Health Service Journal

• Patients able to complain to Monitor about anti-competitive behaviour.
  
  Monitor will consider complaints about anti-competitive commissioning from individual patients and representative groups, under new guidance.
  
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• Exclusive: CCGs defy Hunt by planning to increase competition for out-of-hours GP care.
  
  More than one in five clinical commissioning groups are planning to “introduce” competition for out-of-hours primary care in the next year, an exclusive HSJ survey reveals. The third quarterly HSJ Clinical Commissioning Barometer survey, sponsored by GatenbySanderson, asked CCG leaders if they planned to introduce competition in any areas in the next year and to name the four services most likely to be put out to tender. Twenty-two per cent identified out-of-hours care. The finding comes as health secretary Jeremy Hunt indicates he wants to return to a policy of GP practices having a more direct role in providing out of hours care. The survey suggests a large number of the 211 CCGs created by the government’s NHS reforms are – in contrast – planning to open the service to competition. In the HSJ/ GatenbySanderson survey, out-of-hours primary care was the fifth most chosen target for competition following musculoskeletal services (34 per cent), other community services (31 per cent), community diagnostics (26 per cent) and “care for several long term conditions” (24 per cent). It is the first of the quarterly surveys carried out since CCGs took on their full powers as part of the Health Act commissioning reorganisation. Ninety-four CCG leaders from 86 different CCGs, 41 per cent of the total 211, answered the survey during April and May. Ninety per cent were chairs or accountable officers and the other 10 per cent were other governing body members.
  
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Healthcare Today

• Private firms buy identifiable data on NHS patients.
  
  Private health firms, including Bupa, can now pay a fee to identify potentially millions of patients and then access their health records, detailing intimate medical histories, under a new national arrangement in the NHS. Private insurer Bupa is one of four private firms that has been approved to access England's "sensitive or identifiable" patient data, housed centrally by the Health and Social Care Information Centre (HSCIC). The records, which include sensitive information about hospital visits, such as a mother's history of still births, patients' psychiatric treatment and critical care stays, allow individuals to be identified by use of postcode, gender and age as well as their socioeconomic status. The "indicative fee" for a full set of 20 years' inpatient data is about £8,000 including £140 to make the records identifiable. The initiative is part of Cameron’s plans to increase collaboration between the health service and the life sciences industry announced back in December 2011.
  
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Newham Recorder

• Newham Save Our NHS campaign march on Parliament.
  
  Local healthcare activists joined a national march on Parliament on Saturday to oppose further cuts to and privatisation of the National Health Service (NHS). Newham Save Our NHS is a campaign group made up of health professionals and residents who came together last autumn around a petition against services being contracted out to private providers which gathered around 500 signatures. The demonstration, organised by “Keep Our NHS Public” and trade unions GMB and Unite, began at Waterloo and marched to the Department of Health and the Houses of Parliament. Visit their blog at newhamsaveournhs.weebly.com to find out more.
  
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UK Progressive

• Is the BBC Deliberately Avoiding NHS Cutback Woes?
  
  Is the BBC no longer functioning as the primarily conduit of information, and “interrogator in chief” on behalf of the British public ? The philosophy of objectivity, underpinned by a unique funding mechanism, has entrenched the corporation in the national psyche and it still commands a highly revered international reputation. However, the consistently inadequate coverage of major reforms to that other great British institution, the NHS, in my mind, raises this question. With the passing of the Health and Social Care Act, in March 2012, healthcare provision in the UK has undergone the most fundamental economic and structural change since the NHS’ inception in 1948. The transformation goes to the very core of British society and culture and has been the subject of intense politicking from across the ideological spectrum. The lead up to any legislation would have seen much in-depth debate and forensic critical scrutiny by our core public service broadcast network. Right ? Well, perhaps not. The BBC has been criticised for systematic and willful avoidance of various strands of the isse:
  • lack of explanation regarding the influence of private companies in the reorganization,
  • question of how taxpayer subsidies undercut the Private Finance Initiative (PFI),
  • alleged financial benefits to MPs with shareholdings in private healthcare companies,
  • absence of dissenting expert voices from professional organisations such as the BMA, or
  • simple failure to register public protest.
  What is perhaps most egregious is the lack of interrogation of government hypocrisy. We all know party manifestos are ‘fluid’ in interpretation (just ask student Lib Dem voters) but Cameron’s hollow sound bite “no top down reorganization of the NHS” has largely been allowed a free pass. Reports from independent sources such Open Democracy and Media Lens examine the BBC’s alleged malfeasance and present reasons. But in many ways the specific details of the BBC’s failings are less important than the public perception and possible long terms outcomes. There appears to be a public sense that the corporation has been, at best, quiet on the issue, at worse, guilty of ignorance, manipulation and even collusion with the coalition. Objectivity should be the aspiration for any news organisation rather than something achievable through a journalistic process. The BBC, arguably more than any news provider, sets it stall out as the benchmark of unbiased objectivity. Yet it finds it increasing hard to maintain that ideal and level of editorial control in a much more chaotic news environment. But the seemingly deliberate avoidance of a politically sensitive social issue undermines its often taken-for-granted ‘fourth estate’ role. With its royal charter renewal up for discussion in 2015, perhaps the BBC will be the next British institution to undergo major surgery.
  
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BBC News

• NHS and social care budgets 'should merge'.
  
  Ministers have been told they must go further with their overhaul of social care in England by merging its budget with the NHS. The government is currently pressing ahead with plans to introduce a cap of £72,000 on elderly care bills. But the King's Fund said that on its own the policy was not enough to solve the growing problems. Instead, it called for a joint budget to encourage the two systems to work together more closely. The report is being published on the day the government's care bill gets its second reading in the House of Lords. The legislation will pave the way for the introduction of a cap in 2016. Ministers have also said pilots will start in September to foster greater integration between the NHS and social care on issues such as assessments and hospital discharge. But the King's Fund wants to see a more radical approach. Currently the NHS budget - at over £100bn a year - dwarfs the £16bn social care budget. The King's Fund argued that by merging the two, each would be encouraged to look at the most cost-effective ways of spending money.
  
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Defend London's NHS

• Demonstration, Saturday 18th May: News Reports
  
  This demonstration was called by an unprecedented coalition of London residents, medical staff, trade unions and health campaigners who have come together to raise the alarm regarding the biggest threats to A& E’s, maternity units and in-hospital care for a generation. Closures planned across the capital include nine accident and emergency departments, a number of maternity units and thousands of hospital beds that campaigners believe will put lives at risk. Hospitals and community services are also threatened with take-over by multi-national private companies. Hundreds of thousands of London residents have pledged their opposition to these privatisation plans for the NHS. Across the capital, tens of thousands have taken to the streets to protest and demonstrate to save their local hospitals. 80,000 signed a petition against the closures in North West London. 25,000 joined the demonstration to defend Lewisham hospital. The local campaigns have joined up to call on the government to stop these closures. We are working together to undermine the government’s divisive tactics of playing one hospital off against another. Instead we are demanding that the government provide the funding needed for safe levels of care across the capital. The demonstration has been called by Save our Hospital campaigns across London and London Keep Our NHS Public. It has been backed by Unite the union, a number of MPs and councillors, trade unions and the London Labour Party. Please ask your organisation to pledge their support to publicise the demonstration by adding your name. Donations towards costs will also be gratefully received (Cheques to Keep Our NHS Public c/ o 32 Savernake Rd, NW3 2JP).
  
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Friday 17th May 2013

Hospital Doctor

• GPs must work harder - really, says who?
  
  The article was entitled ‘GPs must work harder – it’s an emergency’, and it was written, or perhaps spewed out would be more appropriate, by Alice Thomson (follow this link, but it’s behind the paywall). She was, of course, talking about the current problem in A& E, the genesis of which is clearly multifactorial, but which she feels is due entirely to the fact that GPs aren’t working hard enough. It’s difficult to know where to start in refuting her arguments, but I’ll pick just three of her points, and you can decide whether or not they constitute the most egregious pile of codswallop you’ve heard in some time. Firstly, she tells us that her brother-in-law’s father was a GP 20 or more years ago and ‘his wife used to answer the phone at 3am and he would slip out to visit the ill’. Apparently, being a GP was not a job to him, it was a vocation…and you can probably fill the rest in yourself. So Alice believes that if GPs went back to being available 24 hours a day, and assuming that their liberated, right-on wives (people probably not unlike herself) thought it was any part of their job to act as unpaid receptionists and health advisers 24/ 7 as well as bringing up children and holding down a day job, our A& E departments wouldn’t still be awash with the feckless worried well ? I don’t think so dear (excuse the condescension, but this has been festering all day. She will no doubt have me down as a typical arrogant doctor anyway, and I wouldn’t want to disappoint her). She might also like to bear in mind that the same dependency culture that leads people to go to A& E with chewing gum stuck in their hair or because their child has nits (two examples given by Ms Thomson herself) is also resulting in overflowing GP waiting rooms – they don’t all go to A& E. That’s one of the reasons that the workload of today’s GPs is way above anything experienced by her brother-in-law’s father (but not the only one, see below). She then goes on to make another, related point. This time it’s the old chestnut about the average GP ‘only’ being in face-to-face confrontation with patients for 22.5 hours a week. That figure is quoted so often, it must have come from somewhere. It may even be true, although I dare say that many GPs would question its application to their own working week. But if it is true, so what ? Does she really believe that personal consultations are all that GPs have to do ? That’s a rhetorical question, and it would seem the answer is ‘yes’, so let me put her right. Today’s GPs not only have a mountain of government-manufactured paperwork to complete and hoops to jump through, they also have to read, digest and act upon the results of all the pathology tests, x-rays and scans requested on their patients. Even 20 years ago, the volume of this type of work would have been much less, and what there was was much less complex: not only were there fewer patients, but the range of tests now available to GPs is much greater – many of them hadn’t even been invented in Alice’s brother-in-law’s father’s day (I can’t keep typing that – let’s just call him ‘DF’ for Dr Finlay).
  
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Age UK

• People are having to wait on average 13% longer in hospital before finding a place in a residential care home, compared to when the Government came to power, with over 1 million NHS days having been lost to people waiting for social care since 2010.
  
  Now those waiting to be transferred to a care home wait on average 30.3 days - costing the NHS £7,575 each on bed and board costs alone. An NHS bed costs on average around £2,502 a day – compared to the £5,243 average weekly cost of residential care. Those waiting for a social care package to be put together in their own home are also having to wait 12.8% longer – on average 27 days. Whilst those needing adaptations such as grab rails or ramps to be fitted in their home now wait nearly 10.4% longer spending an average of nearly 27 days in hospital on average compared to 25.8 when the Government came to power. Overall the underlying trend for days lost to delayed discharge is up by 1.5% from 1,360,230 in 2010/ 11 to a projected total of 1,381,445 for 2012/ 13. In total in 2012/ 13 nearly 36% of the total number of delayed discharge days in the last year are linked to waiting for social care provision. The total estimated cost to the NHS of delayed discharge linked to waiting for social care provision since the Government came to power is £260million – or over 1 million NHS days (1,040,193).
  
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The Guardian

• BMA warns of coalition policies failing children on a grand scale.
  
