Secretary of State says key metric for the NHS should be the number of safety concerns raised by staff, and the rest of today’s news and comment

Live logo

4.24pm HSJ reporter Judith Welikala tweets:

4.21pm Richard Vautrey, Deputy Chair of BMA’s GP committee, tweets:

3.44pm The NHS is continuing to recruit hundreds of extra qualified nurses a month with numbers at their highest for a decade, the latest workforce data shows.

Figures from the Health and Social Care Information Centre shows across the NHS workforce there were 314,173 full time equivalent qualified nurses and midwives in February, 8,148 more than August when the current spike in recruitment following the Francis report began.

There are now more qualified nurses and midwives in the NHS than at any point since monthly data began to be collected in September 2009 and more than in any year since 2003.

However the numbers do not account for increases in patient acuity or demand and the Royal College of Nursing recently highlighted falls in the number of senior experienced nurses being employed in the NHS.

2.45pm GPs representatives have voted that clinical commissioning groups should not commission GP services.

At the British Medical Association’s annual conference of local medical committees, delegates voted overwhelmingly in favour of a motion that “views with alarm” proposals for CCGs to be made co-commissioners of GP contracts.

2.20pm Commenting on yesterday’s exclusive interview with Norman Lamb, reader Steve Burnell writes: “Sadly, the MH sector does not have the wherewithal to create a tariff-like system that will be a genuine payment-by-results alternative to block contracts.

“It has even struggled to define payment-for-inputs, let alone optimised inputs configured to deliver prompt best practice, never mind desired outcomes. The way things are going, maybe it’s true that the best people might hope for is “to go backwards more slowly”.”

2.15pm Claims made by the College of Emergency Medicine about widely accepted figures have been skewed to the extent that we must seriously question its credibility, argues Alex Khaldi, managing director of iMPOWER, a firm specialising in public service transformation.

1.43pm There has been a great deal of interest in our story’Co-commissioning plan could ease pressure on A&E, report author claims’.

A selection of comments from readers:

Anonymous: “15 per cent is also the number that the primary care foundation came up with. It is higher - maybe 30 per cent in urban EDs and out of hours.

” There are no inappropriate attenders, only inappropriate healthcare provision.
A&E and ambulances are the only consistent brands in acute care, and the public know that they will be there for them.

“At least all these ‘inappropriate’ people are travelling to the doctor and are prepared to wait. We should be pleased!”

Robin Stern: “Primary care’ - could logically mean the first point of care. In which case, what good could happen if A&E could be regarded as one point of ‘primary care’? The trad differentiator between primary and secondary care has been access to specialist care - but is this necessary, or even appropriate still? Plenty of specialist care, skill and prowess in primary care already.”

1.35pm Health secretary Jeremy Hunt has used a keynote speech at the Patient Safety Congress to call for increased reporting of concerns about the safety and quality of patient care.

Mr Hunt highlighted the example of Virginia Mason Hospital in the US, which he visited earlier this year. This had seen a 75 per cent fall in the number of litigation claims it received between 2004-05 and 2012-13.

Over the same period the hospital saw the number of reports increase from 2,696 to 9,277 annually.

Senior figures in local government have raised concerns with the Department of Health that if local areas have to wait several months while their plans are subjected to an assurance process, they will not have sufficient time to implement service changes by April 2015 when the programme is due to start.

This could jeopardise the effectiveness of the plans, making it more difficult to achieve a reduction in demand for acute services in 2015-16, they have warned.

12.31pm A row has broken out between a former surgeon at Barts Health Trust and the chief executive of Maggie’s cancer charity.

Sir Marcus Setchell, former surgeon-gynaecologist to the Queen, has been involved in a campaign to stop a new cancer centre being built next to the eighteenth century Great Hall at Barts, which campaigners are concerned could mean that restoration work would not go ahead on the building.

The Friends of Barts are calling for the Maggie’s centre to be moved 20 yards away, so that both plans can go ahead.

