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Tuesday 30th June 2015

Mansfield Chad

  • Plans to close mental health unit in Mansfield.

    A mental health unit in Mansfield faces closure in a shake-up of services for the region. Nottinghamshire Healthcare NHT Trust is carrying out a review of its adult mental health community and inpatient services, which could spell the end of the rehabilitation unit on Heather Close, near to Mansfield Community Hospital. The 18-bed unit provides care and treatment for service users who are recovering mental health conditions but who are not yet ready to return home. The NHS Foundation Trust insists feedback from patients, and clinical evidence shows that the patients prefer to be treated in their own home. A second unit in Gedling is also facing the axe as part of the proposals. In their place, the trust proposes a ‘community rehabilitation team’ to deal with people in their home. A six-week consultation has been launched in which the views of staff, patients and families will be considered. The trust says a final decision will be then be taken. However, a former NHS worker has contacted Chad, and described the consultation as a ‘fait accompli’. The ex employee, who did not want to be named, said: “It’s not going to work, there are some people who just can’t be treated at home. Some are so chronically ill they won’t be going anywhere. They will be treated in private health care which the trust will pay for - which is simply a false economy. They already have a community rehabilitation team in place, so what has happened to them ?

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Oxford Mail

  • David Cameron unhappy about loss of NHS nurses.

    Prime Minister David Cameron has said it was “extremely disappointing” Chipping Norton Hospital was to lose NHS nurses from its intermediate care ward. The Witney MP made the comment after it was revealed nurses at the 14-bed unit at the London Road hospital, currently managed by Oxford Health NHS Foundation Trust, will come under the control of the Orders of St John Care Trust. OSJCT runs the Henry Cornish care home, which is next door, as well as a number of other care homes across the south of England. Campaigners have fought to keep the unit under NHS control, fearing a reduction in the quality of care. Oxfordshire County Council, which commissions the service, has been consulting on the changes and believes it can cut the cost of each individual bed from £1,777 to £823 per week. Campaigners have put together a petition now signed by more than 800 people and have handed it to the council. They are also running an e-petition online.

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Financial Times

  • Leading Tory calls for end to protection of NHS budget.

    The most senior Conservative in local government has called for an end to the ringfence protecting National Health Service spending, intensifying pressure on ministers before next week’s Budget. Gary Porter, who takes over as head of the Local Government Association, branded as “bizarre” the government’s decision to increase the health service budget in real terms. He suggested that politicians must challenge its untouchable status or risk the loss of other crucial services. His comments about the NHS come amid increasing concern in Whitehall at the Conservatives’ election pledge to put a further £8bn above inflation into the NHS by 2020 and its impact on other unprotected areas of spending. Some departments are already trying to redefine parts of their own budget to bring it under the health banner. Councils have already suffered cuts of up to 40 per cent to their main grant in the 2010-11 to 2015-16 spending period. As local government braces itself for further deep cuts in an autumn expenditure review, Mr Porter argued that money must be allocated differently if some councils were not to “fall over” under new cuts that could leave some offering only basic statutory services. Instead about £3bn of the additional money earmarked for health should be put into adult social care to help people remain in their own homes and avoid hospital admissions. That, he said, would produce “considerably greater savings for the health budget than just spending it on retrospectively fixing broken people”.

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Monday 29th June 2015

Birmingham Mail

  • Birmingham NHS staff reveal fears about state of the health service.

    Birmingham NHS workers say they are desperately worried about overcrowding and lack of staff. They revealed their fears to a Birmingham MP who asked them to tell her privately what was really going in. Birmingham Edgbaston MP Gisela Stuart’s constituency includes the Queen Elizabeth Hospital, one of Britain’s largest hospitals. Speaking in a Commons debate attended by Government Health Ministers, she said she had a lot of doctors and NHS staff in her constituency - and she asked them to respond to a survey about conditions in the NHS. She said: “I received about 400 responses to the last survey. Some 74% of respondents said that they were very concerned about the future of the NHS.” One NHS worker said patients were forced to wait on trolleys because there aren’t enough beds. “The hospital bed occupancy consistently exceeds 99%, with hundreds of well patients in beds unable to be discharged due to inadequate social care. Consequently, the A& E is overwhelmed with patients lying on trolleys while I scrabble around trying to get something done.” Another said the stress of work meant they could become ill themselves. “My work load leaves me worrying about my own health in the future.” One said staff shortages meant the NHS was forced to spend money on expensive agency staff.

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The Ninety Nine Percent

  • Why the NHS should never be privatised.

    What I like about blogging is that I can be as subjective as I like, and this blog is going to be very subjective, so if you’re a big fan of privatisation you had best not read on. There are many political reasons both for and against privatisation but, I’m not going to be talking about them (especially the reasons for). What I want this blog to convey is how great the NHS is and why it should remain in the public sector. I’m going to start with a history lesson of the NHS. Many people know that the NHS was formed in 1948 just after the Second World War, with its aim being to provide health care for everyone who needed it regardless of their wealth. Aneurin Bevan, the then health secretary of Labour government, is known as the chief architect of the NHS, what is less known is that the idea of the NHS was actually suggested in 1942 by William Beveridge as part of the Beveridge Report. So what was life like before the NHS ? Well you would be wrong if you thought the poor received no medical help. Researching for this blog I came across an article in the Daily Telegraph which argued that there was no need for the NHS and that medical care was available for the poor pre NHS, the article claims there were no waiting lists and there were sufficient nurses and doctors. I could probably write a whole blog criticising the article to be honest, but that’s not what this blog is about. Needless to say any medical help that was available to the poor certainly wasn’t the care that is offered by the NHS now. Many women who wanted a doctor present at the birth of their children would have to pay for the privilege as well as pay for the cost of the medicine. Sure there was medical help for those without money, but it was in the infirmaries in workhouses. The NHS has brought us out of this and now we have a healthcare system that we should be proud of. No one need go without care that is needed, simply because they have no money, medicine is available to those who cannot afford the cost of it, our children are inoculated against diseases, and all of this is paid by out of taxes meaning that care will be given to those who need it when they need it no matter how much money they have. Sick people no longer need to rely on charities to pay for their care or go into a workhouse to be made fit again.

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On Medica

  • Doctors say public health cuts will hurt NHS.

    Doctors have voted to oppose cuts to public health budgets that they say will damage the nation’s health and increase costs and pressures on the NHS. In an emergency motion at the BMA’s annual representative meeting in Liverpool yesterday, doctors voted unanimously for the motion, which condemned Chancellor George Osborne’s decision to cut £200 million from the public health grant given to local authorities. They also rejected what was called the “spurious justification” that the public health grant is non-NHS funding. Public health became the responsibility of local authorities as a result of the Health and Social Care Act 2012. Dr Iain Kennedy, chair of the BMA’s public health committee, said that Mr Osborne’s decision would directly damage the public’s health and increase pressure on the NHS. Dr Kennedy said: “Investment in public health is already under intense pressure as local authorities use their funding to cover cuts to other budgets. “Yet the government has announced a further £200m of cuts from the supposedly ‘ring-fenced’ public health grant - that’s the equivalent to the total public health grant for Birmingham, Manchester, Leeds and Liverpool combined - potentially leaving services and staffing levels gutted and unable to cope with rising need.

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Our NHS

  • Doctors have always been over-worked, but that's not what's causing the recruitment crisis.

    The greatest reward of being a doctor - relating to patients as fellow complicated human beings - has been lost amidst the growth of tick-box, corporatised management that treats all doctors as if they were 'duffers'. In the last twenty years I have seen my profession lose its vocational spirit and identity: heart and soul; art, intellect and wit. I do not believe these losses are primarily rooted in pay or funding, or even the volume of work, though clearly these are most easily cited by an unhappy workforce. Thirty years ago doctors usually worked longer hours and the remuneration was often less. What has got lost is more subtle. It is about personal identification and gratification, about the relationships we have with our patients and colleagues, about our work as human, rather than technical, experience. The problem is the nature of our work, rather than its volume. Thirty years ago I was a young GP working in the same small inner London practice I have managed – with great difficulty – to conserve. In those earlier years GPs had relatively low interprofessional status, often long and unremunerated working hours, yet much better motivation and morale. Doctors then mostly liked their work through long, stable careers, and then were reluctant to retire. Such personal–professional gratification reflected a culture that both allowed for, and gently encouraged, investment in relationships – both between doctors and patients, and within colleague-ial networks. These relationships developed and functioned relatively ‘naturally’ and informally, with a minimal amount of governmental or managerial control. Healthcare relationships were thus much like a massive extended family. But families are very variable: certainly not all function well or even legally. Even in the ‘best’ families there is sometimes dissonance and unhappiness. They might also not be the best human groupings for efficiency or production.

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BBC News

  • Private health firm 3fivetwo buys Sligo hospital.

    The Belfast-based healthcare business, 3fivetwo Group, is to buy a private hospital in the Republic of Ireland. It has agreed to take over St Joseph's in Sligo, which has 19 beds and employs about 60 people. St Joseph's Hospital Sligo Ltd's most recent accounts show KBC Bank appointed KPMG as share receiver in July 2014. The 3fivetwo Group owns the Kingsbridge Private Hospital in south Belfast and a range of other businesses, including Origin Fertility Care. St Joseph's is to be re-branded as Kingsbridge Private Hospital Sligo, and all jobs will be secured. Mark Regan, 3fivetwo Group development director, said the purchase was good news for the company and for the north west in the Republic of Ireland. Mark Towey, chief executive of St Joseph's, said the deal would provide "an opportunity to consolidate and expand". The private hospital sector in the Republic of Ireland has experienced turbulence as a result of the economic downturn. Fewer people have private health insurance and some hospitals were developed using large amounts of bank borrowing. Several private hospitals have been sold and the Mount Carmel Hospital in Dublin, which was once in the same group as St Joseph's, closed in 2014.

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Pulse

  • £10m fund for struggling practices is not new money.

    The £10m ‘turnaround’ funding pledged to support struggling practices in the ‘new deal’ for general practice will come out of existing money, and will go to practices who have had issues identified by the CQC, Pulse can reveal. A parliamentary answer from recently appointed health minister Alistair Burt in response to Labour MP Emily Thornberry revealed that the funding was to be taken from the Primary Care Infrastructure Fund, the £1bn investment over four years announced as part of the 2014 autumn statement. It was originally believed that the funding was new, and that it would be used to help practices who were in danger of closure due to recruitment issues or withdrawal of funding, among other issues. However, Mr Burt said that the funding will be spent where the CQC has identified a practice has ‘quality concerns in need of improvement’. In his new deal speech, health secretary Jeremy Hunt made no reference to the funding coming out of already-announced investment. He said: ‘I have today also asked NHS England to work with NHS Clinical Commissioners to develop a £10m programme of support for struggling practices. This will include advice and turnaround support for the practice itself and help for the practice to work with others to change its business model.’ Referencing this announcement, Ms Thornberry - who had set up a meeting between practices in danger of closing in London and health secretary Jeremy Hunt - asked whether the £10m represented new funding, what the elgibility will be, and whether it will be contingent on rolling out seven-day services. Mr Burt said: ‘NHS England will be investing up to £10 million to develop a programme of support for general practitioner practices where the [CQC] has identified quality concerns in need of improvement. ‘The funding will be drawn from this year’s Primary Care Infrastructure Fund, a £1 billion investment over four years, announced as part of the 2014 autumn statement. The programme of support will be developed with NHS Clinical Commissioners and will take learning from a pilot scheme which is being currently being delivered by the [RCGP].’ The health minister did not elaborate on the pilot, but the college has already been involved in developing the special measures support regime, which Pulse revealed could cost practices up to £5,000.

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HSJ

  • Health secretary could overturn devolved decisions.