  A series of coalition policies threaten to have profoundly deleterious effects on children's lives, driving widening inequalities and sending more families into poverty, according to a scathing report by the British Medical Association. In the 250-page analysis, entitled Growing up in the UK, the BMA's board of science delivers a sustained assault on government flagship policies covering welfare and health, warning that they are likely to hit the most vulnerable patients in the NHS. The doctors' union says that, contrary to a pledge by David Cameron, "the administration's policies are unlikely to be described by health policy analysts as family-friendly". The report says that cuts to child benefit, Sure Start centre closures and regressive tax policies have already affected women and children. This has occurred, it adds, at a time when there appear alarming trends for young people in society driven by poverty and inequality. Extreme disparities include 250,000 children a year failing to meet a basic standard of good development, such as the ability to speak, recognise words and dress themselves, the BMA reports. It says it is not acceptable to fail children on such a grand scale. Even when the government has made the right noises on alcohol and cigarettes, it has drawn back from legislating for minimum pricing or plain wrapping for tobacco, the BMA notes. And where ministers have acted on healthy eating, they have done so by co-opting the fast-food industry to tackle the rise in obesity. Overconsumption of snacks, fizzy drinks and fast food has caused 20,000 children now starting school to be obese at the age of four. The BMA maintains that the government's "responsibility deal on food" has at its heart a fundamental conflict of interest. It calls for the government to pull out of deals with big business over fast food. The BMA says rising levels of poverty and inequality will place enormous pressure on the NHS, where "there are still significant numbers of children whose deaths are avoidable". Death rates from pneumonia, asthma, and meningococcal disease are higher in the UK than in comparable European countries. "If the UK had the same all-cause death rate as Sweden, around 1,900 children's lives could be saved each year," the report states. The report arrives at a time when there are fears over the gap between the number of paediatricians employed by hospitals and the number required to staff existing acute services. Doctors say that the coalition will have to take responsibility for the fallout of its policies.
  
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BBC News

• A&E must change or face collapse, NHS warned.
  
  Both the College of Emergency Medicine and Foundation Trust Network have put forward proposals to overhaul the system. Funding and staffing have been highlighted as key issues. Health Secretary Jeremy Hunt said it was "very tough out there" and ministers would deal with it by "better joining up" health and social care. The warnings come as fears grow over whether the NHS can continue to cope with rising demand. Under rules designed to encourage the system to reduce A& E admissions, hospitals are only paid 30% of the normal fee for an emergency admission when the numbers rise above the levels that were seen in 2008-9. But with the NHS failing to curb the rise in patients, that is costing some hospitals millions of pounds a year. FTN chief executive Chris Hopson said: "Unless we can change the funding structure, the A& E system is going to fall over. We simply cannot carry on." He said the last winter was "very, very difficult" although with the weather now improving there were signs the system was stabilising. But he added: "Unless we can make some really significant changes over the next six months I think it's pretty clear the system is in danger of falling over next winter." NHS England has already agreed to plough some of the money it saves through these rules back into the system to support the most troubled A& E units in the short-term. It has also ordered a review of emergency and urgent care, led by medical director Sir Bruce Keogh. The findings are expected to be published soon.
  
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HSJ

• Hospital transfer wait 'too long'.
  
  Older patients are having to wait for a month before they are transferred from hospitals to care homes, a charity has warned. Age UK said that patients wait an average of 30.3 days before finding a place in a residential care home - a rise of three days per patient since the coalition government took office three years ago. The charity said that “needless” waiting in hospitals costs the NHS around £250 per patient each day - compared to the £524 average weekly cost of residential care. Health officials are currently grappling with accident and emergency wards that are full to bursting - and part of the problem has been attributed to delays in discharging patients from hospitals. A charity spokeswoman said that a third of the “days lost” due to delayed discharge are linked to patients waiting for social care. Michelle Mitchell, charity director general of Age UK, said: “Waiting in hospital needlessly not only wastes NHS resources but it can also undermine an older person’s recovery and be profoundly upsetting for them and their families as a result.
  
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• CBI developing transparency system for private providers to NHS.
  
  Business leaders are preparing transparency guidelines for private companies running public services, amid calls for the sector to be subject to the Freedom of Information Act. The CBI, which represents business, is in the early stages of drawing up recommendations for the approach, HSJ has learned. A source at one company involved in creating the guidelines described them as an “industry version of the FOI” However, a CBI spokesman told HSJ the guidelines would “not [be] a replica of the FOI Act” The move comes as pressure grows on private companies with NHS contracts to be subject to freedom of information rules. In its March report A fair playing field for the benefit of NHS patients the NHS sector regulator Monitor called for the “government and commissioners [to] ensure that transparency, including FOI requirements, is implemented across all types of provider of NHS services on a consistent basis”. A CBI spokesman told HSJ the plans were being drawn up by the CBI’s public service strategy board, which includes representatives from leading health care outsourcing firms including Serco, Circle and Capita. CBI director of competitive markets Matthew Fell is overseeing the project. However, a spokesman for Serco suggested to HSJ the work could develop into a freedom of information system. He told HSJ: “[Chief executive of Serco UK & Europe] Jeremy Stafford is leading some work with CBI that recognises that private organisations providing public services need to be more transparent. “They are working on an industry version of FOI.” NHS hospital providers have called for private NHS providers to be subject to the FOI Act.
  
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Thursday 16th May 2013

Guardian

• Why the NHS will go out with a whimper, not a bang.
  
  The day after the new NHS "reforms" came into force, last month, I made an appointment for a minor operation. Nothing could have been easier. My GP booked the appointment at an NHS hospital online, while I sat in her office. So is it true that we won't really notice any change ? Or is this just a lull before a storm of privatisation is unleashed ? In reality neither picture is accurate. There won't be a tsunami of hospital privatisation, because operating a full range of hospital services is unprofitable. To make money out of employing large teams of highly trained staff with sophisticated medical equipment to treat high-risk patients means charging prices far beyond the reach of all but the seriously rich. Throughout Europe, as in the UK, very few private hospitals offer a full range of services. Most have fewer than 100 beds and offer diagnostics and standard low-risk surgery. Even then they don't make large profits. On the other hand, NHS hospitals are being degraded. This is the meaning of the assertion by Dr Michael Dixon, a spokesman for entrepreneurial or business-oriented GPs, that many NHS hospitals "will have to shrink or shut altogether because half their services should be provided elsewhere". By "elsewhere", Dixon means facilities run by private providers, because there are no plans to create alternative NHS-run facilities. The shrinking and closing of NHS hospitals is being driven by pressure from at least five main sources. One is NHS hospital debt, especially in hospitals with PFI deals that no responsible government should ever have sanctioned. A second is the McKinsey-inspired programme of "efficiency savings" – in reality mainly staff cuts, salary freezes and the rationing of treatments – which are reducing hospitals' capacities and performance. A third is the new regulations, which will force clinical commissioning groups to put various hospital services out to competitive tender. If hospitals lose these services, they will lose income, while being left with the costly services private companies don't see any profit in. A fourth source of pressure is patients' distrust of commercial out-of hours GP services, which is leading to an inexorable rise in demand for A& E services. A fifth, potentially far-reaching pressure, is about to come from the government's plan to introduce personal healthcare budgets. Patients with chronic, long-term illnesses (and 15.4 million people in England have at least one such illness) are to be offered an annual cash sum to spend on whatever kind of care, from whatever kind of provider, they like. To the extent that they choose to spend it "elsewhere", NHS services will be impoverished, potentially on a mass scale. (And of course, the "elsewhere" service providers, while using the NHS logo, may not prove to be so good, and may also "disappear without warning if they do not make a profit", as Southern Cross did. But by then the previous NHS services will have disappeared.) So NHS waiting times are rising again, services are shrinking and staff tempers are fraying. As all this comes into focus, the only thing stopping many middle-class people from "going private" will be the cost. But – and here is the irony – so long as everyone has the right to free NHS care, the cost of taking out private medical insurance can be comparatively modest. Last week, I asked some friends with a young family to get a quotation. The most comprehensive package they were offered cost just £2,280 a year, while the average cost of health insurance for a family in the US is £10,000 a year. One reason for the difference is the exorbitant cost of health services in the US, boosted at every stage by profits, monopolies, high transaction costs and incentives to over-treat. The full impact of such market-driven costs has still to be felt here. But another major reason is that when your insurance cover runs out in the US, that's it; whereas in the UK you can switch to NHS care. In the UK, insurance packages even offer financial incentives to switch sooner rather than later. This is a major factor keeping premiums relatively low. While that lasts, private medical insurance will look more and more attractive to the better-off. So a first-class national health service is more likely to end with a whimper than a bang. Free provision will be gradually reduced to a level that the middle class see as good enough for the poor, while still serving as an ultimate safety net for themselves. The question is whether our self-respect will allow us to meekly accept this return to Victorian values.
  
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Health Service Journal

• Serco targets Cambridge community services contract.
  
  Serco is preparing to bid for the contract to run community services in Cambridgeshire as it seeks to extend its work in that sector, the company’s director of community services Sharon Colclough has indicated. Ms Colclough, in an exclusive interview with HSJ, said it was likely to bid for services currently run by Cambridgeshire Community Services Trust, which were put out to tender last month. She also revealed the company expected to make a profit on its existing contract for all of Suffolk’s community care services, despite doubts raised by unions. Ms Colclough said Serco wanted to use its running of Suffolk Community Healthcare as a springboard to win more community services and other NHS contracts. Serco won the Suffolk contract, which began last October, after bidding £140m to run services for three years, £10m less than the well-regarded incumbent provider, North Essex Partnership Foundation Trust. Unions were outraged when Serco announced in November plans to cut 137 posts, and said it would make services unsustainable and mean patients “suffer”. However, following further consultation, managers revised cutting plans down to 90 posts, many of which will come through natural wastage. Cambridgeshire and Peterborough Clinical Commission Group began a tendering process for the Cambridge Communities Services contract last month. Tender documents said the contract would begin in April 2014.
  
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Pulse

• Competition guidance for CCGs fails to include opt-out to preserve integration.
  
  New guidance issued to commissioners on the use of competition when awarding contracts for local services to GPs does not contain the promised Government opt-out to preserve the integration of services. The guidance from NHS England, titled ‘Primary medical care functions delegated to clinical commissioning groups: Guidance’, says that if there are other providers who could bid for the service, then CCGs will have to put a contract out to full tender or any qualified provider. It makes no mention of ensuring integration of services, despite the Government’s rewrite of the section 75 regulation, that meant CCGs would be able to exempt themselves from putting services out to competition if they can demonstrate that it will undermine integration. The guidance was produced after the House of Lords rubber-stamped the controversial competition regulations last month, and a spokesperson from NHS England said they did not expect to include the opt-out in their guidance. The BMA remains extremely concerned that there is a lack of clarity in the regulations governing competition that is reflected in this guidance. This document is not explicit enough in describing when a single tender can be used or when the process should be opened up to competition.
  
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Ham & High

• Camden health campaigners to join city-wide demonstration against NHS cuts.
  