In an interview with the Evening Standard, Maggie’s boss Laura Lee branded as “vacuous” Sir Marcus Setchell’s fight to preserve Bart’s Great Hall.

She added: “This is an obstetrician talking. Marcus Setchell is not speaking from a position of authority within the hospital… He has not looked after someone with cancer in his entire career”.

Commenting on the interview, Sir Marcus said: “I’m disappointed by the personal attacks levelled against me by Laura Lee. The claim that I have never looked after someone with cancer is incorrect. Throughout my 44 years as an Obstetrician and Gynaecologist I have treated and cared for countless cancer patients until I retired at the beginning of this year. I know all too well the devastating impact cancer can have, not only on patients, but also on their families and friends, and the benefit they can derive from supportive care from organisations like Maggie’s.

“It’s disheartening to see the debate about the two proposals reduced to an either/or decision. Under our plans, Barts could have both a Great Hall that is no longer a burden on the NHS and a Maggie’s centre with its helpful counselling services, in an attractive garden setting at a lesser cost. We have always hoped that Maggie’s would be able to work with the Friends of Barts Great Hall in order to arrive at a satisfactory outcome for all. “

At least 1,000 patients could have missed out on one of three interventional cardiology procedures to prevent stroke and heart failure after NHS England stopped funding them last year, based on numbers treated in 2012.

As many as 258 children with cerebral palsy will also not have been considered for a treatment that could have improved their mobility, according to an NHS England estimate.

12.07pm Nine out of the 12 trusts inspected earlier this year using the CQC’s new approach must provide safer services for patients, the chief inspector of hospitals told a conference today.

Professor Sir Mike Richards told the Patient Safety Congress that out of the acute trusts inspected between January and March this year, eight were rated as “requires improvement” for safety and one as “inadequate”. Four trusts received a “good” rating for safety. This contributed to an overall rating of either “requires improvement” or “inadequate” for nine out of the twelve trusts.

Sir Mike was clear that these ratings are not representative of the NHS as a whole; this is because several of the trusts were selected for inspection as they were considered to have a higher than average risk based on the information available.

Sir Mike said: “The findings are based on just 12 inspections. What we found is that there is a close correlation between the rating a trust receives for safety and its overall rating. 

“Fewer hospitals were rated as good for safety than for effectiveness, caring, responsiveness or well-led. Out of the eight core services we looked at, the medical care service is more frequently rated as requiring improvement in safety than in any of the other services.”

Trusts will be inspected again to check on their progress and CQC will report on its findings.

The twelve trusts that were inspected, together with their safety and overall rating, are:

  • Oxford University Hospital Trust Safety (Good) Overall (Good)
  • Homerton University Hospital Foundation Trust Safety (Good) Overall (Good)
  • Aintree University Hospital Foundation Trust Safety (Good) Overall (Good)
  • St George’s Healthcare Trust Safety (Requires Improvement) Overall (Good)
  • University Hospitals of Leicester Trust Safety (Requires Improvement) Overall (Requires Improvement)
  • Blackpool Teaching Hospitals Foundation Trust Safety (Requires Improvement) Overall (Requires Improvement)
  • Northampton General Hospital Trust Safety (Requires Improvement) Overall (Requires Improvement)
  • Lewisham and Greenwich Trust Safety (Requires Improvement) Overall (Requires Improvement)
  • Hull and East Yorkshire Hospitals Trust Safety (Requires Improvement) Overall (Requires Improvement)
  • Peterborough and Stamford Hospitals Foundation Trust Safety (Requires Improvement) Overall (Requires Improvement)
  • Royal Cornwall Hospitals Trust Safety (Requires Improvement) Overall (Requires Improvement)
  • Heatherwood and Wexham Park Hospitals Foundation Trust Safety (Inadequate) Overall (Inadequate)

11.52am NHS England’s primary care co-commissioning plan could help ease pressure on accident and emergency services, a researcher behind a new College of Emergency Medicine study has claimed.

