Watford Observer

• Warning issued over private contract at Watford General Hospital. Patients could suffer if plans by hospital bosses to privatise the sterilising of surgical equipment are approved, it has been claimed. Watford General Hospital is currently in discussions with a private company to outsource its in-house Hospital Surgical Sterilising Unit (HSSU). Health bosses are negotiating with Ruislip-based IH Sterile Services to disband the existing Watford-based operation and transfer its 16 staff. If the deal goes ahead the company – which last month was forced to apologise for delivering contaminated equipment to two nearby hospitals – would be responsible for collecting, cleaning and returning hundreds of surgical tools every day. Staff members, who this week passed a letter of concern to the Watford Observer, fear the money-saving measure will delay the process of returning equipment to operating theatres, increase the risk of infection and reduce efficiency. They also raised concerns about their future working conditions, job security and pensions if and when they are transferred out of the NHS and into private hands. The comments come two weeks after the company issued a “wholehearted apology” for returning infected surgical kits to Mount Vernon and Hillingdon hospitals, causing operations to be cancelled.
  
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This Is London

• ‘Privatised out-of-hours care will put patients in danger’. Thousands of vulnerable patients could suffer from plans by NHS bosses to privatise out-of-hours GP services in London. More than 200 doctors have written to Health Secretary Andrew Lansley and Mayor Boris Johnson to protest at the transfer of evening and weekend care to Harmoni, a private health company. In the letter they warn the decision to put cost before care will reduce quality for the 950,000 patients in north London who use long-established Camidoc, a non-profit making company run by GPs which provides care and advice when surgeries are closed. They say the switch to a private provider means GPs will no longer be provided with basic medical equipment such as oxygen for lung patients or defibrillators for life-threatening heart problems. Some doctors are threatening not to work in “unsafe circumstances” where nurses will be used increasingly, instead of doctors, as well as GPs who may lack local knowledge. MPs have now called for an investigation into the decision by primary care trusts in Camden, Islington, Haringey, and City and Hackney to replace Camidoc with Harmoni, whose turnover rose from £3.5m in 2005 to £73m last year.
  
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Camden New Journal

• Tories may force Royal Free and Whittington hospital merger. The Royal Free and Whittington hospitals could be forced to merge if Conservative reforms to the NHS are approved, a council report has said. Health Secretary Andrew Lansley’s reforms aim to make every hospital an independently-run “Foundation Trust”. Despite years of trying under the previous Labour Government, the Royal Free or the Whittington failed to convince the regulator Monitor they could manage their own finances properly. Failure to do so again would push them into a merger, according to the report to Camden health and scrutiny committee. The number of patients treated would be slashed and campaigners warned there was a “real danger” of cuts to beds and staff. The trusts are already facing cuts of up to £900m because of changes to funding tariffs. Senior executives at both hospitals have held meetings with staff about a 7% budget saving across all departments. The council report adds that the upheaval to the NHS could leave Camden health services worse off. Under the changes, NHS Camden would be abolished and GPs given control of 80% of funding decisions. Campaigners believe this will bring about the mass privatisation of the National Health Service.
  
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Tayside and Fife Courier

• Ward closure fears acknowledged by NHS chief. Older people are becoming "frightened" by ward closures and a move to more community care, a Tayside health chief has admitted. NHS Tayside's deputy chief executive Gerry Marr said he and his colleagues need to get better at communicating with older people and help them to understand the fundamental changes that are happening to the way they are looked after when they fall ill or are coping with long-term conditions. At the health authority's annual review he insisted changes to older people's services were improvements, not just cost-saving measures. In recent weeks NHS Tayside has closed a ward for elderly people at Royal Victoria Hospital in Dundee and announced a relocation of elderly beds at Ninewells Hospital. In addition it announced the merger of two wards at Ashludie Hospital in Monifieth, then withdrew that plan — saying both wards would remain open until suitable alternative accommodation could be found for the patients.
  
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Healthcare Republic

• Managers question GPC's NHS anti-privatisation stance. The GPC's stance against the use of private providers could be illegal and is 'unwise', according to the NHS Confederation. The GPC's set of 'principles' for GP commissioning states that ‘wherever possible, consortia should ensure that NHS providers are the providers of choice.’ But Nigel Edwards, NHS Confederation acting chief executive, said GP commissioners should not ‘simply dismiss what non-NHS organisations can offer.’ ‘This principle is doubtful in law and unwise in practice,’ he said. Meanwhile the union Unison has started legal action to block health secretary Andrew Lansley’s White Paper reforms, after threatening to last month. The union is calling for a judicial review on the grounds that Mr Lansley’s reforms are already being implemented before adequate consultation. Soon after the White Paper was published, NHS chief executive Sir David Nicholson wrote to executives instructing them on how to start implementing aspects of the reforms.
  
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Lambeth Guardian

• Lambeth PCT criticised for £3.6m spend on management consultants. The borough’s public health provider has come under fire for spending £3.6m in the last financial year on management consultants, money that should have been spent on frontline services, critics said. Health watchdog London Health Emergency (LHE) said it was “absolutely scandalous” Lambeth Primary Care Trust (PCT) managers spent money on consultants to do work they should be capable of doing themselves. NHS Lambeth, part of the PCT, said the proportion of its £650m budget spent on consultants was under 0.5% and necessary because it did not have the level of in house expertise required to deliver the best possible services. But LHE chairman Geoff Martin said the cash could have funded 100 additional nurses at a time when there was a freeze on recruitment because of swingeing funding cuts. Details of the consultancy spend, totalling £114m across London, came in the last year of the Labour Government. The information was released by Health Secretary Andrew Lansley in what was seen as a highly politicised move.
  
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Pulse

• GPs face fight for control of new 111 service. GP commissioning groups are set to be plunged into battle with ambulance trusts and a skeleton NHS Direct service for control of the new 111 urgent care number. The Government’s decision to scrap the NHS Direct telephone hotline - which Pulse has uncovered cost the NHS £123m this year - has been welcomed by the majority of GPs. But both the ambulance service, which is spearheading the first pilot in NHS County Durham and NHS Darlington, and NHS Direct, set to run the next pilots in the East Midlands and East of England, will use fewer qualified nurses than NHS Direct does currently - and there are questions over how much say GPs will have in the running of the new service. A Pulse investigation earlier this year revealed NHS Direct already sends 22% of its 14,000 calls a day to GPs as urgent or next day cases. And leading Labour MPs, including shadow health secretary Andy Burnham, claim the 111 service will see this rise.
  
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• GPs may have to inherit some PCT debts, Buckman warns. GP consortia may have to accept taking on some PCT debts when they assume full commissioning power, but they should not be forced to prop up expensive Darzi centre and PFI contracts, GPC chair Dr Laurence Buckman has said. The GPC chair insisted PCT debts should be separated into those that ‘inevitably occur as a result of managing patients’, which GPs may have to absorb, and those incurred through expensive schemes imposed on local areas like Darzi centres, which GPs should not have to inherit. He added that consortia should not be responsbile for dealing with PCT debts incurred through brokerage arrangements where some PCTs have propped up neighborughing trusts who had fallen into financial difficulty.
  
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Thursday 2nd September 2010

The Press and Journal

• Community council urges board not to cut out-of-hours GP service. Proposals to reduce number of doctors on call prompt concern that patients will be put at risk. A north-east community council has written to NHS Grampian asking it not to cut the area’s out-of-hours service. The Press and Journal revealed in July that the number of doctors on call outside normal surgery hours could be halved in some parts of Grampian. NHS Grampian is trying to identify ways to cut its budget by £34million and it is understood that cuts to G-Med, the local NHS board’s out-of-hours service, could save more than £300,000 each year. An NHS spokesman said “discussions are still ongoing and no proposals are drawn up yet” and “measures being looked at include changes to shifts where nurses would replace GPs at times of low activity”. He added: “An example we previously cited was the changeover between GP and nurse taking place at 10pm rather than midnight, which would save that shift £40,000 annually. “Our aim is to maintain a safe, reliable service while trying to better match capacity to demand.”
  
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Guardian

• Towards a joined-up health service. We are a long way from an integrated NHS, says a new report – but local successes may point the way forward. The labyrinthine NHS is a mass of contradictions. Doctors, nurses and managers are exhorted to work together to keep people out of hospitals, for example by pre-empting crises to avoid expensive emergency admissions. Yet the introduction of more independence and competition means that these same hospitals, particularly the semi-autonomous foundation trusts, are competing for customers to drive up income. A new report published today by health thinktank the Nuffield Trust highlights a handful of NHS organisations that are beginning to break down some of these barriers between hospitals, community health services and general practice to provide more seamless care to patients. The report, Removing the Policy Barriers to Integrated Care in England, stresses that government and NHS must resolve some policy contradictions by devising more effective methods of rewarding caregivers in whatever setting, while still using the twin drivers of competition and collaboration to improve services. It identifies seven key "policy barriers" to greater integration of care. These include GP commissioning, which often fails to involve community health professionals; a lack of social care funding for frail and vulnerable people; and few incentives to support collaborative working.
  
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• The NHS will exist only as a brand name. The NHS provided the most most influential, economic model for state-funded healthcare services. Not any more, says Julian Tudor Hart. From its birth to the late 1990s, the NHS grew in both body and mind, but was always starved of resources. What else could we expect from governments that believed (as all still do) that healthcare as a universal public service cannot produce wealth ? The NHS became seriously sick only in the 1980s, when the managing director of Sainsbury's was invited to start the process of redesigning it as a business. Successive reorganisations all pursued the same goal: to break it up into competing commercial units, differing from the rest of the market place only in that the government, not the consumer, finally met the bills.
  
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Pulse

• Burnham launches bid to block GP commissioning plans. Shadow health secretary Andy Burnham today launched what he has billed as the ‘mother of all battles’ to stop the NHS reforms outlined in the coalition Government's health white paper, claiming they will fatally 'compromise' the role of GPs. The man whose Cabinet hot seat was taken over by Andrew Lansley and who is now standing as a candidate in the Labour leadership election claimed the top-down reorganisation represented a total U-turn by the Conservative and Liberal Democrat Government and was not wanted by either patients or GPs. Speaking at a meeting in Liverpool, Mr Burnham described the plans for GP consortia as ‘a postcode lottery writ large’, warning: ‘The creation of hundreds of new, untested GP groups means variable service standards, access and quality depending on where you live.’ He predicted that if the plans went ahead, patients would end up having to fight with their GP to get access to services, with GPs compromised by being both providers of services and commissioners. ‘Lobby your GP’, the Government cries. But people don’t want to have to fight for their healthcare, and GPs don’t want it either,' he said. ‘The role of GP as champion of their patient is compromised by their role as budget-holder. It is also the case that the GP will be both a provider and commissioner, placing a major conflict of interest at the heart of the NHS.'
  
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People Management

• NHS bosses to get £130,000 to resign. Chief executives at NHS trusts set to be scrapped by the government have been offered a £130,000 golden goodbye if they resign voluntarily, it has been reported. The mutually agreed resignation scheme (Mars), put forward by the government for NHS trust chief executives and senior managers, will be available until October. It represents the equivalent of a year’s pay with the first £30,000 tax free. Details of the offer, reported by the Health Service Journal, were sent to NHS managers in a letter from Sir Neil McKay, chief executive of the NHS East of England Strategic Health Authority, who will oversee the move. The news follows an announcement by health secretary Andrew Lansley earlier this year that NHS trusts would have to slash management costs by more than 46 per cent over the next four years. Lansley also announced plans to close all 10 strategic health authorities and 152 PCTs, which will affect more than 60,000 managers.
  
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Lancashire Telegraph

• Blackburn jobs fears over NHS Direct closure. Health workers in East Lancashire could lose their jobs as a result of plans to scrap the medical helpline NHS Direct. The Department of Health confirmed the service, which provides advice to 27,000 people a day on the number 0845 46 47, will be replaced by a new non-emergency number, 111. The move, announced via an apparent slip of the tongue by Health Secretary Andrew Lansley during a hospital visit, is expected to affect 12 staff working at the Royal Blackburn Hospital site in Haslingden Road. NHS Direct said the new phone number was intended to work in a 'more efficient' and integrated way with local GPs, ambulance services and hospitals, providing health advice and information about out-of-hours GPs, walk-in centres, emergency dentists and 24 hour chemists. But critics said members of the public would no longer be able to speak with nurses with degrees, but only call-handlers who have passed a 60-hour medical course. And the Royal College of Nursing said it would be 'short-sighted' of ministers to axe expert nurses. A NHS Direct spokesman said it could not comment on the future of staff working in Blackburn until three pilot NHS 111 schemes had been completed.
  
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Tuesday 31st August 2010

Western Mail

• Doctor says health service must resist market reforms. The NHS in Wales could inspire a fightback against the commercially-driven reforms of the Tories and New Labour, according to a leading health theorist. In an extensively rewritten and updated new edition of his book, The Political Economy of Health Care, Dr Julian Tudor Hart says the NHS in Wales remains true to the legacy of its founder Aneurin Bevan. The retired GP argues that the election of a Conservative/ Liberal Democrat coalition at Westminster gives Wales the opportunity to build the foundations of a progressive society for the second time in its history. The book describes how Dr Hart and his colleagues developed relationships based on trust with their patients in a “gift economy” untainted by commercial pressures. Dr Hart argues that since the Thatcher Government was elected in 1979, there have been successive damaging attempts to introduce a commercial ethos into the NHS, setting hospital against hospital. He cites examples from England where American-owned groups have bid successfully against local GPs to provide primary health care in specific areas. In Wales, however, Dr Hart sees the rejection of the Private Finance Initiative as a means of funding new health schemes, and the end of the purchaser/ provider split as a positive development that could mark a new direction.
  
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This Is South Wales

• Overtime pay axed to save hospitals cash. Angry health staff have been left reeling at a decision to put in place an overtime freeze in the wake of top level executives having their salaries protected for up to 10 years. They claim other departments are suffering as a consequence of the Assembly-led policy across Hywel Dda Health Board, which covers Llanelli's Prince Philip Hospital and West Wales General Hospital, in Carmarthen. In a letter entitled overtime constraints, from Simon Jones of the organisation, to all staff it said the situation had come into effect because of the current financial climate. The NHS is expected to save £1.9 billion over the next five years — but it is still shelling out on pay increases for executives who failed to win top jobs, following the mergers of NHS trusts and local health boards last October. And the maximum period of pay protection is 10 years, when an employee has 15 or more years service with the NHS. In the letter to all staff members, it said: "Please be advised that due to the current financial position I have been instructed to advise everyone that there is a restriction on overtime effective from August 2. This means that NO overtime must be allowed unless it has a direct impact on patient care/ safety and any request for overtime working MUST be approved by senior management in advance of it being worked."
  
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Scotsman

• Public flocks to sign NHS petition. An online petition launched by former deputy prime minister Lord Prescott, appealing for the government not to scrap NHS Direct, has passed the 10,000-signature mark. The Department of Health had said the nurse-staffed helpline, providing advice to 27,000 people a day, is to be replaced by a new, non-emergency 111 number. Lord Prescott is aiming for 100,000 signatures - a figure Prime Minister David Cameron said should trigger a Commons debate.
  
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Monday 30th August 2010

The Press Association

• Lib Dems urged to vote down NHS bid. Shadow health secretary Andy Burnham has written to all Liberal Democrat MPs urging them to vote against the coalition Government's plans for reform of the NHS. Mr Burnham also challenged Lib Dem and Conservative health spokesmen to a public debate with him on the reforms, which he will describe in a speech on Tuesday as the biggest threat to the NHS in its 62-year history. The Labour leadership contender warned that plans to give GPs control of an estimated £80 billion of NHS spending and to hand more independence to hospital trusts will destabilise the service, throwing it into organisational chaos at a time when it needs stability. His intervention comes days after the health union Unison launched a legal challenge to the reforms on the grounds that a consultation process being conducted by Health Secretary Andrew Lansley is a sham. In his letter on Monday, Mr Burnham said Liberal Democrat voters were not expressing support for reforms of the kind set out in Mr Lansley's health White Paper when they cast their ballots in the general election in May. He told Lib Dem MPs: "You hold the key to the future of our NHS. People who voted for you at the election did not vote for such a radical break-up plan. I urge you to listen to them and stand up for our NHS in the face of this attack, which threatens to unpick its very fabric." In a speech in Liverpool on Tuesday - shortly before the Lib Dems' annual conference in the city next month - Mr Burnham is expected to say: "There are former Lib Dem councillors here in Liverpool who don't know that their party stands for any more. "When Nick Clegg comes here the week after next, he must explain why these reforms are being forced on the NHS in direct contradiction to what the coalition agreement promised." Mr Burnham will argue that introducing massive structural reform at a time of financial retrenchment will "throw the NHS into chaos" at a time when it needs stability. Handing commissioning power to GPs risks a postcode lottery, with different standards and accessibility of care depending where patients live, he will say.
  
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Pipeline Review

• Criticism mounts over NHS reform but pharmaceutical firms may benefit. The UK coalition government is facing legal action from public services trade union UNISON over plans to shake up the National Health Service in a bid to find efficiency savings. However, the proposed reforms could benefit pharmaceutical companies, with patients gaining access to drugs previously blocked by the health service's cost watchdog. The UK coalition government is facing legal action from public services trade union UNISON over plans to shake up the National Health Service in a bid to find efficiency savings. However, the proposed reforms could benefit pharmaceutical companies, with patients gaining access to drugs previously blocked by the health service's cost watchdog. According to media reports, the government has requested that National Health Service (NHS) managers implement efficiency savings 'immediately', bypassing the white paper consultation phase set to end in October 2010. This could be unconstitutional, and has led to UNISON mounting a legal challenge. The proposed shake ups have already faced criticism from other quarters, with academics branding the reforms as a "gamble". Concerns have also been raised over the influence that pharmaceutical companies may have over general practitioners who will become the new key decision-makers. Furthermore, the Muscular Dystrophy Campaign has suggested that patients will suffer as a result of general practitioners not fully understanding the complex conditions for which they will now have control over budgets. The government has hit back, citing that consultants will work alongside GP groups as part of the planned changes. However, financial criticisms are less easily waved away, with the British Medical Journal having suggested that the proposals will cost some GBP3 billion but provide no efficiency savings.
  
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Wales Online

• Long-term NHS job vacancies rise by over 40%. The number of long-term NHS staff vacancies has risen by more than 40% in just six months. And official figures also reveal the sickness rate among NHS staff has increased slightly, now standing at 5.3%. There were 243 job vacancies, which have been empty for three months or more, at the end of March, compared to just 170 six months previously. Almost half of these are nursing and medical consultant posts, according to the statistics published by the Assembly Government yesterday. But despite the sharp rise in the last six months, long-term vacancies in the NHS have fallen significantly over the last eight years from a high of more than 1,700 in March 2002. Sickness absence figures, which were also published yesterday, show the rate for the first quarter of the year has increased slightly on the last quarter of 2009. The snows of the beginning of the year may have had an impact on this rate. The data shows of the seven local health boards and three NHS trusts, the Welsh Ambulance Service NHS Trust had the highest sickness absence rate at 7% compared to Public Health Wales NHS Trust at 3.8%. And of the six staff groups, the highest sickness absence rates were in the ambulance (7.4%) and healthcare assistant and support worker (7.3%) groups. The lowest sickness absence rate was in the medical and dental staff group at 1.3%.
  
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Sunderland Echo

• Axe to fall on NHS helpline. Medical helpline NHS Direct is to be scrapped and replaced with a scheme being trialled in the North East. Health chiefs were shocked yesterday when the Department of Health said the new non-emergency 111 number, which was launched in County Durham last Monday, would replace the existing service and claim they knew nothing about it. Health Secretary Andrew Lansley made the announcement, apparently in error, during a hospital visit. But the Department of Health yesterday released a statement confirming the news and said many of the services offered by NHS Direct would be "subsumed" by the 111 service. The switch has been criticised by people who say the pilot has not been tested yet and the cost-saving cuts the new service would bring were being rushed into. The Royal College of Nursing urged the government not to axe specialist nurses who work for NHS Direct. Chief executive Dr Peter Carter said: "The evidence suggests the expert advice of nurses has kept 1.5million people out of A and E and saved the NHS £213million a year. "It would be shortsighted to cut back on the experts who deliver these long-term savings." Former deputy prime minister John Prescot has labelled plans to replace the service as "madness".
  
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Friday 27th August 2010

Pulse

• NHS managers prepare to go head-to-head with private sector to provide GP commissioning support. NHS bosses are preparing to pitch themselves into competition with the private sector to offer support to GP commissioning consortia by re-inventing themselves as social enterprises, in moves backed by GP leaders. The Government’s plan to abolish PCTs by 2013 as part of its white paper reforms is expected to lead to GP commissioners employing management directly, or buying in support from outside agencies, with a host of private firms already throwing their hats in the ring. But GP leaders have backed moves for existing PCTs to morph into social enterprise-style agencies that could potentially support several consortia as an alternative to the private sector. And a group of NHS commissioning experts parachuted in to oversee one of Lord Darzi’s most controversial health policies said it too could reinvent itself as a social enterprise or even a private company to combat a projected loss in funding. Meanwhile, Commissioning Support for London, the 200-plus strong team of managers set up in April last year to drive forward the Healthcare for London proposals to shift huge amounts of hospital care to primary care as part of the polyclinic rollout - said it would re-assess its structure as the axe was likely to fall on £27m of its NHS funding. The group’s chief executive Sarah Pinto-Duschinsky said she was overseeing plans to re-design the body as an organisation which would seek to sell its services, including IT systems, service planning tools and referral management consultancy, to GP commissioning consortia in the capital and further afield. She said the group, which receives three quarters of its budget from London’s PCTs, hoped to be able to compete against what is expected to be massive competition from firms such as UnitedHealth, Dr Foster and Tribal. Elsewhere, Commissioning Business Service (CBS), which offers similar support to GP consortia in Greater Manchester, said it was also considering evolving into a social enterprise or private company following the white paper.
  
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BBC News

• NHS records move in East Midlands sees some 90 jobs cut. NHS patient record services in the East Midlands are being outsourced, with the loss of about 90 jobs. Nine Primary Care Trusts have agreed a contract with NHS SBS - a partnership of the Department of Health and IT firm Steria - with some work going to India. Health officials said the move will save up to £9m over six years and will not impact on patient care. But unions said staff had been "sold out" and having some tasks sent to India risked vital information. The move will see payment processing, cervical and breast cancer screening correspondence, medical records and patient registration done by the new firm. NHS staff have been told the current workforce of about 150 will be reduced to 65, based at offices in Leicester and Derby .
  
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News Shopper

• Union threatens trust with a strike. Last minute talks are being held in a bid to avert a strike by London Ambulance Service workers. The workers are due to transfer to a private contractor and are threatening to go on strike next week. Those who are members of the GMB union are protesting about alleged threats by their new employer to reduce their pay and conditions. South London Healthcare Trust is poised to sign a contract with Savoy Ventures Ltd to take over the transport of non-urgent hospital patients to and from hospital appointments. This work is currently done by more than 60 ambulance staff, who will transfer to Savoy Ventures when the contract begins on September 1. But the GMB claims at a meeting between the company and the affected LAS staff, Savoy Ventures told the workers it would not be keeping to the TUPE (Transfer of Undertakings Protection of Employment) regulations. Instead it told them they would lose their final salary pension scheme and their London weighting allowance, salaries may be lowered to those of the company’s existing employees and they would have to work different shift patterns. The union also claims the man who runs Savoy Ventures has been involved with four other failed companies. In an 85% turnout for a strike ballot, 95.8% voted for strike action starting next week. There may also be a mass protest.
  
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Aberdeen Press and Journal

• Trade unionists opposed to cut in hospital beds. Trades union representatives remain opposed to the drive to cut beds in far north hospitals. They insist the move can only make life tougher for the growing number of vulnerable, elderly patients and their families. They are also campaigning against a move to turn the minor injuries casualty unit at Thurso’s Dunbar Hospital into a 9-5 weekday operation. North Highland Community Health Partnership (NHCHP) has already shut four of the 16 beds at Dunbar and a further seven at the Queen Elizabeth ward of Caithness General Hospital at Wick. The health body is meanwhile consulting on its favoured option of doing away with the remaining beds at Dunbar and cutting back on the hospital’s casualty unit, which currently opens 24/ 7. They have pledged to re-invest half of the projected £600,000 annual savings in new community rehabilitation and palliative care services. Thurso and Wick Trades Council is pressing NHCHP to spell out exactly how its proposed new set-up would work.
  
  
  
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Northern Echo

• Alarm at speed of NHS cuts. The Royal College of Nursing (RCN) has said it is alarmed at the speed at which job cuts are to be made in the North- East NHS. The NHS in the North-East has been ordered to make savings of £800m by 2014. One of the main areas of cost-cutting will be in primary care trusts, which are due to be scrapped by 2013. But the RCN, which has thousands of members in the North-East, said it understood that the first redundancies would begin on Teesside as early as October 11. Details of the timetable of redundancies at three primary care trusts have been obtained by the union. They state that up to 82 jobs will go from NHS Middlesbrough, 80 from NHS Stockton and five from NHS Hartlepool.
  
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Teesdale Mercury

• More than 100 NHS jobs to be axed in County Durham. More than 100 NHS jobs in County Durham look set to be axed as health chiefs outline plans to make massive cutbacks. By next April, North East Strategic Health Authority and the 12 primary care trusts (PCTs) in the region aim to save £27m through cuts to managerial and administrative staff. The NHS says the money will be reinvested in frontline services, but union leaders say they are concerned about the affect on the NHS. About 110 jobs are expected to go at County Durham Primary Care Trust and a further 37 at the North East Strategic Health Authority. In total, more than 500 positions are likely to go across the region.
  
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Bucks Free Press

• Day surgery ward closed at Wycombe Hospital. A day surgery ward at Wycombe Hospital has been closed, as health bosses consult on a shake-up of staff and beds. The closure of ward 8 looks set to have knock-on effects for at least two other wards in the hospital's Treatment Centre. Under the plans, set to be implemented by the end of September, most day cases will be sent to another surgery ward. Buckinghamshire Hospitals NHS Trust said the closure of ward 8 was due to less beds being needed, but said no redundancies were planned.
  
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Southern Daily Echo

• Protesters meet to fight threatened closure of centre. Angry campaigners have drawn up a battle plan to stop the axe falling on a city walk-in centre. Feelings ran high as the Socialist Party of Southampton hosted a public meeting to protest about the possible closure of Bitterne Walk-In Centre. Dozens packed the hall in Bitterne as health bosses consider the future. Leading the debate, Tim Cutter, said he believed the move would be dangerous to the health of vulnerable and elderly residents and accused NHS Southampton City of being driven by financial concerns.
  
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Thursday 26th August 2010

Pulse

• Single-handed GPs claim 'aggressive' PCTs are targeting them for closure. GPs have accused their PCTs of harassing them in a bid to drive them out of their surgeries, as a crackdown on smaller and single-handed practices gathers pace. Pulse recently revealed that more than one in six English trusts are planning a cull of GP practices as part of a £20bn cost cutting drive, potentially sounding the death knell for singlehanded practices. A number of GPs who have contacted Pulse say they are now being pressured by over-zealous PCTs, with managers looking for excuses to close them down. But NHS managers have denied they are pursuing a policy to close down small practices. One single-handed GP in Greenwich, South East London, who wished not to be named, said she feared she was being targeted for closure, as the trust scrutinised her contract using traffic-light style ratings. She said NHS Greenwich was zoning in on her practice’s QOF scores, and using the availability of services such as immunisation and cervical cytology to inspect her performance. She said: ‘I know it needs to be done, but I am being harassed. If they want to close single-handed practices, they should come out and say it. But PCTs are pushing doctors to retire by trying to highlight their weaknesses. Nobody is telling the good points of single-handed practices.’
  
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• GPC to push for optional commissioning DES to avoid GP contract rewrite. GP negotiators will resist the Government's attempts to make commissioning responsibility part of the core GP contract, and will instead push for it to be offered as an optional enhanced service, Pulse has learned. GPC leaders revealed this week that they have already begun preliminary dialogue with the Government over its plans, and will look to step up talks when the consultation on the white paper plans closes in October. But the stance appears to put the GPC on a collision course with ministers, who have pledged to write commissioning responsibility into the GP contract. The Government made clear in its NHS white paper that all GPs will be expected to join commissioning consortiums when PCTs are abolished in 2013, and outlined plans to link ‘a proportion of GP practice income to the outcomes that practices achieve collaboratively through commissioning consortia’. The far-reaching proposals would make all GPs contractually responsible for commissioning, and tie a proportion of their GMS income to the results of the consortia they belong to.
  
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People Management

• Unison launches court bid against NHS reform. Unison is taking legal action against the government over its plans to restructure the NHS, alleging the lack of a proper consultation process is “unlawful”. The public-sector union has applied for a judicial review in a bid to block the reforms from going ahead without a full public consultation on the “most fundamental changes to the way the NHS operates since it was created”. Unison says the consultation process currently underway is meaningless, as chief executives at NHS trusts were instructed to start implementing the proposals “immediately”, the day after health secretary Andrew Lansley published a white paper on the radical NHS restructure in July. NHS chief executive Sir David Nicholson, who sent the direction in a letter to other NHS bosses, said the consultation was limited to how the proposals should be implemented, not whether the plans – which involve giving GPs control of £80 billion NHS spending – were supported in principle.Karen Jennings, Unison’s head of health, said: “I find it incredible that the NHS chief executive would say he believes there is no legal duty on the secretary of state to consult on the merits of the proposals in the white paper. “The white paper contains sweeping changes to the NHS and how it should be run. The NHS constitution enshrines the principle that the public, staff and unions have an absolute right to be consulted. And that means not only on how the proposals are to be implemented, but also whether they should go ahead in the first place. She added: “The Department for Health’s refusal to recognise this clear and important legal duty leaves us no option but to issue legal proceedings as a matter of urgency. “The government has confirmed it will be contesting the legal challenge.
  
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Morning Star

• Lansley's deadly prescription. The debate over the government's controversial white paper, laughably entitled Liberating the NHS, is beginning to widen and the scale of opposition to many of its core proposals is becoming clear - even among the group who appear to have most to gain from it. GP magazine found less than one in five of the 300 GPs who responded to a poll believed that the changes would improve patient experience or the funding of primary care services. Twice as many (41 per cent) feared a fresh "postcode lottery," while 71 per cent expected the scrapping of primary care trusts and strategic health authorities to lead to an increase in private-sector involvement in commissioning. No wonder one of the leading apologists for the scheme, Dr Michael Dixon of the NHS Alliance, has issued a rather desperate appeal for GPs not to turn their backs on the government proposals, claiming that it would be "utterly disastrous" if they did not "embrace the white paper and make it work."
  
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Shropshire Star

• Nurses urged to cut shifts at Shropshire hospitals. urses and healthcare assistants at Shropshire’s two biggest hospitals are being asked to voluntarily cut short their daily shifts, as bosses try to make savings and stave off job cuts, it was revealed today. The move is among a number of new measures being introduced by Shrewsbury and Telford Hospital NHS Trust. The trust is under heavy Government pressure to make efficiency savings. Staff will be asked to consider changing the way they work and there will also be a continuation of a major drive to reduce the cost of hiring agency workers at the Royal Shrewsbury Hospital and Princess Royal in Telford.
  
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Tuesday 24th August 2010

Northern Echo

• NHS reform and cuts ‘no gamble’. The Health Secretary last has defended Government plans to reshape the NHS – despite claims the move will cost hundreds of jobs. On his first official visit to the region, Andrew Lansley denied his plan – in which more than 1,700 jobs will be axed in the North-East and Cumbria alone – was a gamble with the future of the health service. Mr Lansley visited the North-East Ambulance Service headquarters, in Newcastle, to launch the NHS 111 telephone service for callers who need non-emergency health care. His visit coincided with the publication of a report by the Royal College of Nursing (RCN) which shows the scale of the cuts to the region’s NHS ordered by the Government. The study, based on information obtained from every hospital and primary care trust in the Northern region – which includes the North- East and Cumbria – suggests that the £800m due to be cut in the next four years will result in 1,750 fewer health care workers and 403 fewer beds. One trust, County Durham and Darlington NHS Foundation Trust, aims to cut £60m by 2014, closing 300 beds and losing 300 nursing jobs through non-replacement. Mr Lansley has also been criticised by North-East health academics for taking a gamble with the future of the NHS by handing control of most of the budget to groups of GPs and abolishing two tiers of NHS administration. Mr Lansley said he thought it would be risky not to give GPs a role in commissioning care. He stressed that while the Government wanted to reduce management spending, it was committed to increasing overall investment in the NHS and switching resources from the “back office” to the frontline. Commenting on the RCN report, Mr Lansley said he was more interested in improving “patient outcomes” than the number of beds.
  
  

Health Investor

• Consultancy spend criticised by Lansley. Health trusts in England spent more than £300m on management consultants last year, the latest Department of Health figures have revealed. Secretary of state Andrew Lansley described the figure as “staggering” , after it emerged the figure is approaching the total cost to the health service of skin and lung cancer treatment. Data obtained from the Department of Health reveal the extent to which primary care trusts and strategic health authorities, both of which are soon to be abolished, have been engaging the private sector to help implement NHS reforms. Costs, critics claim, have been inflated by fees for some consultants who can charge up to £1,000 a day. Lansley blamed the previous Labour government for the rise in fees, but shadow health secretary Andy Burnham hit back by claiming the Conservative’s reforms of the NHS would give consultancy firms a field day. He said: “The NHS needs good managers. By wiping away the expertise currently in primary care trusts he is opening the door to consultancy firms who know that hundreds of new untested GP groups won’t have the experience to go it alone.”
  
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Monday 23rd August 2010

HSJ

• £300m spent on management consultants last year. The NHS in England spent more than £300 million on management consultants in the last year, figures show. The cost is almost the same as the amount spent on skin and lung cancer services combined, the data for 2009/ 10 showed. The government released the figures to show how much was spent on management consultants - as well as advice from architects, lawyers and surveyors - in the last year of the Labour government. Overall, primary care trusts (PCTs) and strategic health authorities (SHAs) spent £313.9 million on consultancy services. Nigel Edwards, acting chief executive of the NHS Confederation, which represents NHS organisations, said: “Any spending of taxpayers’ money has to be justified, and the NHS has been asked by successive governments to perform tasks for which internal expertise was not present or needed to be developed. “Dismissing all this spending as wasteful is unfounded." “External advice will be necessary if NHS organisations are to deliver change and, with the financial challenges and the size of the current reform programme, it is probable that NHS organisations, especially new GP consortia, will require external help to deliver what the Government wants.” Alan Leaman, chief executive of the Management Consultancies Association, said: “Research by the association has shown that on average, for every £1 spent on management consultancy, benefits worth the equivalent of £6 are returned to the client. “An organisation as complex and fast-changing as the NHS is entitled to benefit from the high quality advice and delivery that is offered by MCA member companies.”
  
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Sunderland Echo

• Axe set to fall on health jobs. Hundreds of health workers will lose their jobs and services face cuts under a planned multimillion-pound cost-cutting exercise, according to a union.
  The Northern Royal College of Nursing (RCN) has released information collected from every NHS Foundation Trust and Primary Care Trust (PCT) in the region detailing plans for cutting costs, shedding jobs and reducing bed numbers.Cuts affecting Wearside and Durham include:
  - City Hospitals Sunderland will cut £22.5million this financial year
  - NHS County Durham and Darlington is undertaking a three-year £200million cost-cutting exercise.
  - Sunderland TPCT has identified 85 posts for redundancy
  - County Durham and Darlington NHS Foundation Trust is cutting 300 beds and losing 300 nursing jobs through natural wastage. It will save £20million from the 2010/ 11 budget and £60million by 2014.
  Health chiefs estimate they need to make £800million of efficiency savings by 2014, and all cash saved will be reinvested directly into frontline services.Glenn Turp, regional director for the RCN, said: "It's inevitable that when trusts announce cuts to beds, staff or other areas, but do not announce new investment of equivalent value in, for example, key clinical staff, the suspicion is that this is not a genuine reinvestment programme but just plain old-fashioned cuts."
  
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Morning Star

• New nurses struggle to find jobs. Pressure is being piled onto the Scottish government to protect front-line services as newly qualified nurses and midwives struggle to find jobs in the NHS. The Royal College of Nursing Scotland accused health boards on Sunday of using "unsustainable tactics" in a desperate bid to save money, including freezing posts and not replacing staff who leave. RCN warned that this money-saving drive has led to a devastating drop in job opportunities for newly trained nurses. The union expects that the worse is still to come after the announcement by Scottish Health Secretary Nicola Sturgeon in June that almost 4,000 NHS jobs, including 1,500 nursing and midwifery posts, will be axed this year. RCN Scotland associate director Ellen Hudson voiced her concerns about the impact of any cuts on people trying to start a career in nursing. She also warned of the "devastating consequences" for future patient care if older nurses are not replaced by newly registered nurses. The Royal College of Midwives Scotland has spoken of similar concerns and suggested there may soon be no jobs at all for newly qualified midwives. Meanwhile, the Scottish Labour Party has accused the SNP government of wasting money on training nurses who cannot get jobs. Labour Party health spokeswoman Jackie Baillie said: "These cuts could have a devastating effect on the NHS. Ms Sturgeon has to address the fact money is being wasted on training nurses and midwives who can't get jobs. Labour has called time and again for the Scottish government to protect front-line services." But Ms Sturgeon has insisted patient care would not be affected by the cuts and said there would be no compulsory redundancies. "We are aware that some health boards have lower vacancy rates for newly qualified nurses and midwives than others, and we are working with them to find quick solutions," she said. "Our national one-year job guarantee scheme aims to ensure every newly qualified nurse or midwife receives the offer of a job either through their own means or with assistance."
  