    Decisions made under Greater Manchester’s proposed devolved health and social care system could be overturned by the health secretary if they think the decisions are “wrong”, a minister has indicated. The comments were made during a Lords committee discussion on the Cities and Local Government Devolution Bill on Wednesday. In February, Greater Manchester’s 10 local authorities, along with the conurbation’s clinical commissioning groups and NHS England, agreed a deal with the government to gain control of the region’s health and social budgets from April 2016. Asked about whether the bill would be used to transfer NHS powers to new authorities, or mayors, in Manchester or elsewhere, local government minister Baroness Williams pointed to early proposals already published in Manchester, and was unclear about the future potential for this. On Monday, former Labour health minister Lord Warner is due to propose that “any NHS responsibilities” can be transferred to combined authorities when the health secretary believes this is in the “best interests” of residents, and that the deal lasts for “a minimum of five years”. On Wednesday, the minister was pressed by Lord Warner and Lord Hunt, deputy leader of the opposition in the Lords, on how the bill would affect the NHS. Lord Warner asked what would happen if Greater Manchester’s partners agreed to controversial proposals, such as taking “a large number of beds out of acute hospitals”. In response, local government minister Baroness Williams of Trafford, a former leader of Trafford Council, said she expected a health secretary “would have something to say about it” if he thought “all of them collectively were making the wrong decision”. She added: “I was not saying that the secretary of state would overrule them for overruling’s sake, but if it was fundamentally a wrong decision, I am sure that he would have the power to intervene.” Baroness Williams said the government “cannot have a situation where there is unfettered ability for people to do things without any checks and balances”. She said a “bad decision” would be one which had “negative” consequences for patients and service users, and added: “The secretary of state would have to intervene or call into question the decision of the collective bodies that had made it in partnership.”

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Friday 26th June 2015

OnMedica

  • Doctors say public health cuts will hurt NHS.

    Doctors have voted to oppose cuts to public health budgets that they say will damage the nation’s health and increase costs and pressures on the NHS. In an emergency motion at the BMA’s annual representative meeting in Liverpool yesterday, doctors voted unanimously for the motion, which condemned Chancellor George Osborne’s decision to cut £200 million from the public health grant given to local authorities. They also rejected what was called the “spurious justification” that the public health grant is non-NHS funding. Public health became the responsibility of local authorities as a result of the Health and Social Care Act 2012. Dr Iain Kennedy, chair of the BMA’s public health committee, said that Mr Osborne’s decision would directly damage the public’s health and increase pressure on the NHS. Dr Kennedy said: “Investment in public health is already under intense pressure as local authorities use their funding to cover cuts to other budgets. “Yet the government has announced a further £200m of cuts from the supposedly ‘ring-fenced’ public health grant - that’s the equivalent to the total public health grant for Birmingham, Manchester, Leeds and Liverpool combined - potentially leaving services and staffing levels gutted and unable to cope with rising need. “The government is demanding vast savings when money has already been committed to crucial services, and further cuts will end up costing the NHS and the taxpayer more money in the long-term, and run totally counter to the government’s claim to support more investment in preventative health.” The motion also called on the BMA to work with other concerned organisations to campaign against the funding cut.

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BBC News

  • BMA Scotland criticises NHS waiting times 'obsession'.

    An "obsession" with waiting times statistics is diverting attention from the "real issues" in the Scottish NHS, a leading doctor has said. Dr Peter Bennie, chair of the BMA's Scottish council, said publishing weekly performance figures for A& E wards "misses the point". And he claimed the Scottish government had "bowed to pressure" on the issue. The government said it agreed waiting times were not the only measures on which the NHS should be judged. It has set an interim goal of treating 95% of accident and emergency patients within four hours, in advance of meeting the full target of 98%. In March, it began publishing weekly figures showing whether each hospital A& E department was meeting the four-hour target. Hospitals across the country have been struggling to achieve the interim target, with the latest figures showing 92.2% of patients were seen and subsequently admitted, transferred or discharged within four hours for the week ending 14 June. Dr Bennie will tell the BMA's annual conference in Liverpool later ministers "bowed to pressure from opposition parties" when they began reporting weekly A& E activity. He will say: "All this has served to do is feed an obsession amongst our media and politicians each week in the parliament. The publication of these weekly statistics completely misses the point and diverts attention from the real issues in our health service. "The problems that exist within our hospitals extend far beyond the front door and we need to look at the whole patient journey. Are patients being admitted to the right wards, not boarded internally or miles away ? Are they discharged when they're ready to go home and do they get the support they need to live at home and avoid unnecessary readmission ? That is what is important. Not the weekly accusations flung across the parliament chamber as each party seeks to blame the other for the problems in the NHS." He will add: "We need a rethink on targets in Scotland. If we are to continue with them, the targets must drive improved clinical outcomes for patients rather than an expensive obsession with reducing waiting times, irrespective of patients' best interests."

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HSJ

  • PHE chief questions £200m public health cut.

    Public Health England’s chief executive has reportedly questioned whether the Treasury’s demand for a £200m in year cut to public health budgets was a ‘thoughtful’ decision. It is the first time that Duncan Selbie has substantially commented on the issue since it was announced by chancellor George Osborne earlier this month. He made the remarks at a Faculty of Public Health conference in Gateshead this week, which were reported on Twitter by some of the delegates. A Tweet from Alisha Davies "A plea from D. Selbie @PHE_uk "do not associate treasury driven #cuts as a thoughtful strategy on #publichealth - it wasn't" #fphconf @FPH". Apart from a statement issued on 4 June when the reduction was announced, Mr Selbie had previously only gone as far as to say it was “very unwelcome news” in the 12 June installment of his regular Friday message to PHE staff. HSJ approached Mr Selbie for an interview via the PHE press office. Our offer was declined, although a spokeswoman did not deny the accuracy of any of the quotes attributed to him. The spokeswoman said the organisation had nothing further to add on the subject. A PHE statement sent in response to our enquiry repeated the point made on 4 June, which was that the reduction was a “difficult ask” for councils. Local authorities were best placed to “manage and prioritise resources”, it added.

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HSJ
Exclusive: NHS warned focus on finance risks 'disastrous consequence'.

  • Exclusive: NHS warned focus on finance risks 'disastrous consequence'.

    The chair of the inquiry into care failings at Morecambe Bay has warned of a “disastrous consequence” for the NHS if it focuses too much on financial savings at the expense of patient safety. Bill Kirkup, who led the investigation into maternal and infant deaths at the University Hospitals of Morecambe Bay Foundation Trust, told HSJ his fear was that, as the system sought to bring budgets under control, people would be “distracted” from ensuring safety and past mistakes would be repeated. Dr Kirkup said: “I don’t think that in the medium term there is any dichotomy between pursuing quality and pursuing efficiency because high quality care is more efficient; you get it right first time. “Just because of the financial position we are in at the moment, we are going to see that people’s priorities have to be focused on balancing the books, and that will distract them from patient safety and other aspects of quality. That would be a really disastrous consequence of all of this.” He continued: “One of the major criticisms of people at Morecambe Bay is that they didn’t learn when things went wrong and they kept on making the same mistakes. There is a danger here that the national system will replicate that on a much wider basis, we will fail to learn the lessons and we will have other instances of disaster if we do that.” Dr Kirkup echoed similar comments from Sir Robert Francis after the Mid Staffordshire public inquiry, warning that some NHS trusts “have elements” of the problems at Morecambe Bay. “Unless we address those they will fester and they will cause problems in the future,” he said. He highlighted the focus at Morecambe Bay on achieving foundation trust status, which he said led to “improper behaviour” by the trust and individuals. He warned this could be repeated with organisations focusing on implementing new care models and the NHS Five Year Forward View.

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HSJ

  • CQC to fight 'risk of bias' against private providers.

    The Care Quality Commission is trying to recruit more advisers from the independent sector to guard against the risk of ‘bias’ in the way it assesses private providers, an adviser to the regulator has said. Chris Thompson, a national professional adviser to the CQC on the independent sector, said it was aware of the “risk of political bias” when it assesses services provided by non-NHS providers. Earlier this year the leaders of the CQC team that inspected Hinchingbrooke Health Care Trust, formerly managed by private provider Circle, rejected claims that their inspection was biased against the independent sector. The accusation came after the trust was rated “inadequate” in January. Before the inspection report was published, Circle issued a statement announcing plans to pull out of its 10 year Hinchingbrooke franchise and that it expected the CQC’s judgment to be “unbalanced”. Hinchingbrooke returned to NHS management in April. Professor Thompson said one of the steps being taken to mitigate the risks was a drive to recruit more inspection staff from the independent sector. Speaking at the Private Healthcare Summit in London this morning, he said: “The CQC is recruiting for the very large number of inspections it is going to have to do in the near future around the independent sector. “The reason why there’s a bulge in independent sector inspections coming up is almost all the resources of the CQC over the last couple of years has been faced towards getting the inspection regime right in the NHS. They definitely want people with knowledge of the independent sector to come with them on inspections as special professional advisers – they are out for recruitment now.”

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The Mirror

  • Doctors vote to stop NHS from being 'privatised' under global trade deal TTIP.

    The TTIP treaty will open up trade between the EU and the US - but campaigners fear it'll also let private firms take over the health service. Doctors are pushing the Tories to save health services from a global trade deal over fears it could destroy the NHS. The TTIP treaty will open up trade between the EU and the US - but campaigners fear it'll also let private firms take over the health service. Campaigners say the deal will give private firms 'market access' and let them sue governments if they don't get their way. The treaty, whose full name is the Transatlantic Trade and Investment Partnership, was even the subject of a stand-up protest by Ukip in the European Parliament. Now the doctors' union has voted overwhelmingly to create an exception for the NHS. Edinburgh GP Dr Gregor Venters told the British Medical Association's annual representative meeting in Liverpool: "TTIP seems set up to help big business. "Private corporations could use the process to bully governments into dropping legislation to improve food standards. It will have a deleterious effect on public health and make privatisation of the NHS not only possible but probable. The least we can expect is the exclusion of health and social care and public health policy from the process."

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Thursday 25th June 2015

Belfast Telegraph

  • Cut NHS from TTIP trade deal say doctors.

    Doctors have voted overwhelmingly to urge the Government to remove health and social care services from a controversial trade agreement between the EU and United States. "If there is anything resembling an NHS by the time this treaty is negotiated it won't survive," one GP warned. The debate took place on the first day of the British Medical Association's (BMA) annual representative meeting in Liverpool, where doctors argued that the proposed Transatlantic Trade and Investment Partnership (TTIP) was designed to meet the interest of private corporations and will open up the health service to privatisation by US firms. Dr Gregor Venters, a GP from Edinburgh, said: "TTIP seems set up to help big business. Private corporations could use the process to bully governments into dropping legislation to improve food standards, for example. It will have a deleterious effect on public health and make privatisation of the NHS not only possible but probable. The least we can expect is the exclusion of health and social care and public health policy from the process."

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BBC News

  • Sick pay costs rise for Cornwall NHS hospitals private cleaners Mitie.

    Sick pay costs for cleaners at three Cornwall hospitals have reached more than £1m since a private firm took over, it has emerged. Sick pay cost Mitie £1.2m in its first eight months compared with £280,000 by the NHS in the previous financial year. Union Unison blamed the rise on staff stress which it claimed had been caused by mistakes on pay. The rise was revealed in Mitie consultation papers, seen by the BBC, to reduce the headcount and sick pay of its Cornwall hospitals staff. Revised terms of employment on sick pay and rosters are outlined in the document and are due to start in October. The consultation document said: "We need to reduce our labour costs in order to make the contract financially viable." It also says sickness pay costs are "not sustainable" and warns of "an overall reduction" in the 485-strong workforce.

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Health Investor

  • CQC to employ more inspectors from private sector.

