BBC News

• Health minister attacks plans to close his area's units.
  
  A government health minister has attacked NHS plans that could see the closure of the Accident & Emergency and maternity wards at St Helier Hospital in his area. Paul Burstow, Liberal Democrat MP for Sutton and Cheam said the plans "lack reality" and should not go ahead. The Labour Party has called his criticism "hypocritical". The proposals for south London would be subject to a 12-week public consultation expected in the autumn. The NHS "Better Services Better Value" review recommended the number of A& E departments in south-west London be reduced to improve efficiency. Last week a Scoring Panel of 60 local people, managers and GPs decided that St Helier Hospital should lose its A& E and maternity departments, but have a planned centre for elective surgery. Services would be transferred to Croydon and Kingston Hospitals. But Mr Burstow, who was born at St Helier, said talk of it taking just an extra six minutes to get to Tooting, Croydon or Kingston from Sutton were "inaccuracies" and an example of the "lack of reality" being "foisted into the process" by the NHS locally. He has said the review was initiated by the local NHS, not by the Department of Health. Shadow Health Secretary Andy Burnham said: "It comes to something when a health minister is launching a campaign against the impact of his own policies on the ground in his own constituency."
  
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Guardian

• NHS reforms: a recipe for complete chaos.
  
  I recently attended a management course at a local hospital designed to prepare doctors for the new NHS. The speakers included senior managers and doctors from the hospital hierarchy. The first session gave a brief history of the NHS and its proud foundations, reminding us of its mission statement "to provide healthcare free at the point of delivery". We were then told that the government had decided the NHS had to make £20bn efficiency savings over the next three years. This is the equivalent of closing a staggering 40 large hospitals nationally. Of course this would signify a political disaster for the coalition, so instead they plan to get the medical profession involved in the destruction of the most envied health service in the world. The course was designed to train and empower clinicians in how to make these savings. But in reality, what is under the disguise of efficiency is actually a representation of an unprecedented "risk" of epic and catastrophic proportions to patients and staff. We were all given an example document of the hospital expenditure to run a particular department and were asked almost rhetorically where most of the cost went. It was highlighted that it was on doctors' and nurses' salaries. We were then split into groups and given a task of making a business plan for our own service. Effectively we were being trained in how to maximise resources and make our working patterns as efficient as possible or risk losing our jobs. "Don't worry", one senior manager said, "if the hospital decides that you are not making money for the hospital I am sure you will find a job somewhere else where your skills will be required." It is therefore inevitable that some services will disappear and patients will have to travel further to another hospital to receive the specialist care they would have previously received locally. I pointed out that this is not what patients want, but my comment was met with a blank expression by an executive who then very excitedly suggested how we could make great savings from the cost of hospital outpatient appointments by replacing face-to-face consultations with telephone appointments. Her view of patients as customers was further exemplified by a comment that we should follow in America's footsteps, and certain specialities (plastic surgery for example) could follow up their patients by video link, to save a visit to the hospital. She thought this was a very "cool" idea. As financial incentives take priority and clinical care becomes subordinate to a market-driven political agenda, the doctors most likely to succeed will the most business-minded. This is an inevitable consequence when the medical profession is disempowered of its transcendent qualities – its mystique, code of honour, its notion of duty – and reduced to a rational, financially-driven enterprise. As we are being led towards privatisation, we mustn't forget that during the rapid commercialisation of the US health system in the 1980s, the American medical profession lost public support faster than any other professional group. As morale declines even further, some of the most able clinicians and specialist nurses will want to leave the profession as private companies take advantage of the coalition's destruction of the NHS by setting up a chain of private health clinics in supermarkets and shopping centres. They will claim to offer better working conditions as they cherrypick services. Subsequently hospitals will be left to pick up the pieces as they have to deal with the more complex and costly care. Other medical staff will understandably move abroad or even change career. The passing of the Health and Social Care Act was one of the blackest days of my career. This is not the system I was inspired to slog through years of medical training to work in. What has been dubbed as Lansley's monster is soon to become a reality of catastrophic proportions unless we unite and resist cuts to the workforce and so called efficiency savings that compromise what we still hold in the highest esteem, which is to provide the best care for our patients.
  
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Independent

• Lansley jeered as angry nurses attack cuts to frontline NHS staff.
  
  The Labour Party leader, Ed Miliband, will today accuse the Government of acting like masters rather than servants of the NHS in a speech to hundreds of disgruntled nurses, who jeered the Tory Health Secretary after he claimed frontline staffing levels had increased under his watch. Mr Miliband will use his speech at the Royal College of Nursing's annual congress to announce a new NHS whistle-blower hotline, through which concerned nurses, doctors and patients can report staffing cuts and patient safety concerns directly to Labour. This is likely to be received well to nurses in Harrogate as theylaughed when Andrew Lansley told them to report to their superiors if there were not enough nurses to provide safe patient care. The Government has been accused to failing to improve protection for whistleblowers, despite pre-election promises. The Opposition leader's speech comes amid growing anti-Government sentiment among NHS staff, many of whom are angry about top-down reforms, cuts to frontline staff and unpopular pension changes. Mr Lansley rejected the RCN's evidence that at least 60,000 frontline nursing posts have been lost or have been earmarked for cuts in the past two years. Some nurses from the audience shouted "liar" after Mr Lansley, who appeared more confident and relaxed than he has in months, claimed staffing numbers had increased since the coalition took power. However, there appeared to be confusion among ministers about official numbers. Mr Lansley admitted that 3,000 nursing posts have been lost since 2010 but said that there were 4,000 more doctors. Elsewhere, junior Health minister Simon Burns insisted that only 450 jobs had been lost. The RCN general secretary, Dr Peter Carter, told the nurses the NHS was "under attack" and predicted more major reforms would be needed to "clear up the confusion" left behind by the controversial NHS and Social Care Act. In a rousing speech, Dr Carter said patients being cared for in corridors were reminiscent of the NHS in the 1990s. His words, and the applause they elicited, will worry David Cameron, who has desperately tried to assure voters that the NHS is safe in Tory hands. While Mr Lansley was not booed, as some had predicted, the dissatisfaction among hundreds of nurses attending the three-day congress was made crystal clear during the debates. One of the motions passed overwhelmingly was: "The NHS is not safe in Andrew's Lansley's hands." Dr Carter encouraged nurses to use their voter strength to kick the Government out of office at the next election.
  
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Monday 14th May 2012

The Green Benches

• 30 MPs including 6 government ministers have accepted donations from Virgin but it has to stop.
  
  Among those who accepted donations from Virgin are more than 30 MPs including 6 Government ministers, 4 of whom were Cabinet Members under this government. The accumulated value of those donations rose to more than £106,000. Our newest MPs have not accepted the free trinkets from Virgin and this should hearten us that some lessons have been learned since the expenses scandal. I won't name the MPs for accepting the donations because there was less of a conflict of interest prior to April 2012 in accepting donations from Virgin. But the key reason I am drawing attention to this is that now Virgin has begun buying chunks of our NHS the time has come for MPs to stop accepting donations of any type from Virgin. There is a clear conflict of interest between accepting a gift from Richard Branson and him then bidding for a chunk of the NHS in your seat. Given that Virgin now control parts of the NHS in 18 areas of England it will soon be the case that the majority of MPs will be compromised if they accept donations for the mega corporation.
  
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Coorporate Watch

• As the government looks to open up the NHS further to private companies, it has been as coy in its description of the companies looking to profit from this as the companies themselves.
  
  Health Secretary Andrew Lansley hardly mentions that these companies will be making a profit from his reforms, preferring to talk about modernisation and bringing 'the power of competition to healthcare'. H5, the pressure group set up by five of the biggest private healthcare companies in the UK, and an increasingly prominent voice in the media, says its members are 'dedicated to better healthcare for Britons through private hospitals playing their part complementing the NHS', while the NHS Partners Network, which represents private companies and some not-for-profit groups, is only a little more direct in its assertion that a 'mixed economy NHS' will lead to, 'more choice and better value for money for patients, taxpayers and shareholders'. That the satisfaction of each of these three groups is not mutually compatible has been well argued but the fortunes of Southern Cross over the last month suggest this is an especially severe imbalance when the shareholders concerned are private equity firms. Since its announcement in the middle of March that high rents and government spending cuts had left it financially unsustainable, Southern Cross has been scrambling around trying to renegotiate its rents while councils have been readying themselves for the possibility that 30,000 elderly people will be without a bed if the real threat of the company going under is realised. The crisis was precipitated by local authorities passing on less 'business' to the company: as the cuts bite one of the ways they are saving money is by paying for fewer people to stay in nursing homes. However, the company was especially vulnerable due to, in the words of Chief Executive Jamie Buchan, 'the type of lease arrangements which underpin our business model.' This business model was mainly the consequence of its brief period of ownership by the Blackstone group, one of the world’s biggest, and most successful, private equity investors. After it acquired the company in 2004, Blackstone gave an object lesson in how private equity works: it expanded the company as fast as it could, then sold it, making a lot of money but leaving a lot of problems. Two months after buying Southern Cross, it bought the property company NHP’s 355 care homes as well, followed by the 193 homes of the Ashbourne Group in November 2005, all to be managed by Southern Cross Healthcare. Blackstone then floated the company on the stock market and sold its shares in two chunks, in 2006 and 2007, walking away with reportedly quadruple its original investment, not bad for just three years of ownership. The problem is that Southern Cross now owns very few of the freeholds to the care homes it is operating, and the landlords that now own them are charging rents the company cannot afford. This is not all due to Blackstone – Southern Cross had already sold the freeholds to most of the homes it owned before Blackstone took over – but the acquisition of NHP and the way it was sold saddled Southern Cross with even more unsustainable rent bills. Although it floated Southern Cross Healthcare on the stock market in 2006, Blackstone sold the freeholds of the old NHP care homes separately, to an investment fund for £1.3bn. Southern Cross continued to manage these homes, as it did when Blackstone made the initial acquisition of NHP, but it now had to pay rent to the new owners for the privilege. The residents of these homes weren’t helped by Blackstone’s choice of buyer: the Qatari Investment Authority, which, since buying the homes, has increased rents by 18.6%. All in all, the GMB union, which represents Southern Cross staff, estimates that with Southern Cross paying £248.3m to the landlords of all of its 752 homes (including those owned by Qatari Investment) in 2010, its rents are £100m higher than they should be.
  
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The BMJ

• Behind closed doors: how much power does McKinsey wield?
  
  It’s the most envied management consultancy in the world, and more than a third of its health consultants are medically qualified. But does the enigmatic McKinsey and Company have undue influence over UK health policymakers ? McKinsey remains an enigmatic, even secretive, organisation, keeping a determinedly low profile and rebuffing media intrusions. It claims that this helps maintain client confidentiality; critics say it prevents close public scrutiny. It refused BMJ requests to interview staff for this article. Could McKinsey really have inspired the controversial NHS reorganisation that seemed to emerge from nowhere so soon after the election ? Health minister Earl Howe wafted away peers’ concerns, while McKinsey issued a terse statement that, “We have not . . . been involved in drawing up the proposals in the Health and Social Care Bill or any other bill.” Nevertheless, anyone wanting to show that McKinsey’s involvement with the NHS has been, and remains, extensive can cite plenty of evidence. It has discussed with the Department of Health how international hospital groups could improve NHS hospitals’ performance. It has advised Monitor, the regulator of foundation trusts, on organisational design, and is working with at least 25 clinical commissioning groups. The NHS’s £20bn (€24bn; $32bn) efficiency savings target was first mooted in a McKinsey report for the department in 2009 that also suggested reducing staff by 10%. McKinsey is credited with influencing former health minister Lord Darzi’s programme of polyclinics for London, axed by the coalition government. One of the company’s most striking features is the number of its former staff appointed to influential positions. For example, Monitor’s chair and interim chief executive, David Bennett, spent 18 years with McKinsey before becoming chief policy adviser to the then prime minister Tony Blair and head of the Prime Minister’s Strategy Unit. Monitor’s strategy director, Adrian Masters, also worked for McKinsey, and a non-executive director, Sigurd Reinton, was a McKinsey director. Clearly it is to the NHS’s advantage to have access to knowledge and skills it might otherwise lack. Management consultants can bring objectivity and a fresh perspective to problems with which in-house teams may have long struggled. But do McKinsey and others like them wield influence for which they are unaccountable ? But some have concerns about “revolving door” syndrome, where consultancy staff join government on secondment or civil servants leave to join consultancies they may previously have hired. Walshe says: “We don’t deal with these conflicts terribly well.” Another policy academic asks: “When people are seconded to Number 10 or big departments, where does their loyalty fundamentally lie ? If a conflict of interests arose, on which side would they come down ?”
  
  

Friday 11th May 2012

Croydon Guardian

• SW London hospitals cannot avoid cuts.
  
  Health bosses have said no cuts to A& E and maternity at a SW London hospital is not an option. An NHS review panel recommended St Helier Hospital loses the two frontline departments. A panel of 60 representatives made up from SW London hospital trusts, local authority members and community representatives recommended St Helier lose its frontline services over Croydon University and Kingston hospital. They scored each hospital as part of the Better Service, Better Value healthcare review, which announced two months ago one of the hospitals faced the cuts. The panel ranked which hospital should host a planned surgery centre and lose their A& E and maternity departments. Dr David Finch, local GP and joint medical director for BSBV, said: “The one thing that I took away from that panel was a very strong statement that ‘no change’ was not an option."
  