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Friday 20th August 2010

New Post Leader

• Jobs to be cut in NHS. Hundreds of NHS jobs in the region are to go. The cuts follow the news that by April 2011, North East Strategic Health Authority (SHA), and the 12 primary care trusts (PCTs) in the region, have to make savings of £27m. Across the region 516 jobs are to be slashed from the managements of PCTs, with all savings being reinvested in frontline services. A spokesperson for NHS North of Tyne said: "Our requirement is to reduce management costs by around 35%, which means we have to make significant changes to our staffing structures. To help achieve the management costs savings we are offering staff the opportunity of asking for voluntary redundancy. We would always hope that we can avoid compulsory redundancies but in this case, given the level of savings to be made this may not be possible." Unison lead officer for health in the North East Trevor Johnston said he was concerned a reduction would lead to frontline staff not being able to function effectively due to lack of administrative and managerial back up.
  
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Pulse

• Department of Health warns GPs could inherit PCT debts. GP consortiums may be lumbered with massive financial deficits inherited from debt-stricken PCTs as soon as they take over commissioning powers, the Department of Health has admitted. Radical plans put forward in last month’s NHS White Paper mean that GP consortiums will be expected to take on all of PCTs’ commissioning functions by April 2013, when both PCTs and SHAs will be abolished. But the Department of Health said this week it could not guarantee a clean financial slate for consortiums, amid fears that GPs could inherit hundreds of millions of pounds worth of debt from cash-strapped PCTs. The Government’s refusal to commit on the issue has placed GP leaders on red alert as they seek to ensure that consortiums are given a fair crack of the whip in trying to make a success of the plans.
  
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Healthcare Republic

• GPs demand practice income is protected from commissioning. Three quarters of GPs want the GPC to reject any bid to plunder existing practice income to fund 'quality premiums' for successful commissioners, a poll for GP newspaper shows. But the survey, in partnership with the Family Doctor Association (FDA), found that 47% of respondents remain unsure if the DoH’s commissioning plans are an opportunity or a threat for the profession. Many of the 315 GPs surveyed are concerned that the additional workload will not be adequately resourced. Under a fifth (17%) of respondents are confident that commissioning will lead to a better patient experience in the NHS, with many more (41%) concerned that quality of care will become more varied. More than half (55%) fear the reforms jeopardise GPs’ autonomy and independent contractor status. More than two-thirds (67%) of respondents wanted the GPC to hold a ballot to decide whether to embrace or oppose the reforms. The survey also showed that only a fifth of GPs think the White Paper will improve the NHS.
  
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Recruiter

• Discussions ongoing over private-sector investment into NHS Professionals. Discussions over the possibility of private-sector investment in NHS Professionals are ongoing, according to a spokesperson for the not-for-profit organisation. On 4 August, a Prior Information Notice (PIN) was published in the Official Journal of the European Union seeking potential investors from the private sector. This led to union Unison to voice its opposition to more private involvement in NHS Professionals, singling out recruitment agencies. However, an NHS Professionals spokesperson told Recruiter that no decision would be made until discussions have been carried out.
  
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hc2d.co.uk

• Monitor Board announces decision on Poole Hospital NHS Foundation Trust. Monitor, the independent regulator of NHS foundation trusts, has found that Poole Hospital NHS Foundation Trust is in significant breach of the terms of its Authorisation. This decision is based on concerns around the Trust’s financial position and its governance arising from its performance in 2009-10, when the Trust reported a deficit of £4.5m against a planned surplus of £2.1m. Having considered the available evidence, Monitor has decided not to use its formal powers at this stage. However, the Trust’s performance going forward will be reviewed against specific milestones; if it fails to demonstrate timely progress towards full compliance with its terms of authorisation, Monitor is likely to consider formal intervention.
  
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Herald

• Job fears as health board is warned to cut further. Fears of more job losses in the NHS have been raised after it emerged Scotland’s largest health board may have to cut spending by a further £10m. NHS Greater Glasgow and Clyde (GGC)– which employs 44,000 stafff – is already trying to save £56.9m this year and has announced plans to slash 1200 posts including 670 nurses and midwives. However, a new report has warned the board may well have to make further cutbacks worth £10m. A number of other health boards have also warned that they have spent more money than intended so far this year. NHS Grampian say they had overspent by £1.9m by the end of June. NHS Lothian say they had overspent by £2.7m by July, but that the board did not foresee increasing its current savings target. Collectively, Scotland’s health boards are having to make savings in excess of £270m to break even, according to information submitted to the Scottish Parliament earlier this year.
  
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Pulse

• Commissioning shake-up could be extended across UK. Plans to hand GPs a central role in NHS commissioning could be extended beyond England, with both the Scottish and Northern Irish governments set to re-assess their own health policies in light of the health White Paper. The dramatic move comes as both GPs and ministers in the devolved nations insisted the UK-wide GP contract could be preserved, despite the coalition's plan to tie a substantial proportion of GP income in England to commissioning targets threatening to drive a wedge between the four different countries' health policies. The devolved governments in Scotland and Northern Ireland said this week they are determined to hold on to the UK contract - and even appear willing to consider changing course on their own policy to retain some common ground with England. But the Welsh Government, which has already overseen the complete separation of commissioning and provision in Wales, said it had 'no plans to enable GPs in Wales to commission services'. Scottish health secretary Nicola Sturgeon said earlier this year that future contract negotiations would need to reflect the fact that policies north and south of the border were increasingly going their separate ways. But in a marked shift in tone, the Scottish Government has now pledged for the first time to discuss the possibility of introducing greater GP involvement in commissioning, as it looks at how to adopt aspects of the English White Paper north of the border. The Northern Irish government said it too would look at how to adapt aspects of the White Paper to its own policy. GPC Scotland chair Dr Dean Marshall said the Scottish Government may be looking for 'wriggle room' by pledging to look at commissioning, in case the policy becomes a success in England, and they decided to adopt it in the future.
  
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Tuesday 17th August 2010

Get Bracknell

• Health crisis over job cuts. A union has warned of a “healthcare crisis” in the Thames Valley after another hospital announced job cuts. The GMB has warned the Royal Berkshire Hospital’s (RBH) plans to remove up to 600 jobs over the next three years could compound the effects of cuts in posts planned by Heatherwood and Wexham Park hospitals. The RBH, which offers accident and emergency services to Bracknell and Wokingham people, announced the plans, warning that if it did not take action to arrest its financial problems it could face sanctions from hospital watchdog Monitor. Heatherwood and Wexham Park Hospitals NHS Foundation Trust announced plans in June to scale back its staff by cutting 470 posts as part of a long-running plan to turn around a deficit of £20m. It means, of the four hospitals serving Bracknell, only Frimley Park near Camberley is not making cuts. Since the closure of the accident and emergency department at Heatherwood last year, the RBH is the closest hospital with an accident and emergency department for most parts of Bracknell Forest.
  
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Financial Times

• Hard times call for a new rebate on PFI deals. Jesse Norman, MP for Hereford and South Herefordshire, writes: In this time of fiscal retrenchment, all parts of government must do their bit. But the private finance initiative, in particular, offers potentially huge savings. I have launched a campaign for contractors to contribute a “rebate” to the public purse, by reducing the interest payments they receive from public institutions. Some £210bn of PFI capital assets remain outstanding. A McKinsey study last year suggested that a reduction in interest charges paid to contractors by NHS hospitals of just 0.02 or 0.03% could save £200m. Taken across all existing contracts even this modest rebate could save £500m-£1bn. It is important to note that these savings would not go to the Treasury, but would instead be remitted back to each hospital or school. Mere encouragement from government might be enough to do the job, for the government has many points of contact with the different PFI consortia. Just as importantly, many investors in these companies are themselves public authorities. They may find it convenient to push fairer treatment for projects, rather than allowing contractors to make huge sums at a time of austerity. The idea that our public services are getting a bad deal here is gaining momentum, with the chief economist of the King’s Fund health think-tank recently calling for the NHS to renegotiate its PFI commitments. Indeed, there is a direct precedent for exactly this sort of rebate in the so-called “voluntary code”. The code was agreed in 2002 after several PFI providers made huge windfalls refinancing deals. Under it, 30% of gains from existing projects were returned to the taxpayer. The ratio is 50% for new deals.
  
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Lancashire Evening Post

• Petition rallying cry to try to save mental unit. A woman who has been treated at a mental health unit which is facing the axe will be collecting signatures for a petition to try to save the facilty from closure. Louise Daley, 55, of Avenham, Preston, has bipolar disorder, which is a form of manic depression and she has been admitted to the Avondale Unit based at Royal Preston Hospital several times over the years. Louise is outraged at Lancashire Care NHS Foundation Trust’s decision to close the unit at the end of the year and is joining the campaign to save it from closing.
  
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Healthcare Republic

• GPC in 'driving seat' on GP commissioning, says adviser. The GPC is 'in the driving seat' to make demands in this year's contract negotiations, according to a former health adviser to Tony Blair. Paul Corrigan, now an independent health consultant, says the BMA will push its anti-marketisation campaign when negotiations to make GP commissioning compulsory start. His comments came as health campaigner John Lister said the BMA was making a ‘historic mistake’ by engaging with the DoH’s White Paper reforms. ‘I very much hope that the BMA will take immediate steps to strengthen the very limited critique which seems to inform its current policy,’ he wrote in a letter to BMA chairman Dr Hamish Meldrum. He said the BMA stance put a ‘fig leaf of credibility’ over Conservative plans to privatise large swathes of the NHS. GPC chairman Dr Laurence Buckman said he opposed the DoH’s ‘any willing provider’ policy, but did not think the BMA could stop it. The BMA is still ‘finding out what things mean’, and responding to White Paper and GP commissioning consultations, said Dr Buckman.
  
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• GP at first Darzi centre facing closure warns on APMS contracts. A GP in charge of the first Darzi centre to face closure has warned the profession of the dire implications of APMS contracts. The Alma Road Primary Care Centre in Peterborough has been given six months’ notice to close as the city’s PCT looks to generate savings. APMS contracts contain a ‘no cause’ clause meaning the PCT can cancel the contract without giving any reason. Dr Rupert Bankart, medical director of 3Well Medical, the GP-led firm running the health centre, said many more GPs would face the same fate. According to data from 2009, there are 173 practices in England that operate under APMS deals, which allow non-clinicians to hold the contracts. The recent White Paper Liberating the NHS signalled a move towards a single GP contract which will include aspects of APMS. The Alma Road health centre currently sits in a temporary building. It is one of 150 GP-led health centres built under the last government’s plan to set up one in each PCT. The BMA argued as the centres were being developed that they would be costly and surplus to requirements. The GPs at 3Well Medical say they have little grounds for appeal legally because they were unable to remove the ‘no cause’ clause during tendering. They hope the support of patients, local councillors and GP consortia may help their cause.
  
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Monday 16th August 2010

Guardian

• The magnificent PFI wheeze goes wrong for the NHS. The bonanza for some private sector firms is now translating into significant funding problems for the health service. The private finance initiative (PFI) was a wheeze devised by the Conservatives. It flourished under Labour. In the days in which public policy was dominated by concerns about the size of the public sector or the public sector borrowing requirement, the PFI was seen as a means of funding public sector capital needs, but defining this as private rather than public debt. Successive governments used PFI to mask the expansion of public debt. The optimistic authors of PFI believed that continuous increases in affluence would enable society to pay the excessive costs of this subterfuge. The obvious analogy for PFI is a mortgage where you initially think it is affordable on the optimistic basis of short-term growth in personal income, but then disaster strikes, income growth collapses and repayment becomes a nice challenge. The PFI contracts are very detailed, providing not only for the construction of new hospitals and schools but also for their maintenance, cleaning and other services. Some of these contracts cost several million pounds to draw up and, once agreed, tie contractors to often onerous payments for 30 years and more. Furthermore, they include clauses facilitating the passing on of costs to the NHS when, for instance, national standards of cleaning or safety change. Now the NHS faces declining real income. Of course the Con-Dem coalition is saying the NHS budget is ringfenced. However, this fence is porous. First, the NHS will have to pay increased VAT and national insurance rates. Second, the ringfencing may be eroded by inflation. Third, government cuts in local authority spending mean that social care funding will have to be augmented by transfers from the NHS to council budgets. If this does not happen, "bed blocking" will reduce hospitals' capacity to manage increasing patient demand. Last week it was announced that £500m would be transferred from NHS to social care funding.
  
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Daily Mail

• Doctors face £10,000 cut in NHS bonus squeeze. Doctors face a £10,000 pay cut in a major revamp of the NHS bonus system after concerns that they are spending too much time working for the private sector. Health Secretary Andrew Lansley will shake up the profession by announcing a review of the controversial ‘distinction awards’, which reward senior consultants with bonuses on top of their high salaries. The annual bonuses – worth more than £75,000 for some – cost the NHS £230 million last year. Mr Lansley will announce on Wednesday that the Doctors and Dentists Review Body – which sets pay and bonuses – will have to reduce the millions paid out to doctors.
  It will be told to make the system ‘fairer’, which could see other NHS workers eligible for bonus payments. Mr Lansley is under pressure to scrap the current bonus scheme amid concerns that doctors are spending too much time working for the private sector. The new scheme would cut bonuses by as much as 15 per cent, with some doctors losing more than £10,000 a year. Last night, an NHS source said: ‘We need to bring down the cost of the system while looking at the possibility of extending it to include other hard-working NHS workers. To pay for this, we would have to take away money from consultants.’ A spokeswoman for Mr Lansley said last night: ‘The awards will be looked at. We want to reward consultants who provide an exceptional service for the NHS, but we need to ensure we are doing so in a cost-effective way.’
  
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Pulse

• GP consortiums will take 'several years' to make savings. The current state of GP commissioning is weak and GPs are likely to take ‘several years’ to develop the adequate skills to hold the £80bn purse strings of the NHS, according to a health policy think-tank. The analysis of the coalition Government’s plans for sweeping NHS reforms by the Nuffield Trust dismisses GPs’ ability to lead commissioning, and concludes that there is ‘a real concern whether this level of reform can be implemented without risk of major failure’. The proposals in the White Paper ‘carry significant risks’ the report warns, as PCT commissioning is weak and GP commissioning consortia are likely to take several years to develop adequate skills for the job.’ Pulse recently revealed that a quarter of GPs have already begun to spearhead the takeover of commissioning by entering into talks with their PCTs in order to increase take on more commissioning responsibilities. But the report claims that GP consortiums will lack the financial nous to take on the role, as they are ‘used to acting as small businesses, not large conglomerates handling millions of pounds.’ ‘To make efficient savings in the NHS and improve quality, it is widely recognised that more effort should be made to prevent costly hospital care where avoidable, through integrated care. ‘The ability of underdeveloped GP consortiums to make these changes, in part through commissioning negotiations with hospitals, is very doubtful in the short term. ‘This poses the considerable risk that consortiums are unable to manage demand within the budget allocated, and incur deficits.’
  
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BBC

• More than 500 NHS jobs to be cut in north-east England. More than 500 managers and administrators face redundancy in a huge shake-up of the NHS across the north-east of England. The proposed cuts will affect NHS trusts on Tyneside, Wearside, County Durham and Teesside and aim to deliver annual savings of £27m. NHS North East said it hoped to avoid significant compulsory job losses. Union leaders expressed concern at the planned cuts, arguing managers carried out "important NHS functions". David Stout, executive director of finance and communications at NHS North East, said: "Like all public sector organisations, the NHS in the region must deliver substantial savings in order to meet the challenges of a difficult economic environment. "The management cost reductions we have outlined will inevitably impact on many people and we are of course committed to keeping staff fully informed throughout this difficult process. "The savings made will be reinvested directly in front-line NHS services so that we can meet the future challenges of coping with an ageing population, the introduction of new treatments and technologies and increasing our focus on prevention." The proposed savings are due to take effect from April 2011.
  
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London Today

• Patient care facing cuts as hospitals struggle to pay private finance debt. Three London hospitals have been left so debt-laden by the Private Finance Initiative they are spending more than an eighth of their income on repaying “loans”, it emerged today. The South London Healthcare NHS Trust, which includes Bromley Hospital, Queen Elizabeth Hospital in Woolwich and Queen Mary's in Sidcup, uses 13 per cent of its money to cover debts rather than treat patients. The hospitals have projected deficits of £36 million this financial year. They are locked into paying back the money the private firms spent building them and are paying for maintenance, cleaning and catering in 30-year contracts. New hospitals across England have this “NHS mortgage”, with the total national PFI debt now £65 billion over the lifetime of the schemes, new figures show. The hospitals were worth £11.3 billion when first built. Hospitals are so expensive to build that PFI has been seen as the best answer. But the non-negotiable debt fees, which rise each year, mean government demands to slash spending can only be met by cutting patient care, economists said. South London Healthcare NHS Trust said there are “undoubtedly some constraints from having these fixed costs”. Now the financial crisis has changed conditions beyond recognition, trusts tied into PFI deals have even less freedom to make business decisions that protect services, making cuts and closures more likely.” The Department of Health said the schemes were providing “value for money” and were “affordable”. A spokeswoman added: “One of the benefits of PFI is that the buildings are always contractually required to be kept in good condition. Good maintenance will always cost more than not maintaining facilities to a high standard.”
  
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Friday 13th August 2010

Blackpool Gazette

• Hospital beds to go in service shake-up. Hospital bosses have confirmed Clifton Hospital will not be closing – but 24 beds are to be lost along with 40 jobs. Chiefs at Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust have insisted they have "no plans to close" the hospital, which provides renal care and dermatology services. The reassurance comes after concerned patients heard rumours the hospital was to shut. But bosses say they are changing some of the services at the hospital. The changes will mean a loss of 40 jobs at the hospital, but the trust says it "is committed to no redundancies." Staff are being interviewed to discuss whether they want to work in a new orthopaedic rehab unit at Clifton or would prefer to work elsewhere in the hospital trust. One 24-bed ward, which was temporarily closed in October last year for refurbishment, has remained closed as rehabilitation care for the elderly was provided from other facilities.
  
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Witney Gazette

• Doctors issue warning on mental health cuts. Top mental health consultants have voiced “grave concerns” about proposed cuts to mental health services in Oxfordshire in a letter. About £5.3m worth of service cuts are being planned to hit Oxfordshire, which could result in a 19% reduction in frontline and administration staff. The Oxfordshire and Buckinghamshire Mental Health (OBMH) trust plans to make the savings by 2014. A letter sent anonymously, but signed on behalf of six key mental health consultants, has outlined serious worries about cuts to front line staff, home visits and risk to patient care. Unison Health Oxfordshire called an emergency meeting to discuss a plan of action.
  
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Darlington and Stockton Times

• PCT criticised over ‘sham consultation’ on health cuts. A row has broken out over how people have been allowed to respond to a proposal to close minor injuries units at three community hospitals. A 12-week period is under way to gather views and hear concerns that people have about the plans to axe the minor injuries services at the Friary, Richmond, the Lambert, Thirsk, and St Monica’s, Easingwold. The plans have caused concern in rural areas, with fears that other services may be downgraded, resulting in journeys to Darlington, Northallerton or York for anyone needing help at night or at weekends. But a senior county councillor has accused NHS North Yorkshire and York of conducting a “sham consultation”
  
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Haringey Independent

• MP puts pressure on NHS to halt Horsney clinic closure. MP Lynne Featherstone has called on NHS Haringey to halt plans to close a Hornsey walk-in clinic revealed this week. The Hornsey and Wood Green MP said closing the 8am to 8pm walk-in service at Hornsey Central Neighbourhood Health Centre, in Park Road, without consultation was "unacceptable". The scheme was running as a pilot that started in April and was due to end in July and its success would be reviewed. But health chiefs said there was no chance of the pilot continuing because it could not afford to fund the walk-in clinics. NHS Haringey has extended the pilot for an additional month to give it time to break the news to patients.
  
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Pulse

• Private providers 'should be paid less for less complex work'. Independent sector treatment centres should be paid less to reflect the fact they treat less complex patients than NHS providers, according to leading health economists. A national analysis of all elective procedures carried out in NHS hospitals and ISTCs showed that the NHS has been left to deal with the most complex elective procedures, prompting the researchers to urge the Department of Health to pay private providers less and create a ‘fair reimbursement system’. Critics of private providers have often accused them of unfairly profiting from ISTC contracts by specialising in a small number of high volume procedures, such as hip replacements or cataract removals, and avoiding taking on more complex – and costly – operations. A team at the University of York analysed hospital episode statistics for 30 different procedures performed on every NHS and private sector-treated patient in England in 2007/ 8. Only 93,000, or 1.3%, of all elective procedures were carried out in ISTCs – fewer than the 250,000 per year originally anticipated by the DH, and far fewer than the 6.7 million carried out in NHS centres. Researchers then compared the complexity of patients treated. Across all 30 procedures - which account for more than 80% of ISTC work - patients treated in the private sector had significantly fewer recorded diagnoses, significantly fewer procedures and came from significantly less income-deprived areas. Under new contractual arrangements ISTCs will be paid according to the same Payment by Results tariff as NHS providers for particular types of operations. But the researchers argued that paying private centres less, to reflect the less complex patients they treat, would be fairer. A second analysis of coding quality found that 36% of all procedures were not properly coded. Ms Mason said: ‘If treatment centres don’t code their work properly, it’s impossible to assess what patient care has been delivered and, therefore, to hold private providers to account in their use of NHS funds.’
  
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• Talks between GP groups fail to bring consensus over commissioning plans. Frantic behind-the-scenes talks are being held between national GP groups in a seemingly impossible bid to reach some consensus over the Government’s plans for commissioning. Organisations including the RCGP, the NHS Alliance, the National Association for Primary Care and the Family Doctor Association have been meeting to try to thrash out common ground, as the Government consultation on the plans splits the profession. However there are huge differences to resolve, with some senior NHS Alliance figures now calling for the Government to shelve its plans to scrap all PCTs by April 2013, claiming that some trusts should be allowed to remain in place, if not permanently, at least until GP commissioning groups have proved themselves capable of taking over. The NAPC has blasted the suggestion, arguing that with every day that goes by, tens of millions of pounds of NHS money is being wasted and urging the Government not to dilute its plans. NHS Alliance leaders have been trying to convince other GP groups that the Government’s plans are overambitious and that it should instead launch a series of pilot schemes in areas where GP commissioning is the most advanced. The RCGP and the Alliance yesterday launched a major consultation exercise with GPs to gauge grassroots opinion, with plans for a joint submission to the official Government consultation, which ends in October. NHS Alliance GMS lead Dr David Jenner said talks between the various GP factions had found much common ground, with broad support for the general direction of travel of commissioning. But major differences remain over the timescale and extent of the changes, including the plans to cull PCTs.
  
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• Trusts risk wrath of Lansley as they ignore GP opposition to hospital closures. NHS managers are ploughing ahead with plans for massive cutbacks to services in the face of GP opposition - despite health secretary Andrew Lansley’s claim that GPs should have the final say over any major service reconfiguration. The BMA, the NAPC and the Family Doctor Association have all told Pulse that trusts in different parts of England have been forging ahead with proposals, including the closure of hospital A& E departments, maternity units and children’s services, against the wishes of the local GPs. In Kent, the Maidstone division of the BMA today called for the immediate intervention of the health secretary, claiming he was being made to 'look stupid' by local NHS managers. Maidstone and Tunbridge Wells NHS Trust, backed by NHS West Kent, is pressing ahead with plans to close the maternity and paediatric services at Maidstone hospital, and to transfer them next summer to a new PFI hospital in Pembury. Yet a survey of local GPs shows overwhelming opposition to the plans. The GPs’ intervention in Kent comes on the same day as the BBC revealed the NHS in England faces a massive £65bn bill for new hospitals built under the controversial PFI initiative, with trusts left with annual repayments accounting for more than 10% of their turnover. In a recent letter to all trusts, NHS chief executive Sir David Nicholson made it clear all service reconfigurations must have 'support from GP commissioners'. In the capital a string of trusts in northeast London are pushing ahead with plans to close the A& E unit at King George Hospital in Ilford, claiming that the majority of the workload can be switched to polyclinics, despite a string of LMCs expressing their outrage at the plans.
  
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Thursday 12th August 2010

HSJ

• Two bidders left in NHS hospital franchise race. The outcome of a competitive process that will see a private firm involved in the running of an NHS hospital for the first time is expected to be announced before the end of the year.Two bidders remain in the running for the operating franchise for Hinchingbrooke Health Care Trust after Ramsay Health Care UK dropped out last week, NHS East of England has confirmed. Details of bids from Circle Health and a joint venture between Serco Health and Peterborough and Stamford Hospitals Foundation Trust are being further reviewed by the strategic health authority, trust and commissioners during the summer.The shortlist was reduced from six to three in March, although 11 organisations had originally expressed an interest. SHA director of strategic projects Andrew MacPherson said it was decided Ramsay’s plans were no longer suited to the trust’s circumstances. No details of any of the plans have so far been made public. He said a final invitation to tender would be issued in October and a decision made public in November or December. An NHS East of England spokesperson said: “Circle Health, Serco Health and Ramsay Healthcare were invited to submit bids as part of the second stage of invitation to participate in dialogue. Circle Health and Serco Health have submitted bids which meet [the invitation to participate] requirements and these are now in the process of being evaluated. “Ramsay Health Care, the third bidder, has chosen to submit a bid which does not meet those requirements, therefore it is not possible for [that] bid to be evaluated and they will not be taken to the invitation to tender stage.” The trust, which runs a small district general hospital in Cambridgeshire, has struggled financially and is thought unlikely to reach foundation status in its present form. Unions have criticised the decision to tender the franchise to the market.
  
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• Pessimistic foundation trusts set tough savings target. Foundation trusts are expecting their income to drop by an average 0.8 per cent a year from 2010-11 to 2012-13. The negative forecasts are set out in foundation trust annual plans submitted to their regulator Monitor. It is thought to be the first time the foundation sector has anticipated income reduction rather than growth. In the recent past Monitor has criticised foundations for assuming cuts in NHS tariff prices can be offset by simply increasing workload volumes. Last year, former executive chair Bill Moyes said such growth assumptions amid the recession meant roughly a quarter of foundation trust annual plans were “absolutely worthless”. This year the least optimistic foundations are acute trusts, which are anticipating a compound annual income growth rate of -1.1 per cent between 2010-11 and 2012-13. Specialist trusts are the most optimistic, forecasting average annual growth of 1 per cent. Monitor portfolio director Jason Dorsett said the pessimism in the acute sector was likely to reflect the marginal tariff, which sees trusts paid just 30 per cent of the tariff rate for cases over their 2008-09 volumes.
  
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Pulse

• Commissioning challenge laid bare as analysis reveals PBC cost £250m more than it saved. The huge challenge GPs will face in taking on £80bn of NHS budget has been laid bare by a Pulse investigation finding practice-based commissioning has cost hundreds of millions more than it has generated in savings. Our analysis of PBC since its inception in 2005 found GPs will take on budgets on a hugely uneven playing field, depending on whether GP commissioning has become established in the local health economy. Go-getting GPs in a handful of areas with well-developed commissioning economies have developed numerous services and saved millions of pounds. But in the vast majority of the 100 PCTs that responded to Freedom of Information Act requests, PBC struggled to reshape services and cost far more than it saved. Across the 100 trusts, £290m was spent on PBC since its launch in 2005 – on managerial support, data management, incentive payments and support from private companies – yet only £133m was saved. Extrapolated across the 152 PCTs in England, PBC was likely to have cost £441m and saved £198m – a deficit of £243m. Our investigation underlines the size of the task that will be handed to GP consortiums in England, following the planned abolition of SHAs in 2012 and PCTs in 2013. The findings are likely to alarm many GPs, as the Department of Health plans to tie a proportion of practice pay to the ability of consortiums to stay within budget. They may also fuel the belief among many GPs that the DH should not have pushed ahead with its commissioning plans without piloting first.
  
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• Post-Shipman fitness-to-practise overhaul falls victim to cuts. The Government is set to scrap plans for a massive shake-up of GP fitness-to-practise hearings, in a move it claims will save the NHS more than £60 million by avoiding an unnecessary new layer of bureaucracy. In the latest in a string of Labour initiatives to face the axe, proposals for an independent tribunal called the Office of the Health Professions Adjudicator (OHPA) appear to be doomed, after Treasury forecasts claimed the costs risked spiralling. A consultation published this week sets out three options for the future, with the Government's preferred option enabling the GMC to keep control of fitness-to-practise hearings, but on the condition that it slashes the bureaucracy and red tape involved in a bid to keep a tight lid on costs. The previous administration's post-Shipman regulation agenda has become a prime target for NHS cost-cutting in recent weeks. The GMC recently announced plans to streamline its revalidation process after Pulse revealed the Government was determined to slash the costs.
  
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Morning Star

• Hospital cuts 'put cancer care at risk'. Savage hospital cuts will mean that key targets for cancer care will not be met, the foundation trust regulator has warned. The annual plans submitted by Monitor revealed that a quarter of the country’s 129 foundation trusts (FTs) fear that hospital cuts will cause them to miss waiting time targets for treating cancer and the control of superbugs. More than 20 trusts said they may not be able to meet performance standards such as the maximum 62 days between GP referral and treatment for cancer. Eleven of the FTs admitted fears that they would be unable to adequately control superbugs such as MRSA and C.difficile, while a further three mental health trusts voiced concerns about meeting care targets. Monitor showed there would be a drop in trusts’ income for the first time of between 0.8 and 1.1 per cent by 2012-13. It also said unprecedented "cost improvement plans" would be required of trusts, which would need to make massive savings of 4.4 per cent this year compared to last year’s 3 per cent. Campaigners are expecting that care will be rationed and some operations could be ruled out altogether as a result of the financial strain. Campaign group Health Emergency chairman Geoff Martin said: "These shocking figures, coming before massive cuts across the NHS that we are expecting this autumn, nail the lie that the health service is somehow immune from the Con-Dem public services spending assault. "We can expect what is happening with cancer services to be replicated across the whole range of treatments and procedures as we head back to the bad old days of waiting lists and trolley queues in A& E. "Nobody should underestimate the scale of the crisis that’s brewing up in the NHS as we head towards the busy winter period." Monitor chief executive Steve Bundredsaid the annual plans reflected trusts’ “welcome dose of realism about the prospects they face."
  
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Tottenham Journal

• Out of hours GP service goes private. The out-of-hours GP service has been taken out of the hands of doctors - and handed to a private company. It has emerged that health chiefs have decided to take the service - which enables patients to see a GP in the evenings and at weekends - away from the co-operative of family doctors that has been running it for 12 years. In March, NHS bosses announced that health chiefs would continue to pay the not-for-profit cooperative, Camidoc, to continue providing evening and weekend care across Haringey, Camden, Islington, Hackney and the City. But now health chiefs have decided to take the contract away from Camidoc. They have instead entered into talks with private company Harmoni Ltd - which claims to specialise in out-of-hours care - to provide cover while a contract is re-tendered. The decision has devastated anti-privatisation campaigners. Maeve O'Connor, secretary of Camden Keep Our NHS Public, which campaigns for health services across north London, said: "Our group is horrified to hear that the contract has been revoked after they promised it was going to Camidoc. "It's very bad indeed that it's going to a private company. There is too much privatisation of health services going on and it looks like it's going to get worse." But Camidoc has also come under fire over the years - most particularly in 2005, when Islington journalist Penny Campbell, 41, died from multiple organ failure caused by septicaemia. In the four days before her death, she contacted Camidoc eight times - but its doctors failed to recognise the seriousness of her illess. NHS Camden said the contract was being taken away from Camidoc because of financial concerns. A spokesman said: "NHS Camden, NHS Islington, NHS Haringey and NHS City and Hackney can confirm that a new contract with Camidoc to provide a GP out-of-hours service will not be going ahead. The decision was based on issues around the ongoing financial viability of Camidoc and the proposed changes in government policy.
  
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Tuesday 10th August 2010

Guardian

• NHS funding should not be ringfenced, says citizens' jury. The government should rethink ringfencing funds for health and international development, consider appointing a "minister of the deficit", and do more to explain the need for a debate on which services should be cut, PricewaterhouseCoopers recommend. Those are the conclusions drawn from the research by the accountancy firm. PwC also warns against plans to involve ordinary people in drawing up proposed cuts ahead of the comprehensive spending review on 20 October, because members of the public feel they have "no real idea" what they are being asked to do and are ill equipped to participate. This, says the firm, will make people less likely to accept decisions put to them in the autumn. The government has drawn on the lessons of Canada and Sweden where support for drastic budget cuts are secured by educating and involving the public. People have been asked to send their suggestions to a new Treasury website and, from this week, the public will be asked to rate the ideas. PwC brought together a 24-strong citizens' jury to spend three and half days debating money-saving ideas, and polled another 1,780 people to gauge how well members of the public understand what the government has asked them to do.
  
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Healthcare Republic

• DoH announces review of Dr Foster Intelligence. The DoH has announced that the future of Dr Foster Intelligence, one of the UK's main providers of health information, is under review. The DoH was criticised by the Public Accounts Committee in 2007 for paying £12m for a 50% share in Dr Foster Intelligence even though DoH advisers valued it at £10-15m. Dr Foster Intelligence was launched in 2006 as a joint venture between the NHS Information Centre and Dr Foster Holdings LLP. The DoH owns a 48.75% stake with the rest held by Dr Foster Holdings LLP. The review is in line with the coalition government’s policy to maximise the value of assets and commercial opportunities.
  
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Halifax Courier

• Axed for making us healthier. NHS Calderdale has smashed all its health targets – just weeks after learning it faces the axe. The primary care trust has outstripped its goals in tackling obesity, smoking and drinking, and reducing hospital stays for over-65s. The news has prompted fresh scrutiny of Government plans to scrap England's 152 PCTs and hand over their powers to GPs. John Cafferty, regional head of health for UNISON, said: "It was quite clear from the evidence coming back that PCTs were gradually beginning to have an effect on a number of identified health problems across the country. It's just mind-boggling that a Government comes in and in one fell swoop smashes the organsations that were delivering results." Andrew Lansley criticised goal-setting within the health service. His plans for a radical overhaul of the health service, announced last month, aim to cut costs and bureaucracy. The shake-up is described as the biggest in NHS history and would put hundreds of Calderdale jobs at risk. At the latest NHS Calderdale board meeting, members supported a move to become an "early adopter" of the proposed changes. But Bob Heys, a former consultant at Calderdale Royal Hospital and member of patient forum Calderdale LINK, is calling for the scheme to be tested on failing PCTs before it is rolled out. He said: "If it's handed over to GPs, they'll have to put on staff to assist with the administration tasks so it's doubtful whether it will save cash. I think that's why it's necessary to have pilot studies to see both the financial and care consequences. It seems a great pity if the PCT is doing well that it should be abolished."
  
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Bolton News

• Community bus to health centre given the axe. A community transport service which gives people cheap access to a Bolton health centre is to be axed because it is not “commercially viable”, health bosses say. NHS Bolton, the borough’s Primary Care Trust, says it will not fund the North Bolton Local Link service because it does not make enough money, even though 2,500 people use it. As reported in The Bolton News, the service, which provides a direct taxi to Crompton Health Centre at bus fare prices, was given a stay of execution last week when transport bosses agreed to fund the service for a further three months while they negotiate with NHS Bolton.
  
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Leicester Mercury

• 'It would be a tragedy if children's heart centre at Glenfield Hospital closes'. An MP has said it would be a "tragedy" if the children's heart centre at Glenfield Hospital closed. Keith Vaz is among MPs who are backing the Mercury's campaign to save the service, which it is feared could shut as part of an NHS review. The review, being carried out by the National Specialised Commissioning Group, could see England's 11 children's heart centres reduced to seven. If the one at Glenfield is closed, patients and their families from Leicestershire and across the East Midlands will have to travel to Birmingham, Leeds or London for treatment. The group will publish its recommendations next month ahead of a public consultation in October. Leicester South MP Sir Peter Soulsby said cost-cutting must not be a driving force behind the review. About 30,000 people have signed a petition spearheaded by Heart Link to save the centre at Glenfield. Watchdogs the Leicester City and Leicestershire local involvement networks (Links) have joined forces to make sure they are ready to fight any recommendation which does not see Glenfield being kept.
  
