Rolling coverage of second HSJ annual lecture, presented by Jeremy Hunt

  • Jeremy Hunt delivers the second HSJ annual lecture tonight
  • Health secretary unveils plans for “Ofsted style ratings” for CCG areas across clinical specialties
  • He is announcing measures to stop “pointless” referrals from hospitals back to GPs
  • Read HSJ’s preview.
  • Follow HSJ Live, @HSJNews for real time coverage and have your say using #HSJLecture

HSJ Live logo

6.39pm The Q&A has come to an end. Check, @HSJNews and #HSJLecture for analysis and reaction this evening and tomorrow.

6.38pm Kathy Warwick from Royal College of Midwives asks if there’s a plan to help other sectors close the “time gap”, not just GPs. Mr Hunt says he would be happy to think about extending it to midwives.

6.35pm In response to a question from RCGP president Maureen Baker, Hunt says the aggregated rating of CCG areas is similar to the model Sir Mike Richards uses to assess hospitals, but decided for a “lighter touch” system than the CQC system.

6.32pm Hunt agrees with a CCG leader on involving local people and patients in the new assurance process. He is hopeful about the impact of “intelligent transparency”. Says it will be “incredibly helpful” to have an independent view to compare quality and improve learning between areas.

6.28pm We have the levers to influence health education, Hunt says in repsonse to Sir John’s question. He is confident technology will be adopted speedily when it enhances clinicians’ work. He says there needs to be culture change to help staff challenge their bosses and improve systems.

6.27pm Hunt says he wants to encourage chains and partnerships between trusts and GP surgeries to share the best technolgy.

6.26pm Hunt: we are doing a lot of thinking about empowering and helping people with dementia through technology. Martha Lane Fox’s review will look at this.

6.25pm HSJ comment editor Andy Cowper asks about how to reward quality.

6.25pm Jeremy Hughes from the Alzheimer’s Society asks what will the NHS do for people who are not easily empowered by technology.

6.24pm Sir John Oldham congratulates Mr Hunt on embracing the digital revolution in healthcare. He asks if it’s time to change the way doctors are trained for this new era.

6.22pm Hunt: these new ratings are not a process of blame, we have not announced any sanctions or penalites. He is particularly excited about the ratings for mental health.

6.21pm Hunt: I expect we’ll find a surprising amount of variation when we have ratings of areas. The public will “beat a path” to good areas, and be reassured that something is being done in poor areas to make improvements.

6.20pm The health secretary is answering a question from Mr McLellan on what he wants the impact of “Ofsted style ratings” in the NHS to be, to change public understanding of the NHS.

He says the impact on the public where trusts were placed in special measures, the public were not surprised bu reassured, it meant something would be done to improve the hospital.

6.17pm Mr Hunt has finished the main part of the lecture and is now taking questions from the HSJ editor and the audience.

6.17pm Hunt: I am unashamedly an tech optimist. There really are no limits to what man and machine can do together.

6.16pm Hunt: a patient centred system must reduce variance between hospitals and within them - referring to weekend mortality rates. There is no conflict between staff morale and a patient centred system, he adds.

6.15pm Hunt: we must tackle the “culture gap” the stops the NHS putting patients first. The CQC says variance is not principally about money, but leadership and culture. “Too often a defensive culture make doctors and nurses pay too high a price for speaking out.”

6.12pm: Hunt: we will end embarrassment of fact that NHS currently world’s largest purchaser of fax machines .

6.12pm Hunt: patients will never be powerful if doctors don’t have time to listen; managers can’t make right decisions without time to listen to staff.

Hunt announces four point NHS England plan for GPs to reduce bureacracy and free up their time.

6.10pm Hunt: publishing ratings for the performance of whole health economies has never been done before. It is a true world first for the NHS. New CCG ratings will be published by June next year both as overall ratings for CCGs and specific service areas.

6.09pm Hunt is outlining the “Ofsted style ratings” for CCG areas across clinical specialties. NHS England will provide Ofsted style ratings for CCGs to give people idea of health in their area Read HSJ’s full story on this from early today.

6.06pm World expert on IT systems and Digital Doctor author Professor Robert Wacther to conduct review on the lessons for the NHS to move to a digital future, as Professor Don Berwick did on patient sfatey post-Francis report.

6.05pm Fourth,Mr Hunt warns of the “data security trap”. The NHS needs to win the public’s trust that it can protect their information. The CQC revie and Dame Fiona Caldicott’s guidelines will be “vital” next January.