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Health Investor

• NHS Addenbrooke’s plans new private hospital.
  
  Addenbrooke’s hospital in Cambridgeshire is planning to develop a new private hospital and hotel complex. The NHS hospital is due to open bids to developers for the £135m project – called The Forum – in the next few weeks, the Cambridge News reported. St.Clair Armitage, director of corporate development at Addenbrooke’s, said the scheme is part of the hospital’s 2020 Vision expansion plan, which aims to double the size of the existing hospital and generate additional income. “The NHS is not going into the hotel business and I want to be absolutely clear this is completely separate from our NHS care business,” he told the News. “We don’t have to choose between NHS patients and any other part of the business. We are looking for a commercial partner specifically so that it does not affect care.”
  
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This is Cornwall

• RCHT losing out to private hospitals.
  
  Health bosses have been accused of not doing enough to stop private hospitals from cashing in on lucrative NHS patients. Concerns have been raised after a growing number of NHS patients are opting to have their operations at the Duchy Hospital in Truro. In recent months, RCHT's market share of elective operations has fallen; orthopaedics is currently below plan by 694 procedures worth £2.435 million. By contrast NHS operations at the private Duchy Hospital at Treliske, such as hip and knee replacements, have risen so much that it beat its £8 million NHS target by £2.9m for 2010-11. Last year it treated about 3,400 NHS patients. Next March it is hoping to open a new £5m theatre for major cases, cardiac catheter laboratory and dedicated day-case facilities."NHS patients used to come to us when there was a backlog, but we now offer our services direct. It is part of our core work," said Duchy's general manager Chris Sealey. Campaigners fear that under the Government's reforms, giving patients the right to choose any provider, the RCHT is losing out on profitable business. Graham Webster, vice-chairman of campaign group Health Initiative Cornwall, said: "Hip and knee operations are very lucrative, it is bread and butter money to the RCHT. It is a shame that so much profitable work has been lost to the private sector. The system has exposed what can happen when another provider comes in. I feel the Primary Care Trust (PCT) and RCHT have been too slow to respond and prevent NHS money from being lost. Private firms target patients and are expanding their services," he added.
  
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Guardian

• Edited NHS risk register is published in partial climbdown.
  
  The risk of patient care suffering while NHS managers are distracted by restructuring and financial failures is among those on an assessment of risks of the government's flagship health reforms that has been published by the Department of Health in a partial climbdown from its insistence it will not release the controversial document. The health secretary, Andrew Lansley, also told MPs the department would continue to publish updated assessments of the risk register for at least the next three years. Lansley went to the House of Commons to make a formal statement explaining the cabinet's decision to veto a ruling by the information tribunal after the judges ordered the Department of Health to publish the document. The veto followed decisions by both the lower tier of the tribunal and two investigations by the information commissioner, all of which rejected the department's refusal to publish the information. Lansley repeated the government's argument that it was establishing a point of principle: that civil servants should be able to use "direct language and frank assessments" when giving advice to ministers in a "safe space". However, Lansley also revealed that an edited version of the document, from November 2010 when the original Freedom of Information request was made by the Labour MP John Healey, had been published on the department's website, after the veto was announced but when attention was largely focused on a relaunch of the coalition government by the prime minister, David Cameron, and his deputy, Nick Clegg. Another document published at the same time was a timetable for when future risk register information would be released – in the spring of each year until 2015, when the next general election is due. The edited risk register describes each of the nine areas of concern identified by health officials and discussed with ministers, including problems of co-ordinating the planning and implementation of the complex network of old NHS organisations being phased out and new bodies being created, such as Primary Care Trusts being replaced by GP commissioning groups. Other issues covered are the risk of damaging staff morale and the danger that widespread opposition will lead to the bill being delayed from becoming law while the reforms are already under way. It does not spell out risks in any detail, nor the potential knock-on impact that could be felt by patients, which are spelt out in the original document and in similar risk registers drawn up by strategic health authorities and other local NHS bodies. A copy on the internet of what is apparently the original November 2010 transition risk register goes into considerably more detail, listing, for example, the risk that GPs will hire more private sector staff and so inflate costs, that management could lose focus on "business as usual" during the changes, that "financial control is lost", that "conflict and creative tension" might arise between new organisations, and that when responsibilities become more devolved "emergencies are less well managed/ mitigated".
  
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Tuesday 8th May 2012

The Green Benches

• Is Virgin Care set to take control of NHS services in Andy Burnham's own constituency?
  
  I suspect it will be a very bitter pill for Andy Burnham to swallow when he hears that a chunk of his own NHS in Leigh is about to be handed out to a private medical company. As the bidding does not close until 25 May this month we have no way of knowing who the bidders are to take control of Leigh's Sexual Health Services. Given Virgin Care's recent acquisition of Sexual Health Services in Surrey, Milton Keynes, West Sussex (here) (Brighton) and a place in the North East that escapes me at this moment, it is a fair guess to suggest that they will be in line to bid for the contract. It would be an audacious bid by Richard Branson's firm given the Labour Shadow Health Secretary's passionate opposition to the NHS Bill. Of course, there is every chance the NHS could bid against Virgin for the contract but they beat Virgin at their own peril. When NHS York went up against Virgin and beat them, Branson's lawyers made a legal complaint against the NHS. Virgin complained that NHS York was intent on not making a profit and as such was engaged in predatory behaviour (here) Don't say you haven't been warned NHS Leigh.
  
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• Lansley's latest plans to block NHS Trusts bidding for contracts.
  
  As part of Lansley's efforts to advance the privatisation of the NHS he has commissioned a new report on imposing borrowing limits on all providers, including NHS Trusts, bidding for parts of the NHS. This report is over and above the Health & Social Care Act that has already become law. That report should have been completed on April 20 but we heard no mention of it. We have only come to know this information through a freedom of information request. I have a copy of the invitation to tender that was sent to McKinsey which I will publish if needed. NHS Trusts are already subject to "prudential borrowing controls" that prohibit their debts going above 40% of their budget (excluding PFI) but under these new arrangements that could a) shrink further & b) more worryingly it could be used as a method of blocking NHS Trusts from tendering bids. If a NHS Trust was either already at its debt limit, or submitting a bid that was deemed to be unprofitable, it could be refused the right to bid on the grounds that it breached the borrowing limit or to grant the NHS Trust the contract would be was anti-competitive. Now that the NHS is subject to European Law there is every chance that these types of wrangles could very soon end up in the European Court. This is the exact opposite of Andy Burnham's plans to give the NHS preferred bidder status if Labour win the next election It will shock NHS campaigners even more to note that McKinsey & Co. were invited to tender for this contract. McKinsey have shown a clear agenda thus far to accelerate private influence in the health sector and they can be expected to show NHS Trusts no mercy in drawing up the report. We should have been able to reveal this information to you last month for Monitor blocked one of our Freedom of Information requests. It is only now upon appeal that we have learned both of McKinsey's offer to tender for the £200,000 contract & the remit of the report to restrict indebted providers from bidding for services.
  
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Socialist Party

• Exposed: the dirty world of NHS privatisation.
  
  A second report into 150 GMB members' complaints of bullying and discrimination at the Great Western Hospital in Swindon was published last week. Their employer, Carillion, operates the PFI contract at the hospital and conducted the investigation into the complaints. In the report, Carillion agrees that there is evidence of bribery in Swindon but they have failed to acknowledge the blatant covering up of the bullying and discrimination. To add insult to injury, Carillion have refused to meet with the GMB since publishing this report to discuss its findings and to end the culture of bullying. The union is consulting the workers now about what to do next. At the start of this year the GMB submitted 109 complaints of bullying and discrimination. 90 mainly domestic staff gave evidence, including of managers asking for jewellery in exchange for holiday and shifts that the workers were legally initialled to. GMB members voted overwhelmingly to strike, which lead to 18 strike days, escalating to three 24-hour strikes in February. There was a three-day strike, a five-day strike and a seven-day strike in March and a march of 300 people in Swindon in support of the striking workers.
  
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Socialist Worker Online

• Hinchingbrooke: a warning from the future of the NHS.
  
  The private firm that has taken over the running of Hinchingbrooke hospital in Cambridgeshire is set to make millions in profits by axing services. Hinchingbrooke is the first ever NHS hospital to be privately managed. It is a guinea pig for what Tory health secretary Andrew Lansley wants to do to healthcare. The contract offers a frightening glimpse into the future of the NHS. The firm Circle Health signed a deal in February that allows it to keep the first £2 million of any annual “surplus” at the hospital. It will get a quarter of any profits between £2 million and £6 million—and a third of the profits between £6 million and £10 million. Circle will have to take an axe to services at the hospital in order to make these kinds of profits. Aileen is a health worker in the Unite union. She told Socialist Worker that the danger of privatisation is “felt very sharply” at the hospital where she works. She added, “A private firm took over our pathology services—and now it’s quite clear that patients are no longer being put first.” Hinchingbrooke hospital was picked for privatisation as part of a so-called rescue plan after it fell into £40 million of debt.
  
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BBC

• Ministers block release of NHS risk register.
  
  The risk assessment of the NHS overhaul in England will not be published after ministers vetoed demands to release it. The cabinet decided that releasing the document listing possible risks to services could harm the quality of future advice from civil servants. Labour's shadow health secretary Andy Burnham accused the government of a "cover-up of epic proportions". An Information Tribunal had ruled in March that the risk register should be published. The risk register is a written document drawn up by policymakers that lists the threat to the delivery of services from any changes. The NHS risk register was put together two years ago at the same time the white paper outlining Health Secretary Andrew Lansley's plans was compiled. A draft version of the register was leaked, revealing the risks of rising costs of GP care, poorer response to health emergencies and the high chance that managers might lose financial control of the NHS. The Information Tribunal had ruled that the public interest in publishing the risk register was "very high, if not exceptional".
  
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HSJ

• CCGs appointing non-NHS staff 'must justify' redundancy costs.
  
  Clinical commissioning groups that choose to appoint staff from outside the NHS, adding to redundancy costs, should be prepared to publicly justify their decisions, the NHS Commissioning Board has said. HR guidance from the board says CCGs should keep redundancy costs low and in the first instance look to fill jobs from existing NHS staff. It also tells CCGs to get legal advice for each potential staff transfer they intend to make. The document says: “It is important that CCGs recognise there is no separate budget for redundancy costs, and therefore they will need to demonstrate they have taken all steps to minimise these costs and secure talent from existing NHS staff in the first instance. “CCGs will need to be able to justify this decision in public, particularly if it leads to an increase in redundancy costs, as these are funded from the overall budget for the NHS.” Jon Restell, chief executive of Managers in Partnership, which was consulted on the document, said the guidance could dissuade many CCGs from trying to do things differently. He added: “The rhetoric around the creation of CCGs has, for too long, been about people having a blank cheque. At the end of the day there are financial constraints in the system and how many redundancies you can afford to bear.” Mr Restell said staff wanted more honesty about the transition process, saying: “At the moment we are still talking about re-arranging the deckchairs when what we know is a reality is what will be a significant reduction in the number of staff doing this work.” Shane Gordon, shadow accountable officer for North East Essex CCG and NHS Alliance senior member, said: “It’s important for CCGs to realise they operate within the constraints of the NHS as a public sector employer. The perception may have been that CCGs would have a completely free rein but that was probably an unrealistic starting point.”
  
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Guardian

• Cabinet in confusion over NHS risk register publication.
  
  The cabinet will decide whether the government wants to veto a ruling that it should publish a full and frank assessment of the impacts of its Health and Social Care Act, which was passed in March. Ministers plan to discuss a possible appeal or veto amid confusion over whether they might have missed the deadline for both, following a ruling by the information tribunal last month that the risk register must be made public. The disagreement over dates – which relates to whether the 20-day deadline for a veto and 28 days for an appeal include weekends and bank holidays – is awkward for a government already embarrassed by confusion over another deadline in the Home Office's continuing efforts to deport the radical cleric Abu Qatada. The information tribunal announced in March that it rejected an initial government appeal against the information commissioner, and published its full ruling on 5 April, setting out that the Department of Health should publish the risk register. Under the tribunal's rules, the government has 20 days to exercise a veto – a drastic step it has taken only three times in more than a decade – 28 days to lodge an appeal, or 30 days to publish the information. After a day of confusion, lawyers for the MP who first lodged the request for the risk register to be published suggested that the 28 days to appeal did include weekends and bank holidays, and so had passed. But the government said the 20 days to veto the ruling included only working days, and so the deadline was Tuesday. A third option for the government is to launch a late appeal if it can convince the tribunal that there were good reasons for the delay. Either way, the decision is likely to be controversial, despite the original health bill having passed into law, because Labour has continued to keep up its strong opposition while ministers try to get the necessary secondary legislation passed.
  
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Wakefield Express

• GPs to run A&E overnight as firms bid to run service.
  