  In March, thousands joined a demonstration to save the Whittington Hospital. Camden health campaigners will be joining a citywide march to parliament on Saturday (May 18) to protest NHS cuts.Camden Keep Our NHS Public will be taking part, alongside the Save the Whittington Hospital Coalition, who have been fighting to stop the sell-off of almost one third of the hospital site in Magdala Avenue, Highgate.
  
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Pharma Times

• NHS England and Monitor consult on PbR reform.
  
  NHS England and health sector regulator Monitor have opened a consultation on proposals to reform the way NHS services are paid for. Hospitals are currently paid through the Department of Health Payment by Results (PbR) system, which has been in operation for nearly a decade and under which £29bn-worth of health care services have national prices. This represents almost one-third of all NHS spending on patient care and more than 40% of expenditures on primary care. While PbR has delivered benefits, feedback from the health sector is that the current system is not sufficiently patient-focused, not always based on good-quality information and that it can act as a barrier to delivering integrated care, say NHS England and Monitor. A prominent concern is that in the main, PbR still pays for activities, not patient outcomes, yet there are few types of care in which paying for activities is sufficient to encourage the best patient outcomes, they note. Also, operating separate payment approaches within the health sector and across health and social care is often cited as a barrier to delivering integrated care, while PbR prices are not always based on good information on cost and quality. In particular, the lack of patient-level data on quality limits national understanding of what represents good outcomes for patients. And, faced with patchy information and sometimes inappropriate incentives, some providers and commissioners are opting to negotiate local contract terms. Flexibility is permitted under PbR if it supports innovation, service redesign or the treatment of an unusual mix of patients, but if commissioners and providers agree local prices without clear rules to follow, the quality and sustainability of care may be put at risk, the organisations warn. Moreover, the annual cycle of new prices and new contracts for many NHS services inhibits longer-term planning, potentially constraining innovative investment and decisions on reconfiguring services. Users also complain that cost and coding lags put PbR prices a step behind clinical practice, which can also stifle innovation, they add.
  
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Daily Mail

• Whistleblowers 'still barred in foundation trusts' according to head of NHS despite pledge to help staff speak out.
  
  Vast numbers of NHS staff may still be prevented from acting as whistleblowers, the head of the NHS Sir David Nicholson has privately admitted. Sir David, who refused to stand down over the scandal at Stafford Hospital, claimed he would personally help staff expose abuses. But doctors have described his pledge as a sham after a letter emerged, written days later, in which he tells an NHS employee he cannot help them speak out because a ‘legal process’ had concluded foundation trusts are ‘separate legal bodies’ from the Department of Health. The letter, seen by Channel 4 News, suggests vast number of NHS staff are therefore not covered by this duty of candour. Dr Wilmshurst and other whistleblowers called for an independent system so the doctor or nurse is not being 'tried' by the very people wanting to get rid of them. NHS England said: ‘Sir David has always been clear he would intervene where he believed individuals were being stopped from whistleblowing. Sir David though does not, and has not had, the power to direct NHS Foundation Trusts. However, when contacted directly by individuals who are raising issues of concern relating to Foundation Trusts Sir David has raised these with Monitor and CQC where appropriate.’
  
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Tuesday 14th May 2013

BBC News

• Wales NHS: Abandon south Wales A&E shake-up, say Conservatives.
  
  There are calls for a major shake up of accident and emergency services in south Wales to be abandoned due to the crisis in demand. The Conservatives said it would be "unacceptable" due to to increased pressure at casualty units. The NHS is due to announce a cut in number of specialist A& E departments in south Wales from seven to four or five. Officials say the current range of services can no longer be provided safely at all hospitals. They say the planned changes, due to be unveiled this month, will result in the most seriously ill patients seeing consultants more quickly, although they may have to travel further.
  
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• NHS changes and privatisation claims: Gerada and Skidmore.
  
  Conservative Chris Skidmore, who serves on the health select committee, said there had been "a lot of scaremongering" over claims of privatisation of the NHS in England. He said the "NHS was still there", despite suggestions that the service was under threat. But Claire Gerada, chair of the Royal College of GPs, said profits made by the private companies undertaking health work would "not go back into the state, they will go to shareholders". And she claimed that "competition and markets increase costs" as the pair debated health services after watching a Daily Politics film.
  
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Liverpool Daily Post

• Campaigners urge bosses not to use PFI to build new Royal Liverpool Hospital.
  
  Campaigners are urging NHS managers to ditch plans to fund part of the new Royal Liverpool Hospital using private finance. Sam Semoff and other members of Keep Our NHS Public will lobby the trust at an public meeting about the new build at the FACT arts centre. Retired researcher Mr Semoff says there are alternatives to borrowing through the Private Finance Initiative (PFI), such as the government giving more cash to fund the rebuild. He said: “The thing that concerns me about PFI is that it takes money out of the health service budget. And paying off that PFI debt takes precedence when it comes to the trust’s finances.” The total cost of the hospital project, including new build, landscaping, demolition and other associated costs is £429m, with £211m of that being met through private finance. The trust is seeking to fund the majority of that borrowed money from the European Investment Bank to bring interest rates down. And management have reassured the public that the private repayments will be less than 6% of their annual budget.
  
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Batley and Birstall News

• I agree with MP’s call for CCG head to quit.
  
  Geoff Halliday of Left Unity writes in a letter: It appears that the chair of North Kirklees CCG, Dr David Kelly, cares little for the NHS as an institution. Your article (MP calls on CCG boss to quit leadership role, May 2, 2013) appears to show he is fully comfortable with the privatisation of the NHS. He is content that the NHS brand will continue; why wouldn’t it ? The private sector knows the value of brands, and private health firms will be delighted that they can exploit the NHS “brand” and “market”. It is also interesting to read Dr Kelly’s claim that he said, “when NHS services cease to be free to patients, I will resign.” Whilst he says this is a long way off, he doesn’t say “if” he says “when”. I think he reveals much of the intended consequences of the Health Bill; transformation to a market system of healthcare, with free basic services perhaps surviving only in the short term. Whilst I didn’t attend the 38 Degrees meeting, nor was a witness to his interactions with Mike Wood MP, I wholeheartedly support the call for him to quit. Someone with a leadership role in the NHS should not support the destruction of its founding principles.
  
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Health Service Journal

• Exclusive: Capita challenges NHS Choices 'insourcing'.
  
  Capita is in talks with the Department for Health over government plans to axe its NHS Choices contract, HSJ has learned. The government decided earlier this year to temporarily transfer the running of the NHS Choices website to the Health and Social Care Information Centre. The move came after the Cabinet Office ordered the DH not to grant Capita any further extension to its existing contract for the service, as had previously been an option. Board papers discussed at the information centre’s April board meeting confirmed the government planned to press ahead with the temporary nationalisation. However, HSJ has learned that Capita, the outsourcing firm, has taken “precautionary steps” in relation to the contract, and has since begun talks with the DH and NHS England about its future role in running the website. There is no suggestion the decision not to extend Capita’s contract is related to performance on NHS Choices. In a statement to HSJ, Capita said it had taken “reasonable precautionary steps to protect its position [but] following positive engagement between all parties this precautionary process has been suspended”. HSJ revealed the plans to transfer the running of NHS Choices to the arm’s length body in February. Under the plan, around 140 staff were set to be transferred to the information centre. The NHS Information Centre board papers said this process has already begun but HSJ understands staff are still employed by Capita. Capita took over running Choices in November 2008 on a three-year contract worth £60m with an option to extend for a further two years, which would have finished in November 2013. Both the DH and Cabinet Office declined to comment on the talks or when a final decision would be made.
  
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Daily Mail

• The out of hours doctors on £1,350 a shift: Firm who left sole nurse in charge of 250,000 patients offers bumper pay packet for evening and weekend work.
  
  GPs are being paid £1,350 a shift to work for Britain’s biggest out-of-hours care provider. Documents reveal Harmoni has been offering doctors £150 an hour for a nine-hour shift because managers are so desperate to cover evenings and weekends. They are also offering GPs a £1,000 bonus for referring a friend to work for the service. The shocking revelation comes a day after the Mail told how in one county, Harmoni was using just one advanced nurse practitioner to cover up to 250,000 patients overnight. But despite mounting concern about out-of-hours care, the Health Secretary insisted family doctors should still not be forced to work outside normal office hours.Under Labour’s 2004 renegotiation of their contracts, GPs were allowed to hand responsibility for out-of-hours care to private firms such as Harmoni. But many GPs refuse to work for Harmoni, which has contracts in London, the South East, the Midlands and the West Country, because they are unhappy about care standards. Unless managers offer what are described as ‘market rates’, rotas would not be filled. The documents seen by the Mail include an email from a senior manager working for Harmoni which reveals how doctors have been offered bonuses for referring a friend. The memo, sent last year, reads: ‘I would remind you that there remains a £1,000 bonus fee for staff who successfully introduce a colleague to the service.’ As Harmoni and the other firms are paid by the NHS to provide out-of-hours care, this money effectively comes from the taxpayer. The documents also include desperate emails sent by managers to GPs begging them to work shifts that start in just two hours. There is concern that out-of-hours care is so poor that an extra four million patients are flooding A& E units each year because they have nowhere else to go. The Mail published a series of allegations from a whistleblower, a GP who has worked for Harmoni in Somerset, which included claims that terminally ill cancer sufferers were being made to wait eight hours for pain relief. He also revealed how the firm was using advanced nurse practitioners to cover districts of up to 150 square miles when GPs could not be found.
  
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New Statesman

• Labour MP submits Queen's Speech amendment on NHS privatisation.
  
  John Mann respectfully regrets that "a bill to call a referendum on reversing NHS privatisation was not included in the Gracious Speech". Inspired by the Tory EU rebels, the pugnacious Labour MP John Mann has submitted his own amendment to the Queen's Speech. The amendment is identical in wording to the Tories' but substitutes the words "EU referendum" for "a referendum on reversing NHS privatisation"
  
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Metro

• 30,000 frustrated callers hang up on NHS 111 advice line.
  
  Nearly 30,000 callers to the NHS advice line hung up in frustration after ringing the number for help. The amount of times patients abandoned calls after ringing the 111 service and waiting more than 30 seconds increased from 6,976 in February to 29,100 in March, according to the NHS. But by contrast, the average call length has also risen, from 14.19 minutes in February to almost 18 minutes in March, and the number of calls to the line increased by more than 500,000 in the same time frame. NHS England insisted the majority of 111 services were meeting ‘performance standards’. However, a spokesman did acknowledge there were some areas, particularly at weekends, which were struggling. The Royal College of General Practitioners said patients had ‘lost confidence’ in the new non-emergency number before it was even ready to go live across the country. The service was due to be rolled out on April 1 but officials relaxed the deadline after it emerged many of the advice lines, which are run by 44 local bodies across the country, were not up to the task. People have been complaining about calls going unanswered and poor advice being given, especially at weekends, which has led to hospitals having to deal with an influx of patients.
  
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Daily Telegraph

• Minister: NHS will collapse if elderly bed blocking continues.
  