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Nursing Times

• Private patients in NHS hospitals 'galling' for nurses. Expanding private healthcare in NHS hospitals could be “galling” for nurses and lead to conflict, a union leader has warned. The government has said it will lift the cap that prevents many foundation trusts from significantly expanding the number of private patients they treat. Unison, which has campaigned against the cap being lifted, fears the change will mean more private patients are treated in NHS hospitals. The union’s head of health Karen Jennings said: “Allowing hospitals to generate more money from private patients could undermine the very foundations of the NHS. Nurses will always act professionally. However, some may find it galling to work in a two tier system, where people with deeper pockets jump the queue. In hospitals with more private patients, there is a danger that the relationship between nurses and patients will change, leading to conflict. When someone has paid, they may feel that they have the right to priority attention.”
  
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Monday 9th August 2010

Islington Tribune

• Fears for hundreds of NHS and GP jobs as Camidoc contract is torn up. Hundreds of GPs and NHS staff have been warned their jobs are on the line after Islington’s out-of-hours doctors contract was torn-up and awarded to a private firm. Camidoc, a consortium of local doctors providing care across Islington when surgeries are closed, has been dumped amid concerns over its “ability to manage its finances” and “changes in government policy”. Doctors have rushed to the defence of the not-for-profit “clinicians on call” service, arguing it has not been properly funded under terms of a new deal agreed with health bosses in March. Hertfordshire-based Harmoni Ltd – one of the fastest-growing health firms in the country – is expected to run the service on a nine-month temporary contract from October 1. A leaked memo from Camidoc’s interim chief executive James Hood to staff said: “The reasons given boil down to their loss of confidence in Camidoc’s ability to manage its finances – they were very clear that there are no concerns about either the quality or the safety of our services.” Camidoc was hired in March by the four north London Primary Care Trusts – Camden, Haringey, Hackney and Islington – but Mr Hood’s memo said it no longer had their full support. The Tribune understands Camidoc ran into the red after demand for the service rocketed by 30 per cent. On March 25, 2010, NHS Islington’s acting chief executive Helen Pettersen said: “In awarding the out-of-hours contract to Camidoc we will ensure the continuity and high standard of service that I know local people value.” In fact, Mr Hood’s memo said the NHS Consortium had not signed the contract, leaving them in the clear to cancel the deal. His message said: “I realise that for most of you this may come as an unpleasant shock, and many of you will now be very worried about your jobs. I cannot give anyone any guarantees, but I will say that no one is saying these services should no longer run.” Candy Udwin, from Keep Our NHS Public, said: “This is exactly the kind of thing this government wants – for more private companies to take control of chunks of the NHS.” A joint statement from the consortium read: “We can confirm that a new contract with Camidoc will not be going ahead. The decision was based on issues around the ongoing financial viability of Camidoc and the proposed changes in government policy.”
  
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Pendle Today

• Pendle Community Hospital 'closure' rumours quashed. Rumours surrounding the future of Pendle Community Hospital have been quashed by directors following claims the centre is to close. A memo believed to have circulated among staff at the Leeds Road site suggested there may be a review of rehab and intermediate care. Although East Lancashire Hospitals NHS Trust has denied the claims, the trust announced it is facing "challenging economic times". The trust director of service development, Mr Martin Hodgson, said: "Given the challenging economic times we all face, the trust must consider options which will enhance both the quality and efficiency of the services it delivers to its patients. "There are no plans to change the services delivered at Pendle Community Hospital in the immediate future." But regional officer for Unison Mr Tim Ellis said there was "potentially a threat", adding: "We understand the trust is being required by the government to reduce spending. We would be very concerned at any proposals to reduce health service provisions and are certainly contesting these proposals which would affect the public most vigorously."
  
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Pulse

• Extended hours set to disappear as PCTs review funding. Almost two-thirds of GPs offering extended hours will stop next year if PCTs remove funding, with over half of trusts considering withdrawing local funding in light of the Government’s scrapping of national access targets, Pulse can reveal. Health secretary Andrew Lansley recently announced his intention to abolish the national target for 50% of practices in each PCT to provide extended hours as part of his bonfire of NHS targets. And a Pulse survey of 350 GPs currently providing extended opening, only one in seven said they would definitely continue to work early morning, evening and weekend shifts if funding was withdrawn - with the remainder undecided. Freedom of Information responses from 107 PCTs shows that over half of trusts are reviewing their use of extended hours LES’s for next year, with many likely to scrap funding if the national DES is removed following the abolition of the target. Only a quarter of the 98 trusts currently offering extended hours said they would definitely offer the service next year, with the majority set to re-examine their service and one in five yet to decide whether to review arrangements. These included NHS Hounslow, which said: ‘in light of the White Paper [the] Enhanced Services budget is likely to be reviewed with PBC Consortia’, and NHS Cambridgeshire, which said it would ‘review according to changing national priorities’. Dr Michael Dixon, chair of the NHS Alliance and a GP in Cullompton, Devon, said GPs should be wary of giving up extended hours if it went against their patients’ wishes, regardless of how it’s funded. He said: ‘In an ideal world, each practice should be talking to its patients, rather than to Government targets. ‘Clearly, patient experience will enter the payment structure in one way or another even if not through the extra extended hours DES.’ He added it may also see some practices losing patients to practices that do offer the service, particularly when practice boundaries are abolished. ‘Practices that have wider opening hours are going to more competitive than the ones that don’t. So I suppose it’s a caution to those that are thinking of going back to what they had before.’
  
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BBC

• York Hospitals NHS trust needs to make £30m in savings. York Hospitals NHS Foundation Trust says it needs to make £30m in savings over the next three years. The trust, which runs York District Hospital, said the decision had been made in response to "financial pressures" facing the health service. Chief Executive Patrick Crowley said: "We have asked all of our staff to tell us their ideas for how money can be saved." He added staff car parking charges had been increased to raise income. A trust spokeswoman said it hoped the need for job losses would be avoided and front-line services could be protected.
  
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Friday 6th August 2010

Manchester Evening News

• Maternity hopes are dealt a further blow. Mums in Salford say they are ‘disappointed’ that a review of a controversial decision to close the maternity unit will not include any new public consultation. Health Secretary Andrew Lansley said he was prepared to review the decision to close the maternity unit at Salford Royal. Health bosses at NHS North West will now look again at the region’s maternity care, but will not seek new evidence from mums-to-be. They will, however, review the evidence of more than 250,000 people gathered in 2005. But mums’ groups in the city say they will continue to fight for the new unit.
  
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Islington Tribune

• 25,000 sign up to save Whittington Hospital. Campaigners fighting cuts to the NHS delivered a petition of more than 25,000 thousand signatures to the Department of Health. The Defend Whittington Hospital Coalition has swung back into action after NHS bureaucrats revealed proposals to dismantle the Highgate hospital were not dead and buried. It is feared that North Central London (NCL) will start hacking away at the Whittington’s vital emergency services before the health authority is itself axed under Conservative Andrew Lansley’s NHS reforms. DWHC chairwoman Shirley Franklin said: “We are talking about disgusting, horrible and frightening changes to the NHS. We stand against cuts, privatisation, closures and any cuts to the mental health service. Since winning the election, Mr Lansley stopped NCL’s review and announced plans to devolve NHS spending decisions to GPs. And now health bosses have said they will resurrect their north London hospital closure plans if GP leaders agree. They will be looking to make even bigger savings than NCL was anticipating before the election – placing the A& E, maternity unit and crucial mental health services back under threat. Many believe private firms will snap-up major NHS contracts, with commissioners looking for cheaper options at every step.
  
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Healthcare Republic

• Plug pulled on private firm's contract to commission for PCT. One of the first deals for a private company to commission NHS services on behalf of a PCT has ended, a year early. UnitedHealth UK signed a three-year deal to help NHS Northamptonshire commission NHS services in 2008. But a spokesman for the PCT confirmed ‘both parties’ agreed to end the deal this month. The deal was agreed under Labour’s framework for the procurement of external commissioning support, which approved 14 companies to help PCTs deliver services. Firms are now hoping to work with GP consortia as they take on commissioning under the health White Paper from 2013. The White Paper is out for consultation until 11 October.
  
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Pulse

• GPs express fears over out-of-hours funding Only one in seven GPs believe they will be given sufficient funds to be able to commission out-of-hours care safely, a Pulse survey has found. The Government’s overhaul of the NHS will see GP consortiums assuming full responsibility for commissioning out-of-hours services in England from April 2013, under much tougher regulation than has been the case for PCTs. But GPs responding to Pulse’s survey have expressed serious concerns that consortiums will not be given adequate funding to commission services safely, due to the huge financial pressures facing the NHS. Of 410 GPs surveyed, two thirds said they were not confident they would be handed sufficient funds to commission out-of-hours safely, with just 14% believing they would be given adequate financial backing. The fears come after the Government’s primary care tsar Dr David Colin-Thome told Pulse last week that the sum GPs gave up in return for the opting out of out-of-hours provision in 2004 would not be reimbursed under the revamp, but that the money will remain part of the overall funds available to support commissioning of out-of-hours services. The survey also showed that only one in eight GPs will choose to provide out-of-hours themselves when the changes come into force, despite health secretary Andrew Lansley's recent forecast that many GPs would choose to provide when they assumed commissioning responsbility.
  
  

• PCT to become first in the country to close 'unneeded' Darzi centre. A GP-led health centre in Peterborough looks set to become the first in England to be closed down after it attracted fewer than half of the patients it was supposed to register. NHS Peterborough is planning to shut down the Alma Road Primary Care Centre, run by GP-led company 3Well Medical, to make an estimated £800,000 in savings, as it struggles to tackle a £12.8m debt. The GP-led health centre was procured as part of the Equitable Access in Primary Care programme spearheaded by Lord Darzi, which forced every PCT in England to procure one new centre, regardless of local need. A spokesperson for the Alma Road centre said the PCT's termination notice had been served under the 'no cause' clause of its APMS contract, but the centre has struggled to recruit patients. It had aimed to register 1,500 patients by April this year - but had by the start of last month recruited just 618. Dr Rupert Bankart, medical director for 3Well Medical, said the proposed closure was due to the PCT's financial situation. Pulse revealed in March that Peterborough’s GP-led health centre was one of the best-funded in the country, earning £297.94 per walk-in session irrespective of patient numbers. However at the time the PCT told Pulse it had no plans to revise the terms of its contract.
  
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• Revealed: The 30-year contract with Care UK which GP commissioners will have to honour. NHS managers have saddled GP commissioners with a 30-year contract for an independent sector treatment centre after controversially paying more than £8m to the private company running it as part of a deal to renegotiate terms. News of the deal comes as primary care tsar Dr David Colin Thome told Pulse GPs would be responsible for sorting through and where possible renegotiating contracts when they take over the majority of PCT budgets under the Government’s planned reforms. NHS Derbyshire County has cancelled a previous under-used fixed-term contract with Care UK, private providers of the Balborough Treatment Centre in Chesterfield, and paid £8.2m to purchase the building and sign a new 30-year deal with the same company. Once GPs take over local commissioning, they will inherit the contract and won’t be able to terminate Care UK’s lease. It is the latest in a series of cases where the NHS has paid a high price to modify deals with private companies, including NHS London’s £10m payout to suspend a contract with Clinicenta after ‘significant clinical failings’. The Balborough Centre opened in 2005 but its original contract was cancelled earlier this year, after it was paid £21.9m to perform only £15.1m-worth of orthopaedic surgery on patients in south Yorkshire, Derbyshire, Nottinghamshire and Lincolnshire. NHS Derbyshire has since renegotiated the contract with Care UK on a paid-per-patient basis and is paying the company a further £8.2m to buy the centre – and leasing it back to Care UK. NHS Derbyshire County confirmed when GPs assumed commissioning responsibility in 2012/ 3 they would ‘need to honour the agreed lease’.
  
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Public Service

• NHS sheds 11,000 jobs. Union leaders are threatening to take the government to a judicial review over the pace and scale of NHS reform after the number of health service job losses planned so far this year topped 11,000. The latest proposed cuts are at the Royal Berkshire NHS Trust where 600 posts are to be axed over three years as part of a bid to save £60m. The announcement follows measures already planned across the UK with more than 11,000 health service posts earmarked to be cut, downgraded or left unfilled by the 106 trusts to have submitted data to the Royal College of Nursing. There are fears that in total more than 40,000 jobs may be lost throughout the NHS in England alone. Unison, which represents more than 450,000 NHS employees claimed hospitals were being "pressurised into making rash decisions" by ministers driving a reform agenda that was still out to public consultation. In a letter to NHS chief executive Sir David Nicholson the union claimed the changes being imposed were unlawful because the consultation process was still ongoing and the public, patients, staff and unions had "not had a proper opportunity to have their say". Unison has asked for a response from the government within seven days. Jennings added: "If we are not happy with the reply we reserve the right to issue urgent judicial review proceedings."
  
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Guardian

• Government accused of 'promoting privatisation' of NHS. The government has been accused of "promoting privatisation" of the NHS after a surprise announcement of sell-off plans for an agency which provides thousands of nurses and other health workers to hospitals across the country. The department of health said it would explore options for private sector investment in the state-owned NHS Professionals, which has 50,000 workers on its books and places staff for two million shifts a year at 77 health trusts. Unions were furious over the sell-off. Karen Jennings, UNISON Head of Health, said that "the whole reason that NHS Professionals was set up was because private agencies were ripping off hospitals by charging them outrageous fees for recruiting or finding staff for shifts. It makes no sense at all to bring back private companies who will want their slice of the action in return ... This is purely about promoting privatisation ...regardless of the consequences on patient care. A sell-off may bring a short-term cash injection, but cost NHS Trusts vast sums in the longer term." However the department said the plan "is in line with the government's policy to maximize the value of assets and commercial opportunities," the department said in an e-mailed statement today. The department will hold meetings with the private sector on "options and opportunities," the statement said. There are concerns that the move may be illegal. One website, chiefofficers.net, claimed that "[a] question arises as to whether this is a lawful activity under securities laws [governing the public sector in Europe]. The general principle is that it is illegal to seek investment in a company except in very limited circumstances. A public offering that does not fall within those exceptions will often result in serious penalty for those who are convicted of the various offences related to the conduct.." Unison said said that this may be the "thin end of the privatisation wedge" as European rules exclude the NHS from having to contract out services – yet such a sell-off signals that the government is prepared to aggressively promote the private sector in the NHS. The union said it was now contemplating a "judicial review" of the decision by NHS chief executive, Sir David Nicholson, to press ahead with reorganisation plans that have "neither parliamentary approval nor legal backing". Nicholson wrote to NHS managers outlining a series of "actions that we need to start now" that may see wards shut and hospitals closed. Last week health secretary Andrew Lansley backed the move of specialist cancer surgery from Royal Cornwall Hospitals Trust to Plymouth Hospitals Trust." The Government's White Paper will change forever the NHS as we know it. These sweeping changes were not part of any party manifesto and it is outrageous that these changes are being brought in without consulting the public, patients, staff and unions," said Jennings. "In writing to NHS managers, Sir David is working on the premise that the consultation is only about the best way to achieve pre-determined outcomes – this makes it nothing more than a paper exercise and a sham.'
  
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Thursday 5th August 2010

Healthcare Republic

• Private firms eye changing NHS With GP consortia due to run an £80 billion annual commissioning budget by 2013, the private sector is widely expected to cash in on their lack of management expertise. But what are the opportunities for private firms and how bold are their ambitions ? Will they offer back-office support to consortia, or aim to take over commissioning altogether ? Firms such as UnitedHealth UK, Tribal and Humana already provide support services to PCTs across England. They collect data, analyse health systems and manage contracts. Assura Medical has developed around 30 partnerships with groups of practices, helping them redesign local services - a model which now looks highly relevant. But unions and campaign groups say the White Paper Liberating the NHS represents a massive step towards private-sector-led commissioning. Health secretary Andrew Lansley has yet to fully explain who will step in where local GPs fail. The BMA fears the private sector will be invited to take over if consortia slip up. Dianne Conduit, director of commissioning support at Humana, says the firm would consider taking over commissioning in areas where GPs fail. 'We can provide elements of the service or look at providing the whole package,' she says. Others are more cautious. Kingsley Manning, director of Tribal, questioned whether Mr Lansley's reforms will go that far. 'It could happen down the road I suppose, but it's difficult to see how legislation could ever devolve responsibility for NHS services fully to a private company,' he says. Assura Medical 'hasn't considered it at all', says its chief executive, Bart Johnson. He says the firm is 'committed to working in partnership' with local GPs, who 'know best what needs fixing in their area'. Similarly, UnitedHealth UK seems determined to support, not compete with GPs at this stage. A spokesman said: 'Ultimately it'll be for consortia to decide which levels and types of support they need.' GPs are not hugely confident about commissioning, suggesting they may want to buy in help. A recent GP survey found that more than 70 per cent think they will lack the skills and resources to commission well. But Dr Darin Seiger, chairman of Nene Commissioning, says consortia can work effectively with a small team of in-house managers. 'You could keep out the private sector if you wanted to,' he says.
  
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Pulse

• GPs express fears over out-of-hours funding. Exclusive: Only one in seven GPs believe they will be given sufficient funds to be able to commission out-of-hours care safely, a Pulse survey has found. The Government’s overhaul of the NHS will see GP consortiums assuming full responsibility for commissioning out-of-hours services in England from April 2013, under much tougher regulation than has been the case for PCTs. But GPs responding to Pulse’s survey have expressed serious concerns that consortiums will not be given adequate funding to commission services safely, due to the huge financial pressures facing the NHS. Of 410 GPs surveyed, two thirds said they were not confident they would be handed sufficient funds to commission out-of-hours safely, with just 14% believing they would be given adequate financial backing. The fears come after the Government’s primary care tsar Dr David Colin-Thome told Pulse last week that the sum GPs gave up in return for the opting out of out-of-hours provision in 2004 would not be reimbursed under the revamp, but that the money will remain part of the overall funds available to support commissioning of out-of-hours services. The Government announced last week that GP commissioners would have to meet rigorous new standards for OOH care after some high-profile failures in services commissioned by PCTs. The survey also showed that only one in eight GPs will choose to provide out-of-hours themselves when the changes come into force, despite health secretary Andrew Lansley's recent forecast that many GPs would choose to provide when they assumed commissioning responsbility.
  
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Scotsman.com

• NHS in Scotland could face cuts as ring fencing of funds is ruled out. Scottish ministers have held back from offering a cast-iron commitment to maintaining or increasing spending on the NHS next year, when Scotland's public services will be hit by cuts of nearly £2 billion. Finance Secretary John Swinney has warned the NHS will face "serious financial challenges" come next April, and has ruled out any ring-fencing protecting the health service from cuts. In June, Mr Swinney had said it was ministers' "crystal clear" position to either maintain or grow health spending next year. That is despite the fact that the Scottish Government faces savage cuts to its budget. But the Scottish Government is saying that the final decision on spending on the NHS in Scotland will have to wait until Scottish ministers receive clarity from the UK Treasury on their own budget later this autumn. The matter centres on extra funds which will be granted to Scotland this October known as Barnett consequentials. These will be given to Scottish ministers as a consequence of spending increases to the NHS in England. Scottish ministers have pledged to hand all that cash straight to the NHS in Scotland. But analysts say it does not necessarily follow that, as a result, the NHS in Scotland will have an increase in actual money. Mr Swinney was asked in June whether he wanted to maintain or grow health spending next year. He replied: "That has been our position throughout." Asked the same question on Tuesday evening's Newsnight Scotland, he said: "What I have said throughout this process is that the Scottish Government is committed to pass on the Barnett consequentials." He went on: "There is fundamental difference between that commitment and ring-fencing. Ring-fencing suggests that there isn't any financial pressure on the NHS and that isn't the case". In England, the coalition government says it will increase spending on the NHS putting pressure on ministers in Scotland to follow suit. However, the IBR last week recommended that, given the scale of the cuts to come, no one area should be protected.
  
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Guardian

• Leeds MP criticises 'dangerous' NHS reorganisation. A Leeds MP has criticised government plans for a huge structural upheaval of the NHS, including the abolishment of NHS Leeds. Leeds West MP Rachel Reeves said the changes represent the biggest change to the NHS in its 62-year history. The proposals will mean handing most of the NHS budget to GPs. Primary care trusts like NHS Leeds will be phased out and groups of GP practices will instead commission health services from hospitals. GPs will be free to ask the private sector to help them plan and contract services for patients – the role currently carried out by NHS Leeds. NHS Leeds staff may be forced to move on, or reapply for the same jobs in new organisations. Reeves said today: "I am extremely worried that patients could end up waiting longer and thousands of NHS workers could face redundancy. "A top-down reorganisation is the last thing the NHS needs right now. It needs to focus all of its efforts on meeting the financial challenge it faces. This reorganisation will distract attention, reduce motivation and cost billions. I am determined to fight the Health Bill when it comes before Parliament to stop this dangerous legislation. "Patient guarantees like the maximum 18-week wait for an operation and four-hour wait in A& E have been scrapped or downgraded. "Waiting times are set to rise, leaving patients with the familiar old Tory choice – wait or go private. Services will vary so widely between the new GP groups that, in time, the N in NHS will be redundant – a postcode lottery for patients." Shadow Health Secretary Andy Burnham said the the proposed reforms 'represent the break-up of the NHS'. Health Secretary Andrew Lansley warned that NHS job losses were "inevitable" but said it was vital to switch cash from bureaucracy into frontline services. Evidence suggesting GPs will be more effective than health trusts at commissioning NHS services "is weak", a report has said. Meanwhile, more than 130 NHS Leeds managerial jobs are to be cut over the next three years in a bid to save £5 million.
  
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HSJ

• Oxford Radcliffe Hospitals Trusts paediatric cardiac surgery unit to remain closed. The paediatric cardiac surgery unit at Oxford Radcliffe Hospitals Trust should remain closed, according to a report published last week. NHS South Central commissioned an investigation, led by its director of clinical standards Bill Kirkup, after four deaths there at the start of the year. The unit, the smallest of the 11 paediatric cardiac surgery units in England, performed roughly half the number of procedures per year as the next smallest. The investigation panel recommended paediatric cardiac surgery remains suspended “until arrangements are put in place that will create a critical mass of clinicians who, working as a single team and dealing with an adequate caseload, can maintain their expertise”. The unit previously had one surgeon, who also carried out adult cardiac procedures, but appointed an additional surgeon last year. All four deaths followed procedures carried out by the second surgeon, who has now left the unit. The report said: “We found no errors of judgement that directly led to any of the deaths. The panel’s experts, however, considered several cases may have had a better outcome with different surgical management.” Monitoring systems were also criticised, as was the handling of the four deaths. The report noted it took an enquiry from journalists 12 days after a surgeon first raised concerns for the trust to declare a serious untoward incident. In a statement, the trust said it would develop plans to tackle the issues raised in the report as “a matter of urgency”. The unit will remain closed until at least September, when the strategic health authority board next meets.
  
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• Royal Berkshire Hospital Trusts to cut 600 jobs. The Royal Berkshire Hospital Trust will axe up to 600 jobs under moves to make £60m savings in the next few years, it was announced today. Frontline staff would not be affected by the cuts, which the trust said it hoped to achieve through natural wastage and retirement. But unions said frontline services were bound to be affected by such huge cuts and accused the government of “conning” people into believing that its massive clampdown on public spending would not hit services. The trust, which has a hospital in Reading, an eye clinic in Windsor and provides some services at a hospital in Newbury, employs 4,500 staff. Jobs to be cut will be in human resources, IT, facilities and general backroom roles, said a spokesman. Chief medical officer at the trust Dr Jonathan Fielden said: “Over the past few months we have shared with staff our triple aim of providing the best possible patient experience, the best possible health outcomes at the lowest possible costs. “Everyone is now well aware that we are working to achieve our aim in a challenging financial situation which is facing the whole country and in particular the public sector. “This year we have to identify and deliver a savings plan of £20 million (around 6.5% of our total budget), and over three years need to save a total of £60 million.
  
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• Wakefield District PCT managers face axe. More than 40 management positions at Wakefield District Primary Care Trust are in jeopardy as part of wider cost-cutting measures, the Yorkshire Post has revealed. The trust said workforce cuts were “unavoidable” as part of efforts to slash £1.4m from its management costs before the end of March next year. According to the Yorkshire Post, which submitted a freedom of information request for the details of a private board meeting in June, this will put 42 management positions in the firing line. Alan Wittrick, chief executive of the trust, said: “In line with many other NHS organisations, we have to achieve a total of over 40% savings in our management costs over the next three years. “Unfortunately this means that savings in our workforce costs are unavoidable. We are already working through a process of voluntary and, potentially, compulsory redundancies with our staff.” The trust said savings of £1.4m would be followed by further cuts of up to £3.4m over the next two years in response to the government’s plans to shed thousands of management posts at PCTs across the UK. Front line positions are also in jeopardy at the trust as local hospitals plan to cut costs by £55m in the next two years, the Yorkshire Post reported. The announcement is the latest in a string of cuts across Yorkshire, with more than 130 managers set to leave NHS Leeds over the next three years, the paper said.
  
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Tuesday 3rd August 2010

Glasgow Evening Times

• Health jobs payout could reach £20m. NHS Greater Glasgow and Clyde has already announced plans to shed more than 1200 jobs in the next 18 months and 2000 are to go in NHS Lothian. However, Health Secretary Nicola Sturgeon has pledged there will be no compulsory redundancies despite pressures on budgets. The figures were uncovered by Labour’s health spokesperson Jackie Baillie in response to a Freedom of Information request. NHS Greater Glasgow and Clyde said it could not put a number on how many voluntary redundancies were expected. NHS Forth Valley said it had a voluntary service provision of £2m from savings plans which were already in progress.
  
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Worcester News

• Worcestershire MP calls for volunteer takeover of NHS trust boards. An MP says community hospitals such as the one in Malvern could be run by volunteers rather than a board of directors who get paid tens of thousands of pounds each per year. West Worcestershire MP Harriett Baldwin believes community hospitals could be run by volunteer board members instead of high-paid executives. She sent a written question to Health Minister Simon Burns asking if this would be feasible. The board of directors at NHS Worcestershire, the primary care trust which holds the purse strings to healthcare in the county, gets about £1.3m a year in salaries. In a recent discussion with NHS Worcestershire’s chief executive Paul Bates, who earns about £136,000 a year himself, Mrs Baldwin was told the cost of paying a board was an obstacle preventing its community hospitals from becoming a foundation trust. The Department of Health regulations allow for unpaid board members and the latest statement allows for Worcestershire’s community hospitals to adopt this approach.
  
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Argus

• Sussex health shake-up to save £4m. A shake-up of mental health services across Sussex will save about £4m. Health bosses are planning to cut the number of inpatient beds across the county by 85 and develop more services in the community instead. Beds will go at hospitals in Haywards Heath, Eastbourne and St Leonards, leaving a total of 254.
  
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Healthcare Republic

• PCTs target GP services for funding cuts. PCTs are set to slash GP services, slim down urgent care and put pressure on referral and prescribing rates to cut costs. PCTs across England outlined the plans in operating and strategy reports for 2010/ 11. Plans to reduce GP contract spending – likely to mean pressure on enhanced services and PMS deals – will increase pressure on practices hit hard by PMS contract reviews this year. NHS Peterborough alone aims to save around £4m from GP contracts and payments over 2011/ 12 and 2012/ 13. Its ‘turnaround plan’ proposes ‘cessation and capping’ of local enhanced services, cutting variation in payments per patient to GP practices and stopping two to three GP APMS contracts’. NHS Peterborough hopes to find around £74m in total savings over 2011/ 12 and 2012/ 13. Around £13m could come from primary care, including cuts to walk-in and out-of-hours services. Meanwhile, NHS Brighton and Hove plans to slash GP out-of-hours costs by around £310,000, while NHS Harrow has already saved £45,852 on out-of-hours this year. A spokesman for NHS Harrow said this was achieved by a ‘change in the provider that triages patients to the service’. Several PCTs aim to save money by increasing management of GP referral and prescribing rates. NHS Peterborough hopes to save £800,000 a year over 2012/ 13 and 2013/ 14 from referral management, and £3.1m on prescribing. NHS Western Cheshire planned to continue its 2009/ 10 prescribing cost cuts, while NHS Hounslow aimed to manage referrals ‘more effectively’.
  
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Belfast Telegraph

• NHS office staff to hold cuts protest at hospital. Around 100 administrative staff are expected to gather outside Belfast City Hospital today to protest plans to slash 50 medical secretary jobs and downgrade a further 120. The demonstration, which is the first of two taking place this week, has been organised by the Northern Ireland Public Sector Alliance (NIPSA). The union claims the Belfast Health and Social Care Trust has so far refused to reveal the full details of the proposals which they fear could lead to a “substantial” drop in pay for those affected. Currently, the annual salary for a medical secretary is between £18,152 and £21,798 (Band 4) on the new NHS pay scale. They claim 50 people will be made redundant while 120 will be downgraded to Band 2 or 3. The trust denies this, however. A spokesman for the trust said the document sent to the unions “proposes” what is felt are “the appropriate skills needed to do” the job. “This aspect of change will be managed through a voluntary redundancy scheme and the normal turnover of staff.” NIPSA Deputy General Secretary Alison Millar described the plan as “absolutely shabby”. She said the protest has been organised to “demonstrate the anger” of staff at the decision to “effectively downgrade” them while they performed the same duties.
  
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Derby Evening Telegraph

• NHS wanted deal that would pay per patient instead of a fixed sum contract. Barlborough Treatment Centre hit the headlines when it was revealed that the NHS had spent £8.2m buying it from a private company. It was previously run by Care UK and Derbyshire's NHS trusts and had contracts with the centre to provide knee and hip operations. Barlborough was set up in 2005 to bring down waiting lists – but the deal was based on a fixed sum rather than the number of operations. Over five years it received £21.9m from health trusts in Derby and the rest of the county, but carried out only £15.1m-worth of surgery on local patients – about 17,000 knee and hip replacement operations. In January, the NHS decided to end its contract and tender for another that would pay per patient instead. It was then announced that the new deal – for 30 years – had been awarded to Care UK. It was then revealed that the NHS was paying a further £8.2m to Care UK to buy the centre, with Care UK as a tenant. The move was criticised by unions and politicians, who said people are well-served by hospitals in Chesterfield and Derby already. But NHS bosses said it would be an asset to the health service. The £8.2m was paid by the Department of Health, with local health authority NHS Derbyshire County given rights of ownership. In the past, the centre has been the target of several lawsuits brought by Derbyshire patients claiming their surgery had gone wrong.
  
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Mirror

• Longer wait if private ops on NHS. Condem plans to let hospitals carry out limitless private operations could mean a "two-tier" health service, a minister has warned. Health Secretary Andrew Lansley has removed the cap on how much private income hospitals can generate from paying patients. But, Equalities Minister Lib Dem Lynne Featherstone admitted that could mean longer waiting times for people who cannot afford to pay for treatment as the rich "jump the queue". Labour's Shadow Health Secretary Andy Burnham has also criticised the policy.
  
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Guardian

• Liberating the NHS to benefit patients. In a letter, the Defend the Whittington Hospital Coalition write: A week before the election, health secretary Andrew Lansley stood outside the Whittington hospital and told us our A& E services would be safe and that plans to cut other services across north London would be scrapped. A week after the election, he paid a visit to Chase Farm hospital to tell them likewise. Since then, 10% of the beds (50) have been closed at Chase Farm and the North Central London NHS will not confirm the continuance of current hospital, mental health and other services. The white paper puts the NHS at risk of privatisation and puts the future of all our services in the hands of huge private corporations. But shadow secretary Andy Burnham has also done a U-turn. Only after we had invited Lansley to our pre-election rally did he change his mind about the potential closure of our A& E. Equalities minister Lynne Featherstone, a local Lib Dem MP, helped to lead our campaign, and claimed to have saved the Whittington in her election propaganda. Now she will not reply to our emails. We need the renewed support of all to stop the destruction of the NHS.
  
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Monday 2nd August 2010

Wales Online

• NHS over-spending triggers a ban on locums, agency nurses. A ban on expensive agency nurses and locum doctors will be introduced in large parts of Wales as the NHS tries to save tens of millions of pounds. Cash-strapped health boards are introducing stringent cost-saving measures as they have amassed overspends of up to £12m in three months. But the British Medical Association said last night it had “serious concerns” about actions that could compromise patient safety. One of Wales’ largest health boards – Cardiff and Vale University Health Board – will also introduce a recruitment freeze and cap overtime payments to staff to try to improve its financial footing. It was £9.3m overspent in the first three months of the 2010-11 financial year. The body has an annual budget of almost £1bn. And Betsi Cadwaladr University Health Board, which provides NHS services in North Wales, has announced restrictions on the use of agency and locum staff in the face of an £11.4m three-month overspend.The Western Mail revealed earlier this week that the board, which provides NHS services in five counties in South-East Wales, has already agreed plans to ban agency nurses from September 1, saving £5m a year. A spokeswoman for Aneurin Bevan Health Board said yesterday: “It was decided further work was required to ensure the same zero-tolerance approach would apply in future to the use of agency doctors and other groups of staff. “Further work is being done by the medical director to inform the impact on services but the board is clear it wishes to have substantive staff in place for all services, including medical staff.” Stefan Coghlan, chairman of the British Medical Association’s Welsh consultants committee, said: “Safe services require staff to be present and when you cannot recruit regular staff, for whatever reason or when doctors are off sick, then there has to be a back-up system and that traditionally has been to use an internal locum and if they aren’t available, then to go to an agency.
  
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Scotsman.com

• 125 health staff gone already in job cuts. 120 staff have already left their positions as part of NHS Lothian job cuts.The health board is four months into its drive to cut £31 million from its annual spend, and that includes losing 700 positions. Director of finance Susan Goldsmith revealed 125 places have already been cut out, although they have come from "natural wastage" rather than redundancy. She said: "We've already given up 125 positions and that hasn't yet been reflected in the financial figures. That is a positive development and a real reduction in our staff in post towards our target of 734 full-time equivalents." The savings at health board level will not stop this year. A further 1300 jobs will have to go in 2011, taking the total number of employees down from 29,000 to nearer 27,000.
  
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HSJ

• 'NHS not immune to cuts', warns Scottish BMA. Scottish doctors leaders said it would be “naive” to think the NHS can be immune from the impact of public spending cuts, it emerged. British Medical Association (BMA) Scotland warned against “drastic cuts” in health spending, but called for an “honest and open debate on what the NHS can and cannot afford”. The body also said it was important to avoid a “knee-jerk, slash and burn reaction” to budgetary constraints and said clinicians should help decide where cuts can be implemented. The comments were contained in the BMA’s submission to the Independent Budget Review (IBR) group. The review was drawn up to address the first real-terms cut in spending since devolution, with the Scottish budget set to fall by £3.7 billion over the next three years. It recommended last week that no public services should be protected against the prospect of looming cuts in spending. The UK government has already promised to protect health spending in England, and finance secretary John Swinney has pledged any additional cash due to Scotland as a result of that would go to the health service north of the border. In its submission, BMA Scotland said cuts would be a “seismic shock” to an NHS that has experienced “substantial” growth over the last decade. A spokesman for the Scottish government said: “The Scottish government has made it clear that we will apply any Barnett consequentials arising out of the protection given to the health service by the UK government to the health service in Scotland. “The IBR will help shape the overall budget process, and the finance secretary has invited other political parties for talks on the review’s findings and is engaging with members of the public to ensure they have their say.”
  
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Guardian

• Coalition three months on: the NHS. Neither the Tories nor the Lib Dems fought the election promising massive changes in the NHS. The safest line a politician can take – and the one David Cameron stuck to for the most part – is to pledge to nurture, honour and protect the health service. So it came as a surprise to many when Andrew Lansley's health white paper heralded a radical overhaul of the way care is funded and delivered. Even Number 10 had not realised how big a deal it was until civil servants and media started calling it a "revolution". The most controversial idea is to scrap hundreds of primary care trusts and strategic health authorities and devolve their budgets to GPs. Doctors, it is assumed, know better the needs of their communities and are more trusted by patients than managers and bureaucrats. The risk is that many GPs do not want to take on these new functions and end up using their budgets to rehire the old managers. Meanwhile, the new structures will make it easier for private health companies to bid for contracts to provide key services. Unions are on high alert. It doesn't help that Lansley's other high-profile interventions have been to rubbish Jamie Oliver's drive for healthy school meals and to ditch attempts to enforce more rigorous nutrition labelling. So Lansley, hardly known before the election, is perfectly placed to be vilified as the friend of the junk food industry who launched a stealth privatisation of the NHS. That wasn't the coalition plan. But health was not a prominent part of the Lib Dems' manifesto. They watch on, mute and increasingly nervous.
  
  * POPULARITY FACTOR: 8/ 10 Any party messing with the NHS does so at its peril.
  * SPLIT FACTOR: 4/ 10 The Lib Dems don't have an alternative policy.
  * RADICAL FACTOR: 7/ 10 GPs will never be the same again.
  