The analysis of A&E attendances over a 24 hour period in 12 hospitals found that one in four patients could have been seen by GPs based in emergency departments with access to tests, such as X-ray imaging.

Carried out by the college and healthcare consultancy Candesic, it appears to challenge a key NHS England claim that far more A&E attendees – 40 per cent – could have been treated outside of an emergency department.





11.01am Hundreds of patients are being sent home from hospital in the middle of the night despite a promise to limit the practice, The Times reports.

Over the last two years at least 300,000 people, many of them elderly, have been discharged between 11pm and 6am to relieve pressure on wards.

Also in The Times, GP surgeries would be better off improving access to doctors in the daytime than opening in the evening, research suggests.

Academics looking at more than half a million patients over a six month period concluded the increase use of out-of-hours services, such as A&E departments, was caused by poorer access during normal working hours and not because of surgeries being closed in the evenings.


10.57am Jenni Middleton, editor of HSJ’s sister title Nursing Times, tweets:



10.55am From the British Medical Association:

GP practices and patient services are under imminent threat due to NHS England’s lack of support during changes being made to practice funding, the leader of the UK’s GPs has warned on the opening day of the BMA’s annual conference of local medical committees.

In a letter to Simon Stevens, Chief Executive of NHS England, Dr Chaand Nagpaul raises concerns over the lack of support given to GP practices affected by the decision to scrap vital minimum price income guarantee (MPIG) funding at a time when the pressure on GPs is beginning to have a detrimental impact on some patient services.

In March of last year NHS England assured doctors that a process would be put in place to support those practices most adversely affected, including the 98 NHS England have themselves identified as being at risk of closure1. Twelve months on there is little evidence of meaningful support having been provided despite the BMA raising concerns over the effect it is having on practices from Cumbria to London’s East End2.

In his letter to Simon Stevens, Dr Chaand Nagpaul writes:

“I am writing to express my concern at NHS England’s handling of the process for phasing out MPIG correction factor payments to GP practices which has become a critical issue for our members.  I believe that this poses a serious risk to the delivery of services to patients.” 

Dr Nagpaul adds: “We warned about the inaction that would result from NHS England leaving decisions about how to deal with adversely affected practices to Area Teams. These fears have unfortunately been realised.

“There has been no sense whatsoever of Area Teams proactively attempting to find solutions to the funding problems faced by these practices. Indeed, we have been contacted by a number of practices, both in and outside of the 98 identified outlier practices, who have been informed by their Area Teams that they are not able to provide such support, either due to funding problems or a lack of central direction.

“If this situation is allowed to continue there will be a real and imminent threat to services provided to patients, with some practices at risk of closure.”

One GP to raise concerns is Dr Steve Kite, a single handed practitioner in Hertfordshire, who says his practice faces a funding drop of up to £62,000 over the next seven years. He said:

“The removal of MPIG means that I will simply not be able to employ enough staff, deliver suitable services or keep my building in the right state for patients.

Adding: “I am frankly disappointed by the way this has been handled, particularly the decision to dump this on local area teams to sort out. There is not a national plan of any form to stop practices closing.”

Virginia Patania, Practice Manager at the Jubilee Street Practice, one of the affected practices in Tower Hamlets, added: “Tower Hamlets has some of the country’s highest health challenges, yet we are facing drastic funding cuts that could threaten both patient services and practice viability.

“Since the announcement was made last year we have received very little support in coping with these changes despite promises from NHS England, and we would hope that they will be prepared to sit down with us as soon as possible to discuss what help will be offered.”

.@CNagpaul said the GPC called for halt to because it wanted patients to be sure about the security of their information #LMCconf

— Judith Welikala (@JudithWelikala) May 22, 2014



10.47am HSJ reporter Judith Welikala is at the annual Local Medical Committee Conference today. Chaand Nagpaul, chair of the BMA’s GP Committee, is currnetly speaking.

10.24am The Care Quality Commission has secured a 57 per cent increase in the number of new registered managers across 2,439 health and social care services targeted in a 6-month project.