  The NHS will collapse without decisive action to get more elderly people out of hospitals, Norman Lamb, the health minister, has warned. Mr Lamb, the care minister, said Britain's system of health and social care is becoming “dysfunctional” and could “buckle under the pressure” unless radical changes are made to the way it operates. He issued his warning amid growing concern that Accident & Emergency (A& E) departments and ambulance services are failing to cope, with rising numbers of patients forced to endure long waits. Last week one of Britain's most senior A& E doctors said units had begun to feel like “war zones” while the head of the NHS and social care watchdog said such services were “out of control”. Ministers will announce plans which aim to improve co-ordination between NHS services and councils, and to stop elderly people being stuck in hospital because of a failure to organise care by home-helps, or basic adaptations which would allow them to return home. Regulators have also announced a review of the NHS funding system which currently means that hospitals are paid to keep patients in hospital rather than discharging them to their homes or to care homes.
  
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Friday 10th May 2013

The Guardian

• The ABC of healthcare: access, behaviour and clinical governance.
  
  The current direction of travel for healthcare and the health service is unclear, despite the fact that CCGs have come into operation, Health Education England has taken over Strategic Health Authorities' responsibilities for education and training, and Public Health England is established. I believe that the basic requirements from healthcare remain the same. I will call this the ABC of healthcare. In a system of universal healthcare that everyone should have equal access to, the founding principle of the NHS should always remain its cornerstone feature. Continuing austerity measures are having a negative impact on access, however. With the onset of clinical-led commissioning, this is also changing the relationship between doctors and their patients. GPs are being forced to act as double agents commissioning services on one hand and keeping costs down, while trying to act in the best interests of their patients. Doctors and other healthcare staff need to understand the best way to engage with our patients – empathy, understanding and respect are always paramount. While meaning well we believe that the Francis report and the proposed criminal liability misses the point that there needs to be a complementary duty on employers and others to listen and protect staff when they do speak out. Doctors believe that disclosing mistakes would increase trust in the profession but this would come at the expense of more defensive practice, increased litigation and a worsening effect on medical regulation. The NHS must strive to improve the quality of services and standards and must be accountable. There will be new ways of monitoring and measuring quality with three outcome frameworks, CCG outcome indicators and friends and family tests all along with new target cultures aimed at maintaining quality and standards.Related to clinical governance are the many tiers of workforce issues. One of the biggest challenges for the health service is to attract, train and retain the right talent. Investment in training should continue through medical school, for junior doctors, and beyond this.
  
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London Evening Standard

• Controversy over new Tory health advisor Nick Seddon who called for NHS cuts and charges for GP visits.
  
  David Cameron’s No 10 policy shake-up hit new controversy today when it emerged his new health adviser had advocated deep NHS cuts and even charges to see a family doctor. Nick Seddon was hired from the right-leaning think tank Reform to advise the Prime Minister on health and social care as part of the new team led by Boris Johnson’s brother, Jo Johnson. But Labour said Mr Seddon had “little brief” in the traditional NHS model because he had called for frontline staff cuts, budget reductions and charges to patients. Last July he was quoted by the BBC as saying there was international evidence that charging patients for services such as seeing a GP could be extremely effective. In a 2010 article, he said 150,000 NHS jobs should be axed and criticised Mr Cameron’s promise to raise spending higher. “Oddly, however, the coalition has promised to increase spending on the biggest departmental budget – the NHS – when they should be seeking to decrease state spending in this area,” he wrote. He dismissed cuts in NHS administration as having only a “minor impact”, implying that savings should come from the frontline. “Achieving this will require removing the moratorium on hospital closures – reform has calculated that as many as 32,000 hospital beds should be closed – and reducing the NHS headcount by at least 150,000 jobs.” In a 2010 article he argued for healthcare to be “largely funded by government ... but organised outside of government, by insurance companies and other organisations, answering only to patients.” Before joining Reform, Mr Seddon worked at private health company Circle, which runs the first NHS hospital to be privately managed.
  
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Thursday 9th May 2013

Newmarket Journal

• Cash for op: have your say.
  
  Newmarket’s mayor, Cllr George Lambton, has invited residents to publicly have their say on the row that has blown up over the town council’s decision to spend around £7,000 of public money on a private operation for a key member of the council’s staff. The cash was spent on specialist surgery for a painful neck condition for town clerk, Isabelle Barrett, who has been absent from her post at the memorial hall for months on doctors’ orders. “Council members took this decision because they believed that it was in the best interests of the council in order to ensure that the member of staff returned to work as soon as possible,” said Cllr Lambton. “This was a difficult decision for councillors to make but one that was supported by the great majority, save those who are ideologically and legitimately opposed to the use of private health care as an alternative to the treatment offered by the NHS. I would like to encourage anyone who would like to debate the matter further, to come to our annual town meeting.”
  
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Bromsgrove Standard

• Cash row may see services cut.
  
  Hospital services may have to be reduced if bosses lose a financial dispute with their NHS paymasters. Worcestershire Acute Hospitals NHS Trust has yet to agree a contract with commissioners for the current financial year and had set a deadline for the end of April for a deal to be done. It was expected if no agreement had been reached, senior NHS officials would be called in to make a decision. The dispute revolves around plans by doctors to cut emergency admissions at the Alex and Worcestershire Royal by about 6% by treating more people in the community. The Trust say that would result in a loss of almost £8m - equivalent to closing seven wards. Although hospital bosses say schemes introduced by commissioners to reduce admissions are working they are wary of a repeat of last year when they were told admissions would fall but they ended up over 7% higher than planned. There is also a sticking point over £10m of funding made up of some transitional support the Trust needs to continue to operate until the reconfiguration of hospital services is resolved - including the £2.5m agreed for keeping maternity and paediatric services at the Alex five years ago - and other items that Chris Tidman, the Trust’s director of resources, said some trusts were paid for and they were not. He added if the arbitration ruled against them it potentially would mean changes to some services but the details had not been discussed. Simon Hairsnape, chief officer for Redditch and Bromsgrove CCG, said they acknowledged the Trust needed the £10m of transitional support but it was a question of who would pay for it as the money which would previously have been allocated to the PCT had now been divided between the three CCGs, NHS England and Worcestershire County Council.
  
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Get Bracknell

• Campaigners march in protest at service cuts at Heatherwood Hospital.
  
  Campaigners protested against the closure of three services at Heatherwood Hospital. The group marched along High Street, Ascot, to the hospital on Saturday, May 4, to oppose the decision to close the Ascot Birth Centre, stroke ward and Minor Injuries Unit. Terry Pearce, of campaign group Defend Our Community Services, said: “We marched on behalf of the 25,000 people that opposed NHS Berkshire East PCT’s plans to close services at Heatherwood Hospital. We will fight on until the voice of our community is listened to.” The services are due to close in the next year. However, Frimley Park Hospital NHS Foundation Trust’s board will look into the possibility of consolidating with Heatherwood and Wexham Park Hospitals NHS Foundation Trust. The board will now start work on a detailed business case before discussing its plans with Monitor, which regulates foundation trusts, and the Department of Health.
  
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Health Service Journal

• Junior doctors 'unaware' on reforms.
  
  Junior doctors have poor knowledge about health politics and NHS reforms, research suggests. A new poll of training medics found that 17.7% could not name Jeremy Hunt as the health secretary. Almost a third of those questioned admitted they had poor understanding of the changes to the health service. And 71.6% did not know that following the rollout of the Health April 1, clinical commissioning groups around England are responsible for the provision of healthcare services. “Basic understanding of health politics and NHS reforms was poor, even on issues affecting future training,” the authors said. Researcher Stefano Palazzo, from Chelsea and Westminster Hospital, said: “Most worryingly, almost three-quarters of foundation doctors surveyed were unaware of significant changes that could affect their own training, namely that deaneries will no longer be responsible for co-ordinating education. The NHS is changing, and arguably some of those who will be most affected by these changes are current junior doctors. Although foundation year trainees are interested and concerned by NHS reforms, understanding of them is poor and few seem to be motivated to address this. Given foundation year doctors will be implementing current health policy, and arguably forming the policy of the future, it is essential to engage this population. It may be that improving health politics education - whether through formal teaching sessions for junior doctors or integration into medical student training - will be the only way in which this may occur.”
  
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Staffordshire Sentinel

• North Staffordshire's NHS eye patients to receive private care.
  
  Around 2,000 extra patients with an eye illness are to have their appointments transferred to a private company and paid for by the NHS. The move is to bypass long hold-ups at the University Hospital of North Staffordshire (UHNS).
  The patients with glaucoma will be sent to Cobridge Primary Care Centre and St Jude's Hospital in Basford where they will be treated by consultants from the Birmingham-based Midland Eye Institute. Patients have been referred to the company since January after UHNS was so overwhelmed with work it had to close to new cases. To date more than 100 people have been affected. But from this month, 2,000 stable glaucoma patients needing follow-up consultations will also be moved to the Institute for the free service. The work – costing an estimated six-figure sum – is being paid for by the area's two clinical commissioning groups (CCGs) which now fund the NHS in North Staffordshire. Patients who have been waiting longest for an appointment at UHNS will not have their cases switched to the private firm and checks have been done to ensure their condition is not made worse by the delays. But those whose follow-ups were due in April can expect to be switched to the new venues in the next few weeks. The CCGs are also this month inviting tenders for a new three-year community contract for eye care. It is due to start next January. Meanwhile, senior eye specialists and managers at UHNS are drawing up plans to try to re-open its own eye clinics to new cases.
  
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Daily Telegraph

• Queen's Speech: Crackdown on free access to NHS will not be law until mid-2014.
  
  A crackdown on migrants accessing free health services is rapidly unravelling as it was criticised by doctors and ministers were unable to provide details of how it would work. The Prime Minister David Cameron announced earlier this year that migrants would have their access to the health service restricted to try to dissuade foreigners from coming to live here. However it emerged that the changes – which formed the centrepiece of the Queen’s speech - were only likely to affect certain parts of the health service, and would not stop migrants being treated in accident and emergency units. Health secretary Jeremy Hunt was unable to say how the changes would work while Downing Street sources said they were unlikely to be law until the middle of next year because of a long official consultation period. The plans were immediately criticised by doctors and senior Liberal Democrats. The Royal College of General Practitioners warned against the danger of turning GPs into a form of immigration control. The college’s chairman Dr Clare Gerada said: “GPs must not be a new 'border agency' in policing access to the NHS. General Practice must remain the main access to health care within the NHS. GPs have a duty of care to all people seeking healthcare, and should not be expected to police access to healthcare and turn people away when they are at their most vulnerable. It is important to protect individuals and public health.” Jeremy Hunt struggled to explain how the crackdown would work when he was pressed on the BBC Radio Four’s Today programme. One idea being considered in Number 10 is for migrants to be asked to prove they have private health insurance before they get a visa, or even be asked to pay a fee, before being allocated an NHS number.
  
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Guardian

• Pressure on A&E departments is out of control, warns NHS regulator.
  