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• Health secretary accused of U-turn on hospital cutbacks. Labour says Andrew Lansley has walked away from promised moratorium on closing wards and A& E departments. Andrew Lansley, the health secretary. Andy Burnham, the shadow health secretary, has launched a stinging attack on health secretary Andrew Lansley's "U-turn" over his promises to reconsider the possible closure of hospital wards and accident and emergency departments. David Nicholson, the health service's chief executive, has written to NHS managers saying that there should be plans in place to "reconfigure" hospitals by the end of October– a pressing need given the NHS will need to save £20bn in the next three years. Lansley had promised a moratorium on the changes planned by Labour. However, Nicholson told the managers: "The NHS has always changed and adapted to new technologies, medicines and treatments and must continue to do so." Burnham, who trails the favourites in the Labour leadership campaign, repeatedly questioned the credibility of Lansley's promises on the election trail. "This U-turn proves that Lansley was playing politics with the NHS at the election and has now had to face up to reality. His opportunistic pledge to halt A& E and maternity closures has lasted less than two months," he said. He said Lansley, his successor as health secretary, had also reneged on his commitment to "end top down reorganisations of the NHS". Burnham said: "In May he said that service changes should not be subject to top down processes or timetables. Now he is asking strategic health authorities to oversee a bureaucratic process to review all planned, ongoing and completed reconfigurations to a nationally set timetable. This means more uncertainty for patients and staff. The NHS needs stability right now – what they are being offered is confusion, contradictions and chaos." Experts say that the health secretary is trying to "insulate" himself by getting bodies about to be scrapped to make the decisions about NHS changes. "When they start shutting down wards Lansley will say, 'It is not me, it is the SHAs and I have just abolished them'. It's a clever political strategy but I am not sure the public will be fooled," said Andy Cowper of the blog healthpolicyinsight.com. The issue of how to save money in the health service means that reconfigurations has returned to haunt the government.
  
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Healthcare republic

• Former health secretary launches 'Save our NHS' campaign. Former health secretary Andy Burnham has launched a 'Save our NHS' campaign against the 'unnecessary reorganisations' planned by the government. Mr Burnham criticised the government’s plans for NHS reform arguing its priority instead should be to meet the financial challenge. He said the planned reorganisations are ‘unnecessary and dangerous’ and will ‘unpick the very fabric of our previous NHS’. He called for people to ‘act now’ to defend the NHS. Mr Burnham said: ‘This unnecessary reorganisation will distract attention, reduce motivation and, scandalously, cost up to £3bn – money that could be spent on patient care. ‘The NHS is working. It was recently judged the second best health service in the world and top on efficiency. Now, the coalition government is putting all this at risk. It is a reckless £80 billion gamble with all of the progress made in the last decade.’
  
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Telegraph

• NHS trusts preparing to bid for more private patients. The Department of Health announced last month all NHS hospitals are to become foundation trusts, or part of one, making them independent of Whitehall control. As part of the plans to encourage greater competition between NHS organisations and the private sector, foundation trusts could be allowed to earn more money by treating more private patients once they have fulfilled their obligations to the NHS. Some hospital trusts have already put in place plans to build new wings and wards to cater for private patients and to set up hospitals abroad, according to the Guardian. Papworth Hospital, in Cambridge, which carried out the first successful heart transplant in the UK, Moorfields Eye Hospital, in London, and Christie Hospital, in Manchester, Europe's largest cancer centre, told the newspaper they had all made plans to expand to attract more private patients. Stephen Bridges, the chief executive of Papworth Hospital, which is due to be submerged into the new Cambridge Biomedical Campus, said the Government had “really thrown down the gauntlet”. “In the next five years we aim to triple private income from 5 per cent today to 15 per cent,” he said. “There are plans for a completely new private hospital on the campus." The Christie Hospital, in Manchester, Europe's largest cancer centre, said it would treble its private income from £10million to £30million within a decade. John Pelly, the chief executive of Moorfields Eye Hospital, said: "Without profits [from our commercial business] our ability to invest in our clinical services would be seriously constrained ... “Particularly at a time when the financial constraints facing the NHS are going to be as severe as they are in the next three or four years, it's going to be really important to the NHS that we can take advantage of the abolishing of the cap." But opposition MPs have attacked the Tory proposals, and claim that NHS patients will suffer as private patients are given preferential treatment. Andrew Burnham, the shadow health secretary, said there was "a dangerous combination of lifting the cap on treating private patients and scrapping national waiting time standards," He added: "With no limit on the amount hospitals can earn from seeing private patients, NHS patients can be made to wait. And as waits grow, people will be forced to consider paying for their care. It's the same old Tory NHS choice – wait longer or pay to go private."
  
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Friday 30th July 2010

Healthcare Republic

• BMA defends NHS pensions scheme. The BMA has issued a robust response to the government's public sector pensions review, claiming the NHS scheme has actually delivered a surplus to the Treasury in recent years. Dr Andrew Dearden, chairman of the BMA’s pensions committee, said the NHS’s pension scheme is financed by employees and employers rather than taxpayers, and had already recently been reviewed to deliver value for money. Former work and pensions secretary John Hutton is leading a review of pubic sector pensions after deputy prime minister Nick Clegg said many of the schemes were ‘unfair’ and unsustainable. But Dr Dearden said pensions for NHS staff ‘are by no means a drain on the taxpayer’. ‘They represent a fair deal for staff and value for money for the public,’ he said.
  
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Herald

• 50,000 public sector jobs in the firing line. Scotland has been handed a shocking picture of the swingeing cuts threatening to lay waste to the country’s public services. A budget blueprint yesterday set out a brutal package of options to bridge the £42bn funding squeeze facing Scotland, with no public services spared the prospect of cuts. It warned that up to 50,000 public-sector jobs could be axed and free services like personal care and eye examinations might no longer be affordable. It also placed in the line of fire the free prescriptions and public-sector pay rises. The hard-hitting report by the Independent Budget Review Group prompted immediate calls from Finance Secretary John Swinney for cross-party talks to discuss the measures. The prospect of protecting the NHS, as the UK Government has promised in England, would leave other departments shouldering cuts of more than 20% by 2014 and the reports says alternatives to ring-fencing must be considered. The NHS, with a budget of around £11.5bn, accounts for 30% of public spending in Scotland.
  
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Derby Telegraph

• Patient care will suffer because of cuts at hospital, warn staff. Hospital staff fear patient care will suffer following union claims that pay cuts are being planned in a bid to save millions. Unison says nurses, health care assistants and clerical staff working in Royal Derby Hospital's nine medical outpatient departments could have their jobs downgraded and salaries reduced. And staff say they have been sent letters telling them a review of the workforce is being carried out. Now one nurse, who did not wish to be named for fear of losing her job, has claimed there will be fewer follow-up appointments for patients and fewer trained nurses on duty. She said: "What staff have been told in a meeting with managers is that the hospital can't continue to offer a gold-standard service and that it's got to be safe but it can only be adequate. We've been told the service has to be 'no frills'." She said she was concerned some nursing duties would be taken on by health care assistants, who had less skills.
  
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Burton Mail

• Hospital ward is ‘under threat’ due to £500k cutbacks. A Burton's Queen’s Hospital worker has spoken out as rumours abound that beds could be lost as bosses try to make ‘significant efficiency savings’ in the coming months. The worker, who did not wish to be identified, said that staff at the Belvedere Road hospital were concerned that a surgical ward was under threat of closure as the trust attempted to make ‘£500,000’ of savings. A spokesman for the Burton Hospitals NHS Foundation Trust admitted that it was now consulting with staff in its Surgical Division on ways to ‘maintain and improve service quality for patients, while at the same time seeking out inefficiency’.
  
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Newcastle Journal

• NHS jobs and bed cuts for Northumberland and Tyneside. Hundreds of beds and jobs are to be cut at hospitals in Northumberland and Tyneside as health chiefs look to change the way they treat the ill. NHS North of Tyne has put together a confidential paper outlining how 451 beds will be reduced at hospitals across Newcastle and Northumberland by 2014. The authority insists the move makes sense as more people are being treated in the community rather than needing longer hospital stays. But their hand appears to have been forced by the coalition Government’s insistence that savings are made across the NHS. A confidential document states that beds lost by the Newcastle and Northumbria hospitals trusts are likely to amount to a 14% cut. Nearly 10% of jobs in some hospital departments could be targeted, but these are made up for by an increase in new roles for staff in areas such as prevention and community work. Overall NHS North of Tyne expects to see a loss of 166 posts by 2014. The potential of closing some parts of the two hospitals’ estates is also raised in the End State Visions document. The planning document also confirms plans to transform GP care, with many smaller practices across the region coming together to form fewer larger practices.
  
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Bristol Evening Post

• 'We raised £4 million for children's unit, now they're closing it'. Fundraisers are angry after discovering the £4m dedicated children's unit they raised money for will be closed and moved across Bristol at five times the cost. The Barbara Russell Unit opened in 2000 after the successful Jack and Jill fundraising appeal, but is due to close in 2014 when the rest of the Frenchay site is downgraded to a community hospital, leaving campaigners furious, with one group even asking for their money back. Paediatric burns and neurosurgery will move to Bristol Children's Hospital as part of plans to centralise all specialist treatment for youngsters on one site. But because there is not enough room to accommodate the additional staff and patients, the paediatric services from Frenchay will be housed in a new ward block that is yet to be built. The Jack and Jill Appeal campaign director, Bob Woodward, who also founded cancer charity Clic in 1976, says he feels let down by the NHS for closing the unit that he, and others, worked tirelessly for. He is also chief executive of the Starfish Foundation who granted £1m towards the unit. The charitable foundation tried without success to reclaim the money donated to the appeal when they found out that the children's ward was going to close and has vowed not to support NHS projects in the future.
  
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Pulse

• Government urged to pay 'substantial' incentives for GPs in deprived areas. The Government’s systematic revamp of GP commissioning could inadvertently increase health inequalities unless substantial resources are diverted to deprived areas, a senior health policy expert at the King's Fund has warned. Speaking at a debate on public health, the think tank’s director of policy Dr Anna Dixon said the Government’s ambitious reform agenda could threaten public health goals unless the right incentives were given to GPs. The Government’s NHS White Paper pledged that GP commissioning consortiums will receive extra incentive payments for improving health outcomes, with higher-than-average funding for practices in the most deprived areas. However, practices will also see their pay cut if they are seen to provide a poor quality of care. And Dr Dixon cautioned that health inequalities could increase if the incentives for GPs in deprived areas were not substantial. Dr Dixon said the ‘potential mismatch’ between the geographies of local authorities and GP consortiums could also endanger public health aims, as it could make it ‘more difficult to create partnerships’, and cited a lack of public health data at GP practice level as another potential hurdle to overcome. She also advised that the Government’s new outcomes framework should not focus solely on ‘itemised outcomes’ such as premature mortality, but also take into account ‘wider preventable activities’. Public health minister Anne Milton said the upcoming public health White Paper would flesh out how local health improvement budgets will be allocated through new health premiums. But she did not expand on the Government’s plan to direct funding to GPs in the most deprived areas, and appeared to pour scorn on the notion that changes would only be realised through cash incentives.
  
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• Local council fights GPs' corner in contract row with PCT. Local authorities have weighed in with support for a group of GPs who have accused their PCT of attempting to railroad plans to draft in private providers to run a local practice without consultation. The intervention came after GPs moved to appeal against NHS Mid Essex’s decision to press ahead with an APMS tendering process for The New Surgery in South Woodham without seeking the views of either patients or local clinicians. The case follows the precedent set in North London last November, when NHS Camden was forced to shelve plans to award a Darzi centre contract to a private firm after admitting it acted unlawfully by ‘making a decision to invest’ in without conducting a full public consultation on the proposal. NHS Mid Essex told GPs it did not consider patient and public consultation to be necessary prior to procurement, because the process ‘does not involve any new services, service change or substantial development’. But South Woodham Ferrers Town Council has subsequently written to the trust to demand an explanation, expressing its ‘serious concern’ about the process. The letter reads: ‘Section 242 of the NHS Act requires such arrangements are to be made which secure that users of services such as The New Surgery, whether directly or through representatives, are involved in: the planning of the provision of these services, the development and consideration of proposals for changes in the way the services are provided, and decisions affecting operation of those services. Surely change of ownership and management is a decision which affects the operation of such a service ?’ A survey of 200 patients carried out by local GPs found that none of the residents were in favour of a private firm being drafted in to run the service, with 197 backing the establishment of a John Lewis-style of management where local GPs would run the practice ‘by the town, for the town’.
  
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• No new funding for GPs to take back out-of-hours responsibility. GPs will receive no extra funding for taking on responsibility for commissioning out-of-hours services, the Government has revealed. Primary care tsar Dr David Colin-Thome said that because GPs are not going to be forced to take on provision on out-of-hours - and will instead be able to commission cover from other providers if they wish - there will be no incentives or funding provided. However, he revealed GPs will be forced to take on massive new contractual challenges, involving seeking to re-negotiate or terminate existing deals with a raft of NHS providers, including out-of-hours companies. Full responsibility for commissioning out-of-hours services in England will transfer from PCTs to GP consortia in April 2013 but Dr Colin-Thome said existing practice-based commissioning groups are expected to take a much bigger role immediately. Dr Colin-Thome was asked by Dr David Connolly, a GP in Salisbury, what would happen to external contracts, such as a five-year deal signed by his PCT recently. The primary care tsar replied: ‘GP consortia will have to look at these contracts carefully and renegotiate, terminate or vary them as they see fit.' As well as making the decisions over out-of-hours providers, it means GP consortiums will make decisions over the future of many services which have often been brought in with great opposition from practices, including the use of management consultants and private firms running services in the community.
  
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Thursday 29th July 2010

Evening Telegraph

• One in five jobs will be cut at NHS Northamptonshire to save £3.5m. The health service organisation which manages a budget of nearly £1bn and employs more than 370 people is taking the step as the first stage of a process that is likely to see it disbanded by 2013. Staff are being consulted over the redundancies, which would see 56 people lose their jobs. A further 22 vacant posts will not be filled. The Government has ordered NHS Northamptonshire to reduce it's management costs for this financial year by £3.5m, with more cuts expected in the coming months. Chief executive John Parkes said the savings it makes will be used to ensure there is no impact on frontline services. He said: "This is a difficult time for colleagues, but I have assured everyone the process will be fair and transparent and that everyone will have an opportunity to respond to our proposals over the coming 30 days. We have got a complete range of jobs potentially going, we have dissected straight through the organisation. "The roles include posts such as graduate trainee positions, clerical and secretarial positions right through to senior management positions. We have not just adopted a last in, first out policy and will also be looking for individuals to take voluntary redundancy." NHS Northamptonshire manages the funding for GP surgeries, NHS dentists, pharmacies and many other health services across the county. The job cuts follow a recent Government announcement that primary care trusts and health bodies, including NHS Northamptonshire, are expected to be scrapped by 2013.
  
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Hartlepool Mail

• The accident and emergency service at the University Hospital of Hartlepool will close in October. Staff at the hospital were told of the closure of the A+E department at a meeting yesterday. The Mail reported exclusively in February that there were fears the service could be axed after a memo had been sent to staff. The latest announcement comes just 24 hours after Government Health Minister Simon Burns told MPs he knows of no plans in place to shut the hospital. Hospital bosses say there will still be emergency services available in the town, but they are changing how and where they are available under the momentum: pathways to healthcare programme. They say further changes will come in the future as the programme progresses. Bosses at the North Tees and Hartlepool NHS Foundation Trust, which runs hospitals in Hartlepool and Stockton, say people will be treated at the One Life Centre, in Park Road, for minor injuries and adults with medical conditions will be seen at the emergency assessment unit at the University Hospital of Hartlepool. Hospital bosses say there will be no job losses as a result of the move.
  
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Donegal Democrat

• Sixty beds to close at Sligo General Hospital. Twenty-five workers are set to have their working hours reduced, some of them to as little as just eight hours a week. Staff will also be transferred to the community sector and the hospital's’s drug stock is set to be reduced. Trade union Impact says the services affected include radiology and oncology. The HSE says the plans, which have been outlined to staff and unions, have not been finalised. It warned that in “some most financially challenging times that we have ever seen within Irish health services” it may have to take “severe actions” later in the year “that will have an even greater affect on services into the future”. The cuts, which were outlined on Monday, are part of a reduction of €90 million in HSE spending in Sligo, Donegal and Leitrim. The proposed closure of 60 beds follows the loss of 72 beds at the hospital last year. It is understood the €5.9m of savings are aimed at reducing a projected budget deficit of €12.9 million compared to a budget of €97.5 million for 2010. Richie Carrothers of Impact said that any overspend at the hospital was due to more people needing treatment. “More people are presenting with medical cards and fewer people now have health insurance, leading to more demands on services locally."
  
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BBC

• Aintree University Hospital needs to cut '300 jobs'. Hundreds of jobs will have to be axed at a hospital on Merseyside as it prepares for widespread cuts to the NHS. Aintree University Hospital has confirmed it needs to cut the equivalent of 300 jobs in the next few years. All 5,000 staff have been sent letters offering them voluntary redundancy and flexible working packages. A spokesman said the consultation was in "its early stages". He added that the money they need to save amounted to some 300 posts but this would not mean 300 redundancies. It depended on how many took up the flexible working scheme and altered their hours. The government has announced that the NHS needs to make savings of between £15m and £20m in the next few years. Aintree University Hospitals NHS Foundation Trust is based on two sites in Walton and Fazakerley, and draws patients from three local authorities; Sefton, Knowsley and Liverpool.
  
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• Fears public health may be hit in shake-up of NHS. The overhaul of the NHS may harm the public health drive, experts fear. Under government plans, primary care trusts in England will be abolished and GPs given control of the budget. The shake-up will also mean public health is handed to councils, but the King's Fund health think tank said this could lead the NHS to turn its back on issues like smoking and drinking. The government said it would be setting out detailed plans for public health in England later this year. Public health has traditionally been the responsibility of local health managers working for the 151 PCTs. They have been in charge of recruiting local public health directors and coordinating campaigns to encourage people to adopt healthier lifestyles.
  Continue reading the main story. But under the changes announced earlier this month, that role is to be handed to local authorities.
  
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HSJ

• Patient safety agency cut involvement cash. Data obtained by the patient safety charity Action Against Medical Accidents and shared exclusively with HSJ shows that NPSA spending on patient involvement rose steadily in the agency’s first years of existence, peaking at £270,117 in 2006-07. But after that it declined rapidly. By 2009-10 it was £116,866 - less than half its 2006-07 level. Action Against Medical Accidents chief executive Peter Walsh complained patient and public involvement in the NPSA had been “decimated”. He told HSJ: “The Department of Health has said that patients have a vital role to play in patient safety. One of the NPSA’s strengths at the start was that it acknowledged this and it was built into every aspect of their work. “[But] it has been our perception for some time that patient involvement was being given less priority at the NPSA. These figures confirm our worst fears.” The spending figures were shared with HSJ just days before the Department of Health announced that the agency was one of a number of arm’s length bodies that would be abolished following its review. The NPSA will cease to exist from April 2012 when its functions will be transferred to the NHS commissioning board and elsewhere. When it was established in 2001 the Department of Health said the NPSA would create a “clear role” for patients within the agency so they could highlight the consequences of patient safety incidents that might otherwise be missed. Although his charity has been critical of the NPSA’s cuts in patient engagement Mr Walsh said he was concerned patient safety would be neglected once the agency was abolished. He said: “[The NPSA’s] strength has been its specific focus on patient safety and nothing else. It would be disastrous if the priority given to patient safety itself let alone patient involvement was watered down.”
  
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• NHS Leeds is planning to save £5.7m by axing more than 130 managers. The trust, which has an annual budget of around £1.2bn, will implement the plan from this year onwards, the report said, with 53 posts to go in 2009-10, 38 the following year and 43 in 2012-13. Officials say the redundancy programme represents a budget cut of around 31%. The move comes as the government demands huge efficiency savings and plans to introduce a law scrapping primary care trusts altogether. NHS Leeds chief executive John Lawlor told the Yorkshire Post: “NHS Leeds management teams, trust board and staff representatives are currently discussing a number of options including voluntary arrangements for severance, redundancy and retirement. “To date we have managed to deliver the bulk of management cost savings for this financial year through a vacancy control process. This reduces the need for any compulsory redundancies.”
  
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• Legal concern over private patient income cap. Government plans to lift the cap on foundation trust private patient income leaves it vulnerable to action under EU state aid law, private hospital operators have told HSJ. The cap limits the proportion of total income each foundation trust can earn from private patients to the proportion earned in 2002-03. That has left some trusts with a cap of zero, most with caps below 2 per cent and the Royal Marsden Foundation Trust with the highest cap of 31 per cent. The government’s consultation on regulating NHS providers says it will now “repeal” the “ill-thought-through” cap. But an HSJ investigation last year revealed NHS trusts frequently charged private patients less than the actual costs of their care - most commonly due to poor costing rather than deliberate competitive pricing. The undercharging meant private patients were effectively subsidised with NHS funds. Adrian Fawcett, chief executive of General Healthcare Group, which owns BMI hospitals and is the largest private hospital provider in the UK, told HSJ the company saw that subsidy as “a state aid issue”. State aid is the EU term to refer to illegal government subsidies that distort with free markets. The private hospital company Asklepios already has one complaint lodged with the EU commission against what it views as government subsidies in the German healthcare system. NHS Partners Network director David Worskett said NHS accounting practice meant there had always been “seepage” between NHS and private funds in hospital trusts. “But under the new terms, seepage wouldn’t be the right term and it becomes state aid,” he said. “Under the cap [it] wasn’t a big issue, But if there is a major expansion of NHS players in the private market this will become a more salient point,” he said.
  
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Tuesday 27th July 2010

Daily Telegraph

• NHS hospitals to be allowed to 'earn more money' from private patients. In the biggest shake-up of the NHS in a generation, all NHS hospitals are to become foundation trusts, or part of one, making them independent of Whitehall control. As part of the plans to encourage greater competition between NHS organisations and the private sector, foundation trusts could be allowed to earn more money by treating more private patients once they have fulfilled their obligations to the NHS, it has been announced. There are currently caps, which vary for each trust, on how much they can earn and this has proved a barrier to some organisations becoming foundation trusts, because they already earned too much from private patients. It has also hampered those already in existence from expanding services and investing in their buildings and equipment. In addition the Department of Health is consulting on whether limits on how much money they can borrow should be scrapped. This would allow foundation trusts to raise more capital for new buildings or expansion. The document said it was not fair that the private and voluntary sectors could borrow money without restrictions yet the NHS was being asked to compete with this organisations without similar freedoms. If a trust borrowed more than it could afford, the financial regulator, Monitor, would step in.
  
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Healthcare Republic

• Monitor could investigate 'anti-competitive' commissioners, says DoH Healthcare regulator Monitor could be given new powers to investigate commissioners it believes have acted in an anti-competitive way, government plans reveal. In it's consultation document, ‘Regulating healthcare providers’, the DoH proposes to legislate that the NHS Commissioning Board and commissioners must ‘promote choice, act transparently and non-discriminatory in all commissioning activities’. It said the NHS Commissioning Board and commissioners will not be able to prohibit agreements or other actions that would restrict competition against patients and taxpayers’ interests. Meanwhile, the consultation documents also outlined that while GP consortia will retain primary responsibility for ensuring the continuity of service provision, Monitor could be given powers to intervene in ‘some limited circumstances’.
  
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• Homeopathy should be available on NHS, government says. In its response to the House of Commons science and technology committee report on homeopathy, the government said patients should be able to make informed choices about treatment. The House of Commons science and technology committee recommended in March that homeopathy should no longer be available on the NHS. The committee said the absence of evidence of homeopathy’s efficacy meant it should not be available on the NHS. In its response to the report, the government said: ‘We believe in patients being able to make informed choices about their treatments, and in a clinician being able to prescribe the treatment they feel most appropriate in particular circumstances, within the regulatory and guidance frameworks by which they are bound.’ It added: ‘Our continued position on the use of homeopathy within the NHS is that the local NHS and clinicians, rather than Whitehall, are best placed to make decisions on what treatment is appropriate for their patients - including complementary or alternative treatments such as homeopathy - and provide accordingly for those treatments.’ The health White Paper states that the NHS Commissioning Board will not have the power to restrict the power the scope of the services offered by the NHS.
  
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Mirror

• NHS 'move to private over 10yrs'. The nation will move away from a free NHS system during this decade, according to a study. A part-privatised service is likely, it said. Also patients who ignore health advice could have to pay extra for treatment. The study found more than four in 10 people agreed with a "fat tax" for the obese - even though only two in 10 followed health advice on food, alcohol and smoking. The Visions of Britain 2020 report predicted "a tiered system" and warned the public "will be paying for treatments that are currently offered free". The paper draws on medical opinion and consumer research in an NHS already under threat from the ConDems' deepcutting reforms. Study panel member Dr Sarah Brewer said she and fellow experts expected "a move from a free NHS".
  
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Yorkshire Evening Post

• Leeds NHS health bosses face axe. More than 130 NHS management jobs in Leeds are being cut in a bid to save £5m – though the entire organisation is set to be axed eventually. NHS Leeds, which pays for health services for the city's population, needs to lose 134 posts over the next three years and is planning for redundancies. But since drawing up cost-cutting plans, the Government has announced that the organisation is to be abolished from 2013. Primary care trusts like NHS Leeds will be phased out and groups of GP practices will instead commission health services from hospitals. Prior to that, NHS Leeds was already working out how to cut management costs by 30% or £5.69m by 2014. Staff numbers will be cut by workers leaving and voluntary redundancies, but compulsory job losses have not been ruled out. The latest planned job cuts come after Leeds hospitals said it was to reduce its workforce by 700 and the city's mental health trust is to cut numbers by 300. Hospitals in Wakefield, Pontefract and Dewsbury need to find £55m savings, which could hit hundreds of jobs.
  
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Tayside and Fife Courier

• Kirkcaldy A&E shut overnight once again. Fife's health chiefs have been called incompetent after they announced that overnight closures of Kirkcaldy’s accident and emergency unit are to continue for a second week.Pressure is intensifying on Scottish health secretary Nicola Sturgeon to intervene in the ongoing crisis, which has left NHS Fife unable to staff A& E at Victoria Hospital overnight, and urgent answers are being demanded of the hospital's managers. NHS Fife revealed on Monday afternoon that despite its "continued best efforts," its full contingency plan would once again be implemented. This means the hospital's A& E department will be closed to acute medical admissions from 5pm to 8am each day, with emergencies admitted about 10 miles away at Queen Margaret Hospital, Dunfermline. Victoria Hospital's A& E will operate as a minor injuries unit only. A spokeswoman for NHS Fife said the reason for the contingency continued to be gaps in overnight medical staffing.The contingency plan was prepared by NHS Fife in November as a response to circumstances where staffing difficulties mean it is not possible to admit overnight at the Victoria Hospital. It was drawn up as a result of reductions in the hours medical staff can work under the European Working Time Directive and there have been changes in clinical practice which have led to increasing specialisation. In addition, the recruitment of locums is becoming increasingly difficult.
  
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Scarborough Evening News

• New walk-in health centre opens doors. A new drop-in health clinic has opened its doors in Scarborough's town centre. The Castle Health Centre has now moved into the former Scarborough Building Society premises. The GP-led centre, which is situated next to a new Boots pharmacy store, will provide patient appointments and a walk-in service from 8am to 8pm, seven days a week. Tricia Kennerley, healthcare public affairs director from Alliance Boots, said: "We are very much looking forward to working together with our new partners in providing these essential services to the Scarborough community." The Boots pharmacy will be open from 8am to 8pm Monday to Saturday.
  
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Cambridge News

• 60 jobs hang in balance as axe falls on health agencies. Sixty workers face an uncertain future after South Cambridgeshire MP and Health Secretary Andrew Lansley scrapped an agency. The Health Protection Agency (HPA), which has its regional headquarters in Chivers Way, Histon, will be abolished in a drive to cut costs. There will be no immediate redundancies and the organisation’s functions will be transferred to the Department of Health. But the eventual number of jobs that will go at the agency, which protects the public from infectious diseases and environmental hazards, is yet to be determined.
  
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Independent

• Health Quangos: £180m of cuts 'a blow to the NHS'. Eighteen health quangos will be reduced to between eight and 10 over the next four years. The fertility watchdog the Human Fertilisation and Embryology Authority (HFEA) and the Health Protection Agency (HPA), which deals with infectious diseases, are both slated to disappear in the shakeup. The Health Secretary Andrew Lansley justifies the cuts on the grounds that it would produce savings of more than £180m over the next four years by streamlining the functions of these organisations and slashing their bureaucracy. Although the Department of Health's overall budget is being "ring-fenced", the ever expanding demands on the NHS each year mean that significant savings must be found. Experts in infectious diseases criticised the plan to abolish the HPA as a statutory organisation and transfer its functions to the Department of Health and the new Public Health Service. "It's a very bad idea because the HPA is an absolutely essential national resource," said Hugh Pennington, emeritus professor of bacteriology at Aberdeen University. "There is no merit in making changes to the HPA other than those that strengthen it. It's quasi-independent and a degree of separation between it and the rest of government gives it more scientific freedom and independence," Professor Pennington said. The HPA was central to advising the Government on the recent flu pandemic and has played an important role in monitoring HIV and Aids in the UK. It has also recently absorbed the functions of the National Radiological Protection Board, which was responsible for assessing the health risks of radioactive materials. The fertility watchdog, the HFEA, was set up in 1991 to oversee the licensing of IVF clinics and lay down the guidelines for how this service should function. It was a model for other countries to adopt. But fertility clinics have complained of overzealous regulation and bureaucracy. Mr Lansley said yesterday that the HFEA will be retained for the time being but by the end of the current Parliament its functions will be divided between the Care Quality Commission and the Health and Social Care Information Centre, two of the health quangos to survive.
  
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Lincolnshire Echo

• Help shape NHS. A patient group is urging people to have their say on the reorganisation of the NHS. It was revealed in a Government white paper earlier this month that the country's 152 primary care trusts, including NHS Lincolnshire, would be abolished in favour of GPs forming consortia to commission patient care including hospital services. And in response to the white paper, the Lincolnshire Local Involvement Network (LINk) has invited the Health Secretary, Andrew Lansley, to visit Lincolnshire and answer questions from patients at a public meeting. LINk chairman Preston Keeling said: "The LINk will want to ensure everyone who uses or may need to use the NHS has an opportunity to make sure their views on the extensive changes are made known to the health secretary."
  
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Monday 26th July 2010

healthcare republic

• Petition opposing White Paper to be presented to government. The Keep Our NHS Public petition opposes ‘any further expansion of the role of the private sector in the NHS’. It will be delivered by Professor Wendy Savage, union and community group representatives. Professor Savage, co-chairman of Keep Our NHS Public, said: ‘Rather than making GPs into commissioners and accountants, the government should be getting doctors, patients and managers to work together. ‘The last Health Select Committee said NHS commissioning had produced '20 years of costly failure'. Instead of dragging out that failure still further, the split between NHS purchasers and providers must be scrapped and the health service reintegrated.’
  
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Telegraph

• NHS bosses have drawn up secret plans for sweeping cuts to services, with restrictions on the most basic treatments for the sick and injured. NHS bosses have drawn up secret plans for sweeping cuts to services, with restrictions on the most basic treatments for the sick and injured. Some of the most common operations — including hip replacements and cataract surgery — will be rationed as part of attempts to save billions of pounds, despite government promises that front-line services would be protected. Patients’ groups have described the measures as “astonishingly brutal”. An investigation by The Sunday Telegraph has uncovered widespread cuts planned across the NHS, many of which have already been agreed by senior health service officials. They include:
  
  * Restrictions on some of the most basic and common operations, including hip and knee replacements, cataract surgery and orthodontic procedures.
  * Plans to cut hundreds of thousands of pounds from budgets for the terminally ill, with dying cancer patients to be told to manage their own symptoms if their condition worsens at evenings or weekends.
  * The closure of nursing homes for the elderly.
  * A reduction in acute hospital beds, including those for the mentally ill, with targets to discourage GPs from sending patients to hospitals and reduce the number of people using accident and emergency departments.
  * Tighter rationing of NHS funding for IVF treatment, and for surgery for obesity.
  * Thousands of job losses at NHS hospitals, including 500 staff to go at a trust where cancer patients recently suffered delays in diagnosis and treatment because of staff shortages.
  * Cost-cutting programmes in paediatric and maternity services, care of the elderly and services that provide respite breaks to long-term carers. ts’
  
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Guardian

• Tories say Labour wasted £300m on using private providers to cut NHS waiting times. The decision by Labour to bring private providers into the NHS wasted hundreds of millions of pounds of taxpayers' money, according to Andrew Lansley, the Conservative health secretary. The former government refused to disclose the amounts paid for the controversial "independent sector treatment centre programme" (ISTC), claiming it would "jeopardise the ability of the [Health] Department and the NHS to secure the best value for money". But Lansley has calculated that it would have been £300m cheaper if the NHS had carried out the work private contractors provided, such as cataract operations. Lansley said he was not against using independent sector providers but insisted they must compete on a level playing field and provide value for money. This week he will lay out plans for Monitor, the body that currently oversees foundation trusts, to become the economic regulator responsible for all NHS care by 2013. It will be expected to ensure value-for-money. The minister accused Labour of signing "wasteful preferential contracts". But critics say the figures raise serious questions about the coalition government's own health plans. Paul Evans, director of the NHS support federation, a campaign group, said: "The question is, does a profit-led health service, which is what we are heading towards, deliver the best quality, equity and value for the public ?" Evans argued that today's findings provided an insight into the "murky world of a market-led health service, where deals can be made between companies using public money and we don't see the contracts until the money has already been spent".
  
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HSJ

• Four arm's length bodies being abolished. The NHS Institute for Innovation and Improvement, the Appointments Commission, the National Patient Safety Agency and the Alcohol Education Research Council are being abolished, it has been announced. The proposals are set out in a Department of Health review of arm’s length bodies in an attempt to reduce bureaucracy and help to cut administrative costs by more than 45 per cent. Only six of the 18 have a “clear future as arm’s length bodies”, the review says. These include: Monitor; The Care Quality Commission; National Institute for Health and Clinical Excellence; The Medicines and Healthcare products Regulatory Agency; The Health and Social Care Information Centre; and NHS Blood and Transplant. Other organisations are being abolished, merged, or having functions transferred into other bodies. It is expected that the proposals will be implemented by 2014, with the majority of changes in place during 2012-13, following a health bill and public bodies bill this autumn. The Human Fertilisation and Embryology Authority and the Human Tissue Authority will have functions transferred “to achieve greater synergies where appropriate”. The Health Protection Agency and the National Treatment Agency will no longer be statutory bodies, instead having their functions transferred to health secretary Andrew Lansley and the new public health service being established. The Council for Healthcare Regulatory Excellence is being “moved out of the sector to operate on a full-cost recovery basis”. A commercial review will be carried out to see whether the NHS Litigation Authority and NHS Business Services Authority could benefit from outsourcing, divestment and contestability and/ or employee ownership. The report states: “Overall, these proposals will simplify the national landscape, reduce duplication and bureaucracy and better align the arm’s length bodies sector with the rest of the health and social care system.” The DH will discuss with the NHS Institute whether opportunities exist for “alternative commercial delivery models” such as a social enterprise. It says, in future, the NHS commissioning board will lead on commissioning for quality improvement and the responsibility for improving outcomes will occur “at every level of the NHS.” The government will engage on these proposals and, where necessary, bring forward necessary “legislative proposals” within this parliament.
  
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Ilford Recorder

• GP 'lottery' fears over health plans. A ROW over the future of the NHS in Redbridge is raging with fears government plans to give more power to GPs will turn doctors into bean-counters. Under proposals unveiled by health secretary Andrew Lansley last week, GPs will be made responsible for deciding how millions of pounds of NHS cash is spent day-to-day. The GP-led consortia will replace primary care trusts - including NHS Redbridge which will be axed in 2013 under the radical plans. But hitting out at the proposals, John Lister, director of pressure group Health Emergency, said: "Any GPs who really believe that they can deliver improved care for their patients in this type of health competitive market are kidding themselves." Meanwhile Ilford South Labour MP Mike Gapes said the government plans have left him with "very serious concerns". He said: "I'm worried about the capability of some GPs to cope with the administration involved. "I think we will be left with a postcode lottery depending on what your GP is like." Adding his fears the proposals will lead to the privatisation of health services, Mr Gapes also hit out at the cost of the scheme brought on by likely redundancies of PCT staff. Defending the plans, Conservative Ilford North MP Lee Scott said it "was not a problem" for GPs to cope with the demands of deciding where money is spent. He added: "Many times a constituent comes to me where the doctor's recommendations have been denied for various reasons by the PCT. "The GPs know what's best for their patients." In Redbridge, the five GP-led polysystems covering different parts of the borough are set to act as the decision-making groups. Describing the proposals as a "huge undertaking" Dr Anil Mehta, clinical director of Fairlop polysystem, said: "GPs are best placed to meet the needs of their community. "We now have to sit down and decide how the mechanics of this works going forward.
  