    The Care Quality Commission (CQC) is to recruit more inspectors from the private sector in a bid to avoid bias towards independent providers. CQC national professional adviser on the independent sector Professor Chris Thompson said CQC was conscious of a “risk of political bias” against private providers. Speaking at the Private Healthcare Summit, Thompson said: “They [CQC] definitely want people with knowledge of the independent sector to come with them on inspections as special professional advisers – they are out for recruitment now.” He insisted that the recent wave of private sector CQC inspections was because “almost all the resources of the CQC over the last couple of years has been faced towards getting the inspection regime right in the NHS”.

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Exeter Express & Echo

  • Thousands sign petition to save Exeter’s walk-in centre.

    A petition signed by nearly 6,000 people to save the NHS Walk-In centre in Sidwell Street from possible closure is being presented.

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Norwich Evening News

  • An extra 10,000 people need our mental health service but funding is being cut by another £36 million.

    An increase in stress, anxiety and depression are thought to be among the reasons behind an extra 10,286 referrals to Suffolk and Norfolk’s mental health trust over the last five years. The number of children and adults referred into the Norfolk and Suffolk NHS Foundation Trust has gone up from 34,288 in 2010/ 11 to 44,574 in 2014/ 15, revealed in figures released to the East Anglian Daily Times under the Freedom of Information Act. At a time when more people are being referred into the trust, it is looking to make £36 million in “efficiency savings” over the next four years. Child referrals have gone up by 3,048, while those for adults have risen by 7,238. Ezra Hewing, community development manager at the charity Suffolk Mind, said the figures mirrored an increase in stress, anxiety and depression, which has been seen in studies right across the UK.

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OnMedica

  • GP leader warns of catastrophic workforce timebomb.

    General practice is facing a “workforce timebomb” that requires urgent government action to help “lift the profession off its knees”, according to GP leaders. In his keynote speech to the BMA’s annual representatives meeting held in Liverpool, Dr Chaand Nagpaul, chairman of the BMA’s GP committee, also warned against the government’s “folly” of introducing routine seven-day services when existing services were over-burdened. Dr Nagpaul said it was clear that demand for GP services had outstripped capacity and there were not enough GPs, appointments, staff or space to meet growing demand, which was set to increase further with a growing older population, and more care moving out of hospital. “The BMA's recent biggest ever survey of 15,000 GPs signals a catastrophic workforce timebomb ready to explode, with one in three GPs intending to retire in the next five years, and one in five GP trainees intending to leave the NHS to work abroad,” he told delegates. GPs were often unfairly portrayed as only working 9-5 when the reality was that they were working “flat out dawn to dusk, starting earlier and finishing later than most routine NHS services”, he said. “At a time when government says we’re 5,000 GPs short, when the Centre for Workload intelligence says we haven’t the GPs to sustain current demands, it’s simply unrealistic and illogical to expect GP surgeries nationally to be open routinely seven days a week which will damage quality by spreading an inadequate GP workforce so thinly, and replace continuity of care with impersonal shift-work, and take GPs away from caring for older vulnerable patents.”

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Monday 22nd June 2015

The Guardian

  • New immigration rules will cost the NHS millions, warns nursing union.

    New immigration rules that will mean lower-earning non-EU workers being deported will exacerbate the shortage of nurses in the UK and cost the NHS tens of millions in recruitment, the government has been warned by nursing leaders. The Royal College of Nursing (RCN) said the change, due to come into effect in April next year, will cause chaos in the health service. Under the new rules, non-EU workers who are earning less than £35,000 after six years in the UK will be deported. The RCN urged the Home Office to add nurses to the list of shortage occupations, exempt from the rules, and reconsider the salary threshold. Research released by the RCN to coincide with its annual congress in Bournemouth, suggests that up to 3,365 nurses, who cost £20.19m to recruit, could be affected. But it says that figure could spiral by 2020, particularly, if workforce pressures lead to increased international recruitment, in which case 29,755 nurses, costing more than £178.5m to recruit, could be affected. RCN’s chief executive and general secretary, Dr Peter Carter, said: “The immigration rules for health care workers will cause chaos for the NHS and other care services. At a time when demand is increasing, the UK is perversely making it harder to employ staff from overseas.

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  • Jeremy Hunt launches ‘new deal’ for GPs and denies coalition created shortages.

    The health secretary Jeremy Hunt will unveil his “new deal” for GPs promising a package of measures designed to ease their workload and make the profession more attractive to young doctors starting their medical careers. He will pledge on Friday to ensure the recruitment of 1,000 “physician associates” into GP practices by 2020. They have less medical training than doctors, but help them to diagnose and manage patients and also relieve their administrative burden. They will be among 5,000 extra clinical staff Hunt will say he wants England’s 8,500 surgeries to hire over the next few years to enable the NHS to help primary care services cope with the increasing challenge posed by an ageing population. He is also encouraging practices to take on more nurses, physiotherapists and other qualified staff, each of whom can play a key role in looking after certain groups of patients, and therefore leave GPs with more time for consultations. He will also commit to ensuing that general practice, which has seen its share of the NHS £110bn budget fall to just 8.3%, receives more money, but only if GPs change the way they work and embrace seven-day patient access. In a speech at a surgery in west London, Hunt on Friday highlights cash incentives now being offered to GPs to work in areas that are usually deprived, struggling with acute shortages of family doctors. However, family doctors’ leaders have criticised the plans as containing too much rhetoric and not enough action to relieve the growing strains on their surgeries.

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The Independent

  • New migrant rules will cost NHS thousands of nurses, says union.

    New stringent immigration rules will fuel a critical shortage of nurses in Britain, “cause chaos” in hospitals and cost the NHS millions, according to alarming projections carried out by the Royal College of Nursing (RCN). Up to 3,365 nurses currently working in Britain are likely to be affected by a policy which says migrants from outside Europe must earn £35,000 or more if they are to be allowed to stay on after six years working here. Nurses rarely receive such salaries – particularly not within six years of starting work in the NHS. The loss of these skilled clinicians will compromise patient safety, the nurses’ union says. As nurses with rejected visas return to their home countries it would also mean the NHS had wasted more than £20m on the recruitment of staff who can no longer stay on. The effects of the new rules will start to be felt in 2017. Cuts to nurse-training places mean trusts are relying more on overseas recruitment and temporary agency staff to plug the gaps. Agency spending on doctors and nurses has soared from £1.8bn to £3.3bn in the past three years. A cap on outsourced staff combined with the new immigration restrictions will mean hospitals are doubly limited in their ability to keep up safe staffing levels, the RCN says. Dr Peter Carter, the chief executive and general secretary of the RCN, said: “The immigration rules for healthcare workers will cause chaos for the NHS and other care services. At a time when demand is increasing, the UK is perversely making it harder to employ staff from overseas. The NHS has spent millions hiring nurses from overseas in order to provide safe staffing levels. These rules will mean that money has just been thrown down the drain. The UK will be sending away nurses who have contributed to the health service for six years. Losing their skills and knowledge and then having to start the cycle again and recruit to replace them is completely illogical.”

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HSJ

  • CCGs choose not to use power to ditch QOF.

    There is a little appetite among clinical commissioning groups to move their member practices off the national GP pay for performance framework, despite recently being given powers to do so, HSJ has found. CCGs that took control of their primary care budgets in April, under delegated commissioning arrangements with NHS England, are permitted to replace the national quality and outcomes framework for GPs with a “locally designed incentive scheme”. However, they have overwhelmingly chosen not to do so. This is despite the health secretary voicing his dissatisfaction with the QOF over recent years. HSJ asked all 63 groups that have taken on this responsibility whether they have introduced, or plan to introduce, a local incentive scheme for GPs to replace all or part of the QOF. Out of the 59 CCGs that responded, none have yet implemented a local scheme and none have firm plans to do so this year. Only three - Dudley; Greater Preston; and Chorley and South Ribble - plan to introduce one in 2016-17. Leicester City CCG said it was “looking at the options” for a local framework for next year, and Fylde and Wyre CCG is “considering changes”. Castle Point and Rochford CCG said it “anticipated” reviewing the QOF and bringing a scheme in next year. West Leicestershire CCG is “considering a replacement” to the QOF, but it is in “the very early stages” of talks so any changes would not apply until 2016-17, a spokesman said. The remaining groups either had no intention to replace the QOF or were undecided. Four CCGs - Durham Dales, Easington and Sedgefield; Barnsley; Portsmouth; East Lancashire - have either begun or plan to implement local incentive schemes to run alongside the existing national framework rather than replacing it. NHS England last year gave permission for GPs in Somerset to stop reporting against the majority of QOF indicators in favour of a locally developed approach, which at the time was seen as a significant departure for the national body.

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  • Merseyside trusts made payments totalling at least £135,000 to help cover redundancy costs when they terminated their HR contracts with Capita, HSJ can reveal.

    The company started providing payroll and recruitment services to nine trusts in the “Merseyside consortium” in 2012. However, the contracts were terminated last year, only three years into the seven year deal. The services were brought in house following claims of problems with staff payments and recruitment delays. HSJ also revealed in February that the outsourcing firm was responsible for a breach of NHS employees’ data when it was running the trusts’ HR services. Following information requests to the nine trusts, HSJ has discovered that a contribution of at least £135,000 was made between the eight which responded, to help cover Capita’s redundancy costs when the deal was terminated. Alder Hey Children’s Foundation Trust refused to give the information to HSJ, saying that it was “unable to comment… due to commercial confidentiality” . The largest individual contribution was made by Liverpool Community Health Trust, which paid £40,000. Clatterbridge Cancer Centre FT paid £30,000 and Aintree University Hospitals FT paid £20,000.

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Friday 19th June 2015

Science 2.0

  • Charging Immigrants For Health Care Won't Ease Strain On NHS.

    New measures introduced by the UK government in April linking applications for residence permits to up-front payments for potential use of NHS hospital services, and proposals to further restrict access to NHS services for migrants, will not reduce the strain on NHS resources - and may end up costing more in the long run. The UK is proud of its socialized approach to health care but it has increasingly become unsustainable so government is seeking ways to limit access to people, or get them to chip in for costs. The newly implemented policy imposes an up-front surcharge of £200 ($310) per year to guarantee access to NHS hospital care for people from outside the European Economic Area when they submit an application to work, study, or visit their families in the UK for a period of longer than six months - or when they are applying to extend their visas. Those who cannot pay will automatically have their application rejected. Writing in The BMJ this week, Lilana Keith and Ewout van Ginneken say such policies are "shortsighted and misleading." Some applicants do not need to pay the surcharge, such as asylum seekers and victims of human trafficking, but not all vulnerable groups of migrants are protected from these charges. They include some illegal immigrants. The surcharge will push people into irregularity and prevent some undocumented migrants with a right to reside in the UK from being able to regularise their residence, they warn.

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The Guardian

  • Jeremy Hunt could face legal action over 'watering down of patient safety'.

    Ministers are facing the threat of legal action after watering down a key improvement to patient safety across the NHS introduced after the Mid Staffs scandal. The new “duty of candour”, which obliges healthcare providers to tell patients when treatment has inadvertently caused harm, will give fewer rights to patients who have visited a GP, are in a nursing home or use private medicine than those who have been in hospital. It means GP practices and private providers will not have to disclose some serious lapses in safety which have the potential to result in significant future harm for patients, even though hospitals would need to do so if they occurred there. “It makes no sense at all to create two different duties of candour. It is unfair for patients and bewildering for healthcare providers”, said Peter Walsh, chief executive of the patient safety charity Action Against Medical Accidents (AvMA). The charity has written to Jeremy Hunt, the health secretary, warning him that it will seek a judicial review of his decision, which it says will bring in a “two-tier” approach to the duty of candour. The duty, hailed by AvMA as “one of the biggest advances in patients’ rights and patient safety ever”, was recommended by Robert Francis QC’s landmark report in 2013 into the poor care at Stafford hospital, which contributed to some patients dying. AvMA’s lawyers have told Hunt that the creation of a full and lesser duty of candour is unlawful and that they will challenge it in the high court unless he indicates that he will ensure it covers all care providers equally. The Department of Health hinted that it might be prepared to amend the duty of candour to avoid a legal challenge to its conduct. “We want to make the NHS the safest healthcare system in the world and our duty of candour means that all health and care providers, including GPs, private hospitals and care homes are legally obliged to inform patients about failings in their care,” said a spokeswoman. “We have always intended to keep the new duty under review, and will seek further views on how it is working.” The controversy comes two weeks after Hunt’s credentials as a champion of patient safety came into question when he backed a controversial change that will see NHS England take over responsibility for setting safe levels of nurse staffing in NHS premises from the National Institute for Health and Clinical Excellence.

