NHS Direct announcement comes on the day a TV investigation finds services are unsafe due to a lack of nursing staff.

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3.39pm Sir Bruce Keogh’s comments on how the NHS could learn from the likes of PC World have not been well received by HSJ readers. Click the link and scroll to the bottom to read the comment thread.

Here are a few examples: “The most fundamental anomaly between PC World and the NHS is that PCW’s whole purpose is to make a profit which benefits its shareholders. Can anyone tell me what the NHS achieves for the patient by reducing its budget and handing back its surplus to the Treasury?”

“I find it a rather disturbing comparison. First and foremost, I am not saying that the NHS can’t take lesson from retailers, such as PC World. However, it overlooks the simple fact that PC World has free reign over; 1. What it stocks, 2. Where it will sell stuff, 3. How it will sell stuff, 4. How much it will charge customers.”

“If you must have a retail comparison then I think the John Lewis Group might be a better one to learn from.

 Healthcare is, however, a service industry with complex inter-dependencies is not analogous to automated manufacturing where greater volume & intelligent engineering sent to the Far East can drive up computing power at reduced cost per MB.”

“Not Keogh’s most intelligent move, but come on everybody, this isn’t some inexperienced management consultant here, he’s a very talented man who said something bloody daft…..I’m sure no one on here has never made the same mistake.”

2.19pm NHS England’s chief nurse Jane Cummings wants your help.

She tweets: “Please help and complete this survey on Patient Rights in the NHS Constitution. We must get it right! Thanks”.

Fill in the survey here.

2.07pm Reports submitted by patients via nascent patient satisfaction survey the friends and family test contact which detail devastating care in NHS hospitals will not be released, according to the Daily Telegraph

The newspaper reports: “[Detailed reports], seen by the Telegraph, describe a young woman left for 22 hours without food, water or pain relief, a pregnant woman who thought she had miscarried waiting nearly four hours to see a doctor, and a patient who was told to be quiet after suffering pain from a head wound which was bleeding profusely.”

NHS England is set to announce overall scores for all trusts tomorrow.

2.05pm Some news not related to NHS 111: HSJ’s acute sector reporter Ben Cloverwrites:

“The Department of Health is expected to target ‘huge waste’ in the cost of orthopaedic supplies when it releases its procurement strategy shortly.

“John Warrington, the DH’s deputy head of procurement, told a conference earlier this month the cost of supplies for orthopaedics work was an area where he was seeking to ‘[improve] outcomes at a reduced cost’.

“Mr Warrington said collusion between doctors and suppliers’ sales representatives had led to a situation where orthopaedics supplies had twice the profit margin of other industries.”

1.41pm We have a new blog by Blair McPherson. There will always be staff who feel bullied by managers, he argues.

“Even in the best of times before compulsory redundancies, pay freezes, performance targets, increased workloads, enforced changes in working practices, aggressive absence management and annual appraisals there were staff who felt bullied by managers.

“It was picked up in staff surveys and a regular theme when senior managers held work place staff conferences. In any organisation there will be some poor managers who impose unrealistic deadlines, set unmanageable workloads and make unreasonable demands. There will be managers who due to inexperience try to impose changes, refuse to acknowledge legitimate concerns or recognise resource implications. There will be those who see any dissent as disloyalty and a challenge to their authority as a manager.”

1.26pm The British Medical Association has issued a lengthy response to the NHS 111 news.

Dr Chaand Nagpaul, chair of the BMA’s GP committee said: “The implementation and planning of NHS 111 has been an abject failure.

“NHS Direct struggled to cope with the volume of calls it was receiving despite having years to plan for the launch of NHS 111. Other already overstretched services, such as GP out of hours providers, have had to step in and undertake the workload that was supposed to be dealt with by NHS 111. It is worrying that patients had to wait twice as long as recommended for their calls to be answered.

“Sadly, many of these failures have occurred in many parts of the country.

“The decision by NHS Direct to seek a withdrawal from its contracts to provide NHS 111 reveals worrying flaws not just with the tendering process for NHS 111 contracts, but for how contracts are awarded and monitored throughout the NHS.  The Department of Health gave the BMA written assurances that there would be strict safeguards in place to ensure that NHS 111 providers would have the clinical and financial ability to deliver a safe, effective service to patients1.  

“A number of local GPs and the BMA raised concerns during the tendering process about the low nature of some of the successful bids which were ignored.

