon Tyne Hospitals NHS Foundation Trust, concluded that services were safe, but staffing levels were only just adequate in some areas, particularly on medical wards.

The inspection team was not assured about the sustainability of services and warned that should recruitment or retention fall by even one or two people in some key posts, services would become unsafe.

In his letter, Professor Richards wrote: ‘The senior managers at MSFT, including the chief executive are having to spend inordinate amounts of time ensuring that individual nursing shifts are adequately filled and that sufficient numbers of medical staff will be available for different services. To date they have been able to do this, but I would emphasise the word just.’

Professor Richards continued: ‘We were both surprised and very concerned that a clear transition plan has yet to be developed to ensure the safe transition of responsibility for clinical services to the agreed model of care over the next four months. This clearly requires the full involvement of MSFT and other organisations in the wider health economy.

‘In addition, the workforce at MSFT needs clarity as soon as possible about what is going to happen next. The current uncertainty is contributing to the fatigue and fragility amongst staff. The transition plan should therefore include a commitment by the acquiring organisations to support medical and nursing staff levels at Mid Staffs over the next four months so that services remain safe.’

(A copy of Professor Richards’ report is attached on the right side of this page)

2.05pm Bold gestures by politicians hoping to transform the NHS mean little without engaging doctors, nurses and patients in improving services and embedding cultural change, write John Clark and Vijaya Nath.

2.00pm In response to NICE developing guidance on mid-life approaches to prevent or delay the onset of disability, dementiaand frailty in later life, Janet Morrison, chief executive of the charity Independent Age, said: “We strongly agree that people need to make changes now to reduce the likelihood of difficulties in later life. This applies just as much to social contact as it does to physical health: loneliness and social isolation can be prevented too.  

“However it’s harder to persuade people to think 20 or 30 years ahead when governments, of all persuasions, rarely plan more than two or three years ahead. There’s an urgent need for this and the next government to take the necessary action now for the major demographic changes that ageing will bring to our society.”

1.12pm In response to the Department of Health’s publication of its implementation plan for the NHS visitor and migrant cost recovery programme, Doctors of the World, urges the government to be mindful of the potential consequences for some of society’s most vulnerable people.

In a statement the medical charity said: “Any attempts to better identify potentially chargeable patients and payees of the new migrant surcharge must take into account that many people in the UK are already being excluded from healthcare – including heavily pregnant women and children and people with serious and infectious diseases.

“At the clinic we run for excluded migrants in east London, we’re already seeing more people being excluded from healthcare before any changes have taken place. Any further barriers – such as checks to see if a migrant has paid the surcharge – could increase discrimination and deter sick migrants from even trying to access care.

“Any new system must be applied in a non-discriminatory way that does not deter those who need treatment from seeking it. Moreover, this charging regime needs to be introduced with very clear messaging to the NHS that at no point should care deemed to be immediately necessary or urgent be denied to patients pending payment.”

Lucy Jones, manager of Doctors of the World’s clinic in east London said: “Our experience is that confusion, misinformation and fear mean vulnerable people are not able to access essential care when they need it.

“We are concerned that the proposed changes will apply to the helpless such as children and people being exploited and we welcome the commitment to review how these  groups can be protected.

“Two-thirds of our patients reported difficulty accessing healthcare in the past year and one in five feared arrest if they sought medical help. More barriers will only make it harder for the most vulnerable to access vital healthcare.

“We’ve seen women up to 40 weeks pregnant who’ve had no antenatal care because they were too afraid to access it or had received a bill before their appointment.

“GP practices and A&Es are not designed to identify and charge a small group of patients, any system will have to be applied to the entire population which is not practical. The staff time and resources needed to implement this are likely to outweigh any benefits.

“It will require frontline clinicians to make decisions about people’s eligibility for care when they should be focusing on treating the patient. GP’s must not become border guards.

“People who are deterred from seeking treatment will get more ill – their conditions will get more difficult and expensive to treat – and they won’t be any better placed to pay for it.”

1.05pm Help the Hospices today announces the appointment of Dr Ros Taylor MBE as its national director for hospice care.

Currently a trustee at Help the Hospices, Dr Taylor is a leading figure in the hospice and palliative care sector with more than 20 years’ experience of both providing and championing quality, person-centred care for terminally ill people and their families.