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The Telegraph

  • NHS deficit rises to £822m in England.

    Hospitals and other NHS organisations in England ended the financial year with a combined deficit of £822m, according to new figures that confirm the dire state of the health service’s finances. Rising patient demand and a huge bill for expensive agency staff, used to plug holes in staffing rotas, has forced dozens of hospitals into an overspend. The Government said that while it was aware of the challenges the NHS was facing, it was up to hospitals themselves to “show tight financial grip and live within their means”. But Labour said the figures represented a “financial crisis” and warned that without more money over the next two years, the NHS would have to cut staffing, beds and services. Health regulator Monitor said that while the past year had been “exceptionally challenging”, 2015/ 16 is likely to be even tougher. Within the foundation trust sector – which includes 152 NHS trusts – the spend on agency staff hit £1.8bn for the 2014/ 15 – more than double the amount planned for. The deficits come despite a number of multimillion pound Government bailouts for struggling hospitals. Ministers have pledged to increase the NHS budget by £8bn annually by 2020. However, the health service in England will still have to find “efficiency savings” worth £22bn by that date, simply to maintain services at the their current level. Labour leadership frontrunner and Shadow Health Secretary Andy Burnham said: “Without more money this year and next, the NHS will have to brace itself for a round of severe cuts to staffing, beds and services.” A Department of Health spokesperson said: "We know the NHS is busier than ever and trusts are facing challenges; however we expect them to show tight financial grip and live within their means. We have backed the NHS's own plan for the future by investing the £8bn needed to deliver it.”

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HSJ

  • Bailouts top £870m as trusts struggle to pay bills.

    The Department of Health issued £874m in bailouts to trusts in 2014-15, HSJ can reveal. Information released by the DH shows it made dozens of payments over the course of the year to support trusts, some of which were struggling to pay energy and agency bills (see box, below). The DH made £518.3m in “additions public dividend capital revenue support NHS temporary” to NHS trusts and £204.1m to foundation trusts, data published by the department shows. A further £151.6m was paid to 13 NHS trusts as “policy payments” over the financial year, each described in the DH information as “support for the provision of health services”. The NHS Trust Development Authority’s report for the year said that to qualify for policy payments trusts “must be on track to deliver their agreed financial plan for 2014-15, having delivered the required level of productivity savings and have a clear plan to manage their resources in the future”. The authority also said that to receive this funding trusts were subject to conditions including “controls” on senior management pay, moving to shared back office services, and taking part in procurement and commercial initiatives. The TDA declined to tell HSJ which 13 trusts had implemented restrictions on management pay. The £518.3m trust payments and £204.1m to FTs - labelled as “temporary” payments - under DH rules, must either be repaid in the same year, or reclassified as “permanent” revenue support after a DH subcommittee has approved it. The data showed the DH agreed to £439m of the total becoming “permanent” revenue support in 2014-15. The single biggest “permanent” payment in 2014-15 was £90m to Barts Health Trust. The east London acute trust has a turnover of more than £1bn and ended the financial year with a deficit the TDA recorded as £79.6m. Worcestershire Acute Hospitals Trust received £26.5m of “permanent” support, the DH data showed. King’s Fund director of policy Richard Murray said the scale of the payments raised questions about the tariff system and the relationship between providers and the centre. Mr Murray, a former chief analyst at NHS England and DH director, said: “This underlines the extent of DH cash support going out direct to NHS providers. This raises a whole set of further questions: the credibility of tariff as a payment system when so much money has to flow outside of it [and] the real extent of foundation trust independence when organisations have become dependent on DH cash injections – just to name two.” NHS Providers head of analysis Siva Anandaciva said: “We need more transparency on whether these additional costs and revenue are being accounted for appropriately in national payment and funding systems and thinking.

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  • £2bn acute deficit may mean ‘real trouble’ for frontline services.

    Experts have warned that patients could end up waiting longer for treatment as acute trusts try to tackle an expected overall deficit of more than £2bn this year. HSJ analysis of finance reports from May and June for 142 acute trusts, including specialist trusts, provides the most comprehensive picture to date of the financial challenge facing the sector. Eighty per cent of the trusts have forecast they will end 2015-16 in the red. In quarter one of 2015-16 the overall forecast deficit for the year was £2.1bn, steeply higher than was forecast at this point last year. For the 137 trusts for whichHSJ was able to obtain last year’s forecasts, the projection at this point in 2014-15 was a £654.4m deficit. This year the same group is forecasting a deficit of £1.9bn. In 2014-15 the provider sector overall delivered a £822m deficit. Trusts in the Midlands together predict the largest year-end deficit of £724.4m, whereas trusts in the South predict the smallest shortfall at £272.7m. Northern trusts face a deficit of £543.6m, while those in London expect to be £545.1m in the red. A quarter of the London deficit forecast comes from Barts Health Trust, which has seen the steepest decline of any trust between quarter one in 2014-15 and quarter one in 2015-16. It predicted a £45m loss for 2014-15 and has a £135m deficit forecast for this year. Interim chief executive, Alwen Williams, said the trust faces “significant challenges” but is receiving “targeted support” as part of the special measures regime.

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Thursday 18th June 2015

Kidderminster Shuttle

  • Migrant charge 'may cost NHS more'.

    Government plans to make migrants pay a ''health surcharge'' as part of their visa application could cost the NHS more in the long run, academics have warned. Anyone from outside the European Economic Area (EEA) coming to the UK for longer than six months is now required to pay a £200-a-year fee, which the Department of Health said would ensure they make an "appropriate financial contribution to the cost of the health services they may use". Writing in the BMJ, Lilana Keith of the Platform for International Cooperation on Undocumented Migrants in Brussels, and Ewout van Ginneken, a senior researcher at Berlin University of Technology, said that the Government wants the public to believe the country will become less appealing to undocumented migrants and will save taxpayers' money, but "this view is shortsighted and misleading". They said that the estimated 618,000 undocumented migrants living in the UK - who would not have paid the surcharge - contribute to the economy through their employment, from buying goods and services, and may even pay or have paid income tax.

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Morning Star

  • Campaigning pensioners slam NHS privatisation.

    Campaigning pensioners slammed the privatisation and dismantling of the NHS at their annual conference. The National Pensioners Convention (NPC) in Blackpool vowed to continue campaigning at local level to defend NHS services such as accident and emergency units and GP practices. Many contributors spoke of their own experiences of the effect of Tory privatisation and cuts in the NHS. Among the speakers was GMB national health officer Rehana Azam, who last year was one of the organisers and participants of the People’s March for the NHS from Jarrow in north-east England to London. Ms Azam, who spoke in support of the NHS at the NPC conference, said she was inspired by the pensioners’ determination to fight back. She said many pensioners had joined the People’s March for the NHS and many will be going to the march against austerity in London on Saturday.

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Stroud News and Journal

  • Coaches from Stroud will be full as protesters head to big London demo against austerity.

    About 150 campaigners from Stroud will travel to London to take part in a protest against austerity on Saturday. Full coaches are leaving from Stroud, Gloucester, Cheltenham and Cirencester for the End Austerity Now protest. It is expected the demonstration, which was planned before the election in opposition to the commitment to austerity from the two largest parties, will see tens of thousands of people assemble outside the Bank of England. James Beecher, of Stroud Against the Cuts, said they had organised the coaches "Because this country has seen harder times economically when, at the will of the people, the NHS was set up, social security help for those less fortunate was brought in, millions of houses were built and free education became available to all those under 16.” SATC is also planning a public meeting on Thursday, July 2 to discuss how the group will continue to campaign against privatisation of the NHS, cuts to public services, and more.

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Tuesday 16th June 2015

Daily Telegraph

  • Slashed budgets and STIs: The painful truth about birth control services in Britain today.

    ‘Very worrying for sexual health, as well as other services: Government announces £200m cuts to public health budget.’ So tweeted the All-Party Parliamentary Group on Sexual and Reproductive Health last week, after George Osborne’s announcement that the Department of Health must make £200 million pounds worth of savings from public health budgets. The news was met with alarm from the UK’s sexual and reproductive health (SRH) services. Already a ‘Cinderella service’, SRH care has historically been less well funded or supported than other areas of health, and often finds it hard to attract and retain staff. The proposed cuts could make huge differences to whether you can get an appointment when you need it or even the contraceptive you want.The outlook for SRH services is currently pretty bleak. Freely available contraception is fantastic, but comes at a cost in terms of staffing and availability. All of which will be made even more difficult if the money to fund already struggling services is reduced even further. Clinical Commissioning Groups (or CCGs) can also add confusion to budget cuts. These are local groups led by GPs that allow them to decide what health services to provide for their patients. They are overseen by NHS England - but each group has their own leadership, tariffs and priorities. Meaning some will boost contraception care, while others won’t see it as a priority. Resources can also be diverted away by the need to tackle the UK’s growing number of sexually transmitted infections (STIs). In 2013 alone, 450,000 new cases were diagnosed. This translates into disjointed practice with services offering different care, making it harder to keep track on what communities need and how to direct the right kind of care to them. While there may, in theory, be 15 methods of contraception for us to choose from in reality the more expensive options may be restricted or unavailable to us. And with budget cuts on the horizon, contraception will be prescribed on the basis of financial viability, postcode lottery, and policy directives rather than our actual preference. Indeed, in a survey, just 25 per cent of GPs told Telegraph Wonder Women that they discuss all contraceptive options with women seeking advice for the first time. While in a poll of 1,000 women aged 16 to 45, 41 per cent said they were only using their current birth control because the doctor offered it. Delivering this level of care in austerity Britain is hard. Unlike other areas in health, reproductive care doesn’t have the same level of champions and cheerleaders. You could be one. Start by asking your MP, CCG and local council how they intend to safeguard this unique service so many of us rely on - and which is increasingly under threat.

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Manchester Evening News

  • High-risk emergency surgery could be axed at Wythenshawe Hospital in major healthcare shake-up.

    Thousands of patients could be affected by a major shake-up of healthcare in Greater Manchester. The M.E.N has learnt of drastic proposals which could include high-risk emergency surgery being axed from Wythenshawe Hospital and switched to the MRI. Some vascular services could also be moved from Wythenshawe as part of the reshuffle, with the specialism divided between the two in proposals. The impact could be huge for thousands of patients across Greater Manchester. The proposed changes are part of a deal struck between the University Hospital of South Manchester NHS Foundation Trust - which runs Wythenshawe - and the Central Manchester University Hospitals NHS Foundation Trust. It’s part of a scheme to create a ‘network’ of hospitals, each specialising in certain types of care - like cancer treatment or general surgery.Under the plans, both Wythenshawe and MRI would still have A& E departments and both would have surgeons for general surgery. However, under plans the most serious emergency surgery would no longer be dealt with in Wythenshawe, meaning such patients would have to be taken to the MRI. On Wednesday, health bosses are expected to announce some of their plans under Healthier Together - a major shake-up of hospital and GP services across Greater Manchester.

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Get Surrey

  • Ward closures announced at Ashford Hospital following CCG review.