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Morning Star

• Wales calls on the left to save services. Welsh Health Minister Edwina Hart told the Morning Star annual conference in Pontypridd this weekend that the assembly government must build more partnerships with trade unions to develop a united front to defend services. She said that the Westminster government's determination to abolish the NHS in England would put "clear pressures" on Wales, Scotland and Northern Ireland because of cross-border relationships. Ms Hart stressed that there would be no compulsory redundancies in the health service in Wales "since compulsory redundancies show that you're not managing very well." She pointed out that many GPs in England would not be able to manage the new financial arrangements imposed on them and "the health-care vulture companies will come in to replace them. "These changes are driven by dogma," she asserted. The health minister recognised that the Con-Dem coalition had been assisted by some of the policies implemented by new Labour, leaving the NHS "ripe for privatisation. "Too many ministers followed the private sector good, public sector bad approach instead of constructing an NHS model that would have been more difficult to privatise," she charged. Ms Hart insisted that she did not accept that the current deficit must be reduced speedily, adding: "It is ironic that only the US is following Keynesian principles at the moment." She confirmed the vital nature of the public sector, stating that without it "building firms would go down the pan." Communist Party general secretary Rob Griffiths said: "History teaches us that there is always a way out for capitalism if it can make working people bear the brunt of the crisis." He said that the Con-Dem government had declared war on the working class but most union leaders appeared to be in denial, acting as if the blitz would not hit us in the near future. "Very little preparation is being made. All unions in the public sector must be reminded of their responsibility to unite to resist the coming onslaught." Wales TUC president Sian Wiblin drew attention to the way in which debate had "shifted away from how to restrain the banking sector to how to cut the public sector." She took issue with the myth that public-sector workers had somehow been immune from previous cuts and highlighted the madness of productive workers being driven onto the dole.
  
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Friday 23rd July 2010

Mirror

• Tory donor's firm will make millions from NHS shake-up. A private health firm is set to rake in millions from a shake-up of the NHS - eight months after the boss's wife donated £21,000 to Tory health secretary Andrew Lansley. Care UK expects to earn a fortune in the biggest reform of the NHS for 60 years as private companies win a lucrative role in providing services to local GPs. As one of the UK's biggest healthcare providers, it already runs GP surgeries, NHS walk-in centres and cares for half a million people a year. And Mr Lansley faces accusations of a conflict of interest for accepting a donation from the wife of John Nash, chairman of Care UK. The row comes amid warnings that Mr Lansley's shake-up will cost thousands of jobs and represents a giant gamble with the nation's health. There is also mounting anger that not a word of his plans was put before voters at the election. Nor was it mentioned in the Tories' coalition agreement with the Lib Dems. The Health Secretary accepted Caroline Nash's money in November to help pay for the running of his private office. The hand-out came just weeks after her husband predicted future Government policy would help make his company - which earns 96% of its money from the NHS - even richer. Mr Nash stood down as chairman in March, when Care UK sold out to a private equity firm, but he is still a consultant. Unite's nursing spokesman Barrie Brown said: "These dangerous and untested ConDem plans will see private companies given an even greater stake in the NHS. And it is particularly alarming how one of the biggest private healthcare firms out there could be so closely aligned to Mr Lansley." Dr John Lister, of campaign group Health Emergency, added: "The fact that the man in charge of dismantling the NHS has taken cash from one of the companies looking to profit from his plans stinks."
  
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• Scams of US firm UnitedHealthcare chasing NHS funds. An American giant aiming to control millions of pounds of NHS money has cheated the US health system again and again in the past decade. UnitedHealthcare - set to advise and run GPs' services under controversial plans - was fined tens of millions of dollars for fixing charges last year alone. A catalogue of cheating shows it paid over £1m in 2000 in nine states for offences including overcharging and denying treatment. In 2004 United was fined nearly £1million in New York State for "cheating patients out of money". The same year it settled fraud charges for £6m after allegations that it inflated its costs. Again in 2004, United had to pay £2m to settle charges that it defrauded the national Medicare system. Critics say firms like United - which made £7bn last year - select profitable treatments and exclude the frail. Opponents of the NHS reforms proposed by Andrew Lansley say these companies will aim to deliver the cuts he wants at patients' expense. There are fears that GPs will be asked to provide treatments that ought to be done in a hospital. Cancer doctors in Liverpool have been shocked to find nurses working for GPs, using a healthcare firm, have been removing serious skin cancers "locally" without referral to a specialist. Dr Wendy Savage of campaign group Keep Our NHS Public said: "If companies like United Healthcare get their way we will see more examples. This will all be about driving down costs to maximise profits for the private companies who will sell themselves as saving money for the NHS.'
  
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Camden New Journal

• Protest warning as Whittington hospital cuts fears linger. Campaigners have warned they will stage a second massive protest outside the Department of Health if they do not receive immediate confirmation that health secretary Andrew Lansley has kept his promise to stop cuts at Whittington Hospital in Highgate. Health bosses confirmed on Wednesday they have “halted” their reorganisation of acute hospital services in north London following an intervention from Mr Lansley. But they said their proposals to strip the Whittington of vital services could continue – if GP leaders give the green light.
  
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Manchester Evening News

• Mums on the march to save maternity unit. Mums in Salford are back on the march in a bid to save the city’s maternity unit. Campaigners have organised a rally and a march to the headquarters of NHS Salford. The mums have organised the demonstration after a meeting with the Health Secretary Andrew Lansley and Salford MP Hazel Blears earlier this month. Mr Lansley said he was prepared to review the decision to close the maternity unit at Salford Royal and said he would base the decision on four criteria - whether the unit had a high record of successful clinical outcomes, had patients and public had been properly engaged in the consultation, was there support from doctors for a retention, and how much choice in the decision had been given to mothers and families.
  
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Health Insurance and Protection

• Government 'illogical' to block co-payments in NHS. The government must broaden the funding base for healthcare by allowing co-payments, according to the chief executive of Britain's largest private hospital group. Adrian Fawcett, chief executive of General Healthcare Group (owner of BMI Healthcare), told the thinktank Reform's conference that "allowing people to contribute for themselves must be the logical way forward to increase the funding base." He said: "It seems illogical to reorganise the NHS around freedom of choice yet continue to prevent people from topping up by removing their entire NHS entitlement if they do." Fawcett warned that the self-pay market has effectively halved over the past three years, increasing the burden on the NHS. Current Department of Health guidance states that patients will not be denied access to NHS care if they choose to privately purchase elements not funded by the NHS but that the care must be delivered separately to avoid the NHS subsidising private healthcare.
  
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Medical News Today

• UNISON Welcomes Kings Fund Report. UNISON, The UK's largest health union, welcomed a new report by the King's Fund, which shines a spotlight on the potential savings the NHS could make by sharing best practice between staff. The union is warning that government plans for all hospitals to become independently run foundation trusts will only reduce opportunities for health workers to learn from each other. Foundation trusts will be set up in direct competition with each other, making it much tougher to share best practice. This will not only hit opportunities to make savings, but also to raise standards across the NHS as a whole. Karen Jennings, UNISON Head of Health said: "At the heart of the NHS is an ethos of working together in the interest of patients. This report highlights the huge potential savings that could be made by sharing best practice. If savings have to be made it is only right that they should come from boosting productivity rather than cutting jobs or closing down wards. This huge potential will be squandered if the government presses ahead with plans it set out in the white paper last week. Turning all hospitals into independently run foundations trusts, pitting hospital against hospital, will stand in the way of helping staff to learn from each other.
  
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Pulse

• GPs will lose cash if consortiums overspend. GP practices will lose a proportion of their existing income if commissioning consortiums overspend on their budgets, the Government has announced in a detailed document outlining how its plans for GP commissioning will work. The consultation document recommends that ‘a proportion of GP practice income should be linked to the outcomes that practices achieve collaboratively through commissioning consortia and the effectiveness with which they manage NHS resources.’ Commissioning For Patients recommends that this ‘quality premium’ - funded from within existing resources – should initially be paid to consortiums, who would then ‘be free to decide how best to apportion it between its member practices’. The Government says it expects consortiums to receive ‘a maximum management allowance to reflect the costs associated with commissioning’ but does not stipulate what this is. It says the remainder of a consortium’s commissioning budget will be used ‘exclusively for commissioning care’ - with practice income kept separate from commissioning income. Under the plans, consortiums will not hold practice contracts - which will be held directly by NHS Board, but will be handed responsibility for managing contracts, which is likely to include the collection of benchmarking data on practice performance. The document also makes it clear that GPs will be able to hand their commissioning budgets over to the private sector if they do not wish to play an active role in commissioning.
  
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• Government urged to show some 'cojones' and ramp up NHS private provision. A former Labour health minister has urged the Department of Health to have the courage to go further than the previous Government in ramping up competition for providing services, including bringing in private firms to run GP surgeries in the poorest parts of the country. Speaking at the Reform conference, Lord Warner said he had been frustrated in his attempts to expand competition during Gordon Brown's reign as Prime Minister, and admitted efforts to bring in competition had been a ‘mixed experience’. He said: ‘A burst of competition in primary care in some of the areas in the poorest areas in the country could do quite a lot to improve the health expectation of people in these parts of the country.’ The call for new firms to enter the market was backed by the head of a regulatory body which will be handed major new powers under the White Paper to oversee the expected surge in competition. Steve Bundred, chair of the powerful economic regulator, Monitor, said increased competition was essential to generating the savings required in the NHS, which he said could surpass the £20bn identified in the Government’s White paper.
  
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• GPs to commission care for all registered patients, regardless of where they live. GPs will be responsible for commissioning care for patients who live way outside their own locality under the Government’s sweeping package of NHS reforms. The Department of Health’s consultation on its GP commissioning proposals makes clear that GP consortiums will be responsible for commissioning all care for patients registered at its member practices when the changes come into force. This is despite the fact that the Government’s White Paper, launched last week, also set out plans to abolish practice boundaries – which will allow patients to register with any practice they choose, regardless of geography. The move therefore raises the prospect of GPs having to commission services for patients many miles from their own practice area, when they eventually take on around 80% of the NHS budget. The document is entitled Commissioning For Patients. As widely predicted, the document also confirms that GPs will be responsible for commissioning out-of-hours services, in addition to all urgent and emergency care, elective hospital care and rehabilitative care, most community health services, and mental health and learning disability services.
  
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• McKinsey: GPs 'must close hospitals to save cash'. American consultancy firm McKinsey has said that GPs will need to spearhead plans to close hospital wards across the country if they are to successfully bail the NHS out of its £20bn debt crisis. The firm's controversial report for NHS London, which formed the basis of Labour-backed proposals to shift care from hospitals to polyclinics, was cited by right-wing think tank Reform as a key piece of evidence in how to successfully generate huge financial savings - despite the fact the plans it advocated were recently halted by new health secretary Andrew Lansley. Dr Nicholas Henke, director and head of healthcare practice at McKinsey and Co, told delegates at Reform's conference that GPs' ability to slash funding would be crucial to the success of bailing out the NHS, especially in areas facing huge budget overspends. Dr Henke said the creation of GP consortiums was likely to lead to hospital ward closures across the country. At the recent BMA annual conference, GP leaders overhwhelmingly backed a motion opposing the closure of hospital beds, putting GP leaders, not for the first time, in direct opposition with the infamous NHS consultancy firm.
  
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• Private sector services to benefit under Government plans. GPs will be able to farm out the commissioning of whole services to the private sector under the Government’s root and branch shake-up of the NHS. The Department of Health’s latest consultation on its GP commissioning overhaul says local consortiums will have the option of buying in support for specific services such as financial analysis, or devolving the commissioning of whole services to local authorities, social enterprises or private firms. Commissioning for Patients says GPs will not necessarily need to carry out all commissioning activities themselves under the plans, and will have the freedom to buy in support to ‘analyse population health needs, manage contracts with providers and monitor expenditure and outcomes’. The direction of travel has been backed by former Tory health secretary, Stephen Dorrell, now chair of the health select committee, who said he supported a greater role for the private sector in the NHS commissioning, which he claimed was 'in the last chance saloon.' Speaking at the Reform conference, Mr Dorrell said the extent of the financial pressure facing the NHS meant it was highly unlikely there would be a large budget to fund the management support of GP commissioners, and said the answer was to bring companies in.
  
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Thursday 22nd July 2010

Pulse

• NICE to provide guidance on GP referrals. NICE is set to wade into the debate on GP referrals by publishing guidelines on thresholds for referral from primary to secondary care. The institute, usually tasked with making cost-effectiveness decisions for new treatments and interventions and publishing clinical guidance for use by GPs and the NHS, is set to dramatically ramp up its role and take on even more prominence in primary care. The coalition Government’s White Paper, published last week, revealed NICE is set for a much greater role in the NHS, including publishing the 150 quality standards that will form the basis of the new NHS Outcomes Framework. And speaking at an event yesterday, NICE chief executive Andrew Dillon said NICE would also publish guidance around referral thresholds to encourage GPs to avoid ‘inappropriate’ referrals. ‘We are aware that referrals are a big priority now for the NHS. One of the key decisions that GPs will make in their new role as budget holders is when to refer to secondary care. As soon as that is made it begins to cost significant funds, so it will be critical GPs make the right decision informed by the evidence. ‘It’s not telling doctors what to do. It’s the evidence of when referrals offer significant gains for patients. We will be culling information from existing guidance and we hope they are useful in the new world of GP commissioning as they are now.’ Mr Dillon’s comments came as he also revealed the institute had been forced to slash its own budget by 20% over two years, in order to ‘keep the show on the road.’ But he insisted the rigour of their appraisals processes would not be affected. ‘The Department of Health has already imposed a further 3% reduction in funding this current year, and we have already made that saving, but we will need to save 10% by next April and a further 10% by April 2012. ‘That will not change which drugs we recommend, that’s not an issue. But it does mean that we are going to have to be more efficient and re-organise our processes. We have to make it so, even though we are spending less, the assessments are just and rigorous and the processes just as robust.’
  
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Telegraph

• GPs 'could hand' billions of NHS funds to private companies to manage. GPs will be able to employ private companies to decide how to spend billions of pounds of NHS funding, it has emerged. In the Coalition government's shake-up of the health service, GPs are to be responsible for buying most of healthcare required by their patients. All GPs will be required to be members of a consortium which will take over from primary care trusts and commission care from hospitals and other providers for their populations. New details to be revealed today on how this will work reveal that GPs may not need to do this work themselves and could outsource it to other people or even private companies. It would be controversial as private companies, accountable to shareholders, would in effect control NHS funds. Earl Howe, Parliamentary Under Secretary for Health, said GPs would remain responsible and it would be unwise for them to distance themselves too much from commissioning services. He told the Daily Telegraph: "We are not going to be prescriptive about this at all. Consortia cannot just task anyone to commission services, they will have to be a fit and proper person or body. But we want consortia to have the freedom to arrange themselves how they wish and get support from whom they choose." Consultation documents to be published today will seek opinions and comments on how consortia should function and which services exactly they should commission. Earl Howe said very specialist services for rare diseases would continue to be commissioned on a national scale and cancer services might need to be commissioned on a regional basis. However he said the Department of Health had no fixed ideas on whether consortia should commission ambulance services and maternity.
  
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News.scotsman.com

• Calls for NHS to renegotiate controversial ERI contract. HEALTH bosses in Lothian today faced calls to renegotiate the controversial PFI contract for Edinburgh Royal Infirmary after the Evening News revealed it will cost a total of £1.26 billion but still leave the hospital in private ownership. Lothian MSPs said the contract, which dates back to 1998 and will cost £50m a year until it ends in 2028, had been a bad deal for the health board and for taxpayers. The PFI contract - which involves NHS Lothian leasing the hospital from private operator Consort Healthcare for 25 years - had many critics at the time, including health union Unison, the British Medical Association and Labour MPs Malcolm Chisholm and John Home Robertson. However, health chiefs at the time argued Edinburgh was getting a world-class hospital which would not have happened without private finance. Independent Lothians MSP Margo MacDonald today questioned the way it had been handled and called for a fresh attempt at ensuring the infirmary ended up in public ownership. She said: "We always knew ERI was costing an arm and a leg. From the point of view of the health board, the patients and the taxpayers who are picking up the bill, this contract was not a good deal. "The ERI was much bigger than other PFI projects up to then and it was in the very early days of the policy. I don't think they got in the expertise to negotiate the best contract in the first place and we have been running to catch up ever since. "It is worth trying to see if the contract could be renegotiated so the eventual ownership would pass to the health board because that has happened in the newer contracts. "At the very least the consortium should be approached and told we are all having to cut our cloth and they should cut theirs as well."
  
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HSJ

• Concerns over standard of specialist care. There are concerns over how specialised service commissioning will be controlled at regional level after strategic health authorities and primary care trusts are abolished. The white paper says commissioning specialised services - worth around £10bn in total - will become the responsibility of the NHS commissioning board. Although it adds that GP consortia “will have influence and involvement”. Healthcare Alliance director John Murray said the white paper reflects his view that specialised commissioning should be controlled by a central board without PCT involvement. But he said there were “immediate concerns” around whether there would be some form of regional structure for specialised commissioning. He was particularly concerned about the amount of oversight the central commissioning board would have over specialist services and whether it would have sufficient capacity to ensure quality was maintained across the country. Mr Murray said more details were needed on designation - the process of checking that specialised service providers deliver an agreed quality and level of care within clear financial and clinical standards - and how the role of monitor, as a possible regulator of competition, would sit with this. At present, designation - one of the recommendations of the 2006 Carter review into specialised commissioning - is carried out by specialised commissioning groups aligned with strategic health authorities, which are set to be abolished.
  
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• NHS IT programme faces further cost cutting. The government is expected to confirm a further scaling back of the NHS IT programme as part of central cost cutting measures announced in the emergency budget. The Department of Health said last week an announcement would be made “in the next few weeks” about the future of the national programme for IT, which it said would reflect the “bottom-up philosophy” of its white paper, Equity and Excellence: liberating the NHS. The two largest providers for the programme - CSC and BT - have been involved in Cabinet Office talks with all major IT providers to the public sector which, the Cabinet Office said, should “take costs out of contracts”. A renegotiation with BT in March, under the previous government, cut its £1.2bn contract for the programme in London by £112m and reduced its scope. But no deal was reached with CSC, the provider for the North, East and Midlands. CSC healthcare strategy director Andrew Spence told HSJ the government wanted to make savings on the national programme contracts, although no agreement had yet been reached. But he said the company still expected to complete around seven installations at acute and mental health trusts by the end of December. Separately, the Department of Health has failed to negotiate a new enterprise wide agreement with Microsoft for NHS organisations to use its software, saying future purchases would be “at a local level in line with the proposals set out in the white paper”.
  
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Public Finance

• NHS staffing cuts will hit productivity, says Unison. Unison has condemned reductions in the NHS workforce, claiming they will harm productivity and make it more difficult for the service to make genuine efficiency savings. Figures released yesterday by the NHS Information Centre show that total headcount in the NHS fell by 3,351 during April 2010 – a reduction of 0.3%. The same proportional reduction was also seen in the number of full-time equivalent positions, and in clinical jobs. The union’s comments follow a report from the King’s Fund think-tank that argues savings must be driven by increased productivity, and not staffing cuts. The data suggests that managerial jobs are being cut faster than clinical staff. The NHS employed 662 fewer managers in April than in March, and 489 fewer senior managers – falls of 2.1% and 3.5% respectively. Unison said the reduction in headcount was at odds with the need to cut costs, and warned waiting times would rise as jobs were lost. A spokeswoman said: ‘Staff are key to driving productivity. The NHS can’t afford to lose people – and back-office workers do an important job supporting frontline staff.’ The King’s Fund report, Improving NHS productivity, was published online today and welcomed by Unison. Its authors wrote: ‘As the NHS grapples with significantly smaller increases in funding from 2011, there is a danger that the necessary focus on improving productivity becomes, at worst, a misunderstanding that the NHS needs to dramatically cut budgets, reduce services for patients and sack staff.’ The report calculates that the NHS faces a ‘productivity gap’ of £14bn a year by 2014. It argues that the best way to make savings will be to bring the poorest performers up to the standard of the best, reduce the length of hospital stays, cut re-admission rates, and invest in leadership and management.
  
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Tuesday 20th July 2010

Guardian

• Private health insurance takes a dive. Private health insurance has suffered a record slump in demand, because the recession has forced employers and individuals to cut back on the costs of cover. The number of people buying their own health policies has fallen to the lowest total since the 1970s, according to analysts Laing & Buisson. The trend has also hit dental insurance – there was a 2% drop in the number of subscribers to stand-alone dental benefit plans last year, in stark contrast to annual growth of 31% in the preceding three years. With sluggish demand for both medical and dental insurance forecast to continue, more people will be turning to the NHS at a time when it is facing tough spending curbs.
  
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Daily Mail

• Sacked NHS managers could simply move to work for GPs. NHS managers made redundant by the Government could end up working for GPs under a huge 'revolving door' scandal. Health Secretary Andrew Lansley last week unveiled plans to axe a range of NHS organisations, potentially costing 20,000 managers their jobs. He said family doctors should take over responsibility for these groups' huge budgets. But now GPs have been told by their professional body to employ Health Service bureaucrats to carry out this task. It is even possible that managers could move to work for GPs after taking hefty redundancy packages from the NHS. The British Medical Association's chairman, Dr Laurence Buckman, has sent an email to all members saying: 'We cannot rise to this challenge without the help and expertise that can currently be found in the NHS. We should look inside the NHS and to our professional body for support, rather than going elsewhere for advice.' The email, seen by the magazine Health Service Journal, suggests that many of the sacked managers will simply end up moving across to work for 500 or so GP commissioning groups, who will take on much of the role of Primary Care Trusts. Dr Buckman said Mr Lansley's proposals had created 'serious concerns' for GPs and could represent a 'major threat' both to the current form of GP practice and 'even to the NHS as a public service'. There are concerns that the BMA may demand pay rises for GPs before they agree to take on the new responsibilities.
  
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Nursing Times

• Public health nurses face shift to councils. The majority of public health nurses and some health visitors could be transferred to local authority control under the white paper’s proposals. The government said it would transfer the existing health improvement functions of primary care trusts to local authorities when PCTs are abolished in 2013. As a result, the majority of public health nurses may be transferred to local authority employment. Nursing Times has learnt that care services minister Paul Burstow met last week with a group of PCT chief executives who hold dual roles on their local councils to discuss the plans. Tony Hunter, chief executive of North East Lincolnshire Council, which took on 60 public health staff and 130 children’s health employees from the NHS in April as part of local integration plans, said the council had ensured public health staff were able to maintain their specialist knowledge when they transferred.
  
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e-Health Insider

• Consortia will look to private sector IT. GP consortia are likely to look to the independent sector to meet their IT and information needs for commissioning, according to the NHS Alliance. Dr David Jenner, practice-based commissioning lead for the Alliance, said the information currently supplied by the NHS was not good enough, with successive Department of Health surveys on PBC delivering the lowest scores for quality and timeliness of information. Dr Jenner said GP consortia would need systems that could take data from secondary care and rapidly translate it into information that would enable consortia to quickly see what was happening across different specialties and between practices. Dr Jenner predicted that GP systems would eventually provide an instant price for every decision a GP made. The BMA’s GP committee this week advised GPs not to rush into commissioning consortia and said it expected the DH to publish a supplementary report on its commissioning plans within the next two weeks. The General Practitioner Committee said it would also be writing to GPs and would start releasing what it envisaged would be a “stream of information” on commissioning and the white paper changes as soon as possible.
  
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Healthcare Republic

• NICE to cut spending by 20% as workload rises. NICE will have to cut spending by 20% over the next two years, despite needing to double the amount of guidance it publishes this year.The institute will pursue a self-imposed efficiency drive to reduce spending by one pound in five, following meetings with the coalition government’s new health ministerial team. NICE will look to cut 10% of its spending in 2010/ 11, followed by a further 10% in 2011/ 12. But NICE also plans to double the amount of guidance it issues, from about 100 publications in 2009/ 10, to 200 in 2010/ 11. From this year, NICE will issue guidance on diagnostic and medical devices guidance, as well as NHS Evidence Accreditation decisions. The previous government increased NICE’s budget from £63m in 2009/ 10 to £74m this year to account for the extra work, although this was 3% lower than initial budgets.
  
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BBC News

• Fears over hospital merger plans. An ex-senior civil servant is warning that a new government policy forcing a rethink on hospital reorganisations in England could cost money. Plans to close or downgrade some hospitals in England are facing hold-ups after a review ordered by health secretary Andrew Lansley. Mark Britnell oversaw services moving to fewer hospitals in Birmingham. He believes many of the original plans will go ahead but with delays of up to a year. Mr Britnell held a top job at the Department of Health before moving to the professional service provider KPMG last year. He said: "Elapsed time costs money. My understanding is that many of these plans are good to go.” The review - announced two months ago - told NHS managers to make sure their plans were supported by local GPs and the public, as well as being underpinned with "greater clarity about the clinical evidence base". Further details, which were due to have been released last month, have not yet emerged. Moves to downgrade or close local hospitals have often attracted fierce protests and many local campaigners have welcomed the new policy. But leaders at NHS London, which was planning a big reorganisation, have reacted furiously with the chairman and some board members resigning. Proposals to close a maternity unit in Bury have also been put on hold. This was part of a much bigger plan to reorganise maternity and children's services across Manchester, with a new unit being built in the north of the city. Decisions to close a casualty unit in Burnley, which has already happened, and to move children's services from there to Blackburn will also be reviewed. However, plans to concentrate services for stroke patients in a smaller number of specialist hospitals in London are going ahead this week.
  
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Peterborough Telegraph

• Angry debate on Primary Care Centre plan. Peterborough City councillors and the NHS Peterborough primary care trust have clashed over consultations to close a city care centre. NHS Peterborough was hoping to win approval for an eight-week consultation over the future of the Alma Road Primary Care Centre. However, councillors on the city council’s scrutiny commission for health issues reacted angrily to the plans. They felt that NHS Peterborough officials had already made their minds up on the idea, before sending it out for consultation. The committee also accused the primary care trust (PCT) of basing its consultation document on “half truths.” As a result, the PCT now has two weeks to come up with a new document, before it will go back before the same committee. Among the issues raised by the councillors is the PCT’s decision to close the nearby Millfield Surgery, in Searjeant Street, which has left 2,200 patients looking to join other practices. The care centre opened in April 2009. It opens from 7am to 10pm seven days a week. It was originally commissioned on the basis it would provide services for more than 2,000 registered patients and would also treat 350 walk-in patients a week. Although an average of 500 patients per week are treated at the walk-in, only around 650 people are currently registered on its books. NHS Peterborough says keeping the centre open “duplicates” other similar services in the area. Closing the centre could also save £800,000, which would go towards the PCT’s Turnaround Plan to save £20.2m this year.
  
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Waltham Forest Guardian

• WALTHAM FOREST: Cuts "could kill thousands" A campaign group has been set up to challenge government funding cuts to local services. The newly established Waltham Forest Anti-cuts Union say savings imposed on local authorities, as the coalition government attempts to reduce the budget deficit, will have a devastating effect on society. It claims the cuts will lead to the destruction of the NHS, the loss of 1.3 million jobs nationally, poverty and privatisation.
  
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Monday 19th July 2010

The Independent

• NHS cuts attacked by leading medical journals. Andrew Lansley’s plans for the NHS were attacked today by both Britain’s leading medical journals as the Government admitted £1.7bn had been set aside to fund the changes in the first year. The Lancet and the BMJ published separate editorials criticising cuts in NHS funding and proposals, set out in a white paper “Liberating the NHS” this week, to pass control of the bulk of the NHS’s £105bn budget for England to consortia of GPs. Kieran Walshe, professor of health policy at Manchester Business School says the reorganisation is likely to cost up to £3bn to implement with no guarantee that it will improve performance or lead to better care for patients. None of the different structures put in place over the last 20 years had been better or worse than others, the transition costs were huge and reorganisations had adversely affected performance in the past. “It is a huge distraction from the real mission of the NHS - delivering healthcare and improving quality - and can absorb a massive amount of managerial and clinical time and effort,” he writes. In The Lancet, an unsigned editorial demands that Mr Lansley “tell the truth about NHS cuts” which it claims are happening to front line services in contravention of the Conservatives’ pledge to protect them. It cites a document obtained from Oxfordhsire and Buckinghamshire Mental Health NHS Foundation Trust, dated June 2010, which identifies savings of £5.3m to be achieved on its budget of £42m, a 12.6 per cent cut over the next four years. Three of 19 consultant psychiatrists, 16 care coordinators and nine other workers are to go. It says the cuts may lead to a “reduction in quality of service”, “patients and carer disatisfaction”, and “poorer service response”. Cuts of 14 per cent are faced by many medical schools over the next three years, the Lancet says. “The only way these cuts will be realised is through loss of front line staff.”
  
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Guardian

• The coalition is planning to privatise the health service in defiance of the evidence. But Labour is hamstrung by its record. When it comes to spin and honeyed words, the Cameron-Clegg show is already putting Tony Blair and Peter Mandelson in the shade. However extreme or cockeyed the policy, from savage benefit cuts for the poorest to the chaotic scrapping of school building projects, a gentle gloss or a winning apology from a coalition frontman and critics go weak at the knees. But this time they have outdone themselves. Under the banner of Liberating the NHS, the health secretary Andrew Lansley this week unveiled a programme of dramatic change, promising to free the English health service from bureaucracy, put family doctors in the driving seat and hand power to patients. What could be more appealing to a workforce and users fed up with bureaucratic directives and corporate managerialism ? In reality, Lansley's health white paper opens the door to the comprehensive privatisation of healthcare and the end of the NHS as a national service. If the plans are taken to their logical conclusion, by 2015 the NHS will be little more than a brand. From a major public service with a million employees, it will have become a central fund with a minimal workforce, commissioning services from a string of private companies in a fully-fledged healthcare market. "The bottom line of this is the abolition of the NHS," Dr David Price of Edinburgh University argues. "It will remove the government's duty to provide a universal healthcare service." His colleague, Professor Allyson Pollock, believes it will lead to "full privatisation". Andy Burnham, who did Lansley's job until May, calls it the "dismantling of all public accountability and national standards in the NHS".
  
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BMJ

• Freedom of information requests could suffer in government cuts The UK Information Commissioner’s Office is to launch a new enforcement policy to get tough on public bodies that consistently fail to meet deadlines for answering freedom of information and data access requests. Deputy commissioner Graham Smith, who announced the initiative at a seminar on freedom of information on 15 July held by the Westminster Legal Policy Forum, a cross government forum aimed at raising debate on legal policy, said that some public authorities were consistently failing to meet deadlines. "We are saying we will work with you, but if there is no improvement we will issue an enforcement notice," he said. Other speakers at the seminar warned that freedom of information could be one of the early victims of the colder economic climate, because teams dealing with requests under freedom of information legislation were not likely to be seen as frontline staff.
  
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BBC

• HM Stanley Hospital in St Asaph to close in 2011. A community hospital is to close next year, two years after a reorganisation plan was put on hold. Betsi Cadwaladr University Health Board said HM Stanley Hospital in St Asaph was "no longer fit for purpose" and would be vacated by March 2011. Eye, stroke and outpatient services would be re-provided elsewhere it said. In June 2007, campaigners hoped to keep services at the site after then First Minister Rhodri Morgan called a temporary halt to planned NHS changes. The health board said the closure of the 22-bed hospital and the transfer of its services was recommended in the review, Designed for North Wales in 2007. Planning director Neil Bradshaw said: "We are now spending a significant amount of money on keeping very poor quality buildings going. "A project team is being set up to co-ordinate this work, and this will involve appropriate representation from staff and service users."
  
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Camden News Journal

• Jacky Davis on white paper (Liberating the NHS) - GP commissioning and an increased role for the private sector. Change, change, change… aren’t things bad enough already ? Clearly health secretary Andrew Lansley doesn’t think so. While in opposition he criticised Labour for repeated and pointless reorganisations of the NHS and promised that he would leave it alone. But on Monday he launched a White Paper (Liberating the NHS) proposing the most profound reorganisation of the service since its inception in 1948. Either the coalition document failed to tell the truth or this massive shake-up has been concocted in less than six weeks. At the heart of the proposals are GP commissioning and an increased role for the private sector. This has predictably been dressed up in fine words, with talk of putting patients and GPs in the driving seat of the service and improving outcomes through increased “choice” and “contestability”. But what lies behind the rhetoric ? GP commissioning entails handing over £80billion of the NHS budget to family doctors to buy healthcare for their patients. Many GPs have already indicated that they have no interest in the massive and complex challenge of commissioning. They have neither the time nor the expertise to supervise the management, accountancy and data analysis involved in buying healthcare for their local population. Fortunately the last government had already set up FESC (Framework for External Support for Commissioners) which consists of commercial companies who will do this work for them. Thus private companies will finally get their hands on billions of pounds of the NHS budget to buy care from other private companies, who will increasingly be involved in delivering NHS clinical care under the government’s “any willing provider” policy. Has anyone noticed a possible conflict of interest here ? Hospitals must all become foundation trusts and, along with their staff, will lie outside the NHS. Those who fail – both hospitals and GP commissioning bodies – will be eliminated, as “there will be no bail-outs of organisations which overspend public budgets”. These proposals amount to nothing less than an accelerating privatisation of the NHS to the point where it becomes nothing more than an organisation buying care from a hotchpotch of competing and unaccountable private companies.
  
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Friday 16th July 2010

Harrow Times

• Health cuts in Harrow hitting vulnerable in community hard. Citizens Advice Bureau staff have been left “devastated” after funding for a support service for people with mental health problems was axed. NHS Harrow has cut off funds for the mental health outreach project run at Northwick Park Hospital as it makes swingeing cuts to funds to the voluntary sector. Gill Harrison, chief executive of Harrow's Citizens Advice Bureau, said the body is struggling to cope under the strain of ever increasing cuts. The NHS Harrow cuts have hit a host of health charities in Harrow, forcing some to have to consider closing down services while other larger groups like Mind in Harrow and Harrow Mencap are reeling after considerable reductions in funding. The health trust has insisted the cuts were made on a “transparent, equitable and fair” basis, but insists feedback after the announcement this week has been “positive”. NHS chiefs are due to be grilled over the cuts at a meeting of the Harrow Partnership Board two days after the board is expected to vote through the cuts.
  
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BBC News

• NHS sets £1.7bn aside for reform. The NHS in England has set aside nearly £1.7bn this year for reorganisation - more than seven times what it aims to save on management, the BBC. The fund - held back from the front line - will help pave the way for GPs to take over budgets from managers. The government said significant savings would be made in the long term, but unions voiced concerns about the spending spiralling out of control.When Health Secretary Andrew Lansley announced the plan on Monday, he justified it by saying it would cut management costs by 46% over the next four years. The aim is to trim the £1.85bn bill by £850m by 2014 - £220m of which will come this year.
  
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Wakefield Express

• Hundreds of jobs at risk. Hundreds of jobs are under threat at the trust running Pinderfields. Mid Yorkshire Hospitals NHS Trust plans to make £55m of cuts in the next two years as part of an overhaul of staffing across its three hospitals in Wakefield, Dewsbury and Pontefract. It will mean slashing the wage bill of the trust's 7,500-strong workforce by £20m by the end of March - equivalent to £39m in a full year - with further pay savings of £12m next year. Chief executive Julia Squire said 500 jobs would "change or disappear" by re-grading posts, natural wastage and making about 150 employees redundant. Around 90% of redundancies will be administrative, facilities and management staff, but a consultation document shows nurses, doctors, radiology and physiotherapy staff also at risk.
  
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Birmingham Mail

• Black Country health workers have protested over plans for the future of their Primary Care Trust. Black Country health workers have protested over plans for the future of their Primary Care Trust (PCT). Staff at Sandwell PCT held a demo outside Lyng health centre as their bosses look at whether to become a social enterprise or an NHS provider under government reforms. The PCT is one of just three in the country, including Shropshire, and Telford and Wrekin, looking at the social enterprise option – where services are run like a business but with profits ploughed back in. Tracy Ward, of health workers trade union Unison, said the option felt like “stealth privatisation”.
  
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Pulse

• Private firms prepare major initiative on GP commissioning. A group of leading private companies is planning a major joint initiative to persuade GP consortiums to partner up with them, on the back of the Government’s White Paper on health. UnitedHealth UK, Tribal Newchurch, Humana, Bupa and Aetna UK are drawing up a framework of potential services GPs will be able to ‘buy in’ from the private sector, with companies taking on a share of the commissioning risk. They are confident the White Paper will hugely increase the scope for private firms, with one leading player claiming it will lead to the full 'denationalising' of healthcare in England. Groups of private healthcare insurance, financial services and IT companies will offer GPs a raft of commissioning support services, following moves to hand them control of £80bn of NHS cash. These will include medicines management systems, IT systems, commissioning-support tools, back-office support and patient-management services, many of which have already been used by PCTs under the previous Government’s FESC framework and via individual deals with private firms. Kingsley Manning, director of Tribal Newchurch, said offering GPs a chance to share the risk of the new ventures would be a major part of the private firms’ strategy, following health secretary Andrew Lansley’s warning of no ‘bail out’ for consortiums that fail. ‘We’re working on the assumption that there will be some element of risk transfer. Risk management is going to be a very, very important factor. ‘There is undoubtedly some sense that there should be some pain involved. But by working together, private health companies believe they can draw up a series of packages which will not only be highly attractive to GPs looking to reduce costs and share the risk of failure, but fit what are expected to be ultra-tough quality standards demanded by the new independent NHS Commissioning Board.' Mr Manning said Mr Lansley’s plans could lead to the ‘denationalisation of healthcare services in England’, adding that the White Paper ‘represents the most important redirection of the NHS in more than a generation, going further than any Secretary of State has gone before'. The Government has also unveiled plans to ditch Labour’s ‘NHS as the preferred provider' policy and switch to a principle of any willing provider, which will reduce the barriers to private firms. Although not involved in the new trade body, Virgin-owned Assura Medical, which runs 15 Darzi centres in England and has 30 GP companies involving 1,500 GPs, also said the White Paper would open up new opportunities, saying the plans ‘closely match its business model'. Shadow health secretary Andy Burnham, who brought in the preferred provider policy while in Mr Lansley’s hotseat, described his successor's plans as giving ‘the green light to let market forces rip right through the system with no checks or balances’. Kings Fund chief executive, Professor Chris Ham, said the White Paper would ‘accelerate the trend’ towards further privatisation, adding that it would lead to ‘opportunities for private companies to support GP commissioning and increased opportunities for independent providers to deliver treatment'.
  