  The accident and emergency department at Pontefract Hospital will reopen at night from September. But health bosses have not guaranteed that the move will be permanent, as a review of services is carried out at Mid Yorkshire Hospitals NHS Trust. A private company could run the A& E overnight when a sub-contracted team of GPs and nurses is brought in to staff it from 10pm-8am. Its closure sparked a storm of controversy last November after the trust failed to recruit enough doctors to run the A& E. Stephen Eames, Mid Yorkshire’s interim chief executive, said: “There remains a shortage of hospital emergency doctors so we are sub-contracting a team of GPs. These GPs have the skills needed in emergency medicine to support our existing team and for us to provide the same emergency service at Pontefract overnight as before. We have made it clear that we need a longer term solution to emergency care across all three of our hospital sites, in particular our 24-7 consultant-led A& E at Pontefract.” Mr Eames said Mid Yorkshire had received interest from eight organisations bidding to run the department. Tendering out the service would cost no more than the expense of running the A& E before it was temporarily closed.
  
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Monday 7th May 2012

Dr David Wrigley Blog

• We have heard much about the Health Act and how it will lead to increased competition within the NHS (and therefore increased cost) and also open up the NHS to private providers in a big way, meaning the lawyers and accountants will have a field day making money from negotiating market-driven NHS contracts.
  
  The Future Forum worked on the Health Bill during the most unnatural pause of the legislation and didn't make many significant changes to it. The beating heart of the Health Bill – the increased and vastly expanded role of the market in healthcare – remained healthy and strong. But something else very sinister remains at the centre of the Act. Something that could seriously undermine, or even destroy, the doctor patient relationship. It is called the ‘quality premium'. This concept is all around paying clinical commissioning groups (CCGs) a ‘bonus' if they find themselves with a surplus on their budget at year end and they have met certain ‘targets'. In fact here is the exact DH quote on what the quality premium will be for: ‘We will ensure that commissioning groups receive a quality premium only where they can demonstrate good performance in terms of quality of patient care and reduced inequalities in healthcare outcomes.' Now that sounds OK if you read it in isolation. A little like Quality Outcome Framework Payments (QOF) in primary care maybe – good quality care leading to better patient outcomes and hence increased resources. But remember this payment is in the context of commissioning. Commissioning is all about remaining within budget and having the right contract for the right provider at the best possible price to the NHS. So the quality premium will be paid out to CCGs if they perform well. This means if they come in budget. Lets be blunt about it - everything in the NHS at the moment is focussed on being ‘in budget'. We see the most draconian of cuts before us with the NHS being asked to slash £20bn from its budget over the next few years. This is unprecedented and has never been successfully done in any other leading health economy before. We are talking about cutting one fifth of the NHS budget – an enormous sum of money. So let us take this quality premium down to the consulting room and what might happen there. All GPs now know that money is tight in the NHS. Patients know this too but they still trust their doctor implicitly to do the best thing for them and make the right decision for them. Doctors remain year on year the most trusted profession in the country – with politicians and journalists the least trusted profession in the UK! But if we have this quality premium in place then the way patients see us will change. We may well decide for good clinical reasons that a course of treatment or a procedure is not appropriate for our patient sat in front of us. However, there will be a niggling thought in the back of the mind of our patient of: ‘Is my GP saying this for good reasons, or because he wants to ensure there is some money left at the end of the year to distribute amongst himself and his pals ?' This is a serious concern and could have far reaching implications for the very trusting relationship we have with our patients and on which the whole basis of our consultation is built upon. We would see ourselves knocked off the top slot in the ranks of ‘trusted professions' - much like in the USA where doctors are less trusted because they have a financial incentive to investigate and treat patients. We cannot allow this to happen in our NHS and to our doctors. This quality premium must not be allowed to come about in this way. it is vital for our patients and vital for our profession that we fight this dreadful concept.
  
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NHS Vault

• 31 January 2012 BBC News website:
  
  "If Circle makes a success of Hinchingbrooke, maintains NHS standards and pays off the debt, money can be handed over to the company's private backers." Note the order: first Circle has to make a surplus, then it has to pay off the debt, and when all that has been done, finally, Circle get some profits. Now we know the truth. 3 May 2012 BBC News website (filching the story from HSJ): "If it succeeds in reversing the hospital's fortunes then the first £2m of any yearly surplus goes to Circle. It will then keep a quarter of any profits between £2m and £6m, and of third of those between £6m and £10m. All income above that level in any year will go towards paying the hospital's debts, currently £40m." The actual contract gives a different order: first Circle has to make a surplus, then it takes the first £2m of that surplus, finally, if there is anything left, the surplus will go to pay off the debt. So why is it that the BBC got the order wrong ? The first version sounds so much better to the public, it sounds like Circle are being squeezed hard to make any profit. We know that Circle won't be squeezed. Indeed, HSJ have calculated that for Circle to pay off Hinchingbrooke's £40m debt they will have to make £70m surplus. That is, Circle will be handsomely rewarded by being paid almost £30m. The first BBC article was published while the Health and Social Care Bill was going through Parliament. The Bill, now the Act, has a clause specifically to allow "franchises" like Hinchingbrooke. The government hopes that there will be many more such franchises* and the BBC, through printing government press releases, were helping to spin for the government. The government's aim was to make the Hinchingbrooke deal look better for the taxpayer than it actually was as part of their effort to get the Bill passed. The next franchise is likely to be George Eliot in Nuneaton. There are three NHS bids for this trust, but the Strategic Health Authority, who have to agree to the final tender, have made it known that they would prefer a franchise with one of the private sector bids. The government ought to spend some time in Nuneaton: there is no support at all for a private sector franchise. The local Nuneaton MP, and the nearby North Warwickshire MP, are both Conservative, and have tiny majorities. If only for their sake, it is about time the Government reigned in the privatisers in the Midlands and East SHA cluster, because if this deal goes ahead it will be a significant factor at the next election.
  
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The Guardian

• It's a scandal that big hospital contracts are being awarded in private.
  
  Once upon a time in England, NHS health authorities and hospitals would publish annual accounts to show income and detailed expenditure on staff, services, maintenance, supplies and administration. Scotland and Wales still do, having eschewed the market; Scottish health boards are also now required to itemise all commercial contracts over £25,000. In England, routine information on expenditure is increasingly concealed by freedom of information exemptions under the veil of commercial confidentiality. Meanwhile, public money is diverted to for-profit healthcare companies such as Virgin, UnitedHealth, Netcare, Serco and Circle. In November 2011, the government announced that Circle Healthcare would run Hinchingbrooke hospital for 10 years – the first NHS hospital to have its management taken over by a private business. Circle Healthcare chief executive is the former Goldman Sachs executive Ali Parsa. The recent revelation in a letter from health minister Earl Howe to Lord Haskel that Circle shareholders will have first call of £2m annually on any surpluses raises serious questions about the terms of the contract. How exactly is Circle going to square the circle of shareholder demands and patient needs against Hinchingbrooke's recurrent annual deficit of £38m ? The public cannot make a fully informed judgment about the contract, because both the Treasury and Department of Health have refused to release key information, despite repeated requests under the Freedom of Information Act.
  
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Bad Medicine

• The Secret Nail Exposed.
  
  News of a sort emerged last week that the Iranian Hospitalier’s circle of shadowy investors are to receive an annual bung for stitching up Hinching-brooke Hospital. The first £2 million of any surplus will be top-sliced, and wired to Jersey, or perhaps some other island where the sun shines a lot. The sweetener came to light after the Health Service Journal unearthed a letter deposited in the House of Commons Library last November by Lord Howe. In it, Howe writes: ‘Under the contract with Circle at Hinchingbrooke NHS Trust, the first £2 million of any year’s surplus will go to the Franchisee, Circle, as it must cover its costs and earn a fee [emphasis added]’. Howe may call it a fee, but to Dr No it looks uncommonly like a kick-back. No wonder the thinking epidemiologist’s crumpet, Professor Allyson Pollock, is scandalised. Previous attempts by Professor Pollock to gain further details of the contract have hit the brick wall of Section 43 of the Freedom of Information Act, which grants exemption from disclosure when the disclosure ‘would, or would be likely to, prejudice the commercial interests of any person (including the public authority holding it)’. The government noted the need to balance openness against commercial interests – but still refused full disclosure of the Hinchingbrooke contract details, opining that ‘there is also a strong case for non-disclosure as we believe that release would be likely to prejudice the commercial interests of the NHS and/ or Circle’. Business interests can now, it appears, trump transparency and accountability in the provision of public services. Professor Pollock is right to be scandalised. Yet all this is predictable. Over a year ago, Dr No referred to the Secret Nail in the NHS Coffin. The nail was the abolition of the Secretary of State for Health’s direct and personal responsibility for the provision of health services. Dr No suspected that this change – seen by many at the time as neither here not there, even obscure – was crucial to the Tory scheme to shred the NHS. By disconnecting the captain of the ship from the vessel nominally but now no longer actually under his command, the Health and Social Care Act has severed the highest link of responsibility and accountability; and, inevitably, this severance has caused a miasma of deflection of responsibility and denial of accountability to seep down through the organisation.
  
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False Economy

• The NHS, private patients and two-tier health.
  
  The Health and Social Care Act 2012 opens the door for NHS hospitals to bring in a two-tier system. There were some attempts to restrict the numbers of private patients that Foundation Trusts could treat, but, as I’ll explain below, these are largely ineffective. Subsection (1) of section 164 of the Act adds some new subsections to the 2006 NHS Act. The first of these new subsections (43(1)) says that the principle purpose of a Foundation Trust is to provide NHS services. It is quite amazing that the government thought that it was important to specify this. To the rest of us, it is quite clear that NHS hospitals exist to treat NHS patients: the clue is in the name. The 2012 Act adds a new subsection to the 2006 Act (43(2A)) that says this: “An NHS foundation trust does not fulfil its principal purpose unless, in each financial year, its total income from the provision of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes.” This says that at least half (that is, 50%) of the FT income must be from NHS work. Currently, the average private patient income for an FT is just over 1% (in 2010/ 11 FTs generated £252m income from private patients out of a total income of £26,867m). There is a lot of confusion over this figure. Some people report that there is an absolute cap of 5%. This is nonsense. The NHS Act 2006 (44(1)) says that the proportion of the total income of an FT from private work (including, but not exclusively from private patients) should not be greater that the proportion in 2003. Later Acts said that mental health trusts could earn up to at least 1.5%. As a result, there was a range of caps applied to FTs (to find what it was for your local trust, go to the Monitor FT directory and look for the Schedule 4 document under terms of authorisation). The average cap was around 3%, but some were as high as 30%. The new subsection 43(2A) puts an absolute private patient income cap on all trusts of 50%. This dwarfs the actual average private patient income of 1%. There may be one or two trusts that may get near to this new cap, but for the vast majority this cap is unobtainable, and so it is pointless. The Health and Social Care Act 2012 has been written to increase the number of private patients in NHS hospitals. The few places in the Act where there are “safeguards” these have been written in such a way that they are ineffectual. The clear intent of the government is to introduce a two-tier healthcare system where your ability to pay gives you preference.
  
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Friday 4th May 2012

Financial Times

• Emergency bailouts cost health department £415m.
  
  The Department of Health has been forced to pay out £415m in emergency bailouts for NHS hospitals in the past year, figures obtained by the Financial Times show. The sum is almost twice the size of emergency payouts issued the year before and the largest since health department started collating the data centrally in 2009-10. Andy Burnham, the shadow health secretary, said the figures were an “indictment” of the government’s reorganisation of the NHS at a time when it faces unprecedented restrictions in its funding. “Now was the wrong time to reorganise the NHS,” Mr Burnham told the Financial Times. The largest sums went to South London Healthcare trust which received £79m – on top of £46m it needed last year; and Barking, Havering and Redbridge University Hospitals which received £55m, bringing the total emergency funding it has received in the last three years to £114m – more than the annual turnover of some small hospitals. Although many of the hospitals receiving emergency funding are those with long-running financial problems such as Whipps Cross University hospital, the numbers needing extra help rose from 21 in 2010-11 to 31 in 2011-12. That included two trusts who have received the government’s flagship independent foundation status: Peterborough and Stamford Hospitals, which needed £41m, and Mid Staffordshire hospital, which received £21m. The health department has had to issue £817m in emergency loans to NHS hospitals in the three years since 2009-10 – with more than half of the amount coming in the past 12 months.
  
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Cambridge News

• Fresh calls for Lansley to resign.
  
  Further calls have been made demanding the resignation of South Cambridgeshire MP Andrew Lansley over the Government’s controversial health reforms. The latest calls were made by GPs at the Local Medical Committees (LMC) conference in Liverpool. A motion drafted by the LMC conference agenda committee called for Mr Lansley and Prime Minister David Cameron to step down for their “political arrogance towards the medical profession”. The paper said the Government’s NHS reforms are “merely a smoke screen for the true intent of parcelling up the NHS into bite-size chunks in preparation for privatisation”, and will make GPs scapegoats for the “rapidly deteriorating state of the health of the NHS”.
  
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Management in Practice

• First wave CCG authorisation applicants revealed.
  
  The NHS Commissioning Board (NHS CB) has confirmed 35 CCGs have chosen to take part in the first wave of applications for authorisation. Applications for authorisation will take place in four waves from July 2012 to January 2013. Dame Barbara Hakin, National Director of Commissioning Development at the NHS CB, said the confirmation of the CCGs that will be assessed in waves 2, 3 and 4 are to be expected "shortly". The CCGs taking part in the NHS CB's first wave of applications for authorisation are: Bassetlaw, Blackpool, Bedfordshire, Calderdale, Cumbria, Dudley, East & North Herts, East Leicestershire & Rutland, East Riding, Gloucestershire, Great Yarmouth & Waveney, Islington, Kernow (Cornwall), Kingston, Leicester City, Liverpool, Newbury & District, North & West Reading, North East Lincolnshire, North Staffordshire, Oldham, Oxfordshire, Portsmouth, Rotherham, Sandwell & West Birmingham, Shropshire, Somerset, South Reading, Stoke on Trent, Wakefield, Wandsworth, Warrington, West Cheshire, West Leicestershire and Wokingham.
  