    The closure of two of Ashford Hospital’s wards, used by the elderly for rehabilitation care, is another step to privatising the NHS, according to a trade union. The Wordsworth and Fielding wards will close by the end of this month after a review carried out by the Clinical Commissioning Group (CCG) found patients recover better away from acute hospitals. Patients will now be placed in rehabilitation care at Walton Community Hospital, Woking Hospital, nursing homes and care at home. Stephanie Cesana, Unison regional organiser, said by putting contracts out to the private sector it showed everything is about savings. “It’s a further example of the creeping privatisation in the NHS,” she said. “This Government is determined to chip away at the NHS until all services have been privatised. It’s worrying and disappointing.” Staff at the two wards have been moved to alternative positions within the trust. On May 30, St Peter’s Hospital shut its Ambulatory Emergency Care Unit (AECU) which had been set up to provide urgent assessment and treatment for patients who were brought to hospital by ambulance. The trust said it had not seen the expected patient numbers or flow. The referral service for GPs, which was in place through the AECU, will now run from the Medical Assessment Unit.

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Independent

  • Dentists say government has 'failed' NHS patients with overcomplicated regulations.

    One in three NHS-listed dentists in England is refusing to take on any new NHS patients – and even those who offer appointments are making patients wait up to nine months. The consumer group Which ?, which carried out the investigation, said it was time for the Competition and Markets Authority to intervene to ensure dentists were complying with rules. Regulations currently say that dentists must be clear about their availability and should not require new NHS patients to register before they can see a dentist. However, dentists said the Government had “failed” NHS patients, with a complex payment system they said stops dentists from taking on extra patients as demand grows. One leading dentist said NHS patients in parts of England were now having “real problems” getting treatment. Dr Nigel Carter, chief executive of the British Dental Health Foundation, said that the issue should be “seriously addressed imminently”. The Which ? study is based on findings from undercover researchers, who contacted 500 dental surgeries listed on the official NHS Choices website, posing as new NHS patients. They found the website’s information was very often inaccurate, with 31 per cent of surgeries turning them down for appointments. Of those that could take new patients, more than a quarter could offer no appointments for at least two weeks. Some practices required patients to fill out forms, or even to pay deposits before granting appointments, and some recommended that patients pay for private treatments instead. Patient advocacy group Healthwatch England said that, according to its own data, in some parts of England only a fifth of surgeries are accepting new NHS patients, with some people even having to travel up to 40 miles to find a surgery offering appointments. Only the under-18s, pregnant women and people receiving certain state benefits get free dental care on the NHS. Everyone else can choose between low-cost NHS care and often more expensive, but more readily available, private services. Mick Armstrong, chair of the British Dental Association, said the “byzantine system” had failed dentists and patients.

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Monday 15th June 2015

The Independent

  • Barts NHS Trust paying £47,000 a month for temporary finance director Ian Miller.

    An NHS trust has been paying nearly £47,000 a month – equivalent to an annual salary of more than half a million pounds – for a temporary official, according to a report. Figures obtained by The Daily Telegraph showed that a company called Maxentius was paid £78,000 plus VAT in February and March by the Barts NHS Trust for the services of Ian Miller as a finance director. Mr Miller, who is a director of Maxentius, is still employed by the Trust. The payments, which would add up to more than £560,000 over a year, are nearly three times the salary of Simon Stevens, the chief executive of NHS England, who makes £190,000 a year. However Mr Miller, 49, told the Telegraph that the figures did not reflect his actual earnings because of tax and pension deductions at higher rates than those of ordinary staff. Previously he worked for Maidstone and Tunbridge Wells Trust for five months on rates of pay equivalent to a salary of more than £600,000, the paper added. A spokesman for Barts Health NHS Trust said: “The trust’s previous finance director left with immediate effect in February. “This, coupled with the significant financial challenges the Trust was facing, meant it was imperative for the Trust Board to appoint a highly experienced finance expert to lead its financial recovery programme. Ian Miller was available immediately and had the significant experience needed to lead the finance department of the largest NHS Trust in the country. The process to recruit to a substantive post is expected to be under way shortly.”

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Hospital Dr

  • “Waste exists in the NHS, but it’s not wasteful”.

    The government has pledged at least £8 billion in additional funding for the NHS by 2020. This will mean the NHS will need to find almost three times more - £22 billion over the period - by improving productivity and efficiency. Making savings from the way NHS supplies are purchased and from temporary staffing will make a contribution to filling this gap. This will be a vital area for NHS providers to explore and Lord Patrick Carter's interim review has been published at the right time to help them to do so. Lord Carter has been meticulous over the last year and worked closely with many NHS Confederation members to explore how goods and services are purchased in the health service. Agency staff will continue helping the NHS provide quality care for the foreseeable future but we need to reduce their use and cost. Improvements in flexible working, better technology and arrangements with local agencies can all help shrink their impact on NHS finances. Lord Carter's interim findings are crucial to understanding how costs might be brought down and we expect that the implementation of his review will be developed further with the sector, in the spirit it has been up to now. The potential savings need to be tested and developed with the wider NHS, so that final savings targets due to be handed to the NHS from September, are owned by the whole service. In our recent member survey published last week, 71% of senior NHS leaders described the current financial pressures as the worst they have ever experienced. The NHS needs to demonstrate value for taxpayer money and, like any public service, there is always more that can be done to improve productivity. While it is fair to say waste exists in the NHS, it’s not true to say it is wasteful. In fact, data on spending and outcomes show the NHS is relatively efficient compared to other countries and our members’ efforts to reduce costs in the last parliament delivered almost £19 billion worth of savings.

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Hospital Doctor

  • Anger over U-turn on safe NHS staffing levels.

    Serious concerns have been expressed over NHS England’s decision to suspend work on determining safe staffing guidelines in hospitals. NHS England chief executive Simon Stevens has reportedly asked NICE to cease work on safe staffing levels – which it was asked to do in the wake of the Mid Staffs scandal. It was a specific recommendation made by Sir Robert Francis, in his 2013 report he described NICE as the “accepted authority” to carry it out. Stevens is said to want to avoid “a more mechanistic approach” of nurse ratios. Many trusts are struggling to recruit sufficient nurses to meet staffing ratios, and the health secretary announced last week that he will target locum agencies that are over charging for placements. The Royal College of Emergency Medicine, which has been working with NICE and a range of stakeholders to develop guidance in this area, was “disappointed” by the development. Like the Royal College of Nursing, the RCEM is concerned that this move is driven by affordability rather than patient safety, and calls for patients and staff to be assured that this is not the case. Dr Clifford Mann, college president, said: “There are real pressures on nursing levels in Emergency Departments. In addition, the variation between different departments is enormous. “We are concerned about patient safety and staff welfare. We saw the work that we and others had been doing with NICE in this area as much needed and overdue. To learn that it is now taken away from an independent body and is back to the drawing board is very disappointing.”

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HSJ

  • Revealed: NICE safe staffing work cost £1m.

    The National Institute for Health and Care Excellence spent nearly £1m on its work to develop nurse safe staffing guidelines for the NHS, HSJ has learned. NICE was told to suspend its work by NHS England chief executive Simon Stevens last week. A spokesman for NICE said yesterday it had carried out the work on safe staffing under a contract with NHS England and the Department of Health funded through its “grant aid” from the government. He said the work’s costs included salaries and costs of committees and other overheads. “We’ve spent approximately £1m since autumn 2013,” he added. This included £130,000 in 2013-14, £743,000 in 2014-15 and £123,000 in 2015-16 through to May. A spokeswoman for NHS England said it was “too soon” to say what resources it would have in place to take the programme forward. She told HSJ a timetable setting out the work programme NHS England would undertake on safe staffing would be outlined in “the next few weeks”. There has been widespread concern over the decision to suspend work by NICE, which was a key recommendation of Sir Robert Francis following his public inquiry into poor care at Mid Staffordshire Foundation Trust. An interim report on NHS efficiency by Lord Carter, published yesterday, also said NICE should be used to improve guidance on appropriate staffing levels and skill mix. In a letter to nursing directors yesterday, chief nursing officer Jane Cummings said NHS England would continue to use NICE “where appropriate”. Asked what that meant in practice, an NHS England spokeswoman said there was a lack of evidence for non-acute healthcare settings. This meant there was a “need to find a new approach to testing what is right, which includes looking at what evidence exists, commissioning new research and national and international best practice”.

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  • Inquiry final report: Fewer trusts can stop NHS leadership crisis.

    There should be fewer NHS organisations to avoid management talent being spread too thin, a high profile report on the leadership challenge has recommended. The HSJ Future of NHS Leadership inquiry argues: the NHS has far too many fragmented organisations with bureaucracy built layer upon layer; that it has failed to find sufficient high quality leaders for all these organisations; and that repeated restructuring has meant losing capable leadership at regular intervals. The inquiry calls for the organic reduction of the number of NHS providers and commissioners so that the current leadership talent pool can be spread more evenly and operate more effectively. It specifically calls for the publication of a list of acute trusts that are not sustainable as standalone organisations that has been drawn up by the NHS Trust Development Authority but kept confidential. This should be published by the end of July. These organisations should then be taken over by successful trusts, incorporated into hospital chains or run as franchise operations, the review suggests. HSJ understands that senior government policymakers are concerned about the political opposition the list might provoke among rival parties. The inquiry, chaired by University College London Hospital Foundation Trust chief executive Sir Robert Naylor, has returned to the issue of NHS leadership 30 years after Roy Griffiths’ report prompted the introduction of general management to the NHS, because “NHS leadership is in many respects in crisis”.

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Friday 12th June 2015

A Better NHS

  • Supervision for all.

    Clinical supervision: The key to patient safety, quality care and professional resilience. BMC Medical Education “The performance of the NHS is only as good as the support we give to the staff” So said the Secretary of State for Health, Jeremy Hunt at a conference at the King’s Fund this week. In doing so he echoed the conclusions of Professor Don Berwick who was asked to review the findings of the Francis report into failures of NHS care in 2013. He concluded, The most powerful foundation for advancing patient safety in the NHS lies much more in its potential to be a learning organisation, than in the top down mechanistic imposition of rules, incentives and regulations. Missing from these political statements and grand reports are suggestions about how to make the NHS a more supportive, learning organisation. Clinical supervision has been long established as the way that healthcare professionals provide education and support in their working environment and has patient-safety and the quality of patient care as its primary purposes. Whilst clinical supervision is mandatory for trainees, it not routine for those of us who have completed our training and we may spend the majority of our working lives unsupervised. Consequently we become isolated, uncomfortable with having our work scrutinised, and out of the habit of reflecting on our practice with others. Clinical supervision has many different forms though its functions always include education and support. The flexibility of its forms means that it can be adapted to suit the needs and resources of different groups, small or large, specialist or interdisciplinary. In recent weeks I have attended large group clinical supervision in the form of Schwartz rounds, where senior clinicians presenting have modelled clinical uncertainty, ethical difficulty and emotional engagement with their work that prompted a young nurse to respond, I used to think it was only the most junior members of staff that felt like this.

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HSJ

  • Exclusive: Efficiency rankings must not be 'crude weapon', Carter warns.

    Lord Carter has warned that the new metric he is developing to rate the productivity of every hospital in England must not be used as a ‘crude weapon’ in trust regulation. The Labour peer was speaking exclusively to HSJ ahead of this morning’s publication of the interim findings of his Department of Health backed review of efficiency in NHS providers. The report estimates that hospitals could save £5bn by 2019-20 by improved management of workforce, medicines, estates and procurement. It reveals that the Carter team is considering the possibility of a UK equivalent of the American “Sunshine Act”, which requires medical devices and drugs manufacturers to report all their financial relationships with clinicians and teaching hospitals. It also sets out details of the new metric, the “adjusted treatment index”, which will allow the NHS to rank the efficiency of hospitals against their peers. The first cut of this data is due to be published early next year. However, Lord Carter also warns against using the data as a blunt tool for regulatory action. He writes in the report that while it is not for him to decide how national bodies act on the findings, “a regulatory approach will probably fail to capture the imagination and engagement of hospital boards”. He told HSJ: “It’s going to be extremely important that people get the hang of this data and build up their confidence and comparability in it. We want to make sure everybody has had a chance to comment [and] to explain their circumstances. “We do not want it used as a crude weapon.” He added, however, that every time the review team shared comparative anonymised data with hospitals the “first thing they want to know is where they stand”. That, he said, was “not about regulatory pressure, to me it’s about the inherent sense out there in the system that people want to self-improve”. The purpose of the index data, therefore, was to “help people focus on where they can improve the performance of their trust”. He added: “We cannot create a regulatory system that can do that. This has to be about how individual trusts respond to it.”