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• Private companies 'now running more than 200 GP surgeries'. The growing commercialisation of primary care has been ‘substantially understated’, with private firms now running over 200 surgeries and health centres across England and many companies rapidly expanding their business, a study has shown. A report by the NHS Support Federation obtained data from PCTs on the spread of APMS contracts, which surged following the Labour Government’s nationwide rollout of Darzi centres and APMS practices. It found that 227 GP surgeries and health centres in England are now run by 23 commercial companies, with nine firms, including Chilvers McCrea, Care UK and Assura Medical (recently taken over by Virgin), holding ten or more contracts. Other companies making big inroads into the primary care market include Intrahealth, the Practice PLC and Malling Health. The report argues that the growth has been masked by some providers being referred to as ‘GP-led’, when in reality, many described in this way have a commercial focus, with ‘profit-making intent and a traditional corporate management structure’. It cited 18 examples of private companies started by groups of GPs that are ‘now in the process of business expansion’. The report said that local GP practices are ‘finding it hard to afford to bid for contracts’, and that they risk being ‘squeezed out as the NHS market matures’. It also warned that the complex structure of ownership, where some private firms often team up with groups of GPs, makes it ‘difficult to track who controls the service and where public money is going’.
  
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• GPs to take on out-of-hours responsibility from next April. GPs are set to be thrust into commissioning out-of-hours care as early as next April, as the Government’s root-and-branch restructuring of the NHS begins to take shape. The Government has revealed it will launch a new model contract for out-of-hours by April 2011, which GPs will be expected to use when commissioning the service from providers. The move means GPs will begin the process of assuming responsibility for out-of-hours care next year, ahead of the full-scale implementation of the Government's far-reaching commissioning reforms by April 2013.
  
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• GPs split on Government’s commissioning plans. General practice is split over the Government’s plans for GP commissioning, with broad support over the proposals but nervousness over whether they can be made to work. Just under half of GPs say they are ready to take on a commissioning role, according to the first 250 responses to Pulse's survey of the profession’s views on the Department of Health White Paper. GPs told the survey in general they supported health secretary Andrew Lansley’s radical plans for GPs to take on commissioning budgets - with 51% backing them, 31% not and the rest undecided. But there was a clear divide over whether the profession would be capable of managing the planned £80bn commissioning budget effectively – with 40% saying it would, and 39% saying it would not. Some 43% of GPs said they were ready to take on commissioning budgets, but 46% said they were not ready. Overall, 34% of GPs said they had experience of large-scale commissioning, and 16% had experience of budget management. GPs criticised the haste with which the plans are being introduced, with plans for GP consortiums to take full financial responsibility for commissioning by April 2013 – 60% said the Government was wrong to press ahead without first piloting the changes.
  
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Thursday 15th July 2010

Progress Online

• NHS being dismantled, not reformed. The ConDem coalition's new NHS white paper, 'Equity & Excellence - Liberating the NHS' will fail to deliver either equity or excellence. Even the Equality Impact Assessment on the white paper shows how flawed it is. After promising not to tinker with the NHS's structure, Andrew Lansley has gone back on his word. On top of his broken promise, the proposed reorganisation will be an immediate financial cost to the NHS, not a saving. It is difficult to quantify the economic cost of low staff morale but this will undoubtedly be another cost. And there is no evidence that this reorganisation will deliver more efficient and effective healthcare making savings in the future. Another coalition fallacy is that the NHS is being protected from cuts. Ask any NHS worker whether this is the case and the answer is loud and clear - 'No'. Trusts have been told to make 15-20 per cent cuts and as the Royal College of Nursing reported last week these are cuts to frontline staff not just managers. However, most alarming are how these plans open the door for the private sector to both commission and provide healthcare in the NHS. I have no problem with private healthcare companies being used by the NHS if they add value or capacity, but I vehemently oppose any ideologically-driven proposals that in effect hand over our much-loved NHS to the private sector. Why ? These companies are here to make money; the decisions they make, eg which patients are 'profitable' (people with existing, complex conditions, usually the old and poor, are not), what medicines to use, will be guided by profit margins not clinical need. Many GP surgeries are already owned by private companies like Care UK and Assura (soon to be owned by Virgin). Through GP consortia these companies will have increasing control of NHS funding including contracting with private sector foundation trust hospitals. Mr Lansley's soothing rhetoric that these companies are 'social enterprises' is misleading; according to the coalition BUPA is a social enterprise company! In spite of equity having such prominence in this white paper's title these plans will deliver the opposite.
  
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Morning Star

• Pro-market reforms spell chaos for NHS. Privatised chaos is in store for the NHS under the Con-Dems' pro-market health reforms, unions and health campaigners has warned. The plans unveiled in the coalition's NHS white paper by Health Secretary Andrew Lansley on Monday afternoon would see consortiums of GP practices commissioning the great majority of NHS services for their patients. These consortiums would control around £80 billion of the NHS budget and could choose to buy in outside help from private firms or charities. The white paper also warned that by cutting bureaucracy in favour of front-line services, NHS job losses would be "inevitable" as 45 per cent of management costs are slashed over four years. Mr Lansley added that he wanted to open up the NHS to "any willing provider." Campaign group Health Emergency's John Lister warned that the proposals would turn the NHS from being one of Europe's largest single employers with around one million staff to near zero by the next general election. "The NHS itself will remain in name only as a brand, but be transformed from a major public service into little more than a central fund in which private providers will be encouraged to operate," he said. The Unite union accused Mr Lansley of backtracking on the Tory pre-election pledge that there would be no more major reorganisations of the health service, with national officer David Fleming describing the reforms as "an untested, expensive Trojan horse in political dogma." It would follow the US model in giving private companies an even greater stake in the NHS, he said. And Unison's head of health Karen Jennings predicted that far from liberating the NHS, the proposals would tie it up in knots for years to come. "They are a recipe for more privatisation and less stability," she stressed. Medical charities also voiced concern that some patients could be put at risk by GPs lack of commissioning experience and the Children's Heart Federation warned that profits could be put before youngsters' health. NHS Confederation acting chief executive Nigel Edwards said the changes would mean a huge upheaval for the NHS. "It is hard to stress just how radical this is. The NHS will look much more like the gas, electricity or telecoms market than it will the monolithic state bureaucracy we have come to understand," he said.
  
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Medical News Today

• White Paper Signals More NHS Privatisation And Less Stability. UNISON, the UK's largest public service union, slammed health plans set out in the government white paper saying they will plunge the NHS into chaos. Karen Jennings, UNISON Head of Health, said: "Far from liberating the NHS, these proposals will tie it up in knots for years to come - they are a recipe for more privatisation and less stability". "NHS staff will feel badly let down by plans to undermine national pay bargaining. In a race to do this, the Government wants employers to lead negotiations on new contracts resulting in a two-tier workforce within Trusts and anomalies across the NHS". "If the NHS is to be more efficient it needs to have stability. People in fear of their jobs, or how they are going to be able to deliver services, cannot be expected to make informed or rational decisions. This is no way to take patients or staff with you". "There are just too many contradictions e.g. cutting back on bureaucracy and doing away with PCTs and SHAs, but allowing the proliferation of GP consortia".
  
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Tuesday 13th July 2010

Guardian

• NHS shakeup: The jobs toll. Tens of thousands of managers and administrators could see their jobs disappear as a result of the government's proposals to radically restructure the NHS and the way it operates. Large-scale redundancies are certain because the 10 strategic health authorities (SHAs) and 152 primary care trusts (PCTs) around England are being abolished. Between them they employ 64,000 people, according to figures from the NHS information centre. It is unclear exactly how many of these posts are at risk in the shakeup, and health secretary Andrew Lansley refused to speculate on what the eventual total might be. But informed estimates suggest that the government's determination to drastically reduce what it calls the NHS's ballooning bureaucracy means that about 30,000 people – who are currently involved in commissioning care, a function that will be taken over by groups of GPs in 2012 – may lose their jobs. They will pay the price for Lansley's stated aim of reducing NHS management costs overall by "more than 45%". Kingsley Manning, of Tribal, a public sector strategy and services firm which works with doctors and PCTs, predicts that the NHS's new era "could result in the biggest transfer of employment out of the public sector since the significant denationalisation seen in the 1980s". But some staff are likely to switch to jobs with the regional offices of the planned new independent NHS board which the coalition is setting up.
  
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• Health service: The change remains the same. The Lansley doctrine is about more than doctor worship. The supremacy of the medics will be challenged, and perhaps outdone, by that of market forces. Buried in the small print was a proposal to turn Monitor, the body that currently superintends the foundation trusts, into a full-blown economic regulator to oversee a healthcare market in the same way that Ofcom and Ofgem oversee the markets in communications and energy. Crucially, it will be required to go out of its way to attract corporate challengers to the NHS. Once the shift to a market system is made, European law may make it irreversible. Family doctors may, perhaps, be gaining enough power to shelter themselves from the full gales of competition, but the hospital sector will feel its force as never before. Mr Lansley's decision to remove the cap on foundation hospitals' private work will only aggravate fears about where all this is leading. The biggest risk of all, however, is that the service will not survive the shock. With the baby boomers moving into their 60s, the near-freezing of health expenditure – which is all the health service's much-vaunted protection affords it – will feel like a deep cut. That makes this a dangerous time to go through yet another great upheaval, which – for all their ambiguities – is the one thing that the Lansley plans will certainly produce. In opposition, the Tories rightly damned Labour for reorganising the service too often. Now that they are in office, its weary staff must worry that the only thing that never changes in the political theology of the NHS is the demand for change itself.
  
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e-Health Insider

• Lansley leads information revolution. The government has promised an “information revolution” for patients in its white paper, ‘Equity and excellence: Liberating the NHS’. The white paper uses much of the same language as the Conservative manifesto in the run-up to the general election, but sets out some specific steps to bring about the "revolution". It says that assessments of commissioner performance will be published, that quality audits will be extended to more NHS providers, and that clinical teams will be subject to “meaningful, risk adjusted assessment of their performance against their peers”, with the results put into the public domain. It also says patient reported outcome measures (PROMS), which were introduced following Lord Darzi’s review of the NHS under the last Labour government, will be extended across the NHS “wherever practicable” and that patients will be able to rate more of the services they receive. Lansley told the paper’s press launch that giving patients more information was a pre-requisite for one its major themes: “no decisions about me without me.” The white paper also indicates that the “information revolution” is intended to play a big role in improving quality. An information strategy is promised this autumn on how the changes will be implemented. However, the white paper gives a big boost to the NHS Information Centre, saying it should be put onto a firmer statutory footing and given “lead responsibility” for data collection. Local organisations will be responsible for ensuring their data is accurate and timely, although the new NHS Commissioning Board will set “technical and data standards” to ensure compatibility between different systems. These standards will include record keeping and data security. Information will continue to be published on NHS Choices, but the white paper makes it clear that “a range of third parties will be encouraged to provide information to support patient choice.” The report also wants a market in information, commenting: “While the state should ensure a market is working it must recognise it is not a monopoly provider and should not crowd out what the market could provide.”
  
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Scottish Courier

• Weekend emergency surgery cut at Perth Royal Infirmary. Staff have been told that no operations will take place at PRI between 6pm on Fridays and 8am on Mondays. NHS Tayside said the move would ensure a safe level of cover for local people as the hospital experienced weekend staffing difficulties. However, those who have fought to keep PRI functioning for emergency admissions fear a predicted "death by a thousand cuts" is continuing. One worker said, "Anyone with a serious complaint will have to go to Dundee and it seems to be another money-saving exercise. Weekend admissions of children went a while ago and that was seen as the start of weekend cover being eroded and they are just picking at one thing after another and doing it by stealth."
  
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Isle of Man Today

• Prescription charge about to increase. Prescription and dental charges for NHS patients could increase from September. Health Minister David Anderson MHK will seek Tynwald approval for the increases. 'It is important, particularly in the current economic climate, that we retain the relationship between income from prescription charges and expenditure on drugs,' he said. 'Those who are unable to afford charges will be covered either by the exemption criteria or their financial burden can be eased by being able to purchase a pre-payment certificate.' If approved, prescription charges would increase by 60p per item, from £3.25 to £3.85. It would generate an extra £113,878 per year to the department. In addition, the cost of routine dental examinations, x-rays, a scale and polish and urgent and out of hours care would increase by £1 to £16.50. Fillings, root canal treatments and extractions would cost £45.60, up from £42.40. And the cost of more complex procedures such as crowns, dentures and bridges would increase from £189 to £198. The increases would generate an extra £36,000 per year for the department. If approved, all increases will take effect from September 1. Prescription charges were last reviewed in January 2006. Mr Anderson said that the Island's prescription charge would remain significantly lower than England's, which currently stands at £7.20 per item.
  
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Localgov.co.uk

• Councils gain wider role in health shake up. Councils are set to gain wide-ranging powers as part of the coalition government’s shake up of the National Health Service. Under the plans in the White Paper Equity and Excellence: Liberating the NHS, set before Parliament by health secretary Andrew Lansley, primary care trusts and strategic health authorities will be scrapped by 2013. Consortia of GPs, accountable to an NHS Commissioning Board, will take on the responsibility of commissioning most health services from PCTs, while councils will assume the trusts’ public health functions and lead the integration of health and social care at the local level. Councils will seek to join up services through new local health and wellbeing boards and, with a national public health service, will jointly appoint directors of local public health. Local authorities will be responsible for: * Promoting integration and partnership working between the NHS, social care, public health and other local services and strategies, *Leading joint strategic needs assessments, and promoting collaboration on local commissioning plans, * Building partnerships for service changes and priorities. There will be an escalation process to the NHS Commissioning Board and the Secretary of State, which retain accountability for NHS commissioning decisions
  
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Guardian

• Pro-market agenda drives NHS reforms. The government today unveiled a radical, pro-market agenda in healthcare with proposals to encourage hospitals to increase private income and give GPs responsibility for "buying" medical services. Health services will be judged by results, and failing hospitals will be allowed to go bust. GPs will be handed much of the multimillion-pound budget handled by primary care trusts (PCTs), which will be abolished along with strategic health authorities. Unions said the proposals, set out by the health secretary, Andrew Lansley, were an "untested, expensive exercise in political dogma". Under the plans, hospitals will be freed from the current cap on private income – allowing them to lure wealthier patients for specialised surgery. Lansley said that one of the best performing hospitals in Britain, the Royal Marsden, generated 25% of its income from private patients and this should be replicated across the country. Family doctors are at the heart of Lansley's blueprint. England's 35,000 GPs will be made to join forces in local consortiums, which will take over the bulk of the purchasing of NHS care. An independent NHS Commissioning Board will oversee the new regime, with local councils taking over the public health element of the PCTs' work. The proposals, which amount to the biggest shake up of the NHS in decades, will result in the decapitation of the top tier of NHS managers in England. The 10 strategic health authorities will be abolished by 2012 and the 150 primary care trusts will be scrapped by 2013 as family doctors take over the purchasing of care. The plans will lead to a fight with health service unions. Sir David Nicholson, the NHS chief executive, told reporters ministers want to cut NHS redundancy terms. At present NHS workers can receive two years' salary if made redundant and all NHS staff earning more than £21,000 face a two-year pay freeze. Nicholson said he wanted talks with the unions "pay and redundancy" terms. Under plans set out in a white paper, the government promised to scrap "top-down" targets in favour of a regime based on clinical outcomes. The document warned that NHS job losses were "inevitable" but said it was vital to switch cash from bureaucracy into frontline services. Lansley said all NHS trusts will become foundation trusts, giving more freedom from Whitehall control. And he said he wanted to open up the NHS to "any willing provider" able to meet standards in what he said would be the "largest social enterprise sector in the world". The government wants to slash NHS management costs by 45% over four years, and the white paper acknowledged that means job losses. Lansley told MPs the scale of the reforms was "challenging" but denied breaking a pre-election promise to spare the health service from further top-down reorganisations. He said he was simply accelerating and building on work that was already going on. Given the state of the economy, the health secretary will have to convince the doctors union, the British Medical Association, that GPs need not be paid more for managing patient's care.
  
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Yorkshire Evening Post

• Leeds heart centre review is 'not a cost-cutting exercise'. A review which threatens the future of a children's heart surgery unit in Leeds is "not a cost-cutting exercise", a minister has declared. Health minister Simon Burns said the review into 11 centres in England, including the unit in ward 10 at Leeds General Infirmary, aims to ensure that paediatric heart surgeons are delivering the "highest standards of care." NHS experts think it would be better to have fewer, bigger centres as surgeons would then do more procedures and maintain their skills. Parents last month spoke passionately at a meeting about the problems their poorly children could face if specialist heart surgery is moved out of Leeds. But Mr Burns insisted that "transportation options" and "travel times" will be examined by the review. He stressed that specialist children's heart centres affected by the review will not necessarily close – but they will stop carrying out operations.
  
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Guardian

• NHS shakeup: Private companies see potential to expand their role. Private companies believe the shake-up of the NHS will lead to a big expansion of their currently small role, as many GPs will need their help to carry out their new role as commissioners of healthcare. Firms which already have small-scale involvement with family doctors are preparing to exploit the chance to gain an unprecedented foothold in the NHS once GPs start spending £80bn of NHS funds. They said they expected the switch to GP commissioning outlined in the white paper to help them have a much wider involvement with the NHS, and especially to work closely with the 300-500 new "consortiums" of GPs which the Department of Health expects to emerge to become key purchasers of treatment for patients. Kingsley Manning, business development director at Tribal, which also already provides commissioning support services to some parts of the NHS, cautiously welcomed moves which the firm said "could lead to the denationalisation of healthcare services in England". Doctors' leaders and health experts agree that GPs' clinical skills will not be enough for them to discharge their new responsibilities and that the consortiums will need help them with finance, management, accountancy and data analysis. Nick Goodwin, a senior fellow at the King's Fund health think-tank, said: "It's likely that many of the GP consortia will need to either hook up with a PCT or go outside the NHS to firms like Tribal, United Healthcare or Bupa Health Dialog. Most PCTs don't have the expertise to offer technical skills, like information systems that allow them to understand the health needs of their local population." But the British Medical Association, the doctors' trade union, voiced alarm at the likely expansion of private firms' role and said that most GPs would aim to perform their expanded role without them. "The BMA position on this is that we would not be happy [for private sector involvement]. Dr Laurence Buckman, chairman of the BMA's influential GPs committee. said, "I think the vast majority of GPs will not be keen to involve the private sector in this. This is an opportunity for GPs to unite to make sure that the health service works well for the people of England, without the involvement of the private sector," he added. The issue could lead to tension between the BMA and the Department of Health in forthcoming negotiations about implementation of the planned changes. A BMA spokesman added: "We are concerned that increased private competition within the NHS could lead to wasteful expenditure or the duplication of services, for example independent sector treatment centres providing the same services as as the NHS, when that money could be spent on frontline patient services. We have always said that the private sector is no more efficient than the NHS and a lot of money is being wasted on private sector contracts and companies . We feel the involvement to date of private sector companies hasn't delivered many benefits to patients or the NHS. It's much better if you have services wholly provided by the NHS. The private sector should be the provider of last resort.". He cited the possibility of management consultants coming in to do jobs currently done by NHS staff. "We would be very concerned about that," he said. David Fleming, national officer for health with the Unite trade union, denounced GP commissioning as "an untested, expensive Trojan Horse in political dogma that will give private companies an even greater stake in the NHS – this way of operating has already happened in the USA." The NHS Support Federation, an independent campaign group, said GP commissioning "will create a spaghetti-like snarl of conflicting interests, where profit will inevitably come before patients. Paying companies to spend the huge NHS budget on other companies is a recipe for scandalous waste and the sort of shady deals that the public must be protected from," said the group's director, Paul Evans.
  
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Monday 12th July 2010

Mirror

• NHS privatisation nightmare warning. The ConDem coalition's £80bn NHS shake-up will result in a privatisation nightmare, campaigners warn. GPs will run budgets and admin after thousands of middle managers are axed in the hope of saving £1bn. But the NHS Support Federation fears many doctors will turn to profit-driven professionals to take on the work. Federation boss Paul Evans said of primary care trust cuts: "The door is being opened wide and there will be an explosion in the use of private firms. We trust in the NHS to put patient needs first, but the growing control of services by commercial companies is a serious threat to this." GP Ron Singer, of the Medical Practitioners' Union, said if privatisation went too far "the NHS could end up paying bills with guaranteed money flowing into private firms - a true nightmare". Health Secretary Andrew Lansley said more NHS cash will go to private firms "if they meet the high quality care we are looking for and they can do it within NHS prices".
  
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Health Investor

• Reform comes with £20bn price, says report. Andrew Lansley’s reorganisation of the health service could set the NHS back by as much as a year at a cost of £20bn, a think tank has warned. Research by Civitas found that the new system would need a significant amount of time to bed in, meaning that the health service will get worse before it gets better. Under the government’s new plans PCTs and strategic health authorities will be scrapped, and GPs will in effect run frontline care. As a result around 80% of the NHS budget will be passed on to GPs. But Civitas said that based on the evidence of past reorganisations the NHS would see a one-year dip in overall performance, laying to waste its hopes of making the £20bn of efficiency savings needed.
  
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Scotsman

• Health cash to be slashed. Health chiefs are expecting Scottish Government funding of NHS Lothian to fall significantly over the next few years, it has emerged. In a document, they said the level of uplift would fall to around 1% a year, generating only an additional £10m per annum. Increases in drug costs are also expected, meaning even less spare cash in future years.
  
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Sunday 11th July 2010

Sunday Mercury

• 'No room', so patients being turned away from Birmingham's superhospital. Emergency patients are being diverted away from Birmingham’s new £2.6bn ‘superhospital’ because it is struggling to cope. The Queen Elizabeth Hospital opened in a blaze of publicity last month, offering 1,213 beds, 30 operating theatres and a purpose-built military ward. But some patients and their families have highlighted an alleged catalogue of problems at the sprawling Edgbaston site. One mum told how her son had a brain scan there but was later transferred to City Hospital because there was no bed for him. Paul Brough waited anxiously with wife Noline for 12 hours in the clinical decisions unit. “There is no organisation; they are struggling with staffing and beds; nurses couldn’t get cold water out the taps,” said Mr Brough. “It feels as though they have opened it before it was ready. ” The new hospital opened its doors on June 16 when most in-patient wards from Selly Oak were transferred. But many staff are still working across the two sites because not all departments have moved over. The superhospital is the first major new hospital in Birmingham for 70 years and the second largest Private Finance Initiative (PFI) health building the NHS has ever seen. Building work started in 2006 and although the actual cost of building the hospital was £627m, taxpayers will pay back a bill of £2.58bn to construction firm Balfour Beatty in a mortgage-style 35-year PFI repayment scheme.
  
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Friday 9th July 2010

Daily Mail

• Failing hospital will be the first NHS Trust to be privately managed. A debt-ridden NHS hospital is to become the first in the UK to be privately managed after the only public bidders to run the operation pulled out. Under a new government scheme introduced this year private managers can bid to replace NHS bosses at failing hospitals who will be sacked without a pay-off. This means an entirely new team from a single private company will take over management of struggling hospitals and primary care trusts. Hinchingbrooke Hospital, in Huntingdon, Cambridgeshire, will be privately run after the Cambridge and Peterborough NHS Trust pulled out of the multi-million pound bidding process. It leaves three private companies, Serco, Ramsay Health Care and Circle Health, bidding to manage the hospital. Despite an annual £96m turnover Hinchingbrooke is £40m in debt and was rescued after public pressure from major cuts and threats of closure in 2006. Experts believe around 20 hospitals which are falling short of minimum standards on quality, safety or finances across the country will follow Hinchingbrooke's lead in the next 12 months. Union bosses and local health campaigners fear private managers will put profits before patients and plan a protest march on Saturday to oppose the takeover. Private operators will decide what services are provided, how many staff are employed, what areas are contracted out and, in time, what conditions and pay rates operate. But the hospital will remain owned by the NHS and all staff employed by the NHS. The British Medical Association passed a motion after the last remaining NHS trust pulled out of the bidding process. Doctors raised 'concerns' that only private firms remained in the franchise process. The organisation promised to monitor funding arrangements given to the successful bidder and ensure patient care is not compromised.
  
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Pulse

• GP leaders say they have been ignored in test case over Lansley ruling. NHS managers have claimed success for a consultation on plans for the biggest reconfiguration of services since the new Government came to power, but GP leaders claim their opposition has been ignored. In first major test case for health secretary Andrew Lansley's ruling on no more top down reconfigurations, a dozen PCTs and hospital trusts in London have released the results of a consultation into proposals including the closure of hospital A& E services and a shift up to 60% of the workload to primary care. Managers in north-east London claim ‘broad support’ for many of the proposals, based on Lord Darzi’s original Healthcare for London plans, despite GP leaders warning the plans put patients at risk and will swamp practices. The proposals include plans to close the A& E unit at King George Hospital in Ilford, with trusts claiming that the majority of the workload can be switched to polyclinics. The consultation was carried out before Mr Lansley’s subsequent intervention to demand that all major reconfigurations must have the backing of GPs. A summary document of the report, released by the North East London sector, fails to mention the huge concerns which had been expressed by GPs, councillors and MPs. In their joint response to the consultation LMCs in City and East London, Redbridge and Waltham Forest said the move would see thousands of patients transferred from secondary to primary care without adequate resources to treat them. The LMCs also accused trusts of exaggerating the ability of patients to get to other A& Es at alternative hospitals quickly enough if the King George A& E closed. They also warned the moves could lead to privatisation of services outside of hospital. Announcing its findings, Health for north east London did acknowledge ‘there was more disagreement than support’ from respondents about plans for the closure of the A& E department and plans to close King’s George’s maternity unit, but said patients would 'benefit from the changes'.
  
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• GP commissioners will duck unpopular health service closures, warns NHS Alliance. GP commissioning groups will not be big enough or powerful enough to drive the quality agenda in primary care, the NHS Alliance has warned. A new report by the body also claims that GPs are not best placed to explain hard rationing decisions to patients and will shy away from decisions which they fear will make them unpopular. It is the latest sign of a rowing back from the NHS Alliance over the Government’s plans for GPs’ powerful new commissioning role, after it warned earlier this week that the blanket nationwide rollout planned by health secretary Andrew Lansley must be piloted first. The new paper urges the Government and trusts not to dispense with strong PCT clinical management of primary care, saying that positions such as PEC chairs will be pivotal in the months ahead during the move towards GP commissioning. With 95% of commissioning earmarked to move from PCTs to GP consortia and plans to slash trust management costs by 40%, the NHS Alliance claims GPs will struggle with various aspects of care vital to maintain quality and patient safety.
  
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• 10% of GP practices 'to close due to cash crisis'. Government forecasts predict one in ten GP practices will face closure in the next three years due to the squeeze in NHS finances. The shattering forecast was disclosed during a meeting between LMC leaders, PCT bosses and a senior civil servant, who revealed that the efficiency drive made more acute by the financial crisis had led the previous Government to predict a dramatic reduction in the number of practices. It comes as a Department of Health document reveals instructions to NHS managers to ‘remove very poorly performing practitioners’ in order to tackle the wide variation in GPs’ performance. Although the pronouncements were made prior to the change of Government, experts predict the coalition is set to continue the direction of travel by removing practice boundaries and making it mandatory for GP practices to join federations under the new GP commissioning regime.
  
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Thursday 8th July 2010

Shetland News

• Nurses warn about cuts. Scotland's main nursing union has launched a national campaign to protect patients from massive cuts in the NHS budget. The Royal College of Nursing Scotland pointed out that NHS Shetland must save at least £1.4m this year, part of £250m in cost cuts nation wide. The RCN wants nurses to come forward with suggestions about where savings can be made that will have a minimum impact on frontline services. Last month NHS Shetland announced they would have to lose 17 jobs as part of the savings exercise, but said that the impact on patient services would be minimal. The equivalent of three nurses are being lost from the interim placement unit at Montfield Hospital, posts no longer required since the unit has been turned into a care home by the council. Those three positions are being absorbed where there are current vacancies. Some administrative staff working fixed term contracts are going along with some dental trainees, though extra dental staff are being employed. NHS Shetland has warned that further cuts will be needed and they intend to go out to public consultation later this year on the form these may take.
  
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Healthcare Republic

• PCT managers to merge with local council. A PCT is set to become the first in the country to merge its management team with a local authority. Blackburn and Darwen PCT is to merge its senior management with the council of the same name, and will be led by the chief executives of both organisations. The aim of the integrated management team is to save money and help commission NHS, public health and social services together. The collaboration is expected to save up to £2m annually. Sir Bill Taylor, chairman of the PCT board, said it was the ‘obvious next step’ as health and social services integrate. However, PCTs’ role in the future is uncertain as health secretary Andrew Lansley plans to hand commissioning power to GPs. PCTs could be responsible for just 4% of the NHS budget. Mr Lansley also recently appeared to rule out mergers between PCTs and local authorities.
  
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Bucks Free Press

• Maternity closure 'the thin end of the wedge' union Unison warns. A union leader fears the temporary closure of Wycombe birthing services is the ‘thin end of the wedge’ and could see it shut for good. Steve Bell, spokesman for Unison, spoke after bosses said the hospital’s midwife led unit would close from August 1 for three months. They said there was not enough staff to make it safe – but said new staff had been found but were delayed because of notice periods and the need for safety checks. It would re-open, they pledged. But Buckinghamshire Hospitals NHS Trust chiefs have long said the centre is at risk unless more mums use it, 450 a year. Official figures suggest about 360 are using it a year. One in five mums who went to Wycombe to give birth had to be transferred to Stoke Mandeville Hospital, Aylesbury. Some 200 babies were born there from November to May, but a further 43 had to go to Stoke, before or after birth. Mums have had to give birth in the back of ambulances during the journey from Wycombe to Stoke.
  
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Enfield Independent

• Enfield health cuts on agenda of NHS board meeting this afternoon. Cuts to health services in Enfield will be on the agenda of a North Central London NHS public board meeting. The NCL covers Enfield, Barnet, Haringey, Camden and Islington boroughs. This afternoon it will be reviewing the Barnet, Enfield and Haringey (BEH) Clinical Strategy. As the strategy currently stands, Chase Farm Hospital, in The Ridgeway, would lose its 24-hour A& E department by 2014 and its consultant-led maternity and children's services by summer 2011.
  
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This Is London

• £118k NHS Buckinghamshire watchdog 'not doing job'. Buckinghamshire's official NHS watchdog has been criticised for not taking any formal action over controversial service changes in its first year. The Buckinghamshire Local Involvement Network did not use its power to inspect hospitals unannounced, make recommendations to NHS bosses or demand investigations. It came during a year in which Wycombe Hospital lost key birthing services, clinics were removed from Amersham Hospital and Marlow Community Hospital was shut for a time. The county’s other NHS watchdog will call LINk bosses to explain their actions so far. The LINk is the official watchdog for health and social services and cost taxpayers £118,175 in 2009/ 10, its first full year of operations. Its chairman said it was playing a vital role.
  
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This Is Wiltshire

• Savernake Hospital beds shut. Health chiefs have shut half of the 24 beds on Savernake Hospital’s only in-patient ward, blaming low morale among nursing staff. NHS Wiltshire said the reduction in beds to 12 on the Ailesbury Unit would be for three months only while it carries out an intensive recruitment campaign to attract more nurses. It claims morale continued to be low among nurses at the Marlborough hospital following last year’s judicial review when hospital campaigner Val Compton tried unsuccessfully to get the High Court to overturn a decision by the trust to close the minor injuries unit and day hospital at Savernake. One insider at Savernake said it would be very difficult to attract nurses to work at the hospital because of concern over the long-term future of the hospital following the closure of the MIU and day hospital.
  
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Daily Mail

• 40,000 jobs under threat in the NHS: Axe fails despite 'ring-fence' vow. Tens of thousands of NHS staff face the axe as part of devastating cuts, figures show. Despite the Government’s promise to protect frontline staff and services, union leaders warn that doctors and nurses will be targeted in the redundancies. Health trust managers admit patient care is being compromised as routine treatments such as ear, nose and throat surgery for children and varicose vein operations are slashed.
  
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Tuesday 6th July 2010

Guardian

• Stephen Dorrell warns against ringfencing NHS budget. Stephen Dorrell, the new chair of the health select committee, said today that ringfencing the £100bn NHS budget would be of limited value and instead advocated a radical voucher plan for patients to buy treatment. Dorrell was speaking before the launch of a report, Improving Health Outcomes, by the 2020 Public Services Trust thinktank, on which he sits as a commissioner. The thinktank says that the "societal challenges ahead, such as the ageing population, will cost an extra £300bn by 2025 and [this] questions the economic sustainability of a protected health service budget". However, Dorrell pointed out that the coalition had promised to increase health budgets in the short term because of the strength of public feeling. He said the extra money being poured into the health service should be used to get "real reform", by building good relationships with clinical staff who might otherwise frustrate attempts to redesign the health service, and by allowing the public to buy healthcare. Dorrell's remarks are an important guide to Tory thinking on the NHS, reflecting a strong belief in the power of markets, choice and competition to produce benefits for patients.
  
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Nursing Times

• ‘Shambolic’ practice nurse training leads to reliance on drug companies. Increasingly patchy funding for practice nurse training is encouraging “uneasy” alliances with the pharmaceutical industry, a Nursing Times investigation has revealed. Practice nurses are often responsible for running vaccination programmes and smoking cessation clinics. Senior health figures have warned the reliance on drugs firms for training risks biasing clinical decisions and creating skills gaps in areas of low commercial interest. Queen’s Nursing Institute director Rosemary Cook said the motives of drug companies should be questioned. Nursing Times asked 100 primary care trusts how practice nurse training was funded, receiving 52 responses. Only 15 had a dedicated, ringfenced, practice nurse education scheme, while the rest said training was the responsibility of GPs. More than half said they were happy for the pharmaceutical industry to be involved, from paying for text books, conference travel and accommodation, to funding courses. Some were forging more official alliances. NHS Liverpool is planning formal talks with pharmaceutical companies to see if they can suggest ways of meeting nurses’ learning requirements. Several strategic health authorities, including NHS North West, are also discussing joint working with the industry around patient care, education and training. Many nurses told Nursing Times that shortages in training funding were sparked by the recent division of PCTs’ commissioning and provider functions and were now intensifying due to the impact of public spending pressures. While most PCT provider arms see it as GPs’ responsibility to provide training, the investigation showed some GPs were reluctant to pay for courses. This is forcing nurses to seek commercial sponsorship or means they are paying for courses themselves to ensure they have the skills to work safely.
  
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Healthcare Republic

• RCGP opposes plans to remove practice boundaries. Only 'a few' RCGP members are positive about the government's plans to remove practice boundaries, the college's consultation response reveals. In its response to the DoH’s consultation ‘Your choice of GP practice’, the RCGP said around three-quarters of its members were strongly against the proposals to allow people to register with a GP regardless of catchment area. The RCGP said the ‘most significant and overarching concern’ of its members is that the proposals would lead to the fragmentation of co-ordinated care. It also raised concerns that removing practice boundaries could make the provision of general practice ‘very unstable’ and lead to an increased risk of vulnerable children ‘falling through the net’. The RCGP said its ‘preferred option’ is to maintain the current system of ‘limited walk-in services’ and longer opening hours. Meanwhile, the NHS Confederation has also opposed the DoH's plans, outlining a tension in the proposals between offering unrestricted patient choice and providing GPs with the freedom to design their services as they choose.
  