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Guardian

• Privately run NHS hospital 'will need to make eyewatering cuts'.
  
  The boss of the first private company to run an NHS hospital has promised to pay off £40m of public debt, prompting unions to warn that this will "hit patients and staff as drastic cuts will have to be made to health services and jobs". Ali Parsa, the chief executive of Circle Healthcare, said the 10-year deal to run Hinchingbrooke hospital meant his company aimed to make at least £60m in profits from £1bn in NHS revenues. While the company claims it will improve standards, to make money unions say it will need to implement what have been described as eyewatering cuts. Asked whether he would slash services to make cash, he said: "We have to meet all sorts of outcomes in waiting times, A& E. We would not be able to do this if we cut. That's not what we have done in other hospitals." Although Parsa said he was committed to clearing the debt, he admitted he was not contracted to do so. In a deal signed off by the government in February, Circle takes the first £2m of any year's profits at the hospital in Huntingdon, Cambridgeshire. After that it gets a quarter of surpluses between £2m and £6m, and a third of surpluses between £6m and £10m. The terms mean that in any year Hinchingbrooke makes less than a £6m surplus, more than half will go to Circle. In the past decade the hospital has never made an annual surplus of more than £600,000, suggesting large cuts would be needed to meet targets. This year the hospital is on course to lose £10m. Circle's 10-year management franchise is seen as a potential model for other hospitals. The Health Service Journal, which uncovered details of the deal, calculated the trust would need surpluses of at least £70m over the next decade to pay off its £40m debts. Unions called the deal disgraceful. Christina McAnea, Unison's head of health, said: "Circle and the government promised that a profit would not be made until Hinchingbrooke's debts had been paid off. It clearly had no intention of keeping this promise, having laid down plans to cream off nearly 50% of the hospital's surpluses – making it virtually impossible to balance the books. This is a disgrace. Any surpluses should be going directly into improving patient care or paying off the hospital's debt, securing its future for local people – not ploughed into making company profits." The government had always claimed that if Circle kept its promises and met targets "the whole of the trust's accumulated deficit will be repaid by the end of the 10-year contract".
  
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Thursday 3rd May 2012

The Green Benches

• The Royal College of Nurses issue a stark warning to Lansley about his plans to cut NHS funding for poor areas
  
  Tory plans are to strip NHS funding from poor cities in the North of England and hand the cash over to the posh, wealthier areas of the south. The basic justification for such a blatantly inegalitarian move is that people in the south deserve greater priority for health funding because they live longer. This is the same rationale that has also led the Tories to argue that they should cut northern nurses salaries because it doesn't cost that much to live up north. Today, the Royal College of Nursing reacted angrily to Lansley's proposals. You can read the full press release from the RCN (here). The RCN's regional director Glen Turp said, "It is well known that in areas of social disadvantage, local populations experience higher incidents of heart disease, cancer, emphysema, diabetes, as well as a range of other diseases caused in part by our industrial history and the work that our communities undertook. Health outcomes are directly linked to poverty and inequality, and to use age as the measure rather than inequality is simply the wrong thing to do." Research from the Slope Index of Inequality shows that inner-city areas of England, particularly in the North would be severely affected if Lansley's ideas go ahead. You see the problem is this, in Newscastle, Darlington, Bolton, Middlesbrough and other northern cities people die on average much much younger than wealthier southern areas. In Westminster, men can expect to live 16.6 years less than people in Henley or Kensington. In Newcastle, men can expect to live 14.4 years less. Although the inequalities for women are slightly less than men, women in Newcastle can still expect, on average, to live 11 years less than the women of West Dorset.
  
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HSJ

• Circle deal means Hinchingbrooke needs over £70m to clear debts.
  
  Figures uncovered and analysed by HSJ reveal the scale of the returns needed by Circle to meet its plans to clear the financially challenged £100m-turnover hospital’s debts. The firm took over Hinchingbrooke in February, making it the first NHS district general hospital managed by the private sector. On signing the deal, health minister Simon Burns told Parliament: “If Circle achieves its forecasts, the whole of the trust’s accumulated deficit will be repaid by the end of the 10-year contract. “Circle is paid from the trust’s surpluses, so if there are no surpluses, Circle does not receive a fee. Furthermore, if the trust makes a deficit under Circle’s watch, Circle must fund the first £5m.” Mr Burns did not reveal the firm’s share of any surpluses. However, a letter from health minister Lord Howe to Lord Haskel found by HSJ in the House of Commons library explains that the first £2m of any year’s surplus goes to Circle. The company takes a quarter of surpluses between £2m and £6m, and a third of surpluses between £6m and £10m. The terms mean that in any year Hinchingbrooke makes less than a £6m surplus, more than half will go to Circle. In the past decade, Hinchingbrooke has never recorded a surplus above £600,000. The terms also mean the minimum surplus Hinchingbrooke needs to clear its debts over the next decade is £70m. That would be possible only if the trust recorded £10m surpluses for seven of the 10 years. If surpluses are spread more evenly over the contract term they would need to be higher overall, because a larger proportion would go to Circle. Hospital turnaround specialists described the target as “very challenging”. Bill Upton, head of healthcare at Grant Thornton, said: “It’s going to be extremely difficult, given all the pressure on trusts in terms of [reductions to the] tariff and things like that.”
  
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The Guardian

• Privately run NHS hospital 'will need to make eyewatering cuts'.
  
  The boss of the first private company to run an NHS hospital has promised to pay off £40m of public debt, prompting unions to warn that this will "hit patients and staff as drastic cuts will have to be made to health services and jobs". Speaking to the Guardian, Ali Parsa, the chief executive of Circle Healthcare, said the 10-year deal to run Hinchingbrooke hospital meant his company aimed to make at least £60m in profits from £1bn in NHS revenues. In a deal signed off by the government in February, Circle takes the first £2m of any year's profits at the hospital in Huntingdon, Cambridgeshire. After that it gets a quarter of surpluses between £2m and £6m, and a third of surpluses between £6m and £10m. The terms mean that in any year Hinchingbrooke makes less than a £6m surplus, more than half will go to Circle. In the past decade the hospital has never made an annual surplus of more than £600,000, suggesting large cuts would be needed to meet targets. This year the hospital is on course to lose £10m. Circle's 10-year management franchise is seen as a potential model for other hospitals. The Health Service Journal, which uncovered details of the deal, calculated the trust would need surpluses of at least £70m over the next decade to pay off its £40m debts. Unions called the deal disgraceful. Christina McAnea, Unison's head of health, said: "Circle and the government promised that a profit would not be made until Hinchingbrooke's debts had been paid off. It clearly had no intention of keeping this promise, having laid down plans to cream off nearly 50% of the hospital's surpluses – making it virtually impossible to balance the books. "This is a disgrace. Any surpluses should be going directly into improving patient care or paying off the hospital's debt, securing its future for local people – not ploughed into making company profits."
  
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GP Online

• Cameron and Lansley to face calls to quit at LMCs conference.
  
  A motion drafted by the LMC conference agenda committee deplores the ‘political arrogance towards the medical profession illustrated by, and calls for the resignation of, the prime minister and secretary of state for health’. LMCs will debate a motion warning that the government’s NHS reforms are ‘merely a smoke screen for the true intent of parcelling up the NHS into bite-size chunks in preparation for privatisation’, and will make GPs scapegoats for the ‘rapidly deteriorating state of the health of the NHS’. LMCs will also debate motions warning that revalidation should not go ahead until funding for remediation has been secured and details of how it will work for locums and other sessional GPs made clear. Motions will also be debated hitting out at the BMA leadership for taking too long to ‘wake up’ to the damaging effects of the Health Act. GPs will discuss a call for English practices to pull out of clinical commissioning groups and concentrate on core general practice, and warn of the increasing transfer of work from hospitals into primary care without adequate funding. LMCs will also debate whether registration with the Care Quality Commission is ‘a bridge too far’, and warn of an urgent need to boost the dwindling GP workforce and to protect education.
  
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Public Finance

• The Public Accounts Committee today called for an end to the routine use of the Private Finance Initiative to pay for public infrastructure, saying some of the private sector profits were ‘difficult to justify’.
  
  In some cases, private investors were making ‘excessively high returns’, as much as 60%, the MPs found. They said the PFI model, which has been used by successive governments to pay for around 700 projects over the past 20 years, was unsustainable and ‘inappropriate’. The committee’s report, Equity investment in privately financed projects, called on the Treasury to collect more data on investors’ returns in PFI schemes, and to introduce transparency to show these are in line with risks taken on. The report follows one from the committee in September last year that concluded the PFI was ‘a better deal for the private sector than the taxpayer’. Today, the committee said some of its earlier concerns about the PFI had still not been addressed, including the use of long inflexible contracts, typically 30 years. As well as introducing greater transparency, the government is urged to address these ‘intrinsic flaws’ by increasing flexibility in how private finance is used, and by making procurement quicker. Although the Treasury is reviewing the use of the PFI, 41 contracts have been concluded under the current government and more than 30 are currently being negotiated. Committee chair Margaret Hodge said that any new PFI deals ‘must be able to demonstrate that this was the best way to deliver real value for money for the taxpayer’ and ensure this ‘is properly tested at the outset’. She added: ‘The current model of the PFI is unsustainable. Time and again my committee has reported on problems, including the costly contracting process and the prospect of little risk being transferred but high returns being enjoyed by investors. The 30-year contracts are inflexible and don’t allow managers to alter priorities or change services that have become outdated. We have even seen evidence of excess profits being priced into projects from the start.’
  
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False Economy

• A glimmer of hope: we can stop the privatisation of the NHS
  
  Earlier this year, local health bosses in Gloucestershire were forced to scrap plans to outsource NHS services to a social enterprise following a legal challenge by Michael Lloyd, 76. Lloyd's challenge was backed by Stroud Against the Cuts and other community groups. Nine NHS hospitals and 3000 district nurses, health visitors, podiatrists, physiotherapists and others were at risk of outsourcing. When the case got to the High Court, NHS Gloucestershire was forced to back down and sign a consent order. They agreed to halt plans and go back to the drawing board. Essentially, lawyers argued that the healthcare that Michael Lloyd received would be damaged if services left the NHS. They used existing procurement law to argue that the Primary Care Trust could not just "give" services to a body (that include social enterprises) outside the NHS without a competitive tender. They argued that health bosses had acted unlawfully when they ruled out NHS options without proper consideration. The PCT crumbled and failed to defend the claim. Local anti-cuts groups had realised that the term ‘social enterprise’ (really, a ‘Community Interest Company’, or CIC) was being used by local health bosses to disguise backdoor NHS privatisation in Gloucestershire. A CIC is a private company. Compared to the NHS, a CIC has higher tax liability, wasteful reorganisational costs, no internal democracy or external accountability and is required to turn a profit. Cut loose from NHS financial and administrative support, CICs would be forced to compete as minnows in a shark-filled sea – which never ends well. A clear lesson from the Gloucestershire case is that what all PCTs can (and should) do is try and find a home for health and care services inside the NHS, in existing or new NHS Trusts, without needing to tender. NHS options have been chosen without tender in most other places (even since the passing of the Health and Social Care Act - though expect devious moves ahead). Circumstances on the ground will vary, so if you want to try using the law to halt privatisation, you need to consult solicitors without delay.
  
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British Journal of Healthcare Computing

• New Health and Social Care Act will hinder analysis of national health needs.
  
  Professor Allyson Pollock, Professor Alison Macfarlane and Sylvia Godden argue that the new legislation will make it “extremely difficult” to monitor health inequalities and access to care locally or nationally. The structure of the NHS in England is currently based on defined geographical areas. Under the new legislation, most health services will transfer to non-geographically based clinical commissioning groups (CCGs) that will be able to recruit patients living anywhere in England. This, warn the authors, is likely to lead to erosion of data quality, accuracy, and completeness. For example, responsibility for services such as childhood immunisation, HIV and sexual health, and mental health will be located in local authorities. Since local authority residents may be registered with any one of a number of different CCGs, the local authority will have to subcontract these services to a CCG, which could in turn outsource them to several providers. The authors point out that population-based data has had a key role in public health and the development of healthcare since the mid-19th century. Although it will be possible to compare differences between the new CCGs, “the instability of the denominator population will hinder accurate interpretation of the data,” say the authors. Cancer registries will also be affected, while increased outsourcing of care to private providers creates problems with the quality, completeness, and accuracy of coding of data, they add. The authors conclude: “The NHS is founded on the principle of comprehensive coverage. Equitable public health activity requires reliable information. The abolition of area-based structures and the transfer of most responsibilities to non-geographically based CCGs, as well as some responsibilities to local authorities, undermines the availability of information and routine data required to monitor the comprehensiveness of the health service, inequalities in access, the resourcing of services, and outcomes of care. “Private income generation coupled with the loss of the NHS' population basis and responsibilities for comprehensive data collection and monitoring will make it almost impossible to take the action needed to tackle inequalities in health and in access to healthcare.”
  