Dr Taylor is director of the hospice of St Francis in Berkhamsted, Hertfordshire and will continue in this post, combining it with her new part-time national role. The new position will involve her driving the clinical agenda for hospice care at a national strategic level and promoting and supporting excellence in the end of life care sector.

Confirming the appointment, David Praill, chief executive of Help the Hospices, said: “We are delighted to have appointed someone of Ros’s calibre who brings a wealth of clinical and wider hospice sector expertise and experience to this important role.

“Ros combines a formidable working knowledge of hospice care with a deep-felt humanity for the needs of terminally ill people and their families. She is hugely passionate about sharing the expertise and compassionate ethos of hospices more widely to raise standards of care in hospitals and other settings.

Commenting on her appointment, Dr Taylor said: “I am absolutely delighted to take on this position at such an exciting time for the hospice and palliative care sector, full of both challenge and opportunity.

“The UK’s rapidly increasing ageing population will lead to substantial extra demand for hospice care in the coming decades. Hospices will have a vital role, not only in developing innovative ways to support care, but also in educating and partnering with other organisations and local communities to provide responsive, relevant and kind care. 

Dr Taylor began her career as a GP in Cambridgeshire and Cumbria and went on to lead an innovative palliative inpatient unit in West Cumbria Hospital. She has been Director at the Hospice of St Francis since 1997.

12.49pm: Commenting on the new NICE guidelines about safe staffing levels, Professor Sir Mike Richards, chief inspector of hospitals at the Care Quality Commission, said: “We support the principle that staffing on hospital wards should be based on the needs of patients, and welcome NICE’s guidance.

“Staffing isn’t just about numbers. Under our new approach to hospital inspections, we assess whether staffing levels and the skills and training of staff are appropriate in each of the services we inspect.

“We know that staffing levels impact both on safety and on patients’ experience of care. If we judge that staffing levels are impacting adversely on the quality of care, we expect to see improvements.”

12.19pm: The Department of Health has announced plans to help the NHS to recover more of the costs of migrant and visitor healthcare.

Patients from outside Europe using the NHS will be charged 150 percent of the cost of treatment under new incentives for the NHS to recover costs from visitors and migrants using the NHS.

Visitors and migrants can currently get free NHS care immediately or soon after arrival in the UK, leaving the NHS open to abuse.

But now government is asking the NHS to clamp down by identifying these patients more effectively so costs can be recovered from them.

This will make sure that by the middle of the next parliament, the NHS will recover up to £500 million a year from treating foreign visitors and migrants.

In June, it was revealed that the NHS will receive an extra 25 percent on the top of the cost of every procedure they perform for an EEA migrant or visitor with a European Health Insurance Card (EHIC).

Now details of the non-EEA incentive further strengthens the programme planned over next 2 financial years.

A non-EEA visitor will be charged for their care plus an extra 50 per cent. This means that for a £100 procedure, they could be billed up to £150.

For those who are temporary migrants from outside the EEA and are here for longer than six months, a new health surcharge will be applied when they submit an application for leave to enter or remain in the UK. This surcharge could generate up to £200 million per annum in the future.

Health Secretary Jeremy Hunt said: “We have no problem with international visitors using the NHS as long as they pay for it - just as British families do through their taxes. These plans will help recoup up to £500m a year, making sure the NHS is better resourced and more sustainable at a time when doctors and nurses on the frontline are working very hard.”

Financial sanctions will also be put in place for trusts who fail to identify and bill chargeable patients.

Steps are being taken to help the NHS charge more effectively and consistently. A clear timetable has been issued and a new National Intensive Support Team will be on hand to assist.

A clearer registration process and IT system will help lessen the burden on busy staff. In summer, trials will start in some A&E departments to explore how details can be taken from patients with an EHIC when they register for care.

Options for recovering the costs of primary care services are also being explored. Eligibility to free NHS prescriptions, optical vouchers and subsidised NHS dental treatment will also be tightened.

The EEA incentive scheme will be introduced in autumn 2014. The non- EEA incentives will begin in spring 2015.

12.15pm: Due to a technical issue, all HSJ Live posts from earlier this morning are no longer available. We apologise for this inconvenience.