  Pressure on A& E departments is out of control and unsustainable, the NHS regulator has warned. David Prior, chairman of the Care Quality Commission (CQC), said there should be widespread closures of hospital beds and investment in community care to tackle the increasing burden on emergency care. Prior said far too many patients were arriving at hospital as emergency cases, a problem that could be averted by earlier intervention through care in the community. This has put such pressure on the healthcare system that it is on the brink of collapse, he said – meaning regulators cannot guarantee there will never be another care disaster such as that in Mid Staffordshire. Speaking at a conference hosted by the health thinktank the King's Fund, Prior said: "If we don't start closing acute beds, the system is going to fall over. Emergency admissions through accident and emergency are out of control in large parts of the country … That is totally unsustainable." Prior, who was brought in to lead the CQC in January after it faced criticism for failing to protect vulnerable patients, said almost half of hospitals were now providing care which was either poor, or "not terribly" good. Prior partly blamed the problem on a lack of a market in healthcare, leaving patients with little choice but their local hospital, regardless of its quality.
  
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Tuesday 7th May 2013

Tiverton People

• Staffing shortages force hospital unit closure.
  
  The Minor Injuries Unit at Tiverton Hospital closed overnight once again on Friday because of staffing shortages. The unit shut from 10pm on Friday night and reopened at 7.30am on Saturday morning. It is the latest in a long line of closures which have resulted in criticism of Northern Devon NHS Trust, which runs the unit.
  
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Financial Times

• Virgin Care expands in prison healthcare.
  
  Virgin Care, part of Sir Richard Branson’s business empire, has expanded its presence in UK prisons, as more NHS trusts seek to hand the provision of key services to the private sector. The privately owned company has won its fifth deal to run prison healthcare services at HMP Bullingdon, near Bicester in Oxfordshire. The contract, which will be announced this week, is worth £6.6m over three years, with an option for a two-year extension.
  
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• Private providers attack pace of closure of NHS walk-in clinics.
  
  National Health Service walk-in clinics, most of which are run by companies including Virgin Care and Care UK, are being closed at a rate that is putting pressure on hospital accident and emergency departments, private healthcare providers have claimed. Drop-in GP clinics – which do not require patients to be registered or make an appointment – were pioneered just over a decade ago under the last Labour government. They were intended to relieve pressure on already stretched NHS accident and emergency services by operating longer opening hours than traditional GP surgeries – often from 8am to 8pm – to fit in with busy commuter schedules. But with healthcare trusts facing budget cuts, walk-in clinics are being threatened with closure – a process that the NHS Partners Network, which represents private sector healthcare providers, said has accelerated since the start of the year. The future of the clinics has been made more uncertain by the transfer of NHS budgets to new clinical commissioning groups since April 1, the providers added.
  
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Guardian

• Social care should have £2bn share of NHS budget, says MP.
  
  At least £2bn of the NHS budget should be used to meet the costs of social care for older people in a move that it is claimed would ultimately save the health service money, according to an influential backbench Tory MP. Heather Wheeler, a member of the Conservative 1992 backbench committee and chair of the all-party group on local government, warns that the scale of the challenge facing councils in providing social care means the NHS budget must be re-examined to meet the current funding gap for social care. The shortfall is set to rise as the population ages. Her call comes ahead of the Queen's speech in which the coalition will lay out its plans to address the boundary between NHS acute care and local government-funded means-tested social care in a care and social support bill. The new legislation is also designed to show that the Conservatives are listening to disaffected voters who strayed to Ukip in the local elections. It will contain populist measures to limit benefits to some immigrants with a particular focus on placing restrictions on access to the NHS. On social care, Wheeler said that taking money from the health budget would reduce the need for costly medical interventions – and that there would be cross-party support for the measure.
  
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Monday 6th May 2013

The Morning Star

• Labour inaction hinders grassroots fightback.
  
  The shameful passage of the Section 75 regulations that give real teeth to the Health & Social Care Act through the House of Lords last week completed the Tory strategy to break up and carve up the NHS, offering profitable slices to private bids. The complicity of the Lib Dem peers no longer comes as any surprise after they have so tamely nodded through the rest of the legal framework hatched by their Tory masters. But the limp display by Labour, delivering just over half its potential vote in a three-line whip, and passively watching as Lord Warner broke ranks to declare his interest and then speak and vote in support of the Tory regulations, underlines the scale of the political problem we face in the ongoing fight to limit the damage. So as the pincer teeth of the new Act have snapped tight together, it's no coincidence that accident and emergency departments up and down the country are swamped with emergency admissions, many with long lines of ambulances waiting outside trying to discharge patients for whom there are no beds or services available. The situation has of course been compounded by the utterly predictable fiasco of the privately provided 111 service, which far from relieving pressure on emergency services has been sending vital ambulances on costly wild goose chases, and further increased the queues for care in overloaded hospitals. And it's no coincidence that, even as this chaos develops, ministers and stooge "think tanks" like the King's Fund keep up a litany of calls for more A& E units, beds and hospitals to be closed, "centralised" or "reconfigured" - with full-scale plans for cutbacks in many areas. This has continued even though the new clinical commissioning groups, expected to pick up the enforcement of cash limits where the primary care trusts left off, lack any funds, plans or real commitment to put in place any of the promised alternative services "in the community" to replace the axed hospital care. To make matters worse another £1 billion is to be snatched from the NHS budget and handed to local government towards the minimal provision of social care, which is now increasingly available only to those with the most extreme needs. These services are increasingly being replaced by personal payments that dump the responsibility for finding and organising care onto individuals and their families, who are also expected to pay up to cover any excess costs. It's no surprise that with the pressures on emergency services, waiting times in A& E are up. But we can also be sure that ministers will be quick to exploit every weakness in performance as they embark on a sustained effort to discredit the NHS.
  
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The Guardian

• So you think the fight for the NHS is over? Wrong.
  
  Yes, the act's passed. But most staff were against the marketisation of the health service, and they're still out there running it. On the afternoon of 24 April in London, a meeting took place under the title Citizens and CCGs: Exploring our Future. What was the purpose of this meeting ? Which citizens, whose future, and what do CCGs do again, anyway ? They are groups of GPs charged by the Health and Social Care Act with commissioning the medical services they decide their patients need. The room was mainly health professionals and the staff of 38 Degrees, the group that lobbied so hard against the act. The panel (I was chairing) comprised one member of a CCG, Dr David Wrigley; the leader of the Medical Practitioners' Union (in Unite), Dr Ron Singer; Dr Louise Irving, newly elected to the BMA council; and Roy Lilley, a founding member of the NHS Trust Federation (who told a droll story of his days running a hospital: if they ever needed to close a ward because they couldn't afford it, local councillors always objected. But they couldn't object to decorating the wards, so they'd just stick a bucket of paint in it and say it was closed for renovation). Anyway, you're a patient; let's imagine you were against this act. What do you do ? Wrigley mentioned the health and wellbeing boards, which will have a statutory role from next April. They mainly comprise workers from within the health service, social services and third sector, but it's mandated that they should have one locally elected representative – it doesn't say they can't have two, or 10. Of course there will be frustrations, intransigent bureaucrats, privatising zealots, people whose power simply exceeds that of the "community". But in many areas the clinical commissioners will be receptive to community concerns. They'll have opposed the bill themselves in the first place. So this is a bad time to shut up and go home, either literally or virtually. All this apparatus will be designed as we go along, and it won't be designed by people who have left the conversation. What else can we do, between us ? We can club together to get legal support for CCGs, so if they want to award contracts to NHS providers rather than private companies their decisions will be "judicial review-proof" (if you want to get so angry that you put out your other eye, consider that Virgin – or rather, Assura Medical, in which it has a 75% stake – lodged a complaint before the act was even passed against York Hospitals for "predatory pricing". Because they weren't trying to make a profit, they were just trying to treat people who were ill – so it wasn't fair on the private companies tendering for the business).
  
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• Health minister threatened with ejection from royal college.
  
  A health minister is facing the humiliation of being ousted from a prestigious role within the Royal College of Physicians over claims that he falsely reassured doctors who feared the coalition would privatise of the NHS. Earl Howe's position on an advisory committee is being reviewed following a complaint. Six influential members of the professional body that represents doctors wrote to its president, Sir Richard Thompson, claiming that the minister was "not a fit person to fulfil this important role". Thompson has launched an investigation by the College's trustees into Howe's probity. The senior doctors claim that Howe, a former banker, falsely advised them that reforms under the health and social care bill would not force doctors to use market mechanisms to choose where patients will be treated. According to the doctors, the regulations will mean that clinical commissioning groups – the bodies to be set up by GPs to organise patients' care – will have to put services out to tender if there is more than one provider capable of offering particular treatments. This means NHS hospitals and services will have to compete with private health firms for business. Andy Burnham, the shadow health secretary, said there had been a breakdown in trust between health professionals and government, adding: "This whole issue has become a crisis of trust for the department of health. There would be a straight forward breach of trust given that statements ministers have given have not been honoured. "The medical profession feels the government has mis-sold its NHS reforms. It was sold on the principle that doctors would be in control but in fact it will be the market that will decide." A spokeswoman confirmed that Thompson, and "in the interest of probity", had "referred the issue to the board of trustees and would report back in June".
  
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Thursday 2nd May 2013

Health Insurance and Protection Magazine

• Cambridge trust to develop private hospital complex.
  
  Cambridge University Hospitals partners with John Laing Investments for project NHS trust Cambridge University Hospitals (CUH) has partnered with an investment firm to develop a complex which includes a private hospital and hotel and will be the first of its kind in the NHS. The funding for the £120m project – named the Forum – will be arranged entirely by John Laing, with no public capital spent on it. John Laing is a specialist investor in, and manager of, public sector infrastructure assets. The complex will be sited on the Cambridge Biomedical Campus and comprises a new post-graduate medical education centre, a hotel and conference centre, and a private hospital, which is to be run by Ramsay Health Care UK. There will also be a new car park, shops and restaurants on the site, which is set to employ more than 500 people once completed. CUH will receive an annual income and a share of the profits over the life of the contract, with all of this money set to go towards supporting patient care at Addenbrooke’s and the Rosie hospitals. Following signing of contracts in the summer, building work is planned to start in spring 2014 and be completed in time for a formal opening in summer 2016. CUH will grant a long-term lease on the land it owns but will retain the freehold.
  
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Shropshire Star

• Ex-Shropshire woman is refused NHS birth after flying from Canada.
  
  A heavily pregnant former Shropshire woman was forced to make a 7,000 mile round trip across the Atlantic after she was denied free NHS treatment – despite being told four times she would be eligible for free maternity care, it has been claimed. Rachael Hicken, 36, grew up in Westbury, near Shrewsbury, and moved to Canada six years ago to be with her partner Mile Reinke. She decided to return to her hometown to be near her family for the birth of her first child. And before flying from Prince Edward Island to Shropshire, she asked her mother, Jenny Brookes, to check that she would be eligible for free NHS care. Mrs Brookes claims she called Her Majesty’s Revenue & Customs National Insurance hotline on four occasions and was told that, as a British citizen, Rachael was entitled to free NHS optical, dental and medical care. But when Rachael arrived last month and visited her GP she was told she would have to pay to give birth in the UK – and that any complications could lead to a medical bill costing tens of thousands of pounds. Rachael is now safely back in Canada and has given birth to a baby boy by Caesarean section – but her mother said the ordeal has left her ‘extremely angry’ and ‘extremely hurt’ by the system. Nobody from the HMRC was available to comment.
  
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Blackpool Gazette

• Could NHS be sold off to private sector?
  