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Tuesday 1st May 2012

Pulse

• Bring back co-ops to run OOH.
  
  Dr Krishna Korlipara, a GP in Bolton and founder of the first GP co-op in the UK, writes: Pulse's recent front-page investigation highlighting low ratings by patients of care delivered by private out-of-hours providers in many parts of the country should come as no surprise. Until 2004, nearly 27,000 GPs were members of not-for-profit GP co-operatives providing an excellent service to their patients. There was a network of more than 300 co-ops all over the country that provided care to nearly 30m people. It is worth recalling how GP co-ops evolved. Before 1977, most doctors had to be available to see their patients at any time of day or night, seven days a week. This was very stressful, so there were a few private firms providing an out-of-hours service in return for profits in some areas. The standards of service were appalling, however, and most patients were seen by junior hospital doctors who had no previous experience in general practice. Not surprisingly, these patients had to be re-visited again by their own GP the following morning. It was an absolute shambles. I wanted an alternative, and so turned to the idea of setting up a GP co-op. I called a meeting of local GPs in Bolton and shared my vision, explaining how the new service would relieve us of the need to be available 24 hours a day without being dependent on commercial providers driven by profit. And so the first GP co-op in the UK was born in 1976. On Call Ltd, the private provider, had to quit within a year as Bolton Medical Services became hugely successful. Five years later, we set up the National Association of GP Co-operatives, which went on to become the biggest network of out-of-hours care providers in the NHS, eventually counting more than 300 co-ops as members. But the 2004 GP contract changed everything. As GPs were relieved of the responsibility for out-of-hours care, many PCT managers invited private providers to step in rather than encouraging more co-ops to take over collective responsibility for out-of-hours care. These private providers cost the NHS a lot of money – and standards of care in some cases slipped to unacceptable levels. There is no goodwill among GPs towards commercial organisations, and very few offer their services outside normal surgery hours. The way to improve out-of-hours care is to learn from the current debacle by inviting local GP communities to come up with a collaborative or co-operative model, which will be wholly owned and run by local GPs who know the area's population well. Patients will be reassured to know that while their own GP may not be available, they will be seen by another local GP. Those who work out-of-hours will be paid handsomely as an incentive for others to offer their services, but the overall costs will still be less than in a commercial venture and the standards of care will be higher. In a co-op, we should never need to rely on foreign locums to provide cover out of hours – we now know it puts lives at risk.
  
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• GP providers ‘may have to be licensed by Monitor’.
  
  GPs providing large-scale non-GMS services may have to be licensed by Monitor, the head of the regulator has disclosed. David Bennett, chair and interim chief executive at Monitor, said that while the focus would continue to be on large acute providers, GPs that were involved in providing larger community type services may need to be licensed. The recently passed Health and Social Care Act requires Monitor to register providers as part of its role looking at pricing, competition and integrated care in the NHS. The Department of Health has yet to disclose which providers will have to be licensed by Monitor, although Mr Bennett said that he expected smaller providers to be exempt.
  
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GP Online

• Revalidation fears could trigger walk-out by GP appraisers.
  
  A 'significant number' of GP appraisers could step down over fears that revalidation will change the nature of appraisal, GP leaders have warned. The loss could leave the NHS facing a shortage of appraisers just as revalidation is rolled out at the end of 2012. GPC Scotland chairman and GPC revalidation lead Dr Dean Marshall said there could be a ‘significant drop-out’ of GP appraisers, as revalidation changed ‘the very nature’ of appraisal. Many appraisers were likely to quit due to concerns that their new role gave them too much influence over fitness to practise decisions, he said. Adding to these concerns is the lack of clear information appraisers are receiving about revalidation, Dr Marshall said. Dr Marshall added that primary care organisations had underestimated the scale of the potential drop-out.
  
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Nursing Times

• Unison members split on NHS pensions.
  
  A ballot of Unison members on the government’s NHS pension reform plan has failed to deliver a clear verdict, the union has announced. Members were almost evenly split with 50.4% voting to reject the pensions deal and 49.5% voting to accept the offer. The turnout was low with just 14.8% of the eligible 373,000 members voting. The result fails to deliver the “clear rejection” the union had said it would need to take sustained industrial action. Unison’s head of health Christina McAnea, who had urged members to deliver a clear verdict during the union’s health conference in Brighton last week, described the result as disappointing. She said the turnout was “disappointing” but “reflects the low morale and current difficult state of the NHS”. She said members’ morale was low due to the pay freeze, job cuts, poorer terms and conditions and the Health Act. The Unite union has announced industrial action on 10 May after its members voted by 94 to 6% to reject the government’s offer. The union’s turnout was 24.6%. The Royal College of Nursing achieved a turnout of just 16.9% in February, with 62% voting to reject the deal and 37% voted to accept it. The British Medical Association is due to ballot its members later this month on whether they want to take industrial action for the first time since 1975.
  
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News Medical

• 54% doctors support denying treatment to smokers and the obese until they quit or lose weight
  
  Many doctors have come forth with their support of the measures to deny treatment to smokers and the obese, according to a survey. Doctors.net.uk, a professional networking site, found that 593 (54%) of the 1,096 doctors who took part in the self-selecting survey answered yes when asked: “Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking ?” They believe unhealthy behaviour can make procedures less likely to work, and that the service is not obliged to devote scarce resources to them. One doctor said that denying in-vitro fertilisation to childless women who smoked was justified because it was only half as successful for them. Another said the NHS was right to expect an obese patient or alcoholic to change their behaviour before they underwent liver transplant surgery. Dr Tim Ringrose, Doctors.net.uk's chief executive, said the findings represented a significant shift in doctors’ thinking brought on by the NHS in England's need to save £20bn by 2015. “This might appear to be only a slim majority of doctors in favour of limiting treatment to some patients who fail to look after themselves, but it represents a tectonic shift for a profession that has always sought to provide free healthcare from the cradle to the grave,” he said. Smokers and obese people are already being denied operations such as IVF, breast reconstructions and a new hip or knee in some parts of England. 25 of 91 primary care trusts (PCTs) have introduced treatment bans for those groups since April 2011.
  
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Monday 30th April 2012

Public Finance

• Condition still critical.
  
  Advocates proclaimed it as the saviour of the NHS. Critics decried it as the end of the NHS as we know it. The truth does not lie in the middle but somewhere else altogether. After the filleting the Bill received from the Liberal ­Democrats, the Act has no clear purpose at all. First, it is not clear what approach the NHS Commissioning Board will take or how it will specify the results it is seeking. The central problem is: who is in charge – the board or the CCGs ? Certainly, the board will be very powerful. The ‘lean and expert body’ envisaged in the white paper has long since been replaced by a centralised giant. Close observers of the system report the glee with which David Nicholson, the combative chief executive of the NHS, cheerfully admits that the main result of the listening exercise was to bring most of the power back to the centre. The original aim of the Bill, to encourage local innovation, is likely to be a casualty of the remarkable ability of the system to kick back and retain its power. Second, the Act is unclear what should happen when institutions fail, as they are bound to do. One recent report suggested that of the 18 foundation trusts in London, only six will still be financially viable in 2014. The original Bill envisaged that failure would be one of the spurs to improvement in the system and that Monitor would let institutions collapse. The Act envisages a more managed form of competition but the extent to which Monitor will intervene is still unclear. We do not yet know which services will be deemed to be essential through a transition. The third area of uncertainty is the great philosophical divide in health care. It is widely attested that there are benefits to competition and that there are benefits to integrated care. It is wrong to say that the two are wholly mutually exclusive but the practical tensions are frequent. Finding a system that marries the benefits of competition with the virtues of integrating services around the patient is the holy grail of a complex health system. The revised Act reflects the ­confusion of the argument with respect to competition. Some parts of the system will be subject to competition and some to the attempt to integrate the service from the centre. In the uneasy truce between the advocates of competition and the advocates of integration, it is not likely that the incentives are all in the right place. The Act will not be the final word in this ­argument, not by a long way.
  
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The Guardian

• NHS reforms will affect public health data collection.
  
  The NHS reforms will have "severe implications" for collecting and monitoring data about the health needs of the population across the country, warn experts. All health services, excluding emergency care, will be funded and provided to patients registered with general practices within clinical commissioning groups (CCGs). Unlike primary care trusts (PCTs), CCGs will be able to recruit patients living anywhere in England and could outsource services to several providers. This means that data will be collected from general practice registrations rather than population estimates, and this is likely to harm the quality, accuracy and completeness of data, according to a report published in the British Medical Journal. Without reliable information, it will be extremely difficult to monitor health inequalities, ensure access to care and the allocation of resources for these services. "We have a real disaster unfolding," said Professor Allyson Pollock, lead author of the report and Professor of Public Health Research and Policy at Queen Mary, University of London. "We must retain the area based populations and not allow the shift to membership which is what the Act allows CCGS to do. If this happens people will no longer be counted, the health service will no longer be universal and it will be almost impossible to allocate resources fairly," Pollock explained. It will be possible to compare CCGs but this will not be accurate, say the authors. Cancer registries will also be affected and outsourcing to private providers will lead to problems with the accuracy of data, they added. Resources and NHS staff will no longer be accounted for in bed availability and workforce statistics once they are transferred to the private sector, leading to problems for long term planning, including measuring supply and access. The "confusing plethora of arrangements" along with the discretionary powers of CCGs, local authorities and providers on which services to provide "will lead to a loss of comprehensive population coverage and the national nature of the health service in England," write the experts. "Private income generation coupled with the loss of population basis and responsibilities for comprehensive data collection and monitoring will make it almost impossible to take the action needed to tackle inequalities in health and in access to healthcare," they conclude.
  
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• Drug company attacks Nice for rejecting new lupus treatment.
  
  GlaxoSmithKline was unusually critical of the decision by Nice, the National Institute for Health and Clinical Excellence, and also the Scottish Medicines Consortium, to reject its drug belimumab (brand name Benlysta) in final draft guidance. The UK's appraisal system, said GSK, was "a fundamental problem". Nice's rejection of new drugs has frequently outraged patient groups. When Health Secretary Andrew Lansley took office, he let it be known he would strip Nice of its powers to turn down new medicines, but there has been little information since as to how a new system would work. Most experts believe something like Nice is needed to assess the value of a new drug. There is agreement, however, that drug companies should get a premium price for new medicines that are "innovative", rather than variants on those already on the market. GSK's attack on Nice adds to the pressure on government for change. Nice's defended its final draft guidance, which now goes out to consultation. Chief executive, Sir Andrew Dillon, said the independent appraisal committee had looked very carefully at the evidence and taken into account the views of people with lupus and their doctors.
  
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Pulse

• NHS managers protest to DH over Shared Business Services outsourcing fears.
  
  NHS managers have raised concerns that financial services to be used by every CCG in England will be outsourced to India. The move emerged amid the fallout from the NHS Commissioning Board's controversial decision to force CCGs to use NHS Shared Business Services for their financial services. NHS Greater Manchester's chair Professor Eileen Fairhurst has written to the Department of Health expressing her concern about potential outsourcing overseas, and its effects on local employment. And a board meeting heard Dr Mike Burrows, chief executive of NHS Greater Manchester, had ‘made representations' over the potential for outsourcing abroad - given NHS SBS has a facility in India where it is understood parts of the system will be managed. The NHS Commissioning Board made using NHS SBS – a joint venture between the Department of Health and private firm Steria - a condition of authorisation for CCGs earlier this month, after signing a £15.8m deal for its financial services. The GPC voiced ‘serious concerns' about the decision – which the board said was the ‘the only option' - after a series of GP payment delays and administrative errors.
  
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• NICE advisers call for QOF shake-up as framework too focussed on areas of ‘relatively low benefit to health’.
  
  NICE advisers have recommended a radical change to the way QOF is drawn up, with incentives paid to GP practices under the scheme determined by the magnitude of the expected ‘health gain'. The researchers said the incentives in the framework were too focussed on areas that had a high workload for GPs, but resulted in a ‘relatively low benefit to health'. They found a wide variation in the health benefits that could be attributed to clinical indicators in the QOF, and recommend the removal of badly performing indicators, and the revision of thresholds to ensure payments under the framework are evidence-based. The UK researchers included both current and past members of the QOF Indicator Advisory Committee at NICE, and honorary secretary of the RCGP, Professor Amanda Howe. Their study – published in BMC Health Services Research - looked at the clinical indicators in the QOF from 2004 and 2006 and found 28 had evidence of lives saved or Quality-Adjusted Life Years (QALYs) gained, which accounted for only 41% of the total QOF payments for the average practice. When examining the incentives GP practices gained for a 1% increase in QOF performance, researchers found no association between the payments made and the scale of the improvement.
  
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Friday 27th April 2012

Health Service Journal

• The DH continues to dance around the issue of CCG freedoms.
  