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  • Carter review sets out plan to save NHS £5bn a year.

    A law could be introduced to force medical sales representatives to report all financial relationships with hospitals in a bid to drive down NHS procurement costs, a government backed review has said. The suggestion comes in Lord Carter’s interim report into NHS provider productivity, which includes recommendations he believes could save the service up to £5bn a year by 2019-20. In the report he says that while providers of clinical goods have a legitimate support role, “this is often clouded by the need to make sales”. He adds: “The proliferation of sales representatives selling in the NHS is a huge cost which neither the NHS nor its suppliers want or need if alternative models of doing business could be developed.” The review says a US style “Sunshine Act” could be introduced. This American law requires medical supplies organisations to collect and track all financial relationships with clinicians and hospitals and to report these to the government. Lord Carter also calls for a “tightly controlled” electronic catalogue of healthcare products supported by “strict policies so that employees and suppliers know there are no alternatives”. He says that while clinicians must retain the authority to make purchasing decisions about particular products these choices could be “better informed”. He adds: “Often… such decisions are made between clinicians and sales representatives from the medical companies without proper recourse to all the facts and evidence.” Lord Carter’s other recommendations include: adopting an “adjusted treatment index” measuring and comparing efficiency across the provider sector to allow peer review of performance; developing a “model NHS hospital” to help NHS providers improve productivity; developing workforce standards for making best use of staff time, staff rostering, one to one care, and skill range; and designing a model approach to hospital pharmacy services to improve value from medicines.

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Thursday 11th June 2015

Guardian

  • Will new patient booking system be a cure for previous NHS tech failure?

    On 15 June, the long-awaited NHS e-referral service will go live. According to NHS England, its new service will build upon its predecessor, Choose and Book, acknowledging its failures and lessons learned.Choose and Book, the electronic booking system for outpatient appointments, was introduced by the Labour government to enable patients to select, with their GP, a hospital appointment at a convenient date and time. The decision to replace the system, which has cost £356m since 2004, with the NHS e-referral service, came following a drop in its use by doctors and patients. Unlike Choose and Book, which was outsourced to Atos as part of the NHS national programme for IT, responsibility for developing the new service has been taken in-house under the control of the Health and Social Care Information Centre (HSCIC).

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Wednesday 10th June 2015

East London Advertiser

  • GP surgery faces closure over NHS funding as doctors quit Limehouse practice.

    A busy GP surgery in London’s deprived East End is facing being shut after a fifth of its NHS funding was cut. The Limehouse Practice in Gill Street could be closed down after two GPs quit—leaving the surgery unable to cope with falling incomes and rising workloads. The remaining six GPs are now insecure and are also on the verge of leaving, after the NHS switched the way it funds practices in deprived areas. The practice is “unlikely to find replacements” with the national shortage of GPs and could close within months, it warned. Closure of the Limehouse Practice would strain other surgeries, with 10,000 patients struggling to find a new GP, doctors warn. Embattled GPs across East London have been running a ‘Save Our Surgeries’ campaign since the latest round of cuts began to hit practices.

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GP Online

  • Exclusive: Obese patients denied surgery by NHS rationing.

    GP leaders slammed the ‘rationing’ of NHS services and warned that the restrictions on access to care appeared to breach the NHS Constitution. NHS England’s national commissioning criteria for bariatric surgery could prevent GPs from referring patients for bariatric surgery in line with NICE guidance. The NICE clinical guideline "Obesity: Identification, assessment and management of overweight and obesity in children, young people and adults" was issued in November 2014. It recommends bariatric surgery as a treatment option for patients with obesity if they ‘have a BMI of 40kg/ m2 or more’ or a BMI ‘between 35kg/ m2 and 40kg/ m2 and other significant disease’. It adds that ‘all appropriate non-surgical measures have been tried’ and the patient ‘has been receiving or will receive’ intensive management in a 'tier three' service. The NICE guidance does not impose any time restrictions on access to care. But NHS England’s commissioning policy stipulates that the patient must have ‘received and complied’ with a tier three or four weight-loss management service ‘for a duration of 12-24 months’ in order to qualify for bariatric surgery. It also dictates that the patient must have been morbidly obese – BMI 40 or higher – ‘for at least five years’ to be eligible for the potentially lifesaving treatment. GPC deputy chairman Dr Richard Vautrey said: ‘Such restrictions appear to flout the NHS Constitution, which gives patients a right to receive NICE recommended treatments. Many patients in this situation will find it hard to understand why a national body is picking and choosing the recommendations they follow without being explicit, open and transparent about it. Many locally commissioned weight loss services don't see people for as long as 12-24 months so it would be impossible for such patients to qualify for surgery in these circumstances. We know that rationing decisions are made all the time but patients want that to be done openly and not with pseudo-clinical reasons to justify these decisions.’

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Guardian

  • Revealed: how the stress of working in public services is taking its toll on staff.

    The Clockoff survey, conducted last month, asked about the wellbeing of employees across the voluntary sector and public services. More than 3,700 people, in jobs ranging from social work to police and probation, from social housing to the NHS, charities and NGOs, took part online via the Guardian’s professional networks. A clear picture emerges of staff working long hours, with few breaks, and a workforce that has become wearily resigned to this way of working. Some 93% of respondents say they are stressed at work either all, some, or a lot of the time. The survey also reveals that NHS workers are the least likely to take a break during a working day. Just over a quarter (26%) don’t take a break at all, and only around one in 10 takes more than half an hour. And the large majority of NHS workers (96%) work beyond their contracted hours, doing an average of five extra hours per week. It is not just those in clinical roles who are feeling the pressure. A ward clerk supervisor, who has had to take time off work because stress levels had exacerbated an existing mental health condition, says: “So-called efficiency savings have resulted in remaining staff being overloaded – particularly those who aren’t frontline like administrators and secretaries.” One senior manager admits: “I feel I can’t help my team or myself more to cope and adapt to change and pressure.” The findings come as David Cameron, the prime minister, promises to transform the NHS into a seven day-a-week universal health service.

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Gloucestershire Echo

  • 'No plans' to axe A&E at Cheltenham General Hospital but service downgrade is here to stay.

    A& E will not be axed at Cheltenham General Hospital – but a downgrade of services is unlikely to be reversed. Cheltenham MP Alex Chalk has delivered on his 2015 General Election pledge and met with NHS chiefs to demand clarity over the future of the hospital. And the message he received was clear: There are no plans to close A& E but there are also no plans to put it back to how it used to be. The town's A& E department was downgraded in July 2013 and it is now only fully functional during the day.

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Monday 8th June 2015

Pulse

  • CQC fees 'could double' as Government plans to withdraw funding.

    GP practices are set to face a continual rise in CQC fees over the coming years, as the Government seeks to reduce the grant it gives to the regulator, Pulse can reveal. The CQC - which is currently funded both by the Government’s grant-in-aid and its providers - is expected by the Treasury to work towards fully covering the cost of its regulation ‘over a reasonable time period’ through the fees it charges its providers. Currently, the Government grant covers just over half of the CQC’s costs, while GP practices with a single location pay between £616 and £948, while those with more than one location range from £1,341 to £16,759. But the GPC has claimed that any move to increase GP practices’ CQC fees will cause ‘further detriment to patient services’, adding that the existing workload and bureaucratic registration process already impacts GPs’ ability to provide patient care. In April, practices saw their annual CQC fees rise by 9%, which is expected to add around £60 to the bill of an average practice, while in 2014 practices were hit with a smaller rise of just 2.5% in registration fees. But this is likely to increase in future, with a CQC regulatory fees document published earlier this year stating that it needed to achieve a ‘higher recovery on fees’ as its current position was ‘not sustainable under Treasury requirements’. A spokeswoman for the CQC confirmed to Pulse that: ‘Changes in our fees strategy will affect all providers, not just GP surgeries.’

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Hospital Doctor

  • Anger over NHS England u-turn on safe NHS staffing levels.

    Serious concerns have been expressed over NHS England’s decision to suspend work on determining safe staffing guidelines in hospitals. NHS England chief executive Simon Stevens has reportedly asked NICE to cease work on safe staffing levels – which it was asked to do in the wake of the Mid Staffs scandal. It was a specific recommendation made by Sir Robert Francis, in his 2013 report he described NICE as the “accepted authority” to carry it out. Stevens is said to want to avoid “a more mechanistic approach” of nurse ratios. Many trusts are struggling to recruit sufficient nurses to meet staffing ratios, and the health secretary announced last week that he will target locum agencies that are over charging for placements. The Royal College of Emergency Medicine, which has been working with NICE and a range of stakeholders to develop guidance in this area, was “disappointed” by the development. Like the Royal College of Nursing, the RCEM is concerned that this move is driven by affordability rather than patient safety, and calls for patients and staff to be assured that this is not the case. Dr Clifford Mann, college president, said: “There are real pressures on nursing levels in Emergency Departments. In addition, the variation between different departments is enormous. “We are concerned about patient safety and staff welfare. We saw the work that we and others had been doing with NICE in this area as much needed and overdue. To learn that it is now taken away from an independent body and is back to the drawing board is very disappointing.” Sir Robert Francis said he was “surprised and concerned”.

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London Evening Standard

  • Doctors have warned that failings at the NHS’s biggest trust are affecting care of London patients.

    More than 80 doctors have signed a letter highlighting “unsafe” bed occupancy rates, cuts impacting on staffing levels and the overuse of agency nurses at Barts Health NHS Trust. The GPs and hospital doctors are also calling on the Government to bail out Barts as it did with the banks. They want ministers to cancel the debt Barts owes on more than £1 ?billion of private finance initiative contracts. The trust’s deficit is approaching £100 ?million, with PFI deals partly to blame. Barts serves 2.5 million people living largely in east London, which has some of the most deprived areas in the capital. The letter, seen by the Standard, states: “The position is not sustainable and is impacting negatively on the healthcare of the people of east London. Tower Hamlets has the highest level of child poverty in the UK, how can it be right that money which should be spent on healthcare is being drained into the black hole of PFI repayment ? We think it is time to cancel the PFI debt. In 2008 Government found billions to bail out the banks. The same needs to be done for our hospitals.” The document has been sent to top NHS officials including health secretary Jeremy Hunt and Simon Stevens, the head of the NHS. Signatories include Professor David Rampton, a consultant at the Royal London — one of six hospitals run by Barts.

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The Independent

  • Chief executive of firm accused of 'ripping off' NHS on staffing is a Tory donor.