  Since June 2009 the NHS in the UK has been told it must find ‘efficiency savings’ of £20bn. The original edict came from Sir David Nicholson, then chief executive of the NHS and now head of the all-powerful ‘NHS England’ quango. Since that time no politician has been able to properly explain why these cuts are needed, and I mean proper evidence based reasoning similar to that which a doctor would demand before prescribing some medication to their patient. Politicians have given many reasons for these cuts but they never stand up to scrutiny. The impact will dramatically affect patients and their illnesses so it is vital we hold politicians to account for their constant mantra of the need to make ‘efficiency savings’ with the NHS budget. I believe these cuts are being used to degrade the service in order to allow many more private companies to move in, in a similar way that the British railway system didn’t have the investment it required in the ‘80s and ‘90s so the service inevitably worsened due to the disinvestment and the politicians could then say ‘look how bad the railways are - we will have to move the private sector in to save it’. This year we see the madness of the tax payer owned and highly profitable East Coast Rail service being sold off to the private sector thereby losing all that profit to the City that we could have reinvested into making the rail network even better. The Tory led coalition has also pushed through legislation to ease the sale of NHS services to the private sector. Remember in 2010 after many years of Labour investing in the NHS it had the lowest ever waiting times and highest ever satisfaction ratings, an amazing achievement when you consider how much less we spend on healthcare compared to many other countries.
  
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North West Evening Mail

• NHS cuts ‘hidden by Prime Minister David Cameron’ - West Cumbria MP.
  
  HOSPITALS are missing targets and health services are “at risk” in the hands of the current government, a Cumbria MP has warned. Copeland MP and shadow health minister, Jamie Reed has revealed new data relating to the performance of the hospital trusts serving Cumbria: North Cumbria University Hospitals NHS Trust and the University Hospitals of Morecambe Bay NHS Foundation Hospitals Trust. He said: “David Cameron’s plans for the NHS were deliberately hidden from the public before the last general election. Since then, in addition to cutting NHS budgets, he has spent over £3.5bn on an NHS reorganization that nobody voted for. This money was taken from front line NHS services and this, combined with almost 5,000 nurses being made redundant has seriously reduced the performance of the NHS around the country. The safe level of hospital bed occupancy is 85 per cent, yet information compiled by the Department of Health shows that hospitals across the country are operating at unsafe levels and putting patients at risk. Data is published for 159 hospital trusts in England and every single one of these has operated at above 85 per cent occupancy over recent months. Of these, 146 trusts operated at an average rate of over 85 per cent occupancy and more than half of all trusts operated at an average rate of over 95 per cent occupancy.”
  
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BBC News

• NHS 111 advice line 'still fragile'.
  
  The new NHS non-emergency 111 telephone service in England is in a fragile state in a number of areas ahead of bank holiday weekend, NHS bosses admit. Reports have been emerging for weeks of calls going unanswered and poor advice being given, leading to hospitals being inundated with patients. A board paper produced by NHS England says some of the problems have been "unacceptable" and, despite improvements, the system still remains in a "fragile" state in places.
  
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Tuesday 30th April 2013

Health Service Journal

• Cambridge Hospitals reveals partners for £120m private hospital and hotel complex.
  
  Commerce, one of England’s largest hospital trusts is to team up with an infrastructure investor and a private health provider to develop a £120m private hospital and hotel complex, it has announced. Cambridge University Hospitals Foundation Trust has selected infrastructure giant John Laing as its preferred partner to deliver the complex which it has called the Forum and will be the first of its kind in the NHS. In addition to the private hospital – which will be run by Ramsay Health Care UK – and the hotel, the complex will also have a new car park, shops and restaurants. The trust will receive an annual income and a share of the profits, which it said would invest directly into its main hospitals, which include Addenbrookes in Cambridge. John Laing has selected Ramsay to run the private hospital when it is built. Cambridge University Hospitals chief executive Keith McNeil said: “One of the great advantages of this project is that it won’t cost the taxpayer a penny, and a share of the profits will be ploughed directly back into the hospitals to benefit all the patients we look after here.”
  
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Waltham Forest Guardian

• MP set to speak at Waltham Forest meeting hailing 'threat of private companies dominating NHS'.
  
  An MP and a doctor are two people set to speak out at a meeting against changes to the NHS where services are put out to tender. Leyton and Wanstead MP John Cryer and GP Kambiz Boomla will talk at a public meeting aiming to rally opposition to government reforms which saw primary care trusts become abolished in April in favour of clinical commissioning groups, which seek best value by contracting private companies to provide healthcare services. Jim Fagan, of the We Are Waltham Forest – Saving Our NHS campaign group, said: “The new Waltham Forest Clinical Commissioning Group is being forced to put health care contracts out to competitive tender, so that big business will be in the driving seat. The NHS could be squeezed out of existence by companies like Virgin and Serco.”
  
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This is Cornwall

• Private firms win two more NHS contracts.
  
  Unions have lamented a "sad day for the NHS" after contracts to run two parts of the health service were handed to the private sector. In one announcement, NSL, a company behind on-street parking and enforcement across the UK, was earmarked as taking over non-urgent patient transport services in most of Devon and Cornwall from South Western Ambulance. In a second development, private firm Peninsula Community Health – which operates cottage hospitals in Cornwall – Cornwall Partnership NHS Foundation Trust and Cornwall Council, confirmed a contract for back-room office functions had been signed with BT. Stuart Roden, a regional organiser for Unison, said he was deeply disappointed by the decisions.
  "In my view this is a bad day for the NHS," he said. Mr Roden said staff were deeply worried about their future job security. NSL, which used to be part of the car parking giant NCP, will take over routine patient transport from the South Western Ambulance Service, part of the NHS family which will retain responsibility for 999 services. The company will begin operations in October, except in Plymouth and South Devon, after being awarded the five-year contract. Kernow Clinical Commission Group, the GP-led organisation which took over buying healthcare from the now defunct primary care trusts on April 1, said the decision had been made by its predecessor. Meanwhile Peninsula Community Health (PCH) and Cornwall Partnership NHS Foundation Trust formally signed the contract to award a range of back-room service such as IT and document management to BT.
  
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Guardian

• The NHS and the Section 75 regulations: where next?
  
  And so it came to pass. Despite near universal professional opposition and strong political pressure, the Section 75 regulations that explicitly open up the NHS to competition law were approved in the House of Lords. A three-line whip on Liberal Democrat peers ensured a majority of over a hundred, with Baroness Shirley Williams speaking warmly of "an exciting new direction" for the NHS. The rage expressed across social media forums is unlikely to disappear but what can opponents do next ? The most obvious route is national politics. Given the unlikelihood of the National Health Action party making any significant inroads, it is to the Labour party that hopes will turn. On the surface the signs are encouraging. According to its most recent policy paper on the matter, Labour is committed to repealing those parts of the Health and Social Care Act that force competition into healthcare, and will return to the NHS the status of 'preferred provider'. This is a reassuring stance but one with three weaknesses:
  • Labour needs to win an overall majority at the 2015 general election – it cannot rely on a possible coalition with the Liberal Democrats to deliver on these pledges.
  • Unless it ends the purchaser-provider split and brings foundation trusts back into a public sector 'NHS family' it will still be exposed to competition law – and it has not pledged to do this.
  • By 2015/ 16 private companies could be well-entrenched in the NHS with long-term contracts that would be expensive and legally difficult to cancel.
  This does not mean that opponents must simply wait and hope for the best. The task now is one of damage limitation in the short term with a view to political change in the medium term – but how ? The answer may lie in calling local NHS commissioners to account in a way that has never been possible since Bevan's centralised NHS model triumphed over Herbert Morrison's municipalist vision in the 1940s. The only real option left by this accountability vacuum is to exert direct public pressure on the main local commissioners of healthcare – clinical commissioning groups (CCGs). Whereas few people had ever heard of primary care trusts , the government has now declared that local GPs are in charge of the NHS. There is now a recognisable point of accountability, and general practice is embroiled in the hurly burly of politics — including the awarding of contracts to private companies. How will CCGs respond ? Some will be pro-privatisation – many CCG board members have private company interests and these must be exposed and challenged. Others will reflect the majority view of GPs, one of opposition to the privatising measures in the NHS Act. It is here that the opportunity exists to form an alliance with those campaigning for a public sector NHS, but to do so will require investing in forms of public engagement hitherto unattained. This process will expose private sector bids to the public gaze, and no private company enjoys this sort of attention. And of course this would all be in line with what is claimed to be the fundamental tenet of the NHS changes — 'no decision about me without me'.
  
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Daily Telegraph

• Cut aid and NHS cash, George Osborne told.
  
  George Osborne should abandon his promise to protect the NHS, overseas aid and benefits for pensioners in order to tackle Britain’s “ballooning national debt”, a coalition of leading think-tanks says. Six centre-Right policy institutes say it is “not sensible” to define some public services as “sacrosanct”, as two think-tanks favoured by Labour criticise the ring-fencing of funds for schools, health and international development. The independent Institute for Fiscal Studies also warned that other public services would suffer more “pain” as a result of the “sub-optimal” approach to reviewing government budgets. Mr Osborne will announce details of spending plans for 2015-16, the final financial year of the Coalition, in a statement in June. He has warned that fresh cuts are inevitable.
  Ministers are engaged in frantic negotiations over how much their departments will receive and are sending their final submissions to the Treasury this week.
  Mr Osborne has promised that three priorities will be protected: daily spending on schools, the NHS and overseas aid. However, in their letter, groups including the Institute of Economic Affairs and the Centre for Policy Studies warn that the coalition is “struggling desperately” to eliminate the budget deficit and “presiding over an extraordinary ballooning of the national debt. In light of this we call on the Chancellor of the Exchequer to abandon the government’s policy of implicit and explicit ring-fencing of certain areas of spending,” the letter says. In a rare example of agreement across the political spectrum, two centre-Left think-tanks also signalled that all public spending should be considered for cuts.
  
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Thursday 25th April 2013

Scotsman

• Campaigner backs calls for PFI talks.
  
  A campaigner who exposed the tiny fines NHS Lothian is able to impose on the private firm running Edinburgh Royal Infirmary has backed calls for a parliamentary debate on PFI deals. Gordon Beurskens, of Action to Save St John’s Hospital, obtained hundreds of e-mails between the health board and PFI partners Consort, which revealed NHS Lothian can charge just £28.24 per day when the firm causes operating theatres to become unavailable for four hours or more. Consort is paid £60m a year in public cash and SNP MSP Jim Eadie branded the running of the hospital a “major public scandal” as he led calls for a Holyrood debate into PFI deals. Mr Beurskens said: “Under one of the worst contracts of its kind, the public purse is being fleeced out of extortionate amounts in return for patients being put at risk. There is a serious disconnect here, where the so-called ‘fines’ offer no realistic chance of deterring further calamities. I hope Jim Eadie’s motion will gain cross party support from all MSPs concerned about our health services.”
  
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Sheffield Star

• '25,000 NHS jobs go in three years'.
  