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Guardian

• The NHS may not survive this volcano of ideology. The NHS has a chronic disease – politicians' obsessive compulsive disorder, compelling them to reorganise the whole machine. Now the reorganising virus is back with double virulence. Lansley's white paper, now delayed, hands over almost the entire £80bn NHS budget to GP control. When the new act is passed there will be little more than a year to make this gigantic change. GPs who try to buy in commercial companies to run purchasing for them will have trouble on a management budget that has been halved. Some keen business-minded GPs are licking their lips, seeing a chance to make a fortune: they can set up services and pay themselves. Managers protest that the detail is non-existent, but Lansley says breezily that it's up to each locality to work it out. The whole market ideal depends on canny commissioners. But ever since Ken Clarke's 1991 reforms split NHS purchaser from provider, the purchasing arm was weak. Some (bad) recent history: Labour was ideologically committed to demolishing GP fundholders, a tier that could buy queue-jumping better treatment. In came primary care trusts holding most of the NHS budget. With archetypal Labour hubris, there was something called "world-class commissioning", which never happened. Next came some practice-based commissioning – remarkably like the abolished fundholders. The NHS Board CEO, Sir David Nicholson, reporting last week on practice-based commissioning, gave GPs a score of just three out 10 – so why should many GP consortiums do better ? Now add a bizarre ingredient: Many care trusts will be shells if purchasing goes to GPs. But the Lib Dem manifesto pledged elections to PCTs, so people will be voted on to outfits without power; and experience of patient forums suggests those elected will be heavy NHS users with specialist agendas, not focused on the needs of the community. It was Labour's "targets and terror" regime combined with shedloads of money that got results and ended waiting lists: it was not Tony Blair's endless reorganising. The Institute for Fiscal Studies says the NHS is now due for several years of real cuts never known before. Forget "ringfenced" and "protected": it needs 2-3% to stand still, but will get well under 1% – with an added cut of £20bn "efficiency savings". Whenever the NHS falls below a 2-3% rise, it erupts. Cameron's monumental plan ushers in a no-holds-barred market for the first time, just when the NHS volcano explodes. Add in the 33% cut in local care services for the disabled and elderly that Lansley said last week the NHS would have to subsidise. As hospitals fill with bedblockers, the new GP commissioners will have to meet home care costs from their shrinking budgets. Here is an extra drama: to make GP consortiums work means renegotiating the GPs' contract. The doctors will have Lansley over a barrel: he needs their co-operation and time is painfully tight.
  
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Monday 5th July 2010

Journal Live

• Anger as figures reveal NHS chiefs' pay. New figures have been revealed which show 320 NHS leaders from across the country earn even more than the Prime Minister, whose salary stands at £142,500. The most highly-paid from the region is Sir Len Fenwick, chief executive of Newcastle-upon-Tyne Hospitals NHS Foundation Trust, who is said to receive between £225,000 and £230,000 a year. This makes him the 16th highest paid hospital boss in the country. His wage is also in stark contrast to the starting salary of a registered nurse, which is just over £20,000. Sir Len is followed by Bill Cunliffe as the second highest paid in the North East, and the 19th highest paid in the UK. The former medical director for Gateshead Health NHS Foundation Trust is said to have earned at least £221,000, which equates to more than £18,000 a month. Mr Cunliffe retired from his post last year. However, it is understood his replacement, David Beaumont, will be on a similar pay scale, which rises to £231,000. Jim Mackey, chief executive of Northumbria Healthcare NHS Foundation Trust, saw his salary rise in 2008/ 2009 to £186, 325. Lorraine Lambert at South Tyneside NHS Foundation Trust earns £147,500, whilst Stephen Eames at County Durham and Darlington Trust earns £177,500. In addition, Ken Bremner, chief executive of City Hospitals Sunderland Trust, earned £207,500 in 2008/ 2009 – which was a rise of £35,000 from the previous year.
  
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Pulse

• GP commissioning overhaul 'opens door to private sector'. The Government’s shake-up of primary care commissioning will increase the opportunities for the private sector to advise on how to spend NHS cash, a study has found. The report, Building high quality commissioning, comes after Pulse recently revealed that GPs are already in talks with private companies such as Tribal and Humana over potential risk-sharing partnerships under the new Government’s commissioning plans. Chris Naylor, author of the report, and senior researcher at the King’s Fund, said giving commissioning responsibilities to GPs would ‘amplify the trend’ established under the previous administration, which invited private companies to support NHS commissioning through schemes like the Framework for Procuring External Support for Commissioning (FESC). ‘If PCTs have struggled to ‘do it alone’, this will be all the more true of GP consortia, which will be smaller and have less commissioning experience. In order to be effective commissioners consortia will need support,’ he said. ‘I do think independent sector firms are going to play a role in this.’ The survey showed that the proportion of PCTs reporting using external support had risen from 76% in 2009 to 89% in 2010, with 40% of this support coming from commercial companies.
  
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Wales Online

• Frontline health services must be protected in the face of “unprecedented” £1.9bn cuts, unions today warned. The Royal College of Nursing (RCN) Wales said the Assembly Government faces difficult decisions about the future of services. And it warned the NHS rank and file cannot be expected to shoulder the burden while senior management is rewarded with bonuses and pay increases. The comments come as Health Minister Edwina Hart yesterday said “even more radical action” was needed to address the financial challenge facing the NHS over the next five years. She told a public services summit yesterday: “The challenges of rapidly changing demography, rising drug and technology costs, increasing citizen expectation, my own desire to deliver and now even tighter fiscal constraints mean that even more radical action is now required. ”The NHS has already made £850m of savings between 2005 and 2010 but this year it must find an additional £430m in savings, equivalent to 8% of its budget. Depending on the outcome of the autumn spending review the future financial challenge faced by health boards and NHS trusts in Wales could be anywhere between £1.1bn and £1.9bn to 2015. Dr Andrew Dearden, chair of the British Medical Association’s Welsh Council, said: “The quickest way to save money is not to treat patients. When the English NHS wanted to save £500m a few years ago it closed wards, made staff redundant and stopped operating on and treating patients and they made the savings. Another simple way is to take out one in five staff members. The NHS will not survive that and I expect some patients will not survive cuts of this nature.”
  
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Friday 2nd July 2010

BBC News

• Savernake Hospital in Marlborough to shut half its beds. A community hospital in Wiltshire is closing half its beds because of problems recruiting staff. Savernake Hospital in Marlborough will close 12 beds for three months. Roger Davey of Unison said: "This situation could develop elsewhere. We should not see services being cut because there are not enough nurses." An NHS Wiltshire spokeswoman said despite five recruitment campaigns in the last month, it had not been able to find staff to work there. She said: "This means that we have had to rely on a high number of agency nurses which means that continuity of patient care can be difficult, and the permanent nurses and health care assistants are under more pressure. But Mr Davey said Unison was concerned about the future of other wards in Chippenham and Warminster where he said there was also a shortage of staff. During the closure the trust says staff will be offered career training.
  
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Healthcare Republic

• GPs will outsource commissioning to external organisations, says report. Some GPs will want to outsource full responsibility for commissioning to external organisations when the government hands GPs real budgets, according to a think-tank report.The King’s Fund report said devolving commissioning responsibility to GP consortia is likely to amplify existing shortages of commissioning skills and managerial expertise in the NHS. The report said consortia will ‘undoubtedly’ need a significant amount of support from PCTs or other organisations and said this may lead to consortia entering into longer-term partnerships with external support agencies. The report, 'Building high-quality commissioning: what role can external organisations play ?', said it is important that GP commissioners learn from the experience of using external support in PCTs.
  
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Mirror

• GP hits out at ConDem NHS plans. NHS privatisation could lead to a two-tiered service based on patients' wealth rather than need, a leading doctor has warned. The Government's rush to give private contracts is a threat to the founding NHS principle of fairness, argues Dr George Rae. "There is a huge risk in letting private companies run healthcare," the influential GP said. "It creates a market. But patients are not commodities." Dr Rae likened the ConDems' policy of NHS privatisation to the subprime mortgage disaster. "There could be a subprime for the health service. The NHS is social glue. We could lose a fabric of the nation and run the risk of losing a vital part of society."
  
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Bury Free Press

• Hospital axes rehab beds. Beds were axed at West Suffolk Hospital when one of its rehabilitation wards closed. The move has not resulted in any redundancies, the Bury St Edmunds hospital said. Chief executive Stephen Graves said the changes, which affected rehabilitation wards F7 and F8, were made as a result of patients being discharged more quickly and undergoing rehabilitation care in the community.
  
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Staffordshire Sentinel

• 130 NHS jobs under threat as Government cuts start to bite. More than 130 NHS managerial jobs are being cut in Staffordshire and South Cheshire this year as Government spending cuts start to bite. Around 65 of the posts have already been earmarked after the region's four primary care trusts were told to cut spending by £4.7m by the end of next March. Now health officials have opened talks with unions about where some of the other 70 jobs will be lost. It comes as trusts have already cancelled temporary management contracts and frozen all recruitment. The cuts follow a Department of Health demand that trusts cut their management costs by up to 40% over the next four years.
  
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Yorkshire Post

• Meeting over bed closures 'premature'. The chief executive of an NHS trust has told campaigners a public meeting over bed closures at an East Riding hospital would be "premature." Andrew North, of Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, said no proposals "have yet been developed". Concerns were raised after two wards at Goole Hospital were reduced from 18 to 15 beds. The hospital says it has taken the measures as part of plans to save £15m but insists that if necessary all the beds can be bought back to use.
  
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Pulse

• BMA and unions call for NHS funding shake-up and an end to market-led health service. GP leaders, unions and healthcare experts have called for a comprehensive shake-up of NHS funding that pays trusts on the basis of population need rather than activity. In a joint statement, academics and campaigners from the BMA, NHS Support Federation, NHS Consultants Association, Keep our NHS Public, and Unison, also called for an end to the market model for the NHS in England, and to the purchaser/ provider split. The statement, produced following a round table discussion on the eve of the BMA’s Annual Representatives Meeting in Brighton, said the NHS would become ‘more cost-effective and equitable’ if it focussed on co-operation rather than competition. It called for a distinction between ‘choice as a lever for competition, and choice as the capacity for patients to make informed decisions about their own care’, insisting that most people were not interested in ‘unfettered patient choice’. The experts said funding should be allocated on the basis of population need rather than activity, claiming that the present Payment by Results / tariff system is ‘based upon narrowly defined episodes of care’, can ‘generate perverse incentives in patient referrals’ and does not encourage ‘the pursuit of unmet need’.
  
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• GPs demand referendum over OOH commissioning. GPs have called for a profession-wide referendum on out-of-hours, amid simmering tensions over the Government’s plans to place full responsibility for commissioning the service in GPs’ hands. The call comes as part of a growing backlash following the knife-edge vote at the recent LMCs conference, where GPs narrowly voted in favour of taking a ‘central role’ in commissioning out-of-hours services. Tensions have heightened further in the wake of health secretary Andrew Lansley’s disclosure that he expects many GPs to provide out-of-hours services themselves under the plans, and one LMC is now calling on the GPC to hold a full referendum on the issue, amid fears that GPs could become 'providers of last resort'. Dr Gary Sweeney, a GP in Clacton-on-Sea, Essex, and chairman of North Essex LMC, wrote in a letter to Pulse: ‘I am far from convinced that when the crunch comes we will not become providers of last resort. If we have responsibility for commissioning and cannot get adequate provision then we will ultimately have to take on the provision of the services. In addition to this there are significant concerns about whether the funding for out of hours services will be adequate. If we are given inadequate funding to commission out of hours services the services will be inadequate.’
  
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• BMA leaders tell GPs not to sign up to bed cuts. GPs should not sign up to reductions in hospital bed numbers in their new role as commissioners, BMA leaders have voted. A controversial motion proposed by former GP, turned PCT chair Dr Kailash Chand, won backing at the BMA annual representative meeting, condemning plans to slash hospital bed numbers, although the issue caused division with many GPs believing it is necessary to save the NHS money. The motion was passed with 55% in favour and nearly 40% against. Dr Chand, a former GP in Ashton-Under-Lyne, now chair of NHS Tameside and Glossop, told the conference that while it was vital for hospitals to be efficient, he fears the economic situation will be used as an excuse for mass closures. Ministers have said GPs will have a ‘shared responsibility' to decide them where the NHS axe will fall.
  
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Thursday 1st July 2010

BMJ

• BMA meeting: Doctors’ leaders condemn commercialisation of NHS Opposition to the commercialisation of the NHS in England was reasserted at the BMA’s annual conference in Brighton this week as a series of motions condemning the introduction of the marketplace into health care were passed with only a few dissenters. George Rae, a GP from Whitley Bay in Northumberland and a representative of North East Council, set the tone by arguing that marketisation was "driven by political dogma" and was moving the NHS away from its founding principles. It would fail to produce better quality care and risked destroying the relationship between doctor and patient, he said.
  
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Morning Star

• Secret plans to destroy our NHS. One bizarre side-effect of the Con-Dem coalition government has been the belated publication of two documents which the new Labour government stubbornly refused to allow into the public domain. Both are the result of work by US management consultants McKinsey's. Both address the issue of the drive for "efficiency savings" (aka cuts) in the NHS to bridge a predicted £20 billion gap between a frozen budget and rising pressures by 2016-17. As the Con-Dem coalition cranks up the heat, demanding the same level of NHS cutbacks or more, these proposals are the only ones on the table. So publishing the documents by no means amounts to dismissing their content. And just because the ideas are ill-judged, inconsistent and impractical does not mean that they will necessarily be discarded. Campaigners and health unions will need to pile on the pressure to demand these plans are dumped publicly and unceremoniously in the bin, and demand that any quest for economies in the NHS begins with sacking any and every management consultant who has been picking up fat fees for peddling such nonsense.
  
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HSJ

• New GP role may create deficit. Handing the NHS commissioning budget over to GPs could cause the NHS to generate a gross annual deficit of at least £1.2bn, research due to be published soon suggests. The finding has come to light after questions were raised over how spending would be controlled under health secretary Andrew Lansley’s flagship policy. HSJ has derived the deficit estimate from Nuffield Trust research undertaken for the Department of Health as part of a project to establish a robust allocation formula for GP commissioners. It also compared the notional spending patterns of 8,238 GP practices with their target indicative practice based commissioning budgets. It found that at least 53 per cent of practices under- or overspent their budgets by at least 5 per cent and 26 per cent under- or overspent by 10 per cent or more. Senior sources have told HSJ the Treasury’s concern about controlling deficits has also impinged on plans to give GPs flexibility over who they form consortia with. The government may want to prevent all the surplus-generating GPs joining consortia together and shunning those who run up deficits.Last week, health minister Earl Howe said the government was committed to giving practices their fair shares - something which could imply a redistribution of resources because many budgets are aligned with activity rates, not need.
  
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Pulse

• Call for greater transparency on management consultants' secret 'rich pickings'. BMA leaders have passed a motion calling for the open publication of money-spinning management consultant contracts, as evidence emerged they were still raking in millions from the NHS. The conference heard £1.7bn had been spent in the past seven years on consultants, including two McKinsey reports which called for reduced consultation times and huge shifts in care from hospitals to primary care, but were later dismissed as unworkable. But the conference heard trusts were still paying individual consultant staff up to £1,000 a day. The conference overwhelmingly passed motions calling for money spent on management consultants to be publically available, and meet 'high standards of academic rigour'. Dr Jacky Davis, a consultant in Islington and head of the Keep Our NHS Public campaign, told the conference the spending on consultants was ‘an affront to our democracy.’ ‘Management consultants have had rich pickings from the NHS,’ she said. ‘They have made hundreds of millions and it’s been reported that McKinsey makes a third of its profits from the NHS.’ BMA chair, Dr Hamish Meldrum, added: ‘In the last seven years of the last Government, we estimate they spent 1.5 billion on management consultants in the NHS.’
  
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• BMA and unions call for NHS funding shake-up and an end to market-led health service. GP leaders, unions and healthcare experts have called for a comprehensive shake-up of NHS funding that pays trusts on the basis of population need rather than activity. In a joint statement, academics and campaigners from the BMA, NHS Support Federation, NHS Consultants Association, Keep our NHS Public, and Unison, also called for an end to the market model for the NHS in England, and to the purchaser/ provider split. The statement, produced following a round table discussion on the eve of the BMA’s Annual Representatives Meeting in Brighton, said the NHS would become ‘more cost-effective and equitable’ if it focussed on co-operation rather than competition. It called for a distinction between ‘choice as a lever for competition, and choice as the capacity for patients to make informed decisions about their own care’, insisting that most people were not interested in ‘unfettered patient choice’. The experts said funding should be allocated on the basis of population need rather than activity, claiming that the present Payment by Results / tariff system is ‘based upon narrowly defined episodes of care’, can ‘generate perverse incentives in patient referrals’ and does not encourage ‘the pursuit of unmet need’. BMA chair Dr Hamish Meldrum, said: ‘Many of the reforms of recent years threaten to erode the principles of free access, care based on need, and risk-pooling.
  
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BBC

• Concerns have been raised by the BMA that only private firms have been shortlisted to run a failing hospital in Huntingdon. Three companies were chosen to operate Hinchingbrooke Hospital from next year. The public sector could also apply. The BMA annual meeting has called for a monitoring of the contracting process. NHS East of England said it was pleased the BMA does not oppose the plan but had called for a "level playing field". In August, NHS East of England said it hoped that the winning organisation would find a way to deal with Hinchingbrooke Hospital's historic £40m debt to the NHS. The three shortlisted companies are Circle Health, Ramsay Health Care UK and Serco Health. The committee suggested, through a motion at a BMA national conference, that the process should be observed "to ensure that no special funding arrangements are provided to the successful bidder". The BMA should also "scrutinise this experiment in order to ensure that the private sector is not given preferential treatment and to ensure that patient care is not compromised," the committee added. Andrew MacPherson, director of strategic projects at NHS East of England, said the process had been transparent and an equal opportunity for both private and public organisations. He added that clinicians, including GPs, were involved in the project. The tendering process is due to begin in August, with the successful applicant chosen in September.
  
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Tuesday 29th June 2010

Management In Practice

• NHS could be devastated by economic crisis, doctors warn. The NHS could be "devastated" by the economic crisis, with redundancies and cutbacks to patient services expected, according to a group of medical leaders. The British Medical Association (BMA) said the effects of the crisis are already being felt, with frontline services first to feel the pressure. According to the group, around 40% of doctors questioned said treatments and therapies are being limited due to financial constraints. And it warned worse is to come, with recruitment freezes and more service cutbacks set to have an impact on the NHS. The results of the survey of 92 doctors were published on the eve of BMA national conference in Brighton, where NHS finances are expected to dominate proceedings. Some 72% of the doctors surveyed said their health trust had postponed or cancelled clinical service developments because of financial pressures, while 42% said there were limitations on prescribing. Some 59% (13 out of 22 doctors) said nurses would be affected but 86% (19) mentioned non-clinical staff as being hit by redundancies.
  
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Daily Echo

• Consultation begins on mental health closure plans. A long-awaited public consultation has begun into plans to close two Hampshire mental health units. Bosses at Hampshire Partnership NHS Foundation Trust, responsible for the county’s mental health services, are proposing to close the Rivendale Rehabilitation Unit in Sarisbury Green and the Ellingham Psychiatric Intensive Care Unit at Calmore’s Woodhaven Hospital. Both units were temporarily closed nine months ago so that all 50 staff could be seconded to other vacant posts within the trust due to a staff shortage. They were first earmarked for closure a year ago as part of a proposed package of measures to save £2.2m. Trust bosses insist better community services mean fewer people need to stay in hospital. But staff, patients and relatives have campaigned against the closure of Ellingham ward which opened at the £7m Woodhaven Hospital in 2004.
  
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Health Service Journal

• PCTs to 'road test' direct payments to patients. Primary care trusts in London and Liverpool will be among the first to “road test” direct payments for personal health budgets, care services minister Paul Burstow has announced. Eight PCTs in England will pilot the direct payment scheme, designed to give patients with long term conditions more choice and control over how, where and from whom they receive their healthcare. Previously, personal health budgets could only be held by a PCT or third party. Under the scheme, patients will be given the money directly following an agreed care plan with the PCT, detailing their health needs, the amount of money in their budget and how it will be spent. The money will come from existing funding within PCTs and will cover the full cost of the care plan. It will most likely be given to the patient in monthly instalments, or possibly a lump sum for a one off purchase such as a piece of equipment. The Department of Health initiative is part of a wider programme testing personal health budgets, involving around 70 PCTs in England. More PCTs will be authorised to offer direct payments over the coming year, and the pilot programme - which runs until 2012 - will be used to inform a wider rollout of the scheme across the NHS.
  
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Press Association

• BMA chief urges debate on NHS cuts. The leader of a doctors' union has urged the Scottish Government to have an open and honest debate about the scale of the cuts facing the NHS. Dr Brian Keighley, chairman of the British Medical Association in Scotland, also said doctors should be given a say on where savings can be made. Around 4,000 NHS jobs, including 1,500 nursing and midwifery posts, will be axed this year.
  
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Daily Mail

• NHS chiefs advertise for 'cost-cutting' adviser... at £1000 a day. Hospital bosses are advertising for an adviser to help decide which jobs to axe to save money - and will pay £1,000 a day for their services. The so-called 'turnaround' director will earn twice as much as the Prime Minister to oversee 'efficiency and cost-saving measures'. Details of the lucrative salary came as the NHS is being forced to make spending cutbacks, with frontline staff at risk. Campaigners warn that hundreds of doctors and nurses already face redundancy despite Government pledges to protect the overall health budget from cuts. The advert for the £1,000-a-day post was placed by Mid Essex Hospital Services NHS trust and circulated among head-hunting agencies last week. The successful applicant will be based at the Broomfield Hospital, Chelmsford, and will work for at least six months earning the equivalent of £261,000 a year.
  
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Monday 28th June 2010

AFP

• Redundancies, recruitment freezes and cuts to services could have "devastating and long-lasting consequences" for NHS patient care, doctors warned on Monday. The NHS is feeling the effects of the global financial crisis, according to a survey by the British Medical Association (BMA). Nearly one in four (24%) respondents said redundancies were planned in their organisation, though most of these would be non-medical jobs. Of the 92 doctors questioned, 62% said there was a freeze in recruitment. Of those reporting a freeze, 70% said it included medical posts and 80% said it affected nurses. Nearly three quarters (72%) indicated that clinical service or infrastructure developments were being postponed for financial reasons and two in five indicated that access to treatments or therapies was being limited. While the coalition government recently guaranteed to increase spending on the NHS in real terms, NHS trusts are still expected to find some 20 billion pounds in efficiency savings by 2014. The survey concluded that "despite reassurances that front-line services will be protected, many NHS organisations are already taking actions which could have devastating and long-lasting consequences for the NHS." Speaking at the start of the BMA conference in Brighton -- expected to be dominated by NHS finances -- chairman Dr Hamish Meldrum warned of the threats facing the health services and urged the government not to make the public sector pay for the economic crisis."At a time of recession, of increasing unemployment, of greater hardship and greater stress, the public needs more doctors, not less,"
  
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HSJ

• Co-operation not competition best for NHS, say experts. A group of medical bodies, unions and healthcare experts have said if the NHS was run on its founding principle of co-operation rather than competition, it would become more equitable and cost-effective. Academics and campaigners from the BMA, NHS, Support Federation, NHS Consultants Association, Keep our NHS Public, Unison and others, held a round table event to discuss alternatives to the market model for the NHS in England, coming up with a joint statement calling for:
  
  * New mechanisms to allocate NHS funding more equitably and efficiently: the document calls for funding to be allocated on the basis of population need rather than activity by trusts. It warns that the present payment by results / tariff system is “based upon narrowly defined episodes of care”, can “generate perverse incentives in patient referrals” and does not encourage “the pursuit of unmet need”.
  
  * An end to the purchaser-provider split: abandoning the purchaser-provider split in the NHS would be likely to generate substantial savings, the document says.
  
  * A new vision of what ‘choice’ means: the statement says there is a distinction between choice as a lever for competition, and choice as the capacity for patients to make informed decisions about their own care.
  
  It says that unfettered patient choice as it has so far been conceived in the NHS is not what most patients want.
  
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Friday 25th June 2010

Pulse

• End-of-life care compromised by 'fractured' primary care. A major report into end-of-life care from the King’s Fund has stressed the importance of continuity of care and questions the value of newer GP models including polysystems and polyclinics. Their report on end-of-life care is the first in a set of fourteen reports due from their 18-month inquiry into GP care. The report highlighted continuity of GP care, and the lack of it is provided by out-of-hours services, as a key theme in providing high-quality end of life care in general practice. It found that many GPs said they believe the availability and quantity of out of hours care for patients nearing the end-of-life is ‘often inadequate’ and patients and carers were ‘less positive’ about the care that they receive from out-of-hours services than from their GPs.
  
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• Health bill will force GPs to work in federations. The Government is to make it mandatory for GP practices to join federations in a new health bill being finalised by ministers. The radical overhaul of commissioning will hand GPs control of over 95% of PCT commissioning budgets, putting them at the centre of plans to make huge efficiency savings. Whitehall sources also confirmed plans for the new NHS Board to hold contracts directly with GPs, replacing the existing role of PCTs. The NHS Board is set to have a contract with each federation, which in turn will have a contract with each member practice. Health secretary Andrew Lansley is due to present the bill next month and insiders made clear all GPs would be expected to sign up to joint commissioning arrangements, with practices expected to share back-office functions and human resources, and work to an agreed commissioning budget. With the health secretary having ordered a huge cull of PCT management in the operating framework, it is anticipated federations will employ many as business managers.
  
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Guardian

• Treasury sends back Lansley plan to give GPs control of £80bn. The Treasury is stonewalling over the publication of Andrew Lansley's radical blueprint for the NHS after officials said the health secretary's plans would "hand over £80bn of public money to 35,000 GPs who are private businesses", according to Whitehall sources. Lansley's white paper, the biggest shake-up for a decade, was due to be out next week but the timetable has slipped after Treasury officials said there was not enough provision for making GPs accountable to the public, given they would control 80% of the £100bn NHS budget. The idea of GP budget holding comes from the US, where it has been in place since the mid-1980s. There is evidence that poor management has led to bankruptcies – unthinkable in the NHS – leaving millions of dollars owed to physicians, hospitals and ancillary service providers, because some doctors assumed too much risk and exercised too little control. GP budget holding is a flagship policy of the government. In a speech earlier in the day, Lansley said: "Patients don't want to go to hospital: they want the right treatment, at the right place, at the right time, and GPs are often best placed to design those services." GPs will be expected to band together into 500 "commissioning consortia" by next year. However there are concerns over whether doctors will want to become "accountable" given that budgets are to be squeezed. "There must be doubts [over] budget holding when GPs may perceive they are being asked to make cuts in services and take the lead in unpopular rationing or reconfiguration decisions," wrote Professor Chris Ham in a paper for the University of Birmingham's health services management centre.
  
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Northampton Chronicle

• GP quits practice over plans for private sector takeover. A GP has left a Northampton practice over concerns an upcoming takeover will see profits made the priority over patients. Dr George Takla, of The Lings Brook Practice, said he will become a partner in the Dr Lakha and Dr Abbas practice because of the uncertainty surrounding an imminent takeover from a private provider. Both the Lings Brook and Kings Heath practices, the only county practices where staff are employed directly by the NHS, have been offered together to private bidders. Residents from Kings Heath have already expressed fears about the move but Dr Takla said at a meeting between patients and county councillors his concerns had led him to quit.
  
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Tuesday 22nd June 2010

The Sun

• £850m slash off NHS cash. Spending on NHS management is to be slashed by £850m. Health Secretary Andrew Lansley pledged major cuts in the next four years. He also scrapped two key health targets. GPs will no longer have to see patients within 48 hours - and A& E units will not be obliged to see patients within four hours. Mr Lansley said the changes would help cut the management bill for Primary Care Trusts and Strategic Health Authorities from £1.85bn down to £1bn by 2013-14. The Patients Association backed the review of targets - but did not welcome a return to a "free-for-all".
  
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Galloway Gazette

• NHS row breaks out. A row has broken out over NHS figures released this week. SNP MSP for the South of Scotland, Alasdair Morgan, has hit out at figures showing that over the next five years NHS Dumfries and Galloway faces a bill of £67m for capital projects which are worth only £9.8m. Figures published by the Treasury show that NHS Dumfries and Galloway will actually have made payments equalling the value of the projects over the next five years but that payments will continue to reach £67m over the life of the deal. Mr Morgan said: "These statistics just highlight the economic incompetence of Labour and the Lib Dems who are happy to see the public pay this ridiculous premium for capital projects. The payments don't stop at the value of the asset, they will continue up to nearly £67m; nearly seven times more than the buildings were worth in the first place."
  
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Monday 21st June 2010

HSJ

• Union leader calls for action to fight cuts. A senior union leader has called for an emergency meeting of the TUC to plan a campaign of industrial and political action against expected cuts in the pay and pensions of public sector workers. Bob Crow, general secretary of the Rail Maritime and Transport union, said he feared the coalition government was planning to hit pay, jobs and pensions in the public sector as part of cuts expected to be announced in tomorrow’s Budget. Prime minister David Cameron said it was “fair” that public sector workers should face a pay and pensions squeeze in the emergency Budget. Along with the bill for welfare payments, they were the three major areas of spending “that you can’t ignore” in trying to find the significant savings needed to tackle the record £155 billion deficit, he said. Mr Crow reacted angrily to a weekend newspaper interview given by Mr Cameron in which he insisted there was no agenda against public sector workers despite the need to make savings. Mr Crow said: “RMT is calling on the trade union movement to start the fight-back right here, right now before Cameron and Clegg have had a chance to pull their boots on. “This is not the time for talking, it’s the time for action. We need an emergency meeting of the Trade Union Congress to co-ordinate the political and industrial action that we will need to take as a united movement to drive back the ConDem attack on our members.”
  
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Pulse

• The Government has dramatically abandoned primary care access targets in a move that will have far-reaching implications for general practice. The move, which comes amid a huge bonfire of NHS targets, will abolish existing performance management of GP access, meaning GP practices will no longer be measured on their ability to provide extended opening hours, or to guarantee access to a GP within 48 hours. The Government’s revised operating framework also reveals plans to effectively abolish the 18-week referral to treatment target by removing all performance management of the target, and to reduce the four hour A& E target threshold from 98% to 95%. It also enshrines the coalition’s commitment to a moratorium on all plans to shift services from secondary to primary care that do not have support from GP commissioners, and reveals plans for even deeper squeezes on NHS management, by achieving a 46% reduction in management costs by 2013/ 14. The Government also urged PCTs to press ahead with the transforming community services agenda, but said any plans should be subject to GP approval.
  
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• Academic bodies, think-tanks and charities react to the publication of the new NHS Operating Framework. Dr Jennifer Dixon, director at the Nuffield Trust 'The coalition Government’s plans to move to outcome targets rather than process targets are welcome. But given that waiting for care is such a key part of patient experience on which the NHS is judged by the public, and given the miserable history of long waiting times in the NHS in the past, waiting times should remain firm targets."
  
  Dr John Heyworth, president of the College of Emergency Medicine. 'We welcome the Secretary of State's announcement, which is in line with the College's long held view that the 98% standard should be reconfigured. We look forward to working with the DH to develop more appropriate, clinically relevant, quality and outcome measures that build on the improvements already achieved in our EDs and further enhance patient care.'
  
  Ruth Sutherland, acting chief operating officer at the Alzheimer’s Society 'Proposals for "pathway tariffs" and expanding "re-enablement support" show huge promise to improving care for 750, 000 people with dementia and their carers. We now need more detail to find out if they could help to deliver the National Dementia Strategy for England at a local level and change lives. Any move towards local accountability must not mean a move away from national leadership.'
  
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Friday 18th June 2010

Financial Times

• PFI contractors face pressure on cuts. PFI contractors are to face pressure from ministers to share their efficiency gains with their public sector clients as the government cuts spending hard over the coming years. The Efficiency and Reform Group, headed by Francis Maude, the Cabinet office minister, and Danny Alexander, the chief secretary to the Treasury, are understood to be planning to talk to the market to ask it to share some of the pain of public spending cuts. The move comes as the National Audit Office warned that hospitals with big PFI schemes face very limited room for manoeuvre to make efficiency savings on their buildings and the basic services in them as NHS expenditure is squeezed over the coming years.
  
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Camden New journal

• Camden LINK: ‘Treatment ban will hit poor who can’t go private’. Tough new criteria barring NHS patients from treatment for “low priority” ailments will hit the poor, Camden’s NHS watchdog has warned. Chairman of Camden LINK Neil Woodnick has signalled his opposition to a policy limiting 25 selected treatments and procedures to “special cases”. Mr Woodnick said restricting treatments – including dental implants and minor oral surgery – will affect patients who cannot afford to go private. The cuts to 25 treatments are expected to save NHS bosses £6million a year – but the scale of the restrictions could rise.
  
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BBC News

• Newark Hospital to lose its A&E department. A Nottinghamshire town is to lose its accident and emergency unit, NHS bosses have announced. After months of argument health managers have decided to replace Newark's A& E Department with a minor injuries unit. Opposition to the plans had included a 5,000-name petition and human chain around the hospital. NHS Nottinghamshire County's Board said the changes would improve care for patients. The authority said the town will receive extra ambulance cover and more out-of-hours GP care. The consultation on plans to close the department and replace it with a minor injuries unit received more than 700 replies. Campaigners had said the move would mean patients will have to travel further for treatment, while the NHS said centralising specialist care would improve quality.
  
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Socialist Resistance

• Keep Our NHS Public conference report. The annual general meeting of KONP was held in London on 12th June. There were 70-100 people present. Among the speakers were Professor Wendy Savage, co-chair of KONP, a representative of the BMA and a London GP. As opposed to the big cuts in services, fragmentation and privatisation of the NHS, to which the coalition government are committed, the demands of the speakers were for integration of services, planning and democratic control of the NHS. The highlights of the meeting were reports from representatives of local KONP groups of the fightback against cutbacks and privatisation of NHS services. Candy Udwin from Camden KONP reported on the successful challenge by patients and local residents in Camden against the plan of health authority to hand control of a new super-sized doctors’ surgery to a private company. They argued that they had not been consulted about the plan and the health authorities were forced to withdraw their proposal. Another KONP representative reported on the campaign of an organisation to stop the closure of the A& E department at the Whittington Hospital in North London. It was announced at the meeting that there was to be a protest in London on budget day, 22nd June against the cuts in public services. There was an eagerness by trade unionists and KONP members at the meeting to become involved in the anti-cuts campaign . Their experience in defending the principles on which the NHS was founded, should be utilised in the setting up of the proposed anti-cuts committees.
  
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Nottingham Post

• City's NHS warns a tenth of its workforce could lose their jobs in cost-cutting plans. Nottingham's primary care trust has warned a tenth of its workforce could lose their jobs as part of plans to cut costs. NHS Nottingham City, which pays for and plans health services, says 28 of its 285 posts are "at risk". It wants to save £1.7m from its management costs this year, but will also have to make further savings in the coming years. And unions have warned that further jobs could be lost in future to save money.
  
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Pulse

• GP leaders accept the end of lone practices. GP negotiators expect every practice in the country to join a federation and help manage swathes of the NHS budget after throwing their weight behind the Government’s planned overhaul of GP commissioning. Practices could be asked to form networks with ‘like-minded’ colleagues in other parts of the country under the Department of Health plans, but there remains heated debate over the financial penalties for GPs who don’t actively commission. The GPC supports plans for the vast majority of PCT commissioning to transfer to practice groupings, with the LMCs conference voting GPs should even take on a ‘central role’ in organising out-of-hours care. But the LMCs conference rejected plans, under discussion by the DH, for a ‘radical’ new GP pay model that would provide lucrative incentives to take on commissioning but heavily penalise practices that refused to do so. The National Association of Primary Care is heavily pushing that model in talks with health secretary Andrew Lansley, calling for incentives for GP commissioners to be balanced by the threat to cut funding to those ‘not up to the task’.
  
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• Long-awaited report reveals 'insoluble' flaws in Summary Care Record rollout. A major investigation into the roll-out of the Summary Care Record has concluded the use of electronic records is low and the benefits have been exaggerated. The long-awaited report found records did not reduce consultation times or increase patient safety and were rarely accessed in secondary care. The three-year independent evaluation from University College London researchers was shelved by the previous Government until after the election and lists a myriad of ‘insoluble’ problems with the scheme.
  
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Thursday 17th June 2010

Buckinghamshire Advertiser

• Doctor on call - at a price. Frail or vulnerable people who wish to continue living at home but worry about having to rely on the NHS out-of-hours helpline could get 24-hour access to a GP - provided they can afford it. Two companies which have joined forces to launch the new scheme - a private GP practice and a company which provides home carers to the frail and ill - say it is unique in the UK. For £10 a month, people will be able to speak directly to a GP 24 hours a day, with the option of calling a doctor out to their home immediately for about £150 a time when needed. The companies claim this service will save people the anxiety of knowing that, should they become ill, they may have to spend up to an hour getting medical advice on the NHS helpline, or admit themselves to A& E. Peter Cullimore, owner of Universal Care, which provides about 1,000 care visits a year to frail and ill people in South Bucks and beyond, said the service would be invaluable to many of his clients, most of whom wished to stay out of residential care for as long as possible.
  