  Nigel Edwards – in his masterly analysis of the Health Act – declares that “the real level of autonomy available to clinical commissioning groups is likely to be determined by the behaviour of the NHS Commissioning Board… rather than by the legislation.” He adds: “The act does little to safeguard the system from top-down recidivism in the board.” In that light, Andrew Lansley’s letter to board chair Malcolm Grant commanding that CCGs are to have “assumed liberty” appears significant. Its message is in tune with fierce lobbying by those champions of clinical commissioning, the NHS Alliance and National Association of Primary Care and it might be thought they have forced a U-turn from the government. In the middle of last year, the Department of Health responded to the House of Commons health committee report on the commissioning reforms. It noted the committee’s approval of a “change from the principle of ‘assumed liberty’ to one where commissioners will earn autonomy” during the authorisation phase. It said the process of CCG authorisation “will be undertaken in line with… the principle of ‘earned autonomy’.” However, in truth, the debate is a continuation of the dance performed by the government ever since it revealed its plans for GP-led commissioning. To attract enough GPs to the commissioning table it had to promise them relative freedom. On the other hand, the government had to reassure a whole range of stakeholders that these new GP organisations would not be allowed to do whatever they liked. This dance is set to continue as the new system develops. Professor Grant, in his first ever interview, tells HSJ that CCGs can expect the board’s grip to remain relatively tight during the transition. On one level, this tension is simply created by the desire of any new organisation to have freedom of action – witness the ongoing birth pangs of the foundation trust sector – and the need for the centre, where blame eventually, and inevitably, arrives – to reduce its pain. But there are other, almost subconscious, forces at work. Significant among them is the fear of CCG leaders of being labelled “bureaucrats” – something the government wants to avoid as well. To maintain this construct, CCGs must not be perceived as acting in a bureaucratic manner, making decisions which feel distant from the needs of patients. Since this is impossible to achieve consistently in a system of the NHS’s scale, having someone to blame can be handy. A commissioning board perceived as overly officious may actually play to the advantage of CCGs in establishing their freshness. More significant will be what CCGs do with their “liberty” and how the centre reacts when and if that freedom ends in “failure”.
  
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Public Service

• Children could suffer through NHS reform.
  
  "Deep unease" has been expressed about how vulnerable children will be cared for and protected in the newly reformed NHS. The NHS Confederation warned that there was a risk of creating a more confusing, fragmented and possibly riskier system of care. Child protection (aka 'safeguarding') and child health are currently commissioned and provided by local councils and NHS primary care trusts (PCTs). But with the NHS reforms this responsibility will be split across four different local and national organisations. The government still hasn't made clear who will take over some responsibilities, including which organisation locally will have the overall responsibility for providing specialist safeguarding services, the NHS Confederation said. It is also unclear how organisations across the public services will work together. The Department of Health has taken a welcome step in setting up a children's forum of experts in child health and protection to inform its new child health outcomes strategy but its remit does not extend to the full range of public services involved in child health and safeguarding. The work of the forum must make sure the strategy gets schools, local authorities, the police and the NHS working together. Otherwise the risk of fragmentation will become a reality.
  
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Bridlington Free Press

• Private firms could run new Brid Hospital unit.
  
  The Minor Injuries and GP units at Bridlington Hospital could soon be run by private companies. Bids to run the two units have closed, and it is understood that some of those in the running are private companies. The replacement service is now set to open in October – a month behind schedule and with a drastically reduced budget. Patient’s representatives have raised concerns that, if a private bidder wins the contract, profits will have to be made for shareholders. Hospital bosses, however, say the service will be an improvement for patients and is not a money-saving exercise. The new unit, still situated at the hospital, will tend patients needing emergency treatment for either minor injuries (MIU), or illnesses that would normally be dealt with by a GP. At the moment the former is provided by Scarborough and North East Yorkshire NHS Trust, and the latter by the Wolds View Surgery (WVS). For the last financial year the combined cost of the services was £1.5 million. However, the work has been advertised to bidders with a five-year value of just £6.5m. This is a million pounds less than current costs in total, and represents an average value of £1.3m per year: £200,000 less than is currently being spent. If inflation is taken into account, the annual reduction could be as much as £300,000, or 20%.
  
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Health Investor

• Early wins for Circle as scale of Hinchingbrooke task revealed.
  
  Circle Health will have to address an annual £10 million operating loss at Hinchingbrooke Hospital before it is able to generate any income from the landmark contract. Analysts and investors visited the hospital site in advance of the three month anniversary of the private hospital group assuming management of the NHS facility. Circle reported a number of encouraging operational developments, notably around a reduction in length of stay, but the scale of the financial challenge was also confirmed. Under the terms of the contract, Circle will take the first £2 million of any profits made, with further surplus split with the NHS in varying percentages.
  
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Information Daily

• UK Health cuts: New data released on the effects of NHS cuts.
  
  New data from Laing and Benson's, a healthcare market intelligence agency, has revealed that budget pressures on the NHS caused them to drastically cut the use of temporary staff in 2010/ 2011. The data comes from the new NHS Financial Information report. Laing and Benson's has said that these cuts have come at a time when the NHS was striving "to realise massive cost savings by 2014, and moves closer toward a new commissioning structure". According to the figures, NHS spending on temporary staffing resources has shrunk by 7.4%, from £4.01bn in 2009/ 2010 to £3.7bn in 2010/ 2011. This being said, there was an estimated 4.3% increase in permanent staffing costs over the same period. The most drastic cuts were seen in Primary Care Trusts in England, which on average reduced their use of temporary staff from 7.1% to 6.2% of the total staff costs. In an effort to hit cost cutting targets, spending on consultancy services also dropped significantly. In England and Wales the NHS spent and estimated £452m during the year, which is down by 25% from the £605m spent in 2009/ 2010. Conversely, the use of consultants has been less affected by the cuts. In NHS Trusts and Foundation Trusts, the combined spending on consultants dropped from £283m in 2009/ 2010 to just £274m in 2010/ 2011. The recession has had little effect on the NHS’s private patient revenue in real terms, increasing from £430m in 2009/ 2010 to £441m in 2010/ 2011.
  
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Ham & High

• Royal Free Hospital demo over health ‘privatisation’.
  
  Health campaigners manned a picket line outside the Royal Free Hospital to protest about privatisation of the NHS, cuts in services and charging for essential healthcare. Members of Trade Union Socialist Party, a coalition of socialist and trade union organisations set up 18 months ago to oppose public cuts, handed out mock NHS credit cards to staff and patients at the hospital in Pond Street, Hampstead. Members of the Trade Union Socialist Party, which is fielding candidates in the London mayoral elections, fear that the Health and Social Care bill is a step towards privatising the NHS by putting services out to tender to private companies.
  
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Thursday 26th April 2012

GP Online

• Monitor gives CCGs competition freedom but insists patients are key.
  
  Speaking at a meeting of 150 CCG leaders in London on Tuesday, Monitor chairman David Bennett said: ‘Our job is to ensure that where competition is used it is used fairly. If what you’re doing is in the best interests of patients, hopefully it should be consistent with the rules.’ He posed the question of what happens in a community where provider GPs achieve a dominant position. ‘If there is abuse that is of detriment to patients, that’s a problem. If you’re careful not to do that, there isn’t a problem,’ he added. NHS Alliance chairman Dr Michael Dixon said: ‘We found what you said very reassuring. I think some people might have thought of you as a policeman but I hope ours can be a personal relationship rather than one of envelopes and the like.’ Tweeting from the event, Professor Steve Field, chairman of the DH’s Future Forum looking at NHS reform, said the emphasis on patient interests was the result of his group’s intervention. Mr Bennett acknowledged that Monitor may have a role to play in intervening in disputes between trusts and commissioners where commissioners were unhappy that hospital unscheduled admissions were being reduced but that trust bills were not. He added that it was as yet unclear whether GP providers would be exempt from licensing by Monitor.
  
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Hospital Doctor

• North Somerset health and social care to merge.
  
  Health and social care services in North Somerset are set to be merged in an effort to cut duplication and make savings. Under the plans, which have been agreed in principle by members of North Somerset council’s executive and should be implemented in 2013, health and social care duties will be carried out by a new integrated care organisation. The services affected would include Weston general hospital, community health services and social care. The new organisation is to be responsible for health and social care services for adults and children, and would build on the joint working initiatives already in place. The local authority hopes that the changes will also provide an opportunity to streamline directorate structures within the council, achieving savings in senior management costs. The council said the district’s GPs will be working together as the North Somerset clinical commissioning group. Work is underway to explore opportunities for integrating the council’s health and social care commissioning functions with those of GPs.
  
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The Guardian

• So you think the fight for the NHS is over? Wrong.
  
  On the afternoon of 24 April in London, a meeting took place under the title Citizens and CCGs: Exploring our Future. I always thought this was Andrew Lansley's true genius – not the dismantling of the NHS itself, not the dark hold he has over David Cameron, but the phrase "clinical commissioning group", or more ingenious still, "consortia". If you can jam three words together that all take a bit of unpacking, that's often enough to make anybody normal walk away. Pretty soon it's become an acronym, the debating equivalent of an electric fence. What was the purpose of this meeting ? Which citizens, whose future, and what do CCGs do again, anyway ? They are groups of GPs charged by the Health and Social Care Act with commissioning the medical services they decide their patients need. The room was mainly health professionals and the staff of 38 Degrees, the group that lobbied so hard against the act. The panel (I was chairing) comprised one member of a CCG, Dr David Wrigley; the leader of the Medical Practitioners' Union (in Unite), Dr Ron Singer; Dr Louise Irving, newly elected to the BMA council; and Roy Lilley, a founding member of the NHS Trust Federation. Wrigley mentioned the health and wellbeing boards, which will have a statutory role from next April. They mainly comprise workers from within the health service, social services and third sector, but it's mandated that they should have one locally elected representative – it doesn't say they can't have two, or 10. Of course there will be frustrations, intransigent bureaucrats, privatising zealots, people whose power simply exceeds that of the "community". But in many areas the clinical commissioners will be receptive to community concerns. They'll have opposed the bill themselves in the first place. So this is a bad time to shut up and go home, either literally or virtually. All this apparatus will be designed as we go along, and it won't be designed by people who have left the conversation. What else can we do, between us ? We can club together to get legal support for CCGs, so if they want to award contracts to NHS providers rather than private companies their decisions will be "judicial review-proof" (if you want to get so angry that you put out your other eye, consider that Virgin – or rather, Assura Medical, in which it has a 75% stake – lodged a complaint before the act was even passed against York Hospitals for "predatory pricing". Because they weren't trying to make a profit, they were just trying to treat people who were ill – so it wasn't fair on the private companies tendering for the business). Those were all useful things to think about, but the real starting point for the meeting had happened earlier in the day round the corner, where CCGs had been invited to another event, jointly sponsored by United Healthcare and Capita. No decisions were made, it was just, you know, a message from the sponsors. "Hi. Look at our peanuts and other largesse." Members of 38 Degrees chipped in a quid for a rival meeting, a message from the other sponsors, and raised £65,000 in 48 hours (they didn't spend it all on wine; they're going to do other events in Birmingham and Chester).
  
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The Telegraph

• NHS reforms will put children's lives at risk: NHS managers.
  
  There is "deep unease" in the NHS about the way vulnerable children will be cared for and protected in the new system, experts said. The NHS Confederation, which represents most health service organisations, raised the issue at a conference on the health of children in the NHS system being held in Coventry. It comes after the Royal College of Paediatrics said there are too few doctors with a special responsibility in child protection working in the NHS with one covering more than 200,000 children. The College also warned that action was needed to ensure child protection did not become an 'afterthought' in the rearranged NHS. Currently child protection is the responsibility of the local authority and the primary care trust in each area, yet under the new structure there will be four organisations with a role. The Government is still to clarify where responsibilities will lie, including which organisation locally will have the overall responsibility for providing specialist safeguarding services. It is also unclear how it will encourage organisations across the public services to work together. The Confederation warned: "Without overarching policy to make organisations across public services work together, clarity over who does what and how the system will work from the national to the local level, children face a fragmented and confusing system to ensure their health needs are met and they are protected properly. "Confused and fragmented commissioning and provision of services and a failure of organisations to work together have repeatedly been identified as root causes of major failures of child protection in the past." The Baby P case highlighted major failings in the child protection system when Peter Connelly died aged 17 months having suffered 50 separate injuries over eight months despite having been seen by successive doctors, being known to social services and police.
  
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Social Investigations

• Letter sent to the BBC On NHS Coverage. Dear Ms Boaden.
  
  I am writing in relation to the BBC coverage of the NHS Health and Social Care bill, that has now become an Act. As an organisation that has huge resources, I am curious to know whether you had thought to invest time and money into uncovering some of the vested interests of our parliamentarians in private health care ? As the Lords were sitting in the chamber debating the bill, I was unearthing and putting out the list of Lords and MPs who have these interests. The list went viral and although I accept you may personally have not seen the list, I am slightly aghast that the BBC didn't pick up on it, or think to make this connection yourselves. The research found 142 Peers having financial connections to companies involved in private healthcare. The Conservative Lords have 1 in 4 with these conflicts of interest. Even now, despite the bill becoming an Act, this list represents a threat to our democracy and I alongside tens of thousands of others who have passed this around on twitter feel it must get some coverage. This list is not something of the past, but represents the present, and gives a glaring idea of why this bill was produced. Furthermore, why, when Andrew Lansley has been outed as having been bankrolled by the chairman of CareUK, was this not raised with him whenever he spoke of the bill ? Surely every reasoning he gave as a justification for the bill should be linked to his healthcare financial supporters. The coalition are littered with these connections, yet from the interviews and coverage the BBC has given, you would never guess this was the case. Is it not a dereliction of journalistic duty to allow Andrew Lansley, the Health Secretary and author of the Health and Social Care bill, to repeat his various reasonings for the bill without constantly challenging him and his party's connections to the private healthcare industry ? Finally, i would be grateful if you could tell me if you think the matter of the Lords financial interests in Private Healthcare is now in your thoughts, and whether you will intend to highlight this in a future news item ? Thank you for your time and I look forward to your response.
  