  Almost 25,000 NHS jobs have been axed in the last three years, the Royal College of Nursing (RCN) said. Since April 2010, 24,836 health workers have lost their jobs, including 4,800 nurses and 4,000 healthcare assistants, a new report for the RCN found. And a further 44,000 posts in the UK which are earmarked to go before April 2015, according to the RCN's Frontline First report. The union said that cuts to the nursing workforce are still taking place. An RCN spokesman said that there could be a "massive nursing shortfall" in the future because of nursing student places being cut and an ageing workforce.
  
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Daily Telegraph

• Hospital hotels: patients to be cared for by family members under NHS cost-cutting plans.
  
  Family members could be put in charge of caring for sick relatives in hospital if plans to roll out “patient hotels” get the green light, it has emerged. Under the plans, based on a model adopted in Scandinavia, relatives could be expected to take time off work to provide care and stay in the hospital overnight if necessary. Patients without anyone to look after them could treat themselves under a “self service” system and for the first time non-medical staff would oversee this care. According to the proposed model, a small team of two or three nurses would operate 24-hours a day from a front desk and doctors would have to be called in for emergencies. Rooms would be equipped with panic buttons for patients to alert nurses if they get into difficulty. The move would potentially save the NHS billions each year. Patient groups urged caution over the proposals, saying patients caring for themselves would be a "worrying" precedent. The plans are being formally reviewed by NHS England, the new body responsible for recommending how local doctors' groups should provide care for their patients. Neil Duncan-Jordan, of the National Pensioners Convention, questioned whether elderly patients with dementia would be capable of feeding and looking after themselves. The model is based on treatment in Scandinavia and was first proposed in 2010 by Innovation Unit, a public service reform think tank. However, in Scandinavia a family member is allowed five days leave from work if they need to care for a sick relative. It is unclear whether a similar allowance would be made in the UK.
  
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Daily Mirror

• Section 75: Last-ditch bid to stop NHS services opening to competition fails in House of Lords.
  
  Opponents of controversial NHS competition regulations failed in a last-ditch attempt to overturn the new rules. A Labour move to throw out Section 75, which will open up NHS services to market competition, was defeated in the House of Lords. Over 300,000 of worried people had signed a petition against David Cameron’s “new privatisation plot”. But in the Lords, the opponents lost by 254 votes to 146 despite former cabinet minister Lord Owen warning the rules would leave the NHS unrecognisable within 20 years. Lord Owen, who sits as an independent crossbench peer but was a Labour foreign secretary in the 1970s, warned the regulations were part of the erosion of the traditional NHS. He told peers: "Don't think this is a minor step. If this goes through the National Health Service as we have seen it, as we have believed in it, as we have persuaded the electorate that we support it, will be massively changed. It will take five, 10, 15, maybe 20 years, but unless we pull back from this whole attitude there will be no National Health Service that any of us can recognise. I for one feel tonight one feeling only - overwhelming sadness." Shadow health minister Lord Hunt of Kings Heath, who led the calls for peers to strike down the regulations, said they could not be in the interests of patients. “Every day up and down the country a market is unfolding in the NHS,” he said and warned the interests of patients would be “not first but last” if the regulations went through. Lord Hunt warned of the "fragmentation" of NHS services and said the regulations removed the "discretion" of commissioners to decide when to offer services out to tender. But health minister Earl Howe said the Government had not changed the law relating to competitive tendering “one iota” and the regulations would provide “safeguards”. Liberal Democrat Lord Clement-Jones said his party had received concessions and reassurances on the changes - including the withdrawal of the initial set of regulations - and accused Lord Hunt of promoting "conspiracy theories". The British Medical Association has said the regulations should be replaced with new rules that “unambiguously reflect Government assurances that commissioners will not be forced to use competition when making their commissioning decisions”. Later analysis of division lists showed there were no Government rebels. The move to throw out the regulations was backed by 114 Labour peers, 23 crossbenchers, six others and the Bishops of Bath and Wells and Bristol. The Government was supported by 173 Tories, 63 Lib Dems, 15 crossbenchers, the Bishop of Exter, Ulster Unionist Lord Empey and Labour's former health minister Lord Warner.
  
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BBC News

• 'More pressure' on emergency services with NHS 111.
  
  Doctors in Cornwall claim the new non-emergency phone service, NHS 111, will put "even more pressure" on Cornwall's emergency services. Chairman of Cornwall and the Isles of Scilly's local medical committee, Dr Peter Merrin said the new phone system was "risk adverse" and tended to use ambulances as a default mechanism. He said there would be an increase in ambulance call-outs to non-emergencies. Cornwall is due to receive the new phone service towards the end of May. The free one-stop number is for patients with urgent but not life-threatening symptoms. The service, expected to replace NHS Direct in June, has been piloted in many places across the country but has caused concern. Last month, the British Medical Association (BMA) said the "chaotic mess" of 111 was "placing strain" on overstretched parts of the NHS, such as the ambulance service, and potentially placing patients at risk. Devon is planning to launch its phone line in June.
  
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• PMQs: Cameron rejects NHS criticism from Miliband.
  
  Prime Minister David Cameron has dismissed claims from Labour that "the NHS is not safe in his hands". As Mr Cameron returned to the despatch box for his weekly Commons question session on 24 April 2013, opposition leader Ed Miliband accused the PM of "wasting billions of pounds on a top-down reorganisation that he promised wouldn't happen". Mr Miliband said the new 111 health-advice line - set up to replace NHS Direct - was "in crisis" and thousands of nurses had lost their jobs. The number of people waiting longer than four hours in emergency departments had risen from 340,000 in 2009-10 to 888,000 last year, he added, and last winter every hospital was operating beyond "the safe levels of bed occupancy". But Mr Cameron said waiting times were either "stable or down" since the last general election, and mixed-sex wards had been "virtually abolished". Meanwhile, the NHS in Wales was struggling under a devolved Labour government, he argued.
  
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Guardian

• Who will hold NHS contractors like Serco to account?
  
  It was almost two years ago that whistleblowers exposed the failings of the privatised out-of-hours GP service run by Serco in Cornwall. Finally, they have been vindicated. The powerful parliamentary public accounts committee summoned Serco and the NHS body responsible for commissioning them, the Cornwall primary care trust, and gave them the roasting they deserved for a culture of "lying and cheating" and for "shocking" inadequacies in writing and monitoring the contract. The committee had asked the National Audit Office to report on the service after revelations in the Guardian. Members from all parties were excoriating in their judgment of Serco's behaviour and the inability of the trust to hold the company, which has £2.4bn of public-sector contracts in the UK, to account. The bigger question, however, is whether NHS patients will be any better protected in future as more services are put out to tender. Serco's health business is growing rapidly – it has £300m worth of contracts in the sector. Other than a dent to its reputation, it has suffered no penalty. It has not been fined for lying and breaching its contract, nor has it lost the job. If a private company behaved this way to another private company over a contract, it would find itself in court. Not so when rapacious corporates (the committee's description) do business with the public sector. A small sorry is enough. Protection of the whistleblowers remains woefully inadequate. While Serco has been able to falsify with impunity, whistleblowers have, as the parliamentary accounts committee recorded, been subject to persecution. In the Cornwall case neither Serco's company systems nor the trust's audits had managed to find the repeated shortages of staffing and falsifying of performance data that whistleblowers said had been putting patients at risk as far back as 2010. But then, as the committee's formidable chair, former Labour minister Margaret Hodge, said, they didn't seem to want to look in the right place. To date, the only forensic audit of the data provided to the NHS by Serco remains one conducted by the company under pressure of a period of its own choosing – the first six months in 2012, when it knew it was already being investigated and would have been trying to clean up; the biggest fiddles, according to whistleblowers, took place in the two years before that. The trust, the Care Quality Commission and the NAO have all looked at Serco's audit but no one so far has looked at the earlier period. Are they to be allowed to get away with it ? Hodge's frustration was palpable. Staff, deeply concerned that the service was an accident waiting to happen, went first to their managers, then their unions and professional bodies, and to the commissioner – and got nowhere. They went to local Lib Dem MP Andrew George, who asked the company and the trust to investigate but was fobbed off. They went to the regulator, the CQC, but it said it had no jurisdiction until a rule change in 2012 that required out-of-hours services to register with it. The strategic health authority, responsible for the trust until both were abolished in the coalition's upheaval of NHS structures, told MPs it didn't really do monitoring of out-of-hours services, that was the trust's business, even if the trust was failing. Finally the whistleblowers came to the Guardian. When, in 2012, the regulator did acquire the power to investigate and did so, it at last uncovered evidence of the falsification of data we had reported but did no forensic audit of its own. The fiddling of figures was no mere accountancy exercise, it covered up real risk and a real human cost. The contract between Serco and the local NHS commissioners remains, outrageously, confidential, and freedom of information requests to have it released have been refused, as they are routinely in other privatised deals with public services. In this climate of secrecy, how can private companies be held to account ? Serco has blamed two maverick managers who fiddled the data off their own bat even though they apparently had no financial incentive to do so, a position that Hodge dismissed as "not credible". The pair have now been paid off with confidentiality clauses in their agreements. Serco insists it had found no evidence that the instruction to falsify came from higher up but said the gagging clauses did not prevent the two coming forward to disclose material evidence. We can only hope that if they have taken the fall for a corporate culture of dishonesty, and have evidence that they were acting on orders, as the whistleblowers have consistently alleged but Serco denies, they will feel safe coming forward now they have heard its reassurances.
  
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Tuesday 23rd April 2013

This is Cornwall

• Serco grilled over Cornwall out-of-hours GP services.
  
  Cornwall's out-of-hours GP provider Serco has been forced to dismiss claims it has been overseeing a culture where staff have to "cheat" and whistleblowers are not "comfortable". A senior executive of the multi-national, which has provided cover in the Duchy since 2006, said the picture painted by the chairman of the powerful Public Accounts committee in the House of Commons was "not one I know". Three top managers of the firm appeared before the committee of MPs against a backdrop of repeated criticism of how the private sector firm has handled the loss-making contract. Multi-national Serco, which has around £2.4 billion of public sector work, dismissed two employees after whistleblowers prompted an inquiry that found it gave NHS false data 252 times. Labour MP Margaret Hodge, the committee chairman, told Serco bosses she had the "strong feeling" that the "culture within your company" was one where "people felt they had to cheat", and were not "comfortable about coming forward about levels of service being offered".
  
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Independent

• David Cameron hits back after nursing leaders raise major concerns over staffing levels and Government's plan to get trainee nurses working as healthcare assistants.
  
  Three-quarters of hospital wards in England are operating with unsafe staffing levels at least once a month, a survey of nursing managers says. Nursing leaders also hit out at the Government's plan to get student nurses to work as healthcare assistants for a year, branding the plan "stupid". The Prime Minister David Cameron strongly defended the Government's approach. The Government has so far resisted calls to introduce mandatory staff ratios for hospitals in the wake of the Mid Staffordshire scandal arguing that it would not necessarily improve patient care and could lead to organisations seeking to achieve staffing levels only at the minimum level. But the poll of nurse managers by the Royal College of Nursing found that NHS hospitals are regularly operating at levels that could be potentially unsafe. Of the 2000 nurses in charge of hospital wards and team leaders working in the community almost three quarters, 74%, said staffing levels dropped to unsafe levels at least once a month. More than a third (36%) reported staffing levels were unsafe on a weekly basis, while almost one in ten said staff numbers fell to an unsafe level on every single shift. In his report into the failings of care at Mid Staffordshire NHS Foundation Trust, inquiry chairman Robert Francis QC said officials should consider the “benefits and value for money of possible staff-patient ratios”. At the start of their annual conference in Liverpool the nursing union said nine in 10 of their members said they would support the introduction of mandatory staffing levels to protect patient safety.
  