    Ramez Sousou, founder and co-chief executive of transatlantic private equity firm TowerBrook Capital Partners, which owns Independent Clinical Services (ICS), has donated just under half a million pounds to the party since 2010, including more than £75,000 since his company bought ICS last year. Mr Sousou founded TowerBrook in 2005 and retains a stake in the company. His wife, Tiziana Cantoni, who is not connected to TowerBrook, has also donated personal funds to the party. On Tuesday the Government announced a drive to crack down on agencies providing nurses to NHS trusts, which Health Secretary Jeremy Hunt said are ripping off hospitals with “extortionate” fees. Records of donations to political parties kept by the Electoral Commission reveal total payments of £473,800 to the Conservatives by Mr Sousou since 2010, with Ms Cantoni giving £385,000 to the party in the same period. Of this, £155,000 has been donated since TowerBrook took over ICS in 2014. Mr Sousou has attended dinners organised by the Conservative Leader’s Group, a fundraising group described by party as the “premier supporter Group of the Conservative Party”. He was present at a dinner in 2012, which was also attended by David Cameron and George Osborne. Towerbook Capital acquired ICS in June last year, saying it was a “time of strong market dynamics for healthcare staffing services in the UK”. Within the ICS group are a number of major temporary staffing companies serving the NHS, including Pulse, Frontline Staffing and Thornbury Nursing. The Government has been widely attacked after its announcement to crack down on agencies, with critics blaming a lack of funding and investment in recruitment of the root cause of shortages creating opportunities for exploitation by agencies. Speaking to The Independent, National Health Action Party founder Dr Clive Peedel said: “It’s in the interest of these agencies for the NHS to be understaffed, it works on supply and demand; the cause of the problem is inadequate staffing in the face of a rising population.” In April the Royal College of Nursing said that despite government claims to have hired more nurses, its own research revealed a drop in the overall numbers, from 317,370 in May 2010 to 315,525 in December 2014. The amount spent by NHS trusts on both agency nursing staff and locum doctors has soared in the past three years.

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Friday 5th June 2015

BBC News

  • Nottingham dermatology privatisation 'unmitigated disaster'.

    The privatisation of a renowned dermatology centre which led to its near-collapse, was an "unmitigated disaster", a report has said. Nearly all consultant dermatologists in Nottingham left when forced to transfer from the NHS to Circle. The unit, previously a national centre for excellence at the Queen's Medical Hospital, now has a reduced service with some patients sent to Leicester. The report said no one organisation was to blame but lessons had to be learned. All three organisations involved - Circle, Nottingham University Hospital Trust (NUH) and Rushcliffe Clinical Commissioning Group (CCG) - accepted the findings of the independent report and have promised to work together to find a solution. Problems occurred when full control of Nottingham Treatment Centre was handed to Circle, with staff transferred to the private firm last year. The majority of the consultants refused the transfer and left. Circle had to recruit overseas locums, some being paid £300,000-a-year, who were not qualified to teach. As a result, the Queen's Medical Hospital (QMC), home of the East Midland's major trauma centre, can no longer treat the most severe emergency patients, instead having to send them to Leicester. Dr David Eedy, president of the British Association of Dermatologists, said: "It's inconceivable that an acute and ill patient would have to be moved from one of the largest centres in the UK to another hospital, 25 miles away. "It seems ridiculous and incomprehensible... and would not be optimum care." The report did not blame any one organisation but criticised the delay in responding to the problem when it became clear. "This is a service that fell to pieces when the majority of relevant... consultants declined to [transfer to Circle], and over time resigned from NUH," it concluded. The paediatric dermatology, which is one of the few centres outside London, remains "on a knife-edge" because of the staffing problems despite remaining under the control of NUH.

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London Evening Standard

  • Doctors have warned that failings at the NHS’s biggest trust are affecting care of London patients.

    More than 80 doctors have signed a letter highlighting “unsafe” bed occupancy rates, cuts impacting on staffing levels and the overuse of agency nurses at Barts Health NHS Trust. The GPs and hospital doctors are also calling on the Government to bail out Barts as it did with the banks. They want ministers to cancel the debt Barts owes on more than £1 ?billion of private finance initiative contracts. The trust’s deficit is approaching £100 ?million, with PFI deals partly to blame. Barts serves 2.5 million people living largely in east London, which has some of the most deprived areas in the capital. The letter, seen by the Standard, states: “The position is not sustainable and is impacting negatively on the healthcare of the people of east London. “Tower Hamlets has the highest level of child poverty in the UK, how can it be right that money which should be spent on healthcare is being drained into the black hole of PFI repayment ? “We think it is time to cancel the PFI debt. In 2008 Government found billions to bail out the banks. The same needs to be done for our hospitals.” The document has been sent to top NHS officials including health secretary Jeremy Hunt and Simon Stevens, the head of the NHS. Signatories include Professor David Rampton, a consultant at the Royal London — one of six hospitals run by Barts.

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The Telegraph

  • A&E safe staff levels shelved as costs spiral.

    HS guidance on safe staffing levels in accident and emergency units is being suspended amid concerns over soaring fees for agency nurses and doctors. Nice, the health watchdog, has been developing recommended staffing levels for casualty departments in the wake of the Mid Staffordshire scandal. It follows reports that nurses have had to look after as many as 15 patients at a time, particularly during very busy periods like bank holidays. However, the guidance has been suspended by NHS England, the body which oversees the health service, and will now form part of a wider review. Susan Osborne, director of the safe staffing alliance campaign group, said that the decision was a "dangerous and backward step". She said: “They are not recognising that trusts up and down the country are operating on unsafe staffing levels which must be compromising patient care. This is burying something because it is telling you the answer you don’t want to hear.” It comes after Jeremy Hunt, the Health Secretary, announced a crackdown on on "exorbitant" fees for doctors and nurses charged by agencies which are "ripping off" the NHS. Official figures show that NHS spending on temporary workers has reached a record £3.3billion high, and “catastrophic” levels of debt are being blamed on last year’s rise in agency bills. The number of agency staff has increased partly in response to the Mid Staffordshire scandal Nice began working on staffing guidance on the recommendation of Sir Robert Francis, who chaired an inquiry into the Mid Staffordshire scandal. It has already produced two pieces of guidance for staffing in materinity and adult acute wards , and in July last year published draft guidance for accident and emergency wards.

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The Guardian

  • NHS patient safety fears as health watchdog scraps staffing guidelines.

    The NHS has been accused of backtracking on improvements to patient safety brought in after the Mid Staffordshire hospital scandal in an effort to tackle its escalating financial problems. The National Institute of Health and Clinical Excellence (Nice) watchdog has unexpectedly scrapped work to set out how many nurses are needed in different parts of hospitals to ensure safe patient care. The move drew sharp criticism from nurses’ leaders, patient safety campaigners and Sir Robert Francis, the QC whose official report into Mid Staffs recommended Nice draw up guidelines on NHS-wide safe staffing levels, because understaffing had contributed significantly to the scandal. Nice – which is an independent body – said it had stopped devising a raft of patient to staff ratios intended to help guarantee patient safety in A& E units and mental health settings at the request of NHS England, which will now take over the work. However the fear is that NHS England will either introduce lower standards – in terms of the number of nurses required – that are cheaper for hospitals to meet, or that the guidelines on the safe number of nurses will be abandoned altogether. NHS England has already sparked concern by deciding to start publishing data on hospitals’ A& E waiting times monthly instead of weekly, and to scrap two targets covering patients’ right to be treated in hospital within 18 weeks of referral by their GP. NHS England needs to make £22bn of efficiency savings to help close the £30bn gap expected in its finances by 2020. There are growing fears that hospitals will cut staff to help meet it.

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HSJ

  • Exclusive: CQC to rate hospitals’ efficiency.

    The health secretary has asked the Care Quality Commission to include a hospital’s efficiency as one of the “key criteria” for rating the quality of its leadership. Speaking exclusively to HSJ today, Jeremy Hunt said he did not want a situation where “we have the government and Monitor asking for transformation and efficiency, and the CQC inspection regime asking for a different set of priorities around safety and quality”. It was, he added, “really important is that the whole system is aligned around what it is we are expecting of people running hospitals”. He continued: “The whole theme of my speech [to the NHS Confederation conference this morning] was that quality and efficiency are two sides of the same coin. “So I’ve asked [CQC chief inspector of hospitals Sir] Mike Richards, and he has agreed that he will include use of resources as one of the key criteria that the CQC look at in their well led domain, when his round two inspection regime starts in April next year.” Mr Hunt said Sir Mike would be aided in his work to develop a way of assessing trusts’ use of resources by information from Lord Carter’s ongoing review of NHS efficiency. He added: “What it’ll mean basically is that hospitals who adopt best practice for procurement, for rostering, for efficient use of resources will see a dividend in their CQC ratings.” Asked if he was concerned that changing the inspection regime in this way could dilute the CQC’s focus on quality, he replied: “Quite the opposite.” He continued: “This CQC inspection regime – which is the single thing I’m probably most proud of in terms of the changes we’ve made over the last couple of years – will fail if we see quality and efficiency as two separate things. “Mike is the first person to say it’s not acceptable for a hospital that gets put into special measures to say the problem’s about resources, because there are other hospitals with the same resources that are able to deliver high quality care.”

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  • Osborne announces £200m cut to public health budgets.

    The Department of Health is to consult on an in-year cut of £200m to council controlled public health budgets. The proposal has prompted fears among NHS commissioners of a knock-on impact on their services. The cut was revealed by chancellor George Osborne this afternoon, and was billed as a saving of £200m on “non-NHS” spending. Until 1 April 2013, public health budgets were managed by NHS commissioners, before being transferred to local authorities under the Health Act 2012. The cut will affect spending this year and will be worth 7.4 per cent of the £2.7bn annual budget devolved to councils from the DH via Public Health England. A DH spokeswoman told HSJ that the cuts would not affect “frontline services”. Among the services funded by councils via their public health budgets are: school nursing; screening programmes; drug and substance misuse programmes; smoking cessation services; and sexual health schemes, including HIV prevention. Other common public health services funded by councils are obesity prevention and weight loss schemes. NHS England chief executive Simon Stevens said on Sunday that “the new smoking is obesity”, and pointed out that one in five cancer deaths were now being caused by the condition. Dominic Harrison, director of public health at Blackburn with Darwen council, and a board member of Blackburn with Darwen Clinical Commissioning Group, said the cut went against Mr Stevens’ advice. He said: “The DH seem to be muddled about how public health and local government is operating because many of the statutory services we commission are commissioned from NHS providers, so this will be a cut to NHS services which the government has said it wasn’t going to do. We would struggle to make these efficiencies this year because the nature of contracts with NHS trusts is we have to give 6-12 months’ notice of any [changes].”

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Thursday 4th June 2015

Independent

  • Britain’s first PFI privately funded NHS hospital is a 'major' fire safety risk, say fire fighters.

    Britain’s first NHS hospital financed and built by private capital is a “major” fire safety risk, fire fighters have said. The Cumberland Infirmary in Carlisle was first opened in 2000 under the controversial “private finance initiative” which sees the NHS pay a private company rent-like payments to make use of facilities. An independent report commissioned by the NHS trust that manages the hospital found that fire proofing materials installed by the private company did not meet the required protection standard to allow for save evacuation and prevent a fire from spreading across the building. Local NHS bosses have given dozens of NHS staff members emergency fire safety training to step up safety while work to fix the problems caused by the original contractors goes on. Helen Ray, chief operating officer at North Cumbria University Hospitals NHS Trust, which is fixing the problems, was critical of the PFI deal. She said, “This is not the first time we have uncovered such major flaws in the service provided to us through our PFI partner and the Trust Board remains very deeply concerned that the current arrangements are not providing the high standards of service we require for our patients in North Cumbria on a consistent basis.” PFI yielded assets worth £56.5bn but the UK government will ultimately pay more than five times that amount under the terms of the agreements.

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  • Ministers won't rule out NHS staff cuts as part of £22bn health service 'efficiency savings'.

    Ministers have failed to rule out cuts to doctors, nurses, and other NHS staff as part of their plan to make £22bn “efficiency savings” in the health service. NHS managers will today hear how executives in the health service plan to make the savings, which will be complemented by an £8bn cash injection from the Treasury. In a speech NHS England boss Simon Stevens will stress that the health service can be made more efficient by increasing preventative care and moving care from hospitals to GP surgeries.But despite today’s focus on positive measures and changes to working practices, the Government is refusing to rule out making NHS staff cuts. Ministers at the Department of Health were asked by Labour MP Ian Lavery whether the “efficiency savings” to be rolled out over the next five years would lead to a reduction in staff. Health minister Ben Gummer responded that the Conservative manifesto committed the government to ensuring that adequate staff were in place – but did not rule out cuts to their numbers.