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Public service UK

• Targets in the NHS could be causing harm to patients by compromising safety in operating theatres, according to a survey of surgeons. The survey by Bournemouth University – to which 549 general surgeons responded – found that surgeons were often expected to carry out complicated operations within tight timescales and many were operating on patients they hadn't seen before. Over a period of just two weeks, 40 per cent of surgeons said they had been involved in cases where a patient was nearly harmed and 19 per cent where patients had been harmed. One surgeon said: "Don't be seduced by management into making do, thinking you are being heroic; you're not, you are being dangerous." Health Secretary Andrew Lansley commented: "Patient safety must come first, that means allowing clinicians to focus on the outcome of a patient's treatment, rather than the diktats of managers. That's why we will abolish Labour's top-down process targets and replace them with outcome measures, which drive improvements in the quality of patient care." A spokesperson for the Patients Association said: "This study gives yet more weight to the idea that while the NHS may have been meeting its targets over the past few years, that doesn't mean those targets are always a benefit for patients."
  
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Anaesthesia UK

• Inflexibility of PFI damaging to NHS. A National Audit Office report reports that most PFI hospital contracts are well managed, but questions their long-term value for money and states that they make it difficult for trusts “to make savings without cutting back on services.” The BMA has long expressed concerns that PFI has left many NHS trusts facing decades of debt. Commenting on the report, Dr Mark Porter, Chairman of the BMA’s Consultants Committee, said: “The debts attached to PFI schemes and the lack of flexibility in repaying them hugely increase the financial pressures on NHS trusts. While future funding for the NHS is uncertain, payments to private companies under PFI will burden local health economies for decades. “This inflexibility has created financial instability in the NHS and ultimately makes cuts and closures more likely.”
  
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HSJ

• More than half of primary care trusts are missing permanent executive directors, an HSJ investigation has found. More than half of primary care trusts are missing permanent executive directors, an HSJ investigation has found. Detailed research into the board positions at 35 randomly selected PCTs found of a total 278 executive board posts just under one fifth were filled with interim recruits, had recently merged with other roles or had their director seconded away. The PCTs include Bromley, whose chief executive Simon Robbins was seconded to lead the south east London commissioning sector in April. His post has been covered on an interim basis by board member Clive Uren, whose post the PCT is not actively recruiting to fill. The PCT’s interim communications manager said: “Nobody’s going to be doing anything in the short term because nobody knows what’s coming out of Number 10 or the secretary of state. It would be foolish to plough on regardless when we’re contracting with someone and it may be difficult to get out of later on.” The number of missing senior board members points to a looming crisis of leadership in commissioning organisations. At NHS Bury both the chief executive and chair are interims and the director of finance is working a notice period. A new finance director has been seconded from another NHS organisation. Interim chief executive John Boyington told HSJ the PCT would recruit a permanent chief executive once a new chair was in place. He said: “There are some question marks over future configurations while we await the white paper [which will set out the government’s programme].” Earlier this week HSJ revealed online that NHS London was in crisis talks with the Department of Health and Appointments Commission over concerns it could become technically inquorate. The SHA’s chair and another non-executive resigned last month and a further three announced their resignations on Tuesday. That leaves just three non-executive directors and five executive directors. The rules state decisions cannot be passed without one third of the board present, including the chair and another non-executive.
  
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• PFI hospitals 'may have to cut services'. Private finance initiative contracts offer limited scope for savings, so they may have to be found elsewhere, according to a study from the National Audit Office. The NHS has to find efficiency savings of up to £20bn as part of wider cost-cutting aims. Today’s report said: “It is likely that trusts will be expected to make efficiency savings over the next few years, but their ability to make savings from their PFI contracts is very limited. “Because trusts pay an index-linked fixed sum, it is difficult for them to make savings without cutting back on services. “Contractors who secure economies of scale through managing multiple PFI contracts are rarely required to share these efficiency gains with trusts. “Trusts need to ensure that any decision to reduce services is informed of the long-term consequences to costs and the impact on patients.” The report, which looked at how PFI contracts operate once a building is open, said the cost and performance of services like cleaning, laundry and portering in PFI hospitals are similar to those provided in non-PFI hospitals. While catering is on average slightly cheaper in PFI hospitals, hospitals with PFI buildings spend more on maintenance to keep the buildings to a specified high standard. Amyas Morse, head of the NAO, said: “In the longer term, trusts will need support from the Department of Health to ensure that the current good performance is maintained, that efficiencies are sought and that an appropriate share of benefit comes back to the public sector.” There are more than 70 PFI hospitals in England, costing around £900m a year and with a capital value of more than £6bn.
  
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Tuesday 15th June 2010

Worcester News

• Hospital chiefs ‘plan to cut 120 beds' – claim. More than 100 hospital beds could close across Worcestershire as recession-hit health bosses battle to claw back £60m. An NHS employee said he was aware of discussions at senior level to cut 120 beds in Worcestershire’s acute and community hospitals. The health professional, who declined to be named, said: “A figure of 120 beds across the county has certainly been mentioned. We also understand there is a particular focus on the Aconbury unit at Worcestershire Royal Hospital.” Health chiefs at NHS Worcestershire and Worcestershire Acute Hospitals NHS Trust have admitted acute beds could go but declined to confirm or discuss numbers and locations for bed cuts.
  
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Healthcare Republic

• Darzi centre director calls for 'overfunding' inquiry. The director of a Tyne and Wear Darzi centre has called for an inquiry after revealing the practice receives around £816 a year per patient - over 10 times the pay per patient for GMS practices.Dr Ken Megson, secretary of Gateshead LMC and director of the Medicus practice in Gateshead, told the LMCs conference in London last week it had failed to attract patients and was wasting money. Dr Megson told how just 250 patients have registered at the practice - well below its target of 1,500. It effectively receives £816 per patient, he said. The weighted pay per patient for GMS practices is around £64. 'It's an absolute disgrace to be getting paid this much money for doing nothing,' he said. ‘The PCT won't publish the costs, but I will.' Dr Megson said it was clear 'from day one' that the new practice was surplus to requirements and poorly located. He described the PCT's public consultations as ‘events where there were more people from the PCT than members of the public'. Delegates backed a motion calling for an independent body to report on the cost effectiveness of GP-led health centres across England. Local GPs, campaign groups and the press have struggled to obtain comprehensive figures on the cost of the APMS centres because PCTs claim the information is commercially sensitive. ‘It's not commercially sensitive, it's commercially embarrassing,' said Dr Megson.
  
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Project Datafile

• SNP highlights PFI debt for Scotland. It has been reported that the NHS in Scotland will lose over £6.7bn over the next 30 years to pay for privately funded building projects. The SNP highlighted the figure, which covers 27 capital projects that the party valued at just £1.28bn. In 2011, more than £200m a year will leave the NHS in repayments, hitting £281.5m in 2027 and in Lothian, the figures detailed payments of £26.2m for the £4m Findlay House. The figures were revealed as the Scottish government faces pressure to explain thousands of looming job cuts across the NHS, which Labour says will affect patient care.
  
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Press Association

• Nursing cuts spark fury at NHS plan. MSPs have questioned Government plans to spend £1.25m on up to 50 new officers for patients' rights while hundreds of nursing posts are being axed. The positions are being created through the Scottish Government's Patients' Rights Bill which would provide legally binding guarantees on waiting times. Labour's David Whitton told Government officials at Holyrood's Finance Committee that health boards had raised concerns about the proposals for 40-50 new patient right officers (PROs).
  
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Wales Online

• Fear of two-tier IVF system as private clinics banned from NHS. Patients could be priced out of fertility treatment as one of Wales’ leading clinics is forced to stop providing NHS-funded IVF. The London Women’s Clinic, in Swansea, has been told its contract to provide NHS-funded IVF treatment will end next March as a One Wales pledge comes into force. From next year publicly-funded IVF cycles will only be provided by NHS organisations, under the Assembly Government rules.
  
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Friday 11th June 2010

Management In Practice

• The GP Patient Survey and private finance initiative (PFI) schemes are just two of a number of areas that could be “consigned to the dustbin of history”, the chairman of the BMA’s GP Committee told the annual LMC conference in London. Dr Laurence Buckman suggested a range of areas which, due to the financial crisis, should be cut or reviewed in order to save the NHS money. With NHS trusts under pressure to achieve up to £20bn of efficiency savings by 2014, Dr Buckman said: “Government must be determined to avoid wasteful and ‘unevidenced’ policies.” The GP Patient Survey cost the government £13m in 2009 alone, he said, arguing that “detailed and relevant feedback” could be more usefully and more economically gathered locally from patient participation groups or local patient surveys. Dr Buckman said that “wasteful” PFI schemes, now funding more than 100 new hospital schemes, are set to cost the taxpayer £62.6bn by the time the final payments are made in 2048. Management consultants, “micromanagement of GP practices” and the bureaucracy of the NHS market were further areas outlined by Dr Buckman as wasteful.
  
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Irvine Herald

• MSP's concern over proposed health cuts. An MSP has expressed deep concern about proposed health service cuts in NHS Ayrshire and Arran. Cunninghame South MSP Irene Oldfather said figures estimated there would be a reduction of 112 in staff levels. Most of them – up to 74 – would come from the nursing and midwifery sector, she said. Scotland is expected to lose more than 3700 health workers.
  
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Press Association

• NHS 'should share burden of cuts'. A report has called for more than £90bn reductions in Government spending by 2015, and says the NHS should take its share of the burden of cuts. Chancellor George Osborne is due to put a figure on the overall reduction in the Government's £670bn annual expenditure needed to repair the hole in Britain's public finances when he delivers his emergency budget on June 22. But Prime Minister David Cameron has already committed the Government to defending the NHS, along with schools and overseas aid, from cuts, and few commentators expect the axe to fall as heavily as the report by the Adam Smith Institute (ASI) think tank recommends. The report The Party is Over - A Blueprint for Fiscal Stability argues the Government should eliminate Britain's deficit over the course of this Parliament in order to avoid a Greek-style collapse in confidence. Author Nigel Hawkins argues that no budget should be ring-fenced and that even the health budget should be subject to an annual reduction of around 2% a year. Further cuts would have to be made within the current year, beyond the £6bn already announced by Mr Osborne, in order to reach the goal of eliminating the deficit. The report calls for Cabinet ministers to be sacked if they are unable to deliver the necessary savings.
  
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• Patients complain about NHS car park charges. NHS patients and their families are the victims of wheel clamping, fines and too-high costs in hospital car parks, with a hospital in Hertfordshire topping the poll for having the highest minimum parking charge, according to a new report. Barnet and Chase Farm Hospitals NHS Trust in Hertfordshire had the highest minimum charge in England - £4 for two hours of parking. Epsom and St Helier University Hospitals NHS Trust clamped 1,671 cars in 2008/ 09 and made £1.85m profit from its car park, the study said. Meanwhile, Leeds General Infirmary (part of the Leeds Teaching Hospitals NHS Trust) issued 10,330 fines, generating £142,000. The Royal Derby Hospital received the most complaints (82) about parking, according to the study from consumer group Which ?. It collected data from 126 NHS trusts and hospitals in England after writing to 172 organisations using the Freedom of Information Act. Hospital car parking is free in Scotland, Wales and Northern Ireland. In England, each hospital decides how much it wants to charge patients for parking - raking in more than £100m a year.
  
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Pulse

• NHS Direct nurse cuts to 'put safety at risk'. NHS Direct is drafting in managers with no background in nursing or medicine to run its call centres, in cuts its own staff warn will make it unsafe. Reconfiguration plans outlined in board papers would reduce the number of nurse managers to just one to every 39 members of staff, with claims the move will ‘significantly compromise’ patient safety. The proposals come as figures obtained by Pulse under the Freedom of Information Act reveal that more than 40% of NHS Direct’s current call-handlers have no nurse training, and that nearly a quarter of all callers are directed to their GP. Scotland’s service, NHS 24, is meanwhile facing serious criticism for the lack of expertise of its staff and there are growing calls from GPs for it to be axed.
  
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• LMCs conference condemns 'dangerous' plan to scrap practice boundaries. The Government’s plans to abandon practice boundaries will create a ‘dangerous fragmentation of care’, and will discriminate against the elderly, infirm and vulnerable, GP leaders have warned. In a passionate debate at the annual LMCs conference in London, GPs backed a motion condemning the proposals, and said the proposals would also lead to greater medication abuse and hamper GPs' input into children’s services. GPs also passed a separate motion which said the plans would prove ‘extremely costly’ when the country ‘can least afford it’, would undermine practice-based commissioning, destabilise funding formulas, and add risk to the GP home visiting service.
  
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Thursday 10th June 2010

BBC News

• Scrap NHS Direct, GPs suggest. Consideration should be given to scrapping NHS Direct as part of a scaling back of health spending, GPs say at their annual conference. The British Medical Association questioned the effectiveness of the telephone service, claiming it delayed patients getting healthcare. They also highlighted spending on new buildings and management as areas for potential savings. But GPs also said possible cuts to community services were a concern. The NHS has been told to find up to £20bn of savings by 2014 even though the health service is due to see rises in its budget in the coming years. Dr Buckman said if it was to go patients could contact their out-of-hours GP service instead, although he acknowledged in some areas this would need improving. He also said there were "unnecessary" tiers of management which could go, while new hospital building schemes funded by private money through PFI, walk-in centres and polyclinics should be stopped. He was supported by fellow GPs at the conference. Dr Nigel Watson, a family doctor from Dorset, said it was right to look at NHS Direct alongside these other areas.
  
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Morning Star

• Green light for health profiteers. Plans to impose crippling fines on hospitals who readmit patients within 30 days of being discharged were labelled a "green light" for more NHS privatisation on Tuesday. Tory Health Secretary Andrew Lansley was forced to defend his policy of refusing to pay hospitals for treatment if a patient is brought back as an emergency within 30 days of being discharged. He insisted it was a "much better system" than the current set-up where the government pays the NHS for each emergency treatment even if the patient has to return several times. "What we need to escape from is the perverse situation at the moment where a hospital might discharge patients too early and then when the patient comes back as an emergency, the hospital gets paid again," said Mr Lansley. Hinting at further privatisation within the NHS, he added that patients should be "given more control" over their health. The Tories have argued that some patients are discharged too soon and without proper care plans in place. But campaign group Health Emergency chairman Geoff Martin said: "The main reason why hospitals are forced to readmit patients is because there isn't enough beds and so hospitals have no option but to discharge patients early. "Fining hospitals is not the answer. We have to reinvest money so that hospitals can increase their capacity as the only people who will suffer from these destructive policies are the staff and patients." He warned that the policy was a "green light" to pile yet more debt onto the NHS so that private companies could "rob it blind" and profit from patients' illnesses. "This is a classic political gimmick and is window-dressing without giving a single thought about the consequences of patient care," he added.
  
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HSJ

• PCTs, councils and firms 'will commission for GPs'. GP consortia will be able to pick between primary care trusts, local authorities and independent organisations for commissioning support, Andrew Lansley has said. The health secretary said his GP commissioning policy would not mean doctors having to act as managers because, if a GP group did not want to run everything itself, it could buy support from elsewhere. In a podcast interview published today by HSJ partner website doctors.net.uk Mr Lansley said: “They can get their commissioning support – they can create it themselves as consortia; they can go to independent organisations to provide it to them; they can ask the primary care trust to continue to do their commissioning for them if they wish; they can ask their local authority to help to do their commissioning for them. The government is planning for 500-600 commissioning GP consortia to be contracted directly by a new independent NHS board - removing all of PCTs’ existing GP contracting and performance management functions. In today’s interview, Mr Lansley said one of the reasons GPs had to take responsibility for commissioning was that PCTs had failed. Mr Lansley said payments to GPs for their primary care services would remain separate from allocations for other patient services.
  
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• First ISTCs lose activity guarantees. Care UK looks set to secure a 25 year deal on one of its independent sector treatment centres. It plans to operate the centre without a guaranteed activity contract. It is the first time a private provider has agreed to run an independent treatment centre without guaranteed activity levels meaning the centre will entirely depend on the company’s ability to attract patients, in line with a government announcement in July 2009. The private provider, which delisted from the stock market on 27 April after a management buyout, is finalising arrangements on a 25 year lease with NHS Derbyshire County to continue operating the Barlborough NHS Treatment Centre, the future of which was in doubt. It has also renewed a contract to continue running the Mid and South Buckinghamshire NHS Diagnostic Centre without an activity guarantee, and has secured preferred bidder status to take over the running of the Eccleshill NHS Treatment Centre from Nations Healthcare. Care UK managing director Mark Hunt told HSJ the independent centres would carry out procedures at tariff price and there were “no backhanders [and] no hidden charges” on offer to soften the blow of the lack of activity guarantee.
  
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• PCTs to lose responsibility for GPs. Primary care trusts will have their responsibilities radically stripped back under plans being developed by health secretary Andrew Lansley. The government has already announced plans to make GPs the lead commissioners for care worth up to £60bn. HSJ understands this will mean 500-600 GP consortia contracting directly with a new independent NHS board, removing all of PCTs’ existing GP contracting and performance management functions. The coalition government’s document Our Programme for Government said PCTs would have a responsibility for public health spending, act as a “champion for patients” and commission “residual services”. Public health spending accounts for approximately £4bn a year - just 4.7 per cent of the total £84bn now allocated directly to PCTs. HSJ has been told the further “residual” commissioning responsibilities likely to be left with PCTs include maternity care, optometry, pharmacy, dental services and services for patients “GPs don’t want” such as homeless people. DH and PCT sources said the government’s plans meant the future for many staff employed by PCTs now lay in “selling [their] services to GP consortia”. The DH source said: “If I were them I would be trying to do a good job now. Some of them would be a shoo-in as managers of a consortia.” A chief concern is where the line of accountability will sit and who will be the accounting officer for GP commissioners. At present that accountability lies with PCTs, but DH officials are considering transferring it to either consortia chiefs or independent board regional offices. News of the uncertain future of PCTs comes as SHA regions have been given separate management cost reduction targets. The 2010-11 operating framework said the target was 30 per cent by 2013-14. But HSJ has been told the target in the South East Coast region is 40 and in London it is 50.
  
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Tuesday 8th June 2010

Aberdeen Press and Journal

• Watchdog urged to probe cost of out-of-hours cover in rural areas. Scotland’s public-sector watchdog is being urged to investigate the true cost of providing out-of-hours GP cover in rural areas. Mid Scotland and Fife Tory MSP Murdo Fraser is to contact Audit Scotland after being petitioned by a constituent in Highland Perthshire. For several years, residents at Kinloch Rannoch have battled to get evening and weekend GP cover restored by NHS Tayside. The lack of provision stems from the 2004 GP contracts which let doctors opt out. NHS Tayside claims this would be too expensive and that suitable alternative arrangements are provided. Residents at Kinloch Rannoch feel lives are being put at risk, however.
  
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Bracknell News

• Axe falls on 470 jobs at hospitals. More than 470 jobs are set to go as a hospital trust swings the axe in a plan to turnaround its financial situation. Heatherwood and Wexham Park Hospitals NHS Foundation Trust has said that it hopes not to have to make compulsory redundancies and that there are already 320 vacancies across the sites in Ascot and Slough which will contribute towards the posts to be axed. But a trade union representative has called the situation “horrific” and warned that as many as 600 people could be affected and that the local economy could be harmed. The job cuts are part of the trust’s ‘Getting Better Together’ scheme which is a plan devised after it found itself in around £20m worth of debt just over a year ago
  
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Guardian

• Hospitals face penalties for discharging patients too soon. The health secretary, Andrew Lansley, will announce plans to impose financial penalties on hospitals if a patient has to be readmitted for emergency treatment within 30 days of discharge. He will make it clear it is not acceptable for patients to be sent home until their treatment is complete and they are fully fit. Emergency readmissions are not only traumatic for patients but are very expensive for the NHS. The numbers of patients having to be brought back to hospital for emergency care within 30 days of discharge has risen steeply during the past 10 years. But while it appears that too many people have been discharged from hospital too soon, the reasons are complex and it is as yet unclear exactly what the financial deterrent will be.
  
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Monday 7th June 2010

Pulse

• Deanery 'cannot replace GP educators' as funding cuts bite. GP educators who leave their posts will not be replaced under drastic plans to slash NHS training costs, a regional deanery has warned. In a letter to GP educators, NHS East of England Deanery said it needed to make ‘significant savings’ of 10% in this financial year, and at least 5% in the next. As a result, it warned that ‘appointments even to existing posts in our deanery are frozen’, and that ‘any GP educators who leave will not be replaced’. One GP educator said the move felt like ‘moral blackmail’ for those employed by the deanery, who fear they would be damaging future GPs’ training if they left their positions. The news comes just a week after Pulse reported the GMC’s warning that the new Government’s plans to scrap SHAs by 2012 in an bid to tackle NHS administration costs will have ‘major ramifications’ for GP training, and could see budgets cut. The deanery said the move would also mean that its administration team is likely to shrink in number. ‘We ask for your understanding as we tighten our corporate belts,’ said the newsletter. But Dr Mark Woolterton, GP in Brentwood, Essex and training programme director for East of England Deanery, said the cuts could put future GPs’ training at risk.
  
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Morning Star

• Anti-cuts alliance call for East End. Hundreds of east London community activists and trade unionists gathered at the weekend for a one-day event calling for a broadbased alliance to defend local services against cuts and privatisation. The celebratory event had a serious undertone, with participants sharing their concerns about issues affecting their community. Some 60 platform speakers addressed a series of workshops at the Stoke Newington Media School on Saturday, covering public sector cuts, the anti-racism struggle, youth unemployment, and education. Event organiser and Hackney Trades Union Council secretary Jane Holgate said that the aim was to create a "strong collective voice" to defend communities against the planned cuts - estimated at £100 billion over the next few years and threatening around 1 million public sector jobs. Local authorities across Britain are bracing themselves for massive budget reductions hitting hospitals, schools, nurseries and social care services. Hackney Council's health budget will be slashed by £187 million as part of planned London-wide NHS cuts worth £5.1 billion by 2017. Keep NHS Public campaign speaker Bronwen Handyside warned that "efficiency savings" also meant "an avalanche" of back door privatisations. "Ambulance services have been privatised but they still carry the NHS logo" she said, calling for a "militant campaign" against cuts and privatisation.
  
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Healthcare Republic

• Diverting hospital prescribing to primary care increases costs. GPC prescribing lead Dr Bill Beeby said that pressure to move prescribing to primary care had increased over the past 18 months. 'I have absolutely no doubt that there is a huge push towards trusts pushing prescribing into primary care,' he said. ‘It is absolutely aimed at reducing costs.' NHS Information figures show that, over the past four years, prescriptions issued in the community have risen 23%, while those issued in hospital outpatient prescriptions have fallen by 2%. Dr Beeby said, as well as moving workload and clinical responsibility, such action introduced inefficiencies into the healthcare system and ended up costing the NHS more. Any money saved on hospital drug budgets would be outweighed by the cost of staff time spent on unnecessary appointments and paperwork, he pointed out. It was also inappropriate for GPs to continue most off-label prescribing initiating in hospital, he said.
  
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HSJ

• Scottish NHS 'to pay £6.7bn in PFI fees'. The NHS in Scotland will lose nearly £6.7bn over the next 30 years to pay for privately funded building projects, according to figures. The SNP highlighted the figure, which covers 27 capital projects that the party valued at just £1.28bn. The payments for PPP/ PFI schemes, signed under the Labour-Liberal Democrat executive, come after warnings from the Scottish government’s chief economic adviser of a possible £35bn spending cut over the next 15 years. From next year, more than £200m a year will leave the NHS in repayments, hitting £281.5m in 2027, the Nationalists said. In Lothian, the figures detailed payments of £26.2m for the £4m Findlay House.A deal signed in May 2007 for an acute hospital in Larbert, Forth Valley, will cost £1.7bn despite capital costs of about £293m. The figures were revealed as the Scottish government faces pressure to explain thousands of looming job cuts across the NHS, which Labour says will affect patient care. SNP MSP Kenneth Gibson said: “The NHS will be paying the price for Labour’s reckless buy now, pay later policy for decades to come.
  
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Friday 4th June 2010

Bexley Times

• Residents urge Times: FIGHT ON FOR OUR HOSPITAL. Furious patients have urged the Times to fight on for vital A& E services at Queen Mary's Hospital, fearing the Conservatives' pre-election promises to reopen it will not happen. The Conservatives promised to reopen the hospital unit in Sidcup, which closed temporarily during the night last September and which is due to be axed permanently this September. However, Department of Health chiefs in the new coalition government can still not confirm if the future is safe for the much needed unit.
  
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Yorkshire Evening Post

• 'Op death' centre firm likely to lose contract. A private firm is likely to lose its contract to run a West Yorkshire NHS treatment centre where a lecturer's operation went fatally wrong. The centre came under fire from a coroner and politicians following the death of John Hubley, from Leeds. He died in 2007 after suffering "torrential bleeding" during keyhole gallbladder surgery at Eccleshill NHS Treatment Centre, Bradford. The centre, run by Nations Healthcare, is paid by the NHS to do thousands of routine operations for Leeds and Bradford patients. The contract with Nations ends this month but it is unlikely to be re-awarded to the firm. Instead Care UK, which runs 10 NHS treatment centres across the country, has been awarded "preferred bidder status".
  
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Herald

• 4000 NHS jobs to be axed in Scotland. Almost 4000 jobs are to be axed from the NHS in Scotland this year. More than 1500 nursing and midwifery posts will disappear in the money-saving cull and there will be 68 fewer doctors. Every regional health board in the country intends to squeeze the workforce by next April, except for NHS Orkney and NHS Western Isles. The loss of 4000 staff from the 130,000 workforce equates to a 2.8% reduction. Details of the cuts were published by Health Secretary Nicola Sturgeon under pressure from Labour, who said she had the information for a month. Unions expressed deep concern and warned patient care could suffer if boards continue to cut staffing levels to stay within increasingly tight budgets. However, Sturgeon said she was setting up a national group, including the largest unions, which would scrutinise boards’ plans and ensure they do not compromise the quality of care. Sturgeon guaranteed there will be no compulsory redundancies but the alternatives are also causing unions concern. Nearly 100 management posts and more than 1000 administrative jobs are also expected to go.
  
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Pulse

• GP polysystem plans axed. PCTs are already scrapping plans for GP polysystems following health secretary Andrew Lansley’s decision to shelve massive shifts of hospital care to GPs. A number of trusts have ordered a stop to plans, pending further consultation with local clinicians and patients. But there is still confusion over what constitutes GP consultation, with some trusts insisting the co-operation of local commissioning groups is enough. Among trusts pledging to alter existing plans were NHS Milton Keynes and NHS Hillingdon, which said its plan was under review. But NHS Westminster will continue with plans drawn up ‘in close liaison’ with PBC leads.
  
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• CQC reopens inquiry into Clinicenta. The Care Quality Commission is set to launch a second round of inspections into private provider Clinicenta after an NHS report detailing failings in its services. The CQC, the Government’s health and social care watchdog, had conducted an initial inspection of Clinicenta sites in October following death of a patient, but was accused of only ‘scratching the surface’.
  
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• GPs set for central contracts in deal to take over from PCOs. Ministers want to scrap GMS and PMS contracts and replace them with a radical new system of GP pay, under which practices report not to primary care organisations but directly to the new national NHS Board, senior managers have been told. Health secretary Andrew Lansley is believed to want centrally held contracts to underpin plans for GPs to take on as much as 95% of the commissioning functions of PCOs, including responsibility for organising out-of-hours care. GPs could opt out of responsibility for commissioning under the plans, but might have to accept a pay cut if they were to do so. The overhaul of the GP contract would massively reduce the power of PCOs and could see practices granted funding directly from the NHS Board for management and back-office functions. But it could also see GPs come under tough new performance management directly from a national level. Highly placed sources have suggested basic practice funding under the new system would amount to less than the existing global sum and QOF combined, with extra payments for GPs who threw themselves into commissioning.
  
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Thursday 3rd June 2010

HSJ

• Monitor chair wants FTs off public balance sheet. Steve Bundred has told HSJ foundation trusts’ assets and liabilities should now be taken off the public sector balance sheet. In 2002, then Chancellor Gordon Brown, the leading Cabinet critic of separating hospitals from state control, was perceived to have won a victory when Tony Blair ruled foundations would be kept on the government’s books. Mr Bundred said changing this would give foundations more freedom because the Treasury and Department of Health - no longer counting FTs in their spending - would have no reason to tell them what to do. Moving FTs off the Treasury books might encourage banks to increase lending to foundations. But it would also prompt fears that services could be shut or buildings sold off to pay debts. Mr Bundred said measures could be put in place to prevent such sell-offs. He said a model for the process of removing FTs from the public finances was the 1992 Further and Higher Education Act, which took polytechnics from local authority control and placed them off the balance sheet.
  
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The Hunt's Post

• Scrap Hinchingbrooke Hospital franchise plans, says ex-NHS chief. The process of privatising the management of Hinchingbrooke Hospital has become so flawed that it should be abandoned, according to a former Huntingdonshire NHS chief. Instead of franchising the hospital's management, the Government should be looking for solutions that do not mirror the NHS's current, defective structure, former Huntingdonshire Primary Care Trust chairman Michael Lynch told The Hunts Post. Mr Lynch, whose company, Anglia Health Solutions (AHS), withdrew from what later transpired to be an unsuccessful bid to run the hospital, says the position of Hinchingbrooke is an example of NHS discrimination against Huntingdonshire. "Huntingdonshire has never had its fair share of the NHS money allocated to Cambridgeshire, and that has continued since the creation of Cambridgeshire Primary Care Trust [in 2006]," Mr Lynch said. He pointed to the removal of the child respite care provision from The Laurels in Huntingdon 18 months ago, so that the cash could be used elsewhere in Cambridgeshire. He believes those managing the process towards franchising the management of the hospital next April are failing to share information on which either the 'stakeholder group' set up for the purpose or the public can judge whether the process is robust and the likely outcome will offer good value. The three private companies bidding to win the franchise to run Hinchingbrooke Hospital rolled into Huntingdonshire for a Q& A session last week... and offered absolutely no answers to any of the important questions. It was a case of: "We don't know" or "we can't say". One of the firms is due to be appointed to take over the management of Huntingdonshire's hospital in October, taking the reins from the NHS in April. However, despite there being just four months before the tender for the hospital is awarded, the people who will have to rely on the services at Hinchingbrooke and the staff who work there still remain in the dark about what changes would be made, what plans the firms have for the hospital, how they intend to make a profit or how the companies would pay off the £40million debt.
  
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Telegraph

• Giving patients a choice of hospital has not improved care: think tank. One of the key reforms under the Labour Government was allowing patients a choice of hospital when they needed treatment in order to drive up quality of care by forcing hospital trusts to compete with each other. But the independent King's Fund think tank has found that although patients appreciated being offered a choice, seven in ten still opted for their local hospital. The report Patient Choice: How patients choose and how providers respond, published jointly with the Picker Institute, RAND Europe and the Office of Health Economics, found hospitals were collaborating instead of competing. And where they were competing they were targeting GPs instead of the patients, as most people tended to rely on the advice of their family doctor when deciding where to go. Despite a massive effort to increase the amount of information about hospital services by launching a new website, NHS Choices, only four per cent of patients consulted this before making their choice. GPs involved in the research strongly criticised the Choose and Book computer system aimed to allow them to book patients into their hospital of choice as they found it difficult to use.
  
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Dumfries and Galloway Standard

• Fears are growing over the future of NHS jobs in Dumfries and Galloway after it was revealed cuts are “likely”. Numbers are expected to be outlined in a workforce plan that has to be submitted to the Scottish Government in July. Until then a spokesman for NHS Dumfries and Galloway insists “no firm figures are available”. But Unison official Alf Hannay told the Standard: “It is likely that jobs will go in Dumfries and Galloway as there are so many cuts being made to the health sector up and down the country, but we will not know for sure until the workforce plan is revealed in July.” NHS Lothian and NHS Greater Glasgow and Clyde have revealed their plans to axe 2,000 posts this year with another 1,250 posts going respectively over the next two years. Mr Hannay added: “The health board faces difficult decisions in the coming months. They can only make so many efficiency savings before it starts to affect people’s jobs.” Dumfries MSP Elaine Murray is calling on the Scottish Government to come clean over the cuts. And she fears patient care would be “damaged” if cuts are made to frontline services. She added: “You can’t make cuts on this scale without damaging patient care.
  
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HealthCare Republic

• The confidential report that recommended cutting 137,000 NHS jobs has finally been published by the DoH. On its release, the health secretary Andrew Lansley distanced himself from the infamous DoH report, and promised that staff could be ‘redeployed' to improve productivity rather than made redundant. The previously unreleased report, produced in March 2009 under Labour by consultants McKinsey, said 137,000 jobs could be cut and services of little value should be dropped to make savings. Achieving World Class Productivity in the NHS 2009/ 10 - 2013/ 14: Detailing the Size of the Opportunity set out McKinsey's vision of how the NHS in England could save £13-20bn over the next five years. The biggest staff and budget cuts in the report target hospital trusts, but it proposes the primary care budget is cut by 13% and community budgets by up to 28%. The report also suggests that the variation in productivity between GP practices be reduced drastically by increasing working hours. NHS London recently released another controversial McKinsey report that was believed to have informed plans to replace local hospitals with polysystems, and slash GP appointment times by up to 20%.
  
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• The roll-out of revalidation should be delayed by another year, the health secretary Andrew Lansley has announced. Having reviewed the plans for revalidation, Mr Lansley writes that more time is needed to ‘develop a clearer understanding of the costs, benefits and practicalities of implementation'. The extended pilot will ensure there is ‘full engagement with the profession and public before a decision to move to full implementation,' writes Mr Lansley. Before the health secretary's announcement, revalidation was expected to begin in 2011 after pilots had been reviewed. The health secretary aims to pace implementation in a way that is ‘affordable, supports high quality care, and makes effective use of doctors' time. Professor Rubin said: 'The decision to extend piloting of revalidation in England will ensure that these systems are sufficiently robust without being burdensome or bureaucratic for doctors and employers.
  
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• GP incomes 'to be published by government'. A spokesman for the Cabinet Office said this is the direction of travel for the new government, which hopes the transparency agenda will ‘win back people's trust'. In its coalition document ‘Programme for government' the government said we need to ‘throw open the doors of public bodies', and said it would require ‘full, online disclosure of all central government spending and contracts over £25,000'. It said: ‘We also recognise that this will help to deliver better value for money in public spending, and help us achieve our aim of cutting the record deficit.' The news follows the release on Tuesday of the list of the 171 public workers earning more than £150,000, which placed DoH chief executive David Nicholson, who earns between £255,000 and £259,999, in second place. A spokesman for the Cabinet Office said: ‘The publication the list [of public sector workers earning over £150,000] just covered civil servants. ‘There is a transparency commitment to cover all public bodies. This is the direction of travel, but it will require consultation with staff.'
  
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• Darzi centre targets GPs' elderly patients. A PCT has launched an investigation after its Darzi centre sent 'upsetting' letters to elderly patients encouraging them to switch practices. GPs in St Helens, Merseyside, found their patients with limited mobility had received letters encouraging them to register with the local GP-led health centre, which offers a home-visiting service called ElderCare. The letters were put together by an advertising agency. Aspect Health, which runs the service at the Sherdley medical centre in St Helens Hospital, has since apologised for the ‘error of judgement'. Dr John Chen, a GP at the Filletti and Sword practice in St Helens, said local GPs were ‘up in arms' about the letters, which had ‘upset and confused' some of their elderly patients. ‘Money has been wasted on advertising when there are cutbacks and front line services are already set up and on offer to patients,' said Dr Chen. ‘If they succeed, and patients move, some of the smaller surrounding practices may be forced to close,' he said. DoH guidance says that material promoting NHS services must not misguide or suggest a service is better than others.
  
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Tuesday 1st June 2010

Guardian

• Paid more than the PM: 170 highest-earning civil servants revealed. The government last night released the names of 170 senior civil servants who earn in excess of £150,000 – more than the prime minister's wage – in the first step towards publishing swaths of data about public spending. David Nicholson, the chief executive of the NHS, earns between £255,000 and £259,999 – including £45,000-£50,000 for a rented flat and expenses for living in London. Several more are paid six figure salaries but only work part time.
  
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Health Service Journal

• Scottish patients to be assessed by nurses to increase productivity. Controversial proposals have been announced that will see patients in Scotland assessed by nurses instead of consultants in a bid to achieve targets for NHS waiting times. Other measures to increase productivity in the NHS include many follow-up appointments being scrapped and a scheme that could see patients discharged from hospitals over the weekend. The plans are aimed at meeting 18-week referral to treatment targets. They will see specialist nurses and health professionals judge whether a patient needs specialist attention or just requires advice. Holyrood ministers hope the move will free up consultants’ time for other tasks.
  
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Monday 31st May 2010

The Sentinel

• The first two wards to be axed at Staffordshire's biggest hospital have been lined up for closure in mid-summer. And a third will go in October as the University Hospital of North Staffordshire (UHNS) looks towards the closure of a total of at least nine wards. But the move is dependent upon alternative patient services having first been set up in the community. Planning and strategy director Jane Marshall said the hospital trust was working with local PCTs with the aim of closing a surgical and a medical ward this summer. "This of course depends on the right facilities being in place outside the