“If this failure can occur with NHS 111, there is no reason why it could not happen with other parts of the NHS, as demonstrated by the recent investigation into the provision of out of hours services in Cornwall. Tonight’s Dispatches programme is likely to highlight a further catalogue of mistakes across NHS 111’s operations. We cannot have a situation where patients are placed at risk or suffer from substandard healthcare because contracts have been improperly awarded.

“The government should expand its review into NHS 111 to include an examination of what went wrong with the tendering process, particularly whether providers were given an advantage if they put in the lowest bid. There must be a firm commitment in the light of this failure from ministers that the procurement process across the NHS meets strict quality standards and happens safely and effectively.

“If NHS 111 is to recover it must receive proper funding and be closely integrated with local NHS services. The government must review its competitive tendering approach and instead look towards an integrated model based on cooperation between local services.”

12.51pm Here’s another response to the NHS 111 story.

Unite national officer for health Barrie Brown said: “There was no logic for the government to replace the successful single service NHS Direct, which was highly rated by users, with a fragmented NHS 111 set up with 46 different contracts.

“The impetus here is not patient care, but cost-cutting by a government whose foot is firmly on the privatisation accelerator.

“Health secretary Jeremy Hunt needs to show a modicum of leadership and step in to sort out this mess of his government’s making.

“What is needed is a unified, well-funded service staffed by professional clinicians that gives worried callers confidence that they will receive the best advice possible. This currently is not the case.”

12.50pm Official responses to today’s NHS 111 news are coming in.

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said the service is “in chaos”:  “This is the latest in a series of very worrying developments. NHS Direct has proved itself to be a key source of information, reassurance and advice for people and families for many years, giving expert care and shouldering a burden which would otherwise be taken up by the emergency services.

“The RCN fully supports a single point of contact for patients to get help and advice from the NHS. However, this latest announcement raises concerns that a locally commissioned, fragmented system may simply not be able to provide the high standard of service and advice that patients need.  We remain concerned that patient care may suffer if the person who takes calls is unable to quickly and easily access clinical expertise or escalate relevant calls to senior staff who are able to make decisions about the care needed.

“More worryingly, the service may be unable to prevent anxious people not in need of urgent care from calling ambulances or going to accident and emergency unnecessarily. Despite the best efforts of their staff, some parts of the NHS 111 service are now in chaos, and urgent action is needed to prevent this from having tragic consequences for patients.”

12.24pm Political blogger Guido Fawkes is an End Game reader, it appears. They’ve followed up our story about the prospective new inhabitants of Monitor’s Matthew Parker Street headquarters.

11.44am HSJ’s London reporter Ben Clover has news of the Lewisham judicial review.

Here is a series of tweets he’s just posted on the subject:





11.26am Sarah Calkin has the full story on NHS Direct’s withdrawal from 111 contracts this morning. Here it is.

11.15am The Telegraph’s Laura Donnelly has a story about NHS pensions: NHS officials have handed out £30m in NHS pensions to former employees who have died, she reports.

Over the past decade, the health service has made such payments on more than 70,000 occasions, after its systems did not detect that former workers had died, new figures show.

11.05am Here are a couple of new stories following up today’s national coverage of the NHS.

‘Failings’ in NHS 111 hotline, and Make NHS service like PC World: Keogh.

11.03am To refresh your memory on NHS 111, here’s how HSJ covered the policy debacle between 2010 and summer 2013.

11.00am NHS England’s interim operations director Dame Barbara Hakin is about to appear on BBC news to talk about NHS 111. Meanwhile shadow health secretary Andy Burnham tweets: Sad news about NHS Direct. One of this Government’s worst acts of vandalism.

10.57am More new opinion on HSJ: The Keogh review into 14 trusts with high mortality rates was a wasted opportunity for integrated care, argues Billy Boland. Dr Boland is a consultant psychiatrist and lead doctor in safeguarding adults at Hertfordshire Partnership University Foundation Trust.

“While the report is undoubtedly thorough, it is a missed opportunity for thinking about integrated care. Sir Bruce’s selection of quality indicators exclusively concerned health, looking at parameters such as infections and serious incidents resulting in death… But Sir Bruce makes it clear that his report was less about demonstrating poor performance and more about creating solutions. Given that “integration” is a current watchword of service reform, should consideration have given to social care?”

10.47am Regular readers will not be surprised by NHS Direct’s announcement this morning. Our reporter covering emergency services Sarah Calkin reported nearly six weeks ago that the organisation was losing £1.5m a month and was likely to exit the market by the end of the year.