6.03pm Third is “the cost trap”. Mr Hunt laments when resources have been diverted from frontline care towards big IT system projects. He says “incremental” improvements are as important as big bang changes.

6.02pm The second trap is the “accountability trap”. Hunt warns there is a risk of accountability being blurred when patients take responsibility for their healthcare and use technology alongside working with clinicians. He says one the biggest lessons he’s learnt is “if the buck stops with six people, it stops with no one”.

6.00pm Mr Hunt is outlining the four “elephant traps” facing clinicians and how to counter them. The first is the “trap of bureaucracy”. We must ensure new IT systems improve, not hinder, clinician productivity, he says.

5.58pm We put too many obstacles in front of clinicians wanting to do the right thing, says Hunt.

5.57pm Hunt: We will continue improving MyNHS to encourage a “consumer revolution”. He outlines the steps the NHS has taken to improve transparency and opennes. “Intelligent transparency will not only help patients, but make the NHS the world’s largest learning organisation.”

5.54pm Hunt: I perhaps “foolishly” said I wanted the NHS to be paperless by 2018. The spirit of that ambition still remains. From April 2016 all patients will be able to access their full GP electronic records, full health record by 2018 and social care by 2020.

5.53pm: Hunt: With chronic conditions, when patients learn to manage their conditions the outcomes are better. Doctors working with patients who take decisions can transform life chances.

5.52pm Hunt: technology gives patients more responsibility over their healthcare. “Is this good or bad for doctors?” The future will involve clinicians working in partnership with technology.

5.51pm The health secretary is giving examples of new technologies and apps that help treat people with long term conditions and mental illness. He talks about an attachment for an iPhoe, e-prescriptions and e-deliver and help people diagnose and treat conditions without leaving their homes.

5.48pm Hunt: “How will the world of medicine look in a decade’s time?”

5.46pm Hunt: the relationship between healthcare and patients is changing to a more democratic one. The technological developments in healthcare will be as “profound for humanity as the invention of the internet”.

5.44pm Unexpectedly, Mr Hunt shows us a hip-hop video from the US about health IT. Really.

5.41pm Hunt: my lecture will explore patient power, inspired by a recent trip to the US with Tim Kelsey. He jokes that tonight could also be “the Tim Kelsey memorial lecture”, ahead of Mr Kelsey’s departure from NHS England to Australia.

5.39pm Mr Hunt has started his lecture. He starts by “giving a bit of context”, referring to his King’sFund speech in the summer, where he spoke about “empowered patients”.

5.36pm Mr McLellan says the purpose of the HSJ annual lecture is for a key figure in healthcare to set out their vision for the health service. Simon Stevens used his lecture in 2014 to set out the implementation phase of the Five Year Forward View.

5.35pm HSJ editor Alastair McLellan is welcoming the audience and will soon introduce Mr Hunt to the stage.

5.30pm Mr Hunt is due onstage to begin his lecture very shortly.

4.59pm The invited audience have started arriving for the second HSJ annual lecture. Jeremy Hunt is due onstage at 5.30pm.

4.11pm A reminder that Jeremy Hunt will deliver the second HSJ annual lecture from 5.30pm.

HSJ Live and @HSJNews will be providing real time coverage of the health secretary’s address as soon as he takes the stage.

A story put out by the Department of Health this morning to trail the lecture said Mr Hunt will unveil plans for “Ofsted style ratings” for clinical commissioning group areas across a range of clinical specialties including cancer, dementia, and mental health. He will also announce measures to stop “pointless” referrals from hospitals back to GPs.

Ahead for the main event, you can read HSJ’s preview here.

4.02pm The board of Aintree University Hospital Foundation Trust has backed the recommendation of senior hospital consultants that it should pursue a merger with the Royal Liverpool and Broadgreen University Hospital Trust.

3.33pm You can now watch our expert panel debate the current context and likely future of regulation on demand.

Hugo-Mascie Taylor, previously special administrator of Mid Staffordshire Foundation Trust, joined chief inspector of hospitals Sir Mike Richards for the discussion live yesterday.

The panel also included Neil Grant, partner at specialist health and social care lawyers Ridouts, and HSJ patient safety correspondent Shaun Lintern.

The webinar, run in association with Ridouts Solicitors, is free to access.

3.22pm NHS Clinical Commissioners has taken the opposite view and “welcomes” the DH’s conclusions on the tariff objection process.