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Manchester Evening News

  • Manchester experts warn against Tories' seven-day NHS plan because 'blanket approach' won't work.

    The Tories’ ‘blanket approach’ to a ‘seven-day’ NHS is not cost-effective and offers no guarantees of preventing excess deaths, Manchester experts have warned. University of Manchester health economists say health bosses could achieve twice as much with the cash the government plans to spend implementing the new service if they were to follow different guidelines. The research, published in the Health Economics journal, concluded that the roll-out of seven-day services across the NHS, which could cost up to £1.43bn, was ‘unlikely to be a cost-effective use of resources’. The findings challenge the government’s plans to develop a seven-day health service by 2020. Researchers say 5,353 excess ‘weekend deaths’ occur every year and, according to National Institute for Health and Care Excellence standards, the NHS should spend no more than £831m eradicating the ‘weekend effect’. That is almost half the amount the Tories say the seven-day service pledge will cost to implement. Experts say the costly plans will also offer no guarantees that excess deaths will be prevented or that weekday care will not deteriorate as staff take up weekend duties. Dr Kailash Chand, a Tameside GP and deputy chairman of the British Medical Association, has warned that David Cameron’s vision for ‘truly seven-day NHS’ will be unworkable unless the government tackles a £30bn funding gap and a ‘chronic’ shortage of medical staff. Although the Tories have promised seven-day GP access the next five years nationally, town hall and health chiefs in Greater Manchester aim to start rolling out the extended service by December as part of the region’s radical devolution deal.

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BBC News

  • Consortium bids for £690m cancer contract.

    A £690m cancer care contract in Staffordshire is expected to be awarded to a consortium including private firms. A leaked document said a group of organisations, also featuring two local NHS trusts, had come together and was the last remaining bidder in the process. The BBC understands it could be led by private firm Interserve. Pending further discussions, the deal is due to be awarded in December.Outsourcing contracts to cover both cancer and end of life care in Staffordshire were announced last year. Together, they are expected to be worth £1.2bn and cover a 10-year period. The contracts will cover the areas controlled by Stafford and Surrounds, Cannock Chase, Stoke-on-Trent and North Staffordshire CCGs. Trade unions have previously described the involvement of private companies as a "huge gamble". Campaigners are expected to hand over a petition on Thursday against awarding the contracts to the private sector.

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Guardian

  • Regulators to take over NHS services in three English regions.

    NHS regulators are to push through major changes to how hospitals and GP services are run in whole parts of England where services have been beset by major problems for years. The unprecedented move will see three key national NHS bodies intervene to dictate how all local services tackle longstanding problems such as understaffing, financial trouble and poor care. The new “success regime” will be applied first to three areas of England – Essex, North Cumbria and North, East and West Devon – where previous efforts have failed to produce improvements. But it is understood that it may be extended to other places, including Kent and Staffordshire, where hospitals in particular have racked up mounting debts, struggled to cope with rising demand for care and had difficulties in delivering key waiting time targets, such as for A& E and cancer patients. The move is part of the NHS Five Year Forward View, the blueprint for the service’s future, which Stevens and fellow bosses of other key NHS bodies published last year.

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Tuesday 2nd June 2015

Pulse

  • Patients hit by practice closures: the thousands who have had to find a new GP.

    GP leaders have been warning that many practices are on the brink of closure. But now Pulse can reveal that more than 160,000 patients across the UK were displaced as a result of their practice closing in just two years. This is not only distressing for patients, but also piles the pressure on neighbouring practices, which are often forced to take on additional patients. And GP leaders say they expect the number of closures to climb further over the next year. Pulse has been campaigning for additional support for struggling practices in its Stop Practice Closures campaign, and there are signs NHS managers are finally starting to listen. But this will come too late to help the thousands of patients whose practices have lost the fight to survive. GPC chair Dr Chaand Nagpaul believes the figures obtained by Pulse are the ‘tip of a much bigger iceberg’. He says: ‘There are many practices on the brink of collapse, while others may not be closing, but are significantly reducing the level of services they can offer. We have many practices running at half capacity and having to reduce the number of sessions.’ The closures are having a dramatic impact in some areas. In the Midlands, seven GP practices closed between April 2013 to April 2015, displacing 27,000 patients. Birmingham LMC executive secretary Dr Robert Morley describes the situation as ‘absolutely dire and getting rapidly worse’. He adds: ‘We have small partnerships that are becoming unviable because of issues of recruitment, retention, impossible workload, GP illness and singlehanders retiring, and practices are also being closed by the CQC, while commercial APMS contracts are being terminated.’ Pulse recently revealed a 500% jump in the number of practices seeking advice from NHS managers about closure or merging. And some area teams are looking at emergency measures to support these practices, as called for in Pulse’s campaign. Only a few areas of the UK have avoided major closures, but local GP leaders are warning that it is only a matter of time before more practices succumb.

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Daily Mirror

  • Campaigning doctor slams NHS 'privatisation' after agency firms for backup medics enjoy boom in trade.

    A campaigning doctor has slammed NHS 'privatisation' and says the Tories are 'reaping what they sow' after it emerged firms are making billions filling gaps in staff. An investigation claimed 10 of Britain's biggest medical recruiters have posted revenues of £7.7bn since 2009 - money paid to ensure patients are safe at understaffed hospitals. One of the biggest firms, Independent Clinical Services (ICS), has seen its profits more than double in just four years since the Coalition took power. Cancer specialist Dr Clive Peedell, one of the founders of the National Health Action party, warned the NHS will 'never be able to compete' amid a booming private market. "This is one of the forms of privatisation that's going on," he told Mirror Online. "You've got a number of private firms in a workforce market that's driving up agency fees. The side that's winning is the agencies and that's clearly driving up the costs." Dr Peedell, who stood against David Cameron in the General Election, blamed Tory efficiency savings which have 'put patient safety at risk'. He added: "After the Francis report came out hospitals realised 'crikey, this is dangerous, we need to recruit more people' and now we've got a supply and demand issue. We're ending up paying the private sector a lot of dosh to ensure patient safety and they're making huge profits. The government - they're reaping what they sow. They cut staff and now they're having to fill in the gaps."

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Guardian

  • No more £3,500-a-shift doctors, Jeremy Hunt tells NHS.

    Jeremy Hunt has told the NHS to cut its soaring £3.3bn bill for agency staff, which has resulted in hospitals paying up to £3,500 for a doctor to work a single shift. The health secretary is introducing curbs on the use of employment agencies, some of which he says are “ripping off” the NHS by charging “extortionate” rates. He has acted after the annual bill for agency staff rose from £1.8bn to £3.3bn over the past three years. Hospital trusts, forced to improve quality of care since the Mid Staffs scandal, have sought to hire extra staff, but many have had difficulty attracting enough extra personnel and have increasingly relied on agency personnel to fill their rotas. New rules will introduce a maximum hourly rate that agencies can charge for a stand-in doctor or nurse’s services and cap the amount that any trust in financial trouble can spend on them. Trusts will also be banned from using agencies that are not on a new approved list. Some experts raised doubts about how Hunt’s initiative would work, given the health service’s chronic lack of many types of staff, including nurses, GPs, A& E doctors and radiologists. Andy Burnham, the shadow home secretary, said mistakes by the Conservatives had led to the expanded use of agency staff. “The decision to cut 6,000 nursing posts in the early years of the last parliament, alongside big reductions in nurse training places, has left the NHS in the grip of private staffing agencies.” NHS Employers said that hospitals would continue to need to recruit permanent staff from abroad to fill vacancies.

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Monday 1st June 2015

The Telegraph

  • The extraordinary boom in agencies supplying doctors and nurses to the NHS amid a rapidly deepening deficit in the health service is revealed today.

    An investigation by The Telegraph shows how total revenue at 10 of Britain’s biggest medical recruiters rose by almost 40 per cent over three years, with the companies posting overall takings of £7.7 ?billion since 2009. The businessmen running the agencies are earning up to £950,000 a year and living expensive lifestyles in properties worth millions of pounds, prompting warnings last night that the NHS needed “to get a grip”. Official figures show that NHS spending on temporary workers has reached a record £3.3 ?billion high, and “catastrophic” levels of debt are being blamed on last year’s rise in agency bills. Simon Stevens, the NHS England chief executive, has promised to tackle the high cost of agency spending. He told the Andrew Marr Show on BBC One: “We will have to clamp down on some of these staffing agencies, who are frankly ripping off the NHS.” The Telegraph's investigation shows how revenue at one of the NHS’s largest outsourced recruitment firms, Independent Clinical Services (ICS), increased by 60 per cent in just two years, to £314 ?million. Meanwhile, spending on agency staff by NHS foundation trusts – two-thirds of hospitals – rose by 64 per cent over a two-year period, pushing the health service into debt. Figures obtained by The Telegraph show that Barts Health NHS Trust in London spent most heavily on agency staff, with an £81 ?million bill in 2014-15. It was followed by King’s College Hospital foundation trust and Royal Free London NHS trust, which each spent more than £60 ?million. The trusts blame their reliance on temporary staff on a lack of qualified nurses. Many have tried to employ more nurses in the wake of the Mid Staffs scandal, but struggled to find permanent workers, causing the agency bill to spiral. Critics say the problem has been caused by underinvestment in training, a lack of any effective cap on the rates that agencies charge and a failure to recruit enough staff.

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The Independent

  • Thousands of patients have had to find a new GP because their local practice has closed, as staffing shortages and workload pressures take their toll on surgeries, new figures show.

    In England, Scotland and Wales, 61 practices have closed since April 2013 which has forced more than 160,000 people to register somewhere new, figures obtained via Freedom of Information (FOI) requests show. Closures are being forced by problems both in recruiting new GPs and in retaining the existing workforce. The figures, obtained by the GPs’ magazine Pulse, were described as “the tip of an iceberg” by one senior GP. Data released by the Government last year indicated that more than 500 practices had closed between 2009 and mid-2014. These also include practices lost through mergers and takeovers. However, a previous FOI request by Pulse revealed a sharp increase in the number of practices approaching NHS managers for formal advice about closing: 169 made such requests between April and December last year – compared with just 37 in a year between April 2013 and March 2014. Practice closures are piling pressure on other GPs who must take on the displaced patients, doctors’ leaders said. Dr Chaand Nagpaul, chair of the British Medical Association’s GP committee, told Pulse: “There are many practices on the brink of collapse, while others are significantly reducing the level of services they can offer.

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HSJ

  • Revealed: £690m Staffordshire contract bidders discuss private led consortium.

    Negotiations are taking place to establish a private provider led consortium to take on a 10 year, £687m contract to integrate cancer services in Staffordshire. Sources close to the procurement, part of a wider £1.2bn cancer and end of life care tender by four Staffordshire clinical commissioning groups, have told HSJ the discussions were prompted after commissioners made clear their preference for a consortium to lead as a prime provider across the county. This led to the two NHS trusts, University Hospitals of North Midlands Trust and the Royal Wolverhampton Trust, and three remaining private bidders – Interserve Investments, Optum (formerly UnitedHealth UK) and CSC – to consider withdrawing their standalone bids and instead forming a consortium. Sources said this could be led by Interserve Investments. HSJ understands no final decision has been made but it is expected both trusts will not pursue individual competitive bids for the contract. One source with knowledge of the process told HSJ: “The NHS trusts withdrew when it became clear the CCGs wanted a private sector provider. The trusts are being asked by the CCGs to work in partnership with the private sector providers.” None of the bidders, which were revealed by HSJ in November, were prepared to comment on the developments today. The cancer pathways contract could be awarded by the end of this year while the end of life pathway, worth £535m, has been delayed until 2016. Virgin Care, CSC, Health Management, Interserve Investments and Optum were named as bidders for the end of life care contract. It is unclear whether this second contract will also be steered towards a private provider led consortium but both deals will last for 10 years.

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