The project which ran from November 2013 to April 2014 was set up by CQC last September to improve the high number of locations operating without a registered manager in place for the longest periods of time. This is in addition to reviews carried out by CQC inspectors at locations across the whole of England.

Based on project figures set out in yesterday’s CQC Board report, 1,395 out of those locations now have a registered manager in place.

A further 470 (20 per cent) manager applications have been submitted to CQC for approval.

CQC also used enforcement powers across 590 locations that failed to appoint or submit an application for a registered manager. A high proportion responded without the need for the regulator to take further action but 42 per cent have paid a Fixed Penalty Notice.

CQC will continue to work with providers to ensure all health and adult social care services that are required to have registered managers fill these positions.

Andrea Sutcliffe, Chief Inspector of Adult Social Care and Corporate Lead for Registration said: “This is really positive news for people who are using services and I am very encouraged that providers have responded to our challenge and taken steps to ensure that registered managers are in post.

“We know the role of the registered manager is an important one in making a difference to people’s experiences of care. They are vital in helping to make sure people receive services that are safe, effective, caring, responsive and well-led.

“As part of our new approach to changing the way we inspect and regulate adult social care that we’re currently consulting on, we are proposing that any location providing adult social care services will not be able to achieve a rating higher than ‘requires improvement’ if it has been without a registered manager (where one is required) for more than 6 months without reasonable justification.”

10.23am The Daily Mail reports that hospitals have been told to end the ‘unacceptable’ practice of sending frail patients home late at night or in the early hours.

Figures from around half of England NHS trusts showed more than 150,000 patients, including 18,500 over the age of 75, were recorded as being discharged from hospital between 11pm and 6am in the past year.

10.02am The Guardian reports that Simon Stevens has criticised the lack of managers from black and minority ethnic backgrounds involved in running hospitals – which, he says, means they are not reflecting the communities they serve.

Mr Stevens is developing a plan to tackle the lack of diversity in leadership.

10.00am Looking through this morning’s papers, The Daily Telegraph reports that doctors will today debate the introduction of a £25 charge for patients to see their GP.

A doctors’ conference will be told that general practice is under such pressure that fees should be considered. But a group of doctors has written to the paper saying that the proposals could harm the nation’s health.

Signatories include Dr Clare Gerrada, the former chairman of the Royal College of GPs, and Dr Clive Peedell of the National Health Action Party.

Elsewhere in the paper, phasing out the Liverpool care pathway because some medical staff do not know how to use it is ‘extreme’, a leading ethicist has warned.

Dr Anthony Wrigley, of the Centre for Professional Ethics, at Keele University, said the use of morphine or insulin would not be stopped because some medical staff had used it incorrectly and it should be the same with the Liverpool Care Pathway, writes Rebecca Smith.

Finally, the paper reports that thousands of patients are being forced to use GP out of hours services because surgeries are failing to offer enough appointments at convenient times, new research has concluded.

A survey found that patients who cannot get through on the phone, cannot book a routine appointment within two days and find the opening hours of their surgery inconvenient are more likely to resort to GP out-of-hours services.

9.48am Simon Stevens, speaking at the Kings Fund annual leadership summit yesterday, said: “As NHS managers we’re not just in the business of performance; as NHS leaders we’re in the business of change. As the legendary Peter Drucker put it: ‘There is nothing so useless as doing efficiently that which should not be done at all.’ That means constantly asking: why are we doing it like this? Is there a better way?

My argument is that’s necessary not just because of the obvious economic pressures. It’s because all industrialised countries face profound and defining health care choices over the coming decade – about how to respond to the new possibilities opening up in medicine, in technology and social transformation. Will we hunker down and try and fend them off, or will we embrace them and harness them?”

7.00am The College of Emergency Medicine and Candesic delved into data on A&E attendances and found discrepancies that should be viewed as an opportunity to design services fit for the future, write Clifford Mann and Michelle Tempest.