Dr Steve Kell, NHSCC co-chair, said: “We are really pleased that the Department of Health has listened to the calls of our members to remove the share of supply threshold and increase the objection thresholds for providers and commissioners to the NHS pricing method from 51 per cent to 66 per cent.

“The 2015-16 tariff objection process was a good example of why it needs to be urgently rebalanced. While organisations that provide services to the NHS have the right to challenge any proposal to revise tariffs, the delay in reaching an agreement was detrimental to the whole system.  

“We were clear in our consultation response however, that if there is real and genuine engagement with the whole health system by Monitor, NHS England and DH to understand the funding challenges facing both commissioners and providers, and build whole system solutions, the need to trigger the objection mechanism at all will be reduced.

“It is also encouraging to see the option of multi-year financial tariffs being explored. Along with multi-year settlements this will be key to enabling CCGs and the wider system to invest upfront in long term priorities and the prevention agenda, which will allow us to make savings in the following years and improve healthcare for our patients and local populations.”

3.15pm NHS Providers says its members have been “disenfranchised” by the DH’s decision.

Saffron Cordery, director of policy and strategy, said: “Today’s results reinforce what we and our members have tried to avoid – NHS providers will no longer be able to raise a formal objection to the national tariff. This undermines the ability of the NHS frontline to provide an early warning signal if proposals are undeliverable, and risk compromising the quality of care. Raising the objection threshold to 66 percent and abolishing objections ‘by share of supply’ component make it mathematically impossible for NHS foundation trusts and trusts to trigger the objection mechanism, despite NHS providers providing over 95 per cent of all services covered by the tariff.

“The objection mechanism should only ever be a last resort, used in exceptional circumstances as was the case last year. With the majority of providers already in deficit this financial year, NHS trusts across the acute, ambulance, community and mental health sectors were right to raise formal objections to the tariff last year, which led to the proposals being revised and £500m for the provider sector. This demonstrates the mechanism worked.

“2015-16 is proving to be the most difficult year financially in the NHS’s history and 2016-17 is set to be critical for the provider sector. With the challenges to cope with rising demand, meet unprecedented operational pressures and support the transformational changes required by the Five Year Forward View, the need to set the tariff fairly and for providers to be paid the full cost of the treatment they provide, has never been greater. We agree with the Department of Health that it is crucial that the tariff development process operates more efficiently and effectively than has been the case in 2015-16, and we look forward to working with the national bodies to achieve this.

“However, the tariff setting process must continue to be open to scrutiny and challenge and this requires a genuine dialogue between national system leaders and local providers. We will continue to facilitate constructive engagement with all parties to minimise the impact on the very patients the frontline is trying to help. Regrettably the essential safety value of the objection mechanism will no longer be available to help ensure a fair and safe result for the NHS and thus for patients.”

3.08pm The Department of Health has confirmed measures which will make it more difficult for providers to block the national tariff payment system.

After a consultation process, officials will remove the “share of supply” objection threshold, and raise the proportion of commissioners or providers that must object from 51 per cent to 66 per cent.

2.50pm The health secretary has tweeted about some of what he will talking about in his lecture: “At HSJ lecture I’ll set out plans for Ofsted style ratings by area on cancer, mental health & maternity services”.

2.43pm Earlier this week, HSJ senior correspondent David Williams discussed Jeremy Hunt’s developing approach to the health service, dubbed “Huntism”, in our Executive Summary.

Mr Hunt’s big theme as health secretary has been that safer care and lower costs are two sides of the same coin.

2.24pm The story put out by the Department of Health this morning to trail Jeremy Hunt’s lecture on plans for “Ofsted style ratings” for CCG areas across a range of clinical specialties has been picked up by national media including The Guardian and The Daily Telegraph. Meanwhile the BBC focused on the measures to stop “pointless” referrals from hospitals back to GPs, also to be outlined tonight.

Mr Hunt will unveil more detail at the HSJ annual lecture this evening. HSJ Live and our Twitter account @HSJNews will be providing real time coverage from 5.30pm. Give your reaction using #HSJLecture.

Ahead of the main event, you can read HSJ’s first take on the story.

2.00pm The HSJ annual lecture was launched last year to provide a high profile annual platform for a leading figure in healthcare to set out their long term vision for the UK’s health service.

Talking about the lecture earlier this year, HSJ editor Alastair McLellan said: “There are many examples of similar stages outside health policy, most famously the chancellor’s annual Mansion House speech. The NHS – the UK’s most highly respected institution and one of the defining characteristics of our nation – deserved equal treatment.”