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Staffordshire Sentinel

• Private firm lands NHS transport deal.
  
  A multi-million pound NHS contract to transport hundreds of patients a day across North Staffordshire has been awarded to a private company. NHS leaders have stripped West Midlands Ambulance Service of the contract after more than four years. Instead, the £3 million annual deal has been struck with London-based NSL. The contract has been awarded by the GP-led North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups (CCGs) less than a month after they took over the running of the NHS. The CCGs have come under fire nationally over fears their formation would lead to the privatisation of parts of the NHS. The non-emergency ambulance service ferries 600 people a day to medical appointments in outpatients departments and day or community hospitals. The work has always been carried out by the NHS – except for a spell when private company Parkwood ran the service amid a series of disputes over workers' pay. NSL will take over the contract in August. It was among six organisations, including the West Midlands trust, to pitch for the contract. NSL already runs NHS patient transport services in other areas, including South Staffordshire. The CCGs are refusing to reveal the name of the winning firm because the decision is still open to challenge.
  
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Guardian

• NHS: Section 75 of the health act is an engine for destruction.
  
  Andrew Lansley's Health and Social Care Act, which came into effect on 1 April, had a troubled passage through parliament, including an unusual legislative "pause". This was to allow the government time to "listen" to its many critics, including most healthcare professionals and a majority of the public, who believed the plans would create and lock in rights for private providers to make a profit from the NHS. Lansley gave assurances that these voices had been heard, and that clinical commissioning groups would be able to decide "when and how competition should be used". However, concerns about privatisation return to centre stage this week, when the regulations governing procurement and competition are debated in the Lords. As Lucy Reynolds, a research fellow at the London School of Hygiene and Tropical Medicine, puts it, if the act itself was the aircraft of privatisation, the structure that gave the idea the potential to fly, section 75 of the regulations is the engine that will allow take off. The wording of section 75 requires commissioners to put out to tender everything that could be provided by an organisation other than the NHS. Private contractors are more likely to win these tenders than doctors, many of whom will never have even seen a tender notice. The regulations would create rights for commercial providers under rules originally devised by US corporations to promote their commercial interests. If implemented, they will drag the NHS into a competition law regime which creates obligations for governments to compensate private providers in the event of services being brought back into public provision. The British Medical Association, along with many other health organisations including the Royal College of General Practitioners, are calling for the regulations to be withdrawn, as is the Labour party. The BMA says they must be replaced with new regulations that "unambiguously reflect previous government assurances that commissioners will not be forced to use competition when making their commissioning decisions", and explicitly state this principle. As contracts are lost by public sector bidders, the teams that would have delivered them will be made redundant because funds will not be available to pay them. Under the proposed regulations, the government is not permitted to rescue such a service unless all other competitors are equally subsidised, in the interests of non-discrimination. The competitive tendering forced by the current draft of the regulations requires a large amount of administration, which will divert funds away from frontline care. Thanks to market-driven changes that have already taken place administrative costs have risen to at least 16%, in contrast to the pre-1980 figure of less than 5%. These regulations will act as the motor of the NHS privatisation by giving companies a mechanism to force their way into NHS service provision for the patients, procedures and places wherever they see profits. The likes of Care UK or Virgin Care will try to cherry-pick easy and profitable services – diagnostics, routine elective surgery, and simple treatments, for example – leaving behind A& E, care of the elderly, mental health services and anything that is unpredictably expensive. Seeking the withdrawal and replacement of these regulations is not scaremongering; there is plenty of evidence that market-driven health services lead to limited choice, escalating costs, and reduced quality. There is no evidence to support the idea that competition breeds excellence in healthcare. According to Robert Evans, professor of economics at the University of British Columbia, market innovations in the NHS over the last 40 years have led to greater inequity, increased inefficiency, cost inflation and higher levels of public dissatisfaction. It is time to reject the market ideology that has plagued the NHS for more than a quarter of a century, wasting billions of pounds in the process.
  
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BBC News

• Labour rules out 'massive' NHS spending increases.
  
  Ed Miliband has said "massive increases" in spending on the NHS "won't be available" if his party wins the next general election. He told the BBC that healthcare would always be a priority but refused to say whether he would pledge to spend more overall than the coalition government. Labour is to set up an independent commission to investigate how best to integrate health and social care. It says that without this there will be a £29bn gap in funding by 2020. Mr Miliband's comments follow former Prime Minister Tony Blair's warning to avoid promising ever more public spending.
  
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Monday 22nd April 2013

HSJ

• 'Market' consulted about taking over parts of Mid Staffs.
  
  The special administrators of Mid Staffordshire Foundation Trust are to launch a “market engagement exercise” asking whether other providers - including in the private sector - would be interested in taking on its services, HSJ can reveal. The exercise is designed to gauge the level of interest in running the services among other NHS providers, and those in the independent sector. The “market engagement exercise” will be launched on Monday and allow providers to express their interest as part of administrators’ work to make the services clinically and financially sustainable. In a statement on the launch of the exercise the special administrators - led by medical manager Hugo Mascie-Taylor and consultants Ernst & Young - said: “This market engagement exercise is intended to assess the potential capability of a range of providers to deliver these services and is not part of a procurement process.
  
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OUR NHS

• Personal care budgets could further fragment the NHS.
  
  Aside from whether patients welcome the cash payments there are wider issues that need addressing, namely whether the scheme strips cash from the NHS and so weakens the service for others; will it be a subsidy for private care; and who steps in if the money is spent before the year is up ? By April 26 the public are invited to tell the Department of Health what we think about direct payment ‘personal budgets’ (Direct payments for Healthcare document). It proposes that any NHS patient with a chronic illness (such as lung disease or diabetes, or disability caused by a stroke or neurological disorder or mental illness) should have the right to have an annual sum of money paid into their bank account so that they can buy the care they need for themselves, from whoever they like. If this will make life at all easier for these people, surely no one with the slightest awareness of the struggle normal life is for many of them could possibly grudge it. Some people have queried whether the pilot projects that have been conducted really show that personal budgets are beneficial. There was no evidence that they led to any health improvement, and some experts have questioned whether the evidence even shows that they improved patients’ ‘care-related quality of life’, as the government claims. Still, there is no evidence that they made it worse, so why not go ahead anyway, if patients want it ? Besides which, at first sight the amount of money involved doesn’t look enormous. Even if all the 50,000 people now getting ‘continuing’ NHS care’ are given personal budgets (which they will have the right to ask for from 2014), the extra costs involved (and there will be some) look quite minor, relative to the total cost of the NHS. So on this basis too it seems churlish to raise any objection. Yet the proposal actually raises some major issues. One concerns the potential impact on the services available to everyone else. A disabled patient who receives a direct payment into her bank account and decides to use it to buy care services from a private company instead of the local NHS trust may reduce the trust’s income by several thousand pounds a year. If several patients do the same, the impact on the trust’s ability to serve other patients could be serious. In an appendix to the consultation document, which perhaps few people will read, the Department of Health says CCGs will just have to ‘manage’ this risk ‘in the short term’. But in the long term, it says, reducing the funding of existing providers ‘may well be necessary’ (ibid, Annex B, para 40). In other words, personal budgets are expected to lead to a contraction of NHS provision and an expansion of other kinds of provider, in practice private companies.
  
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BBC News

• Tens of thousands in Support Stafford Hospital march.
  
  Thousands of people have marched in opposition to plans to downgrade Stafford Hospital's services. A Monitor report published in February called for the closure of acute services including the A& E department. The trust that runs the hospital was put into administration by the health regulator Monitor on Monday. Support Stafford Hospital campaigners and police said up to 30,000 people had joined the mile-long march, from the town centre to the hospital. The campaign group said the town's Market Square was so full of protesters it took 45 minutes for it to clear after the march started at about 1400 BST. Thousands of people had previously signed a petition calling for Stafford Hospital's services to remain and a campaign shop from the protest group has been set up in the town centre. Jean Tabarner, one of the marchers, said she had had cancer and that Stafford Hospital had saved her life. She said: "We've got to try - if you don't try, no-one will listen. We've got to keep plugging away and hope that the administrators listen to what the people around here want." Sue Hawkins, chair of the Support Stafford Hospital group, said she believed it was important for people to move on from what had happened in the past at the hospital.
  
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Socialist Health Association

• Mud sticks: the new s.75 NHS regulations once enacted will be the ultimate disaster.
  
  The Canadian model is built on a recognition of the limits of markets in distributing medically necessary care. Most markets distribute goods on the basis of supply and demand, with price signals used to affect production and consumption decisions. When price drops, demand should increase, with a near-infinite demand for free goods. Conversely, with fixed supply and high demand, price should rise until enough people get priced out of the market to balance supply against this new (lower) level of demand at the new equilibrium price. Yet health care markets stubbornly refuse to follow these economic laws. Economists have debated why this is so and whether they can force health care to behave in accordance with theory. In Canada, there is remarkable tension with power being devolved to the provinces, meaning that if anything goes wrong, it is hoped that central government can escape the blame. This latest set of ‘top-down reforms’ of the NHS are estimated to cost £2bn, and the widespread perception is that the system has been thrown into chaos because of a lack of fundamental understanding of the pre-existing culture of the NHS and overcoming the “barriers to change”. GPs in the UK are likely to be the ‘fall guys’ for this failed implementation. When the US sneezes, the UK catches a cold. We can already see this phenomenon being rehearsed ad nauseam across the pond. For example, in a recent American blogpost, “Who is to blame for the current healthcare crisis ?” , Dawn J. Lipthrott comments that, “Doctors are to blame when they try to make up loss by over-scheduling and growing careless, or by failing to communicate with their patients. The notorious Section 75 regulations – set the legal framework for NHS competition under the government’s health reforms. They have already been revised once, after opposition to an original version from both the Liberal Democrats and Labour.The original plans would have seen NHS trusts forced to ask private companies to bid for every service, even if commissioners were satisfied with the way it was being run by the public sector. The new revised regulations insist that Clinical Commissioning Groups must invite bids for services in all cases except those which they are sure can be provided only by the current provider. This will mean only the most difficult and expensive contracts will be held by public sector organisations, as private companies will say they are capable of providing all others. The concerns were confirmed by a recent Lords committee, which said the revised rules were “substantially the same as the original regulations”. Although many members of the committee said the new wording was an improvement, they also warned: “The wide range of interpretations of the substitute regulations is, we believe, likely to translate into uncertainty about how they will operate.” Even with the new section 75 NHS regulations, when the private providers take the CCGs to court over the tenders, and the judge rules against the CCG on the process grounds of openness, transparency, Wednesbury reasonableness or even proportionality, and there is a huge public outcry, the Department of Health can easily blame the CCGs for a failure in the procurement process, especially as they do not have a comparable skill-set for doing slick procurement.
  
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