10.44am Here’s NHS Direct’s full statement:

“NHS Direct’s Annual Report and Accounts for 2012/13 highlights that the trust is seeking to agree a managed transfer of NHS Direct’s 111 services, and the frontline and other staff who currently provide them, to alternative providers.

“NHS Direct is seeking to withdraw from the NHS 111 contracts it entered into as these have proved to be financially unsustainable. The trust will continue to provide a range of web, mobile and telephone services for patients which complement NHS 111 and support the NHS. These services are unaffected by the discussions currently taking place.

Nick Chapman, NHS Direct chief executive said: “We will continue to provide a safe and reliable NHS 111 service to our patients until alternative arrangements can be made by commissioners. Whatever the outcome of the discussions on the future, patients will remain the central focus of our efforts, together with protecting our staff who work on NHS 111 to ensure that the service will continue to benefit from their skills and experience.”

10.40am NHS Direct has announced it is to pull out of all it NHS 111 contracts. More soon.

10.33am Also new today: 59 out of 211 clinical commissioning groups remain under legal direction by NHS England, largely because of concerns about governance and leadership, following a review of authorisation conditions. Forty six have had conditions lifted following a review by NHS England.

10.29am Some exclusive news on HSJ today, courtesy of East of England reporter James Illman: Privately-run Hinchingbrooke Health Care Trust has applied for a £3.5m “working capital loan” from the Department of Healthto help “accelerate” its capital programme.

Circle, which runs the financially challenged trust, is devising a package of measures to fund the £7.8m capital programme at the same time as attempting to make £7m savings on revenue costs.

10.21am New on HSJ this morning: Nick Timmins on the differening health policies in the four nations of the UK. “One huge wasted opportunity”, he calls it. “Wasted because there is so little comparing and contrasting going on when, on paper, this is a golden opportunity to evaluate what happens when four countries do things differently with what is, essentially, the same concept.”

Read the whole thing here.

10.18am A millionaire doctor who ran an out-of-hours GP service regularly started his shifts three hours late – and sometimes simply didn’t turn up, a tribunal heard.

The Daily Mail reports that instead of being on duty visiting sick and dying patients, Ravi Sondhi, 53, was relaxing at his £2.8million mansion 140 miles away.

One call worker employed by the out-of-hours service was forced to phone him 114 times before he responded.

10.13am The influential Labour MP Tom Watson has slammed Sir Bruce Keogh’s comments (see 10.09am) on Twitter.

He tweeted: The #NHS boss Sir Bruce Keogh has had a Gerald Ratner moment. Our NHS should never be a pile ‘em high, sell ‘em cheap provider.

10.09am The Independent has an interview with NHS England medical director Sir Bruce Keogh today.

Here’s the key passage, in which Sir Bruce discusses the efficiency challenge bearing down on the NHS: “We have to change dramatically if we are to retain everything we are proud of in the NHS. I don’t think everyone recognises the urgency. I think sometimes, when there is a really difficult challenge ahead, some people find it easier to ignore it. But this is really significant…

“If you go down to PC World or Dixons, each year you would expect to pay less for a PC and you would also expect the specifications to improve,” he says. “I have all sorts of people [in the NHS] saying to me: ‘Give me £1,000, give me £200,000; I can improve our service’. My challenge is every other aspect of industry has to improve the quality they offer for less. So we need to change that mindset.”

10.02am The Daily Mail leads this morning on the Channel 4 Dispatches undercover probe.

A manager at a 111 call centre in Surrey, run by private firm Harmoni, told a Dispatches reporter: “We don’t have the staff to deal with the volume of calls coming in. We had a very bad service. Realistically, on the weekends we (are) still unsafe.

“A patient shouldn’t be waiting more than ten to 15 minutes (for a nurse). That’s the target, but they do, they wait a lot longer than that.”

The undercover reporter was told that callers regularly had to wait several hours to be telephoned back by a nurse.

10.00am NHS 111 features prominently in the national press this morning, mainly with preview stories about a Channel 4 Dispatches documentary to air this evening.

The top line is that the investigation foudn some centres have no qualified nurses to diagnose patients at weekends.

Here’s the Daily Telegraph’s version, which features prominently calls from Dr Peter Carter, chief executive of the Royal College of Nursing, for immendiate intervention from the government.

8.45am: Good morning, 70 per cent of stroke survivors often want psychological support between the first six weeks to six months post-stroke. Although the physical impact of stroke is well acknowledged, very little is known about the impact on psychological wellbeing. Between December 2011 and February 2013, 960 stroke survivors who experienced a stroke were offered the opportunity to respond to a survey on their care. Julie Dunlop analyses the results of the survey here.