The first lecture was given in December by NHS England chief executive Simon Stevens, who used his speech to launch the implementation phase of the Five Year Forward View. He also revealed NHS England’s “success regime”.

1.30pm In case you missed it yesterday, the health secretary said in the Commons “not a single junior doctor working within the legal limits for hours will have their pay cut”.

Mr Hunt offered a pay guarantee to junior doctors as part of plans to end the impasse between the government and the British Medical Association, which has dogged him for months. There could be questions about the NHS workforce from the audience following his lecture.

1.23pm Here is a roundup of some the day’s other big stories:

1.00pm To follow - or critique - the lecture live on Twitter tonight, you can use the hashtag #HSJLecture. For the background to Mr Hunt’s speech, and the history of the HSJ lecture, you can read this piece.

12.50pm Clinical commissioning group representative body NHS Clinical Commissioners has - unsurprisingly - taken a more nuanced view of the ratings plan.

NHSCC co-chair Dr Steve Kell said in a statement: “The Secretary of State is right to move towards greater transparency and we agree that patients and local people should have more information about those who are accountable for buying local healthcare services. Bringing in expert moderation as part of the overall process should provide further reassurance to the public and patients. The recent King’s Fund report Measuring the performance of local health systems,highlighted the complexity of the current healthcare system that CCGs work in, and therefore how difficult it is to simply rate them with an aggregate score. The recommendations in that report to provide information for patients and the public at various levels of detail would offer a more rounded and realistic view of a local health system.

Challenge and assurance of performance is vital but being given the support, the freedom and the flexibilities to continue to innovate, develop new models of care, and shift investment out of hospital activity will be key to a safe and sustainable future for the NHS.

Relieving the NHS of unnecessary bureaucracy to be able to focus on delivering for patients can only be a good thing, and that applies as much to commissioners as it does to providers.”

12.45pm Meanwhile, the Royal College of GPs has taken almost the opposite tack to NHS Providers.

RCGP chair Dr Maureen Baker said: “We welcome the promise of more investment to make the NHS more focussed on patients - the next step to achieving this is to ensure that this money is targeted towards general practice and that we have a workforce fit to deliver it.

“We have been saying for sometime that the levels of bureaucracy family doctors are facing are beyond control and are simply adding to GP pressures and increasing levels of GP fatigue – both of which threaten our patients’ safety.

“Measures to reduce bureaucracy in general practice, which will allow us to spend more time with our patients and streamline our patients’ experience of the health service, are encouraging. We look forward to hearing more details about these plans.

“However, we question whether the introduction of Ofsted-style ratings systems for area health teams will improve patient care whilst there is no evidence that this does improve outcomes in a health setting.”

12.40pm NHS reactions to the Hunt lecture story have been rolling in this morning. Representative body NHS Providers backed the plan for CCG ratings, with policy director Saffron Cordery saying in a statement: “Clinical Commissioning Groups receiving Ofsted style ratings will enable a clear move towards assessing quality.  The use of sector expertise to develop these ratings is also extremely positive, and the move will allow local people to compare individual organisations and have a better understanding of outcomes. At the same time, the data that is brought together on CCG ratings must inform patient choice. Therefore it must be presented to the public accurately, together with a  clear narrative on why any variations in performance may be justified.

However, she said proposals for “cutting back on the referring of patients by hospitals back to GPs” needed to be “carefully thought through”. She continued: “The primary consideration should be identifying ways of reducing missed hospital appointments in the patient interest, to avoid  simply transferring patients without addressing the underlying causes.

“It must be remembered that the GP has a key role as the patient’s closest contact and gatekeeper to secondary services – part of their role is to be informed of what is taking place that results in the patient being referred back to them.  NHS England and NHS Improvement will need to consider how that role will be performed, if secondary care providers are going to take responsibility for patient attendance.”

12.30pm This evening Jeremy Hunt will deliver the second HSJ annual lecture. HSJ Live and our Twitter account @HSJnews will be providing real time coverage of the health secretary’s lecture from the moment he takes the stage at 5.30pm. However, according to a story put out by the Department of Health this morning to trail the event, Mr Hunt will unveil plans for “Ofsted style ratings” for clinical commissioning group areas across a range of clinical specialties including cancer, dementia, and mental health. He will also announce measures to stop “pointless” referrals from hospitals back to GPs. As prep for the main event, you can read HSJ’s first take on the story here.