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Open Democracy

• When camaraderie is for show: Virgin loves the London Marathon, helps dismantle the NHS.
  
  The depth of Virgin’s respect for camaraderie is questionable. It is one of the companies rushing to grab a slice of another of our national institutions, the NHS. On Tuesday 27 March, the Health and Social Care Bill, which reconfigures the entire structure of the NHS, was made law. Despite the profound impact that this Bill will have on patient care and broader society, media coverage has hit an all time low. RIP the BBC as our trusted provider of “independent, impartial and honest” coverage. The Bill’s endorsement of the private provision of NHS services has triggered fervent opposition from patient groups and the medical profession. Conservative Health Minister Simon Burns boldly stated in his blog on the 22 February, “Just in case there’s any doubt, we are not privatising the NHS. This Bill is not about privatising the NHS.” We await his retraction. The NHS is being carved up for corporations like Circle Health, Virgin Care and SERCO at an alarming speed. It is clear the wheel was in motion long before the Bill was ratified in law. So now for the entry of the two-tiered system, where the affluent purchase the extra health care that they need and the rest of us go without. The burden of ill health will no longer be shared across society between the healthy and sick, the rich and poor; it will be each for their own. Perhaps appropriately, this resonates in the tag line for the until recently favoured bidder to run services for disabled and vulnerable children in Devon: “Virgin Care: Providing NHS Care good enough for our own families.” Just for your own families and not for every family ? Good enough, maybe, but how much health care ? What will be provided and how much will the extras cost ? And where is the voice to represent the families struggling to protect their children ? What has contributed to Virgin’s unprecedented winning streak in securing health contracts ? The answer is its large base of equity, part of which came from the government’s discount sale of broken banks. On November 2011, Northern Rock plc. joined the Virgin Empire at the bargain price of £747 million. The charge for Virgin with time will amount to £1 billion, but this is still less than the estimated £1.4 billion of taxpayers’ money which was injected into the bank; net loss to the government of £400 million. Northern Rock has however been projected as a great governmental success. The combined sale of Northern Rock plc. to Virgin and profits from Northern Rock Asset Management (the part of the old bank that is still owned by government), is forecast to generate £11 billion in profit over the next 15 years. However, viewed over this extended timeframe and against the £37 billion invested by the government, it amounts to only modestly more than inflation. Compare this to the Private Finance Initiative (PFI), which has delivered us £64 billion worth of infrastructure in the form of hospitals, schools, public housing and defence since 1991, in return for £230 billion from HM Treasury.
  
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The Independent

• Drugs firm takes cost conscious doctors to court.
  
  Independent experts have condemned the Swiss pharmaceuticals company Novartis for trying to force the NHS to buy an expensive drug to treat patients suffering from a degenerative eye disease, rather than using a cheaper, unlicensed alternative. Novartis is taking four NHS areas in the south of England to a judicial review because they have allowed doctors to prescribe the anti-cancer drug Avastin to treat the wet form of age-related macular degeneration. Novartis wants Southampton, Hampshire, Isle of Wight and Portsmouth to revoke the policy of prescribing Avastin, but is not making any financial claims of the Primary Care Trusts or the NHS. Novartis says Avastin is unlicensed for the eye disease and wants its own licensed drug Lucentis, which costs £740 an injection compared with £60, to be used. John Harris, a professor of medical ethics at Manchester University, said companies such as Novartis should not be allowed to block attempts at using more cost-effective treatments to maximise their profits. "It is legitimate for healthcare providers to appraise and approve off-label treatments which are significantly more cost-effective than those that pharma are prepared to licence," Professor Harris said.
  
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Tuesday 24th April 2012

Isle of Wight County Press

• NHS faces legal action over drug.
  
  A pharmaceutical company wants to take the Isle of Wight NHS to court over its use of a drug to treat a condition that causes blindness. Novartis, a drug company that makes Lucentis, used to treat wet age-related macular degeneration (AMD), has called for a judicial review into the use of a cheaper alternative, Avastin, by several health trusts including the Isle of Wight. Avastin was developed to treat cancer, but it was discovered it produced similar effects to Lucentis in treating AMD. An injection of Avastin costs around £60, compared to £740 per injection for Lucentis. Lucentis can arrest the development of AMD, but it can cost more than £10,000 for a two year course of injections. Avastin has not been licensed by the National Institute for Clinical Excellence (NICE) for the treatment of AMD, however the Isle of Wight, Portsmouth, Hampshire and Southampton NHS trusts have all agreed for that use to be funded locally, in addition to the continued use of Lucentis. Avastin, Lucentis and a third drug, Macugen, have all been used on the Island for the treatment of AMD for several years. In 2008 the director of public health Dr Jenifer Smith had accused drug companies of blackmail over the issue. She criticised drug company Roche, responsible for the manufacture of both drugs at the time, of not pursuing a licence from NICE for the use of Avastin to treat AMD. Following her comments a Roche spokesman said the drugs differed in the chemical composition and they had no plans to develop Avastin for the treatment of AMD.
  
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Daily Telegraph

• IT firm in redundancy row as it sheds more jobs.
  
  An American computer services firm is at the centre of a compulsory job cuts row after it announced plans to shed hundreds of UK roles and "guarantee" Indian offshore jobs, according to unions. Computer Sciences Corporation (CSC) said it plans to cut 640 jobs from its UK business, bringing the total number of job losses announced since February to 1,140. The technology firm, which was behind the failed NHS IT project, said in February it would cut up to 500 jobs within its UK healthcare business following the botched online database contract. However, a row has broken out between Unite and CSC over the nature of the job cuts, with union bosses claiming the company is ignoring the option of voluntary redundancy.
  
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Nursing Times

• 'We firmly believe regional pay would destabilise the entire NHS'.
  
  Fiona Farmer, national officer for Unite the Union, writes: The pay review body report published in March 2012 has accepted the second year of the government’s public sector pay freeze, along with recommendations to implement regional pay for nurses and NHS staff. It outlines the case for making pay more market-facing in local areas and, let’s be quite clear on this issue, regional pay is not about enhancing the pay of nurses but a cynical move to dismantle national pay and national bargaining. So how could this impact on nurses across the UK ? Evidence extracted from pay surveys in the private sector points to lower levels of pay in the North of England in comparison with the South, with significant differences between the South West and the North West. If this was implemented across the NHS then a nurse in Blackburn could be earning a lot less than her counterpart in Bristol. This surely would undermine the whole infrastructure of Agenda for Change and create damaging competition between employers. It is likely that rates of pay would be maintained and perhaps enhanced in the form of high cost area supplements in “hotspots” such as London and Bristol, at the expense of other areas. This would mean nurses elsewhere facing the potential of continuing pay freezes or, even worse, a series of cuts in pay. Regional pay cuts will deal a fierce blow in the hard-pressed communities already hit by job losses and cutbacks. Pay inequality will be a real issue - the foundations of Agenda for Change and national bargaining will be rocked to the core. The reason nurses covered by the Agenda for Change national pay agreement are currently paid the same in Blackburn and Bristol is the commitment to equality and equal pay for equal work. Pay drift would rapidly be followed by job drift with nurses migrating to the higher-paid localities. The impact on service provision and the delivery of healthcare in lower-paid and deprived areas would be huge. Medical and dental staff are unlikely to be included in these proposals so, again, it is the nursing profession that will bear the brunt of this attack on pay and conditions. There is also the question of how NHS employers would negotiate regional pay and whether they have the capacity to manage such a process. Some have already expressed concern at increased administration burdens that might be placed on the service. We firmly believe the NHS could be destabilised by local pay as the service struggles to deal with cuts, restructuring and the impact of the Health and Social Care Act. There is no indication that governments in Scotland, Wales and Northern Ireland would embrace market-facing pay; as such acute recruitment and retention problems could emerge in English regions bordering Scotland and Wales, with the devolved countries potentially retaining higher levels of pay. Unite has always opposed local pay bargaining in the NHS. Previous attempts to implement such a strategy proved disastrous across the board and took many years to unravel. There are existing mechanisms for dealing with the cost of living encapsulated within Agenda for Change. These include allowances and recruitment and retention premia, which are agreed through the national framework. There is no requirement to introduce regional pay with ill-defined regions and zones; Unite sees this proposal as yet another “quick fix” for the government to raise revenue from hard-pressed nurses to repay the national budget deficit. Enough is enough, the proposals for regional pay must be vigorously opposed. One option is to contact your MP and ask how they would react if regional pay was imposed on members of parliament.
  
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Coventry Telegraph

• Private firm 'to run' Nuneaton's George Eliot Hospital.
  
  George Eliot Hospital in Nuneaton could be heading towards a private takeover as hopes of a merger with a neighbouring NHS hospital fade. It is nearly a year since bosses at George Eliot Hospital admitted they needed to find a partner to ensure short-term survival. Now South Warwickshire Foundation Trust – which runs Warwick Hospital and the county’s community health service – fears its popular takeover plan will be sidelined. It looks increasingly likely health chiefs will bring in a contractor to run the George Eliot as a “franchise”. Senior NHS officials and trade union leaders believe that would favour a takeover by a private firm.
  
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BBC News

• Scottish NHS boards planning '£226.7m in cuts'.
  
  A report from an independent health economist shows NHS boards plan to make £226.7m in planned cuts next year, Scottish Labour has said. The paper to Holyrood's health committee was prepared by Dr Andrew Walker, of the University of Glasgow. It examines what level of savings boards plan to make in 2012-13. The Scottish government said it was committed to protecting health spending and Labour was wrong to suggest that the health budget was being cut. NHS boards, along with other public services in Scotland, have been asked to deliver 3% efficiency savings in 2012-13. According to Scottish Labour Dr Walker's report shows NHS Ayrshire and Arran plans to save £14m, Borders £5.9m, Dumfries and Galloway £7.5m and Fife £17.5m. Forth Valley has proposed £11.2m in savings, Grampian £12m, Greater Glasgow and Clyde £58m, Highland £23.8m and Lanarkshire £19.2m. Cuts of £27m are planned by Lothian, Orkney £1.4m, Shetland £2.5m, Tayside £24.5m and Western Isles £2.2m. Scottish Labour said front line staff have borne the brunt of spending cuts. It said more than 4,500 NHS workers had lost their jobs since 2009, including more than 2,000 nurses.
  
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Friday 20th April 2012

Management in Practice

• GPs remain pessimistic about NHS reform success.
  
  GPs are “extremely uncertain” about how the NHS reforms will affect their finances, research suggests. Lloyds TSB Commercial's Healthcare Index shows 94% of GPs expect further financial pressures over the next five years and 92% anticipate increased competition in the market during the same period. Over 81% also expect a rise in the number of larger practices, potentially arising from the formation of clinical commissioning groups. The Index findings suggest GP confidence in the future of the healthcare sector is low, certainly much less positive than pharmacists and dentists. GPs registered -61 when asked a number of questions regarding their confidence in the future of the NHS, compared with -50 among pharmacists and -26 among dentists. In fact, GPs' collective long-term confidence (gauged over five years) fell even further to -81. Worryingly for CCGs, nearly half (49 per cent) of GPs still remain split over whether a move to clinically-led commissioning groups is a good thing.
  
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Daily Telegraph

• Private companies providing GP out of hours services are 'worse than NHS'.
  
  Private firms providing GP out of hour services fail to assess urgent cases within 20 minutes and leave patients waiting longer than two hours to see a doctor, a study has found. They are more expensive and perform poorly when compared with NHS and co-operative style services which are provided as not for profit services by GPs. GP out of hours services have been mired in controversy and have been heavily criticised after a series of high profile deaths including David Gray, from Cambridgeshire, who was killed by a morphine overdose given by a German doctor. Daniel Ubani had been employed by out of hours provider Take Care Now and was on his first shift in Britain when Mr Gray died. An inquest found Mr Gray had been unlawfully killed and major changes were recommended to GP out of hours services. Take Care Now has been taken over by Harmoni, which is now the largest provider of GP out of hours services. An analysis highlighted by Pulse magazine, found that private companies perform worse, yet are the more expensive than co-operatives, which are not for profit organisations run by GPs. Around a quarter of the population is covered by a private out of hours provider, it is thought. Harmoni performed significantly below average not only on patient satisfaction but on key requirements to assess urgent cases within 20 minutes and see them face to face within two hours, it was found. The analysis by the Primary Care Foundation looked at five indicators across 81 out-of-hours services, 32 provided by not-for-profit organisations, 27 in house by the NHS and 22 by private firms – 12 by Harmoni. Private providers were paid an average of £8.11 per head compared with £7.39 for not-for-profit organisations and £9.10 for NHS providers. But just 59.5 per cent of private services were rated good or very good by patients, compared with 65 per cent for not-for-profit services and 64.7 per cent for the NHS. Just 51.7 per cent of Harmoni’s services were rated good or very good by patients, although the company was cheaper than some private firms, at £7.93 per head. Private providers saw 91.2 per cent of urgent cases within two hours – with Harmoni scoring just 81.4 per cent – compared with 95.3 per cent for not-for-profit and 91.6 per cent for NHS trusts. However the private companies generally performed better on giving a definitive assessment within 20 minutes. But private providers gave 84.1 per cent of urgent cases definitive assessment in 20 minutes, compared with 82.4 per cent for not-for-profit providers and 82.7 per cent for NHS trusts. Harmoni averaged 74.3 per cent.
  
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Scotsman

• Nicola Sturgeon backs NHS Lothian in PFI dispute.
  
  Health Secretary Nicola Sturgeon has given her backing to NHS Lothian which is taking legal advice after a surgeon was forced to finish an operation by torchlight when contractors shut off the power. Two operating theatres were affected when maintenance workers switched the power off at the ERI last month, meaning one patient was stitched up with only a torch shining. Surgery which was due to start had to be postponed until power returned. It is understood that PFI provider Consort was to carry out planned maintenance work on the emergency power supply after surgery was finished, but switched off the power too early, while doctors were still at work. NHS Lothian said it was “angry and frustrated” with Consort’s performance, and it was consulting with lawyers to discuss what options it has in relation to the contract. Ms Sturgeon said today that the health board had her “100% support”. She added: “The whole situation underlines the fact that these PFI contracts that were put in place under past administrations - and this one was put in place before the Scottish Parliament even existed - they simply didn’t put the public interest first and unfortunately we are now paying the price of that PFI folly. NHS Lothian has signalled that they are going to consult their lawyers. I think they’re right to do that and I think they now have to look at all options.”
  
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Tuesday 17th April 2012

BBC

• Hospitals overcharging for short-stay patients - report.
  
  NHS money is being wasted by hospitals in England wrongly charging the health service for treating short-stay patients, a watchdog says. The Audit Commission said hospitals could earn more than five times as much by recording them as inpatients rather than outpatients. Overcharging and the managerial rows it caused took up time and resources. The Department of Health said the NHS had to accurately record care given and it would work to improve this. The NHS spends £6.8bn a year on short-stayers - 17% of the hospital budget. During its review, the Audit Commission took evidence from a small number of hospital trusts and management bodies over how they dealt with patients whose treatment lasted less than 24 hours. It found plenty of evidence of the same treatment being recorded as an inpatient in one hospital and an outpatient in another. One trust said the time spent dealing with the disputes caused by the issue was taking up the equivalent of one staff member's entire workload. But the watchdog said it was willing to give hospitals the benefit of the doubt, saying there did not seem to be systematic abuse of the system. Instead, the commission said it was more likely to be related to historic custom and practice. As medicine has developed, more and more treatment and recovery is being done during short visits rather than overnight stays.
  
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GP Online

• LMCs to demand GP power to sack CCG boards.
  
  Motions submitted to the conference, seen by GP, demand a financial mechanism to fund work transferred to primary care and a redefinition of core GP services, to prevent unfunded work being loaded onto GPs. Concerns over the rollout of revalidation, cuts to pensions, the implications of the Health Act reforms and a GP recruitment crisis will dominate debates at this year’s conference in Liverpool on 22 and 23 May. A North Essex LMC motion calls for practices to be able to ‘recall the CCG governing body should a majority of practices support such action’. Essex LMC chief executive Dr Brian Balmer said that if most of a CCG’s GP members thought the group was making poor decisions, they should be able to hold an emergency general meeting and a vote of no confidence in the CCG board. Somerset LMC has submitted a motion calling for CCGs to become more accountable to local GPs. Somerset LMC chairman Dr Barry Moyse said the motion urged CCGs to explain the rationale behind commissioning decisions and to allow practices to make suggestions. Despite strong LMC opposition to the Health Act, LMCs said motions urging GPs to boycott commissioning were unlikely. Cleveland LMC secretary Dr John Canning said: ‘No-one would want to disengage entirely. We need to make this work.’ Dr Balmer added: ‘The LMCs are going to have to deal with this day to day. I’m not surprised that there are not a lot of "take to the streets" motions against commissioning.’
  
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Pulse

• Not-for-profit GP providers cheaper and rated higher than private out-of-hours firms.
  
  Private out-of-hours services are more expensive and rated worse by patients than those delivered by not-for-profit alternatives such as GP co-operatives, a major Pulse analysis reveals. Companies often matched the performance of not-for-profit and NHS providers on the National Quality Requirements under which contracts are monitored, but lagged significantly behind on separate patient satisfaction scores. Harmoni, the country's largest out-of-hours provider, performed significantly below average not only on patient satisfaction but on key requirements to assess urgent cases within 20 minutes and see them face to face within two hours. Our findings come from a detailed breakdown of the first ever Primary Care Foundation benchmarking exercise to name individual providers, and will seriously challenge the growing dominance of private firms in the out-of-hours market. The analysis looked at five indicators across 81 out-of-hours services, 32 provided by not-for-profit organisations, 27 in house by the NHS and 22 by private firms – 12 by Harmoni. Private providers were paid an average of £8.11 per head compared with £7.39 for not-for-profit organisations and £9.10 for NHS providers. But just 59.5% of private services were rated good or very good by patients, compared with 65% for not-for-profit services and 64.7% for the NHS.
  Just 51.7% of Harmoni's services were rated good or very good by patients, although the company was cheaper than some private firms, at £7.93 per head.
  Patients' different views of services were only partly reflected in performance on key National Quality Requirements. Private providers saw 91.2% of urgent cases within two hours – with Harmoni scoring just 81.4% – compared with 95.3% for not-for-profit and 91.6% for NHS trusts. But private providers gave 84.1% of urgent cases definitive assessment in 20 minutes, compared with 82.4% for not-for-profit providers and 82.7% for NHS trusts. Harmoni averaged 74.3%. The Primary Care Foundation said there was too much focus on fulfilling National Quality Requirements, and urged commissioners to also consider patient satisfaction, audits of clinicians and integration of services.
  
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The Guardian

• David Cameron faces pressure as NHS waiting times grow.
  
  Patients are enduring increasingly long delays before having some of the most common forms of surgery, according to official data that casts serious doubt on David Cameron's pledge to keep NHS waiting times low. New research by the Patients Association also shows that fewer patients are undergoing planned operations such as joint replacements, cataract removal and hernia repairs, as the NHS tries to make £20bn of efficiency savings at a time when demand for healthcare is growing. A report from the association, based on information supplied by 93 of England's 170 acute hospital trusts, found that waiting times for a range of elective operations rose between 2010 and 2011. The average wait before having a new knee fitted rose from 88.9 days to 99.2 days, while patients needing hernia surgery typically waited 78.3 days in 2011 compared with 70.4 the year before. Smaller numbers of patients also had surgery for all these procedures over the same period, according to responses from hospitals to freedom of information requests submitted by the association. Trusts that supplied figures jointly performed a total of 18,268 fewer operations for these conditions in 2011 than in 2010, with those blighted by worsening vision, especially older people, most affected.The biggest fall was in cataract removals. Some 175,731 were performed in 2011, which was 14,267 fewer than in 2010 – a fall of 7.5%. Clare Eaglen, eye health campaigns manager at the charity RNIB, said it was "deeply concerned" by the findings. "We already know that some primary care trusts are refusing cataract operations or delaying operations, forcing patients to live with unnecessary sight loss and a reduced quality of life. Cataract surgery should be performed when consultants believe it is in the patients' best interest. Introducing arbitrary thresholds, which delay cataract operations, is a false economy," she said.
  
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• Care UK fails to process x-ray records of 6,000 patients.
  
  The private health company Care UK is being investigated by the health service after the x-ray records of 6,000 patients were not processed at an "urgent care centre" the company runs in London. GPs were informed of the incident last month when NHS managers in north-west London wrote to doctors to tell them that patients at the Central Middlesex hospital "had been sent for x-ray and the provider cannot confirm that the radiology reports have been reviewed for missed pathology". Care UK were awarded the right last year to manage the centre, which sees 50,000 patients at the hospital. NHS Brent found in March that out of a sample of 300 patient x-rays, 120 required further action from a doctor. The NHS then asked Care UK to check all 6,000 x-rays. The letter from NHS Brent told GPs that "the issue has been logged as a serious incident and a full investigation is under way". The company – one of the biggest to which the NHS outsources work – said on Tuesday that after examining 1,400 records only 60 patients needed to be called about their x-rays. Care UK's national medical director, Richard Clapp, said: "I would like to stress that, in all the cases reviewed, no further clinical care has been required.
  
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BBC News

• Beds to close at Royston Hospital due to staff shortage.
  
  Inpatient beds at a Hertfordshire hospital are to close because of a shortage of staff. The nine beds currently in use at Royston Hospital will close from 17 April, but outpatient clinics and community services will continue. The hospital is due to close permanently in June. Hertfordshire Community NHS Trust said it had been difficult to maintain staffing levels due to the uncertainty over the hospital's future. In a statement, the trust confirmed that additional beds will be opening at Hitchin Hospital to offset the closure and Royston Hospital will continue to provide outpatient clinics until new facilities are built at Royston Health Centre. New services will be put in place to provide beds in local nursing homes and to increase support for people in their own homes.
  
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ShareCast

• Serco signs operational agreement for NHS partnership.
  
  Outsourcing specialist Serco Group has signed an agreement to operate the Anglia Support Partnership (ASP), which includes six partnering NHS organisations. As part of the establishment of the strategic partnership Serco will acquire the assets of Anglia Support Partnership from the partner, for which it will pay about £9m in 2012. The annual revenue to Serco of the current contracts is around £30m. The new four-year agreement is the group's first shared services proposition in the emerging market for middle and back office support to the UK health sector. It enables, among others, all National Health Service (NHS) organisations in the new Midlands and East Strategic Health Authority to access services equivalent to around 25% of total NHS spend.
  
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Pulse

• LMCs to debate concern over overbearing CCGs.
  
  Concern over how developing CCGs will performance manage practices and engage with grassroots GPs is set to dominate the upcoming national LMCs conference next month. The debates will take place against a backdrop of fears that LMCs are being sidelined from decision making and their role will be diluted in the new NHS. A motion from Lewisham LMC says CCGs ‘should have no role in the performance management of the GP contract', while a motion from Wessex LMCs calls for CCGs to ‘consult LMCs in the same way health bodies now'. Liverpool LMC has tabled a motion calling for LMCs to be invited to attend CCG governing body meetings, while Manchester LMC wants conference to back a motion that ‘deplores the side-lining of LMCs by PCT clusters, as LMCs, not CCGs, are the representatives of GPs.' Berkshire, Buckinghamshire and Oxon LMC has put forward a motion warning that shadow CCGs ‘have a tendency to mimic their predecessor PCTs', and ‘vary in their adherence to democratic principles'. Dr Duncan Walling, a GP in Wilton, Wiltshire and medical director of Wessex LMCs, said it was vital that LMCs were not by-passed in the new NHS. He said: ‘At the moment there are provisions for the NHS Commissioning Board to consult with LMCs, but not for CCGs to consult with LMCs.'
  
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Bristol 24-7

• £28m spent on NHS reforms in Bristol, MP claims.
  
  More than £28m has been spent on the NHS in Bristol to pay for the government’s controversial reorganisation plans, a Bristol MP claimed. A leaked report from the Department of Health suggested the full cost of the reorganisation across England was more than £3bn, with £28,110,576 spent in Bristol. Reacting to the figures, Labour MP for Bristol East, Kerry McCarthy, described the Government’s NHS reforms as “a scandalous waste of money”. She added that the city’s NHS had already been forced to spend £873,000 laying off staff – only for many expected to be re-employed elsewhere in the system.
  
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Financial Times

• NHS redundancy costs force rethink.
  
  The government has been forced to sacrifice a core principle of its health service reform to avoid a potential multimillion-pound increase in the redundancy bill for NHS administrative staff. The health white paper originally stated that groups of GPs would have the flexibility to run their organisations as they saw fit. But the government is now preparing to tie the groups to a pre-existing agreement with trade unions, committing them to collective bargaining and fixed terms and conditions for their staff. The move – described by one GP leader as leaving “a yoke around our heads” – is the latest compromise the government has had to make to its health reforms to make them politically acceptable and affordable at a time when the NHS faces the most sustained period of spending restrictions in its 63-year history. The compromise has been forced because of a technicality in the employment contracts of some 35,000 administrative and managerial staff who work for the 151 NHS primary care trusts that are scheduled to be abolished next April and replaced by the GP groups as the main purchasers of NHS care for patients. At least a third of those staff are forecast to lose their jobs. But around 10,000 are expected to be offered new posts with GP groups, which would keep the redundancy bill at about £800m. GP groups are not currently party to the national NHS pay and conditions deal with unions, and the government has been advised they therefore do not formally constitute “NHS organisations” for the purpose of staff employment contracts. If that is not changed, existing NHS staff would be able to turn down posts in the new organisations without invalidating their ability to claim redundancy – which averages £63,000 a head. If half of those expected to be offered jobs in the new GP organisations refused the posts and instead claimed redundancy, the lay-off bill would soar by £300m, tipping it over £1bn. But the department has now said it would try to avoid the extra costs by adding the new GP groups to the list of organisations subject to the agreement with NHS trade unions, known as Agenda for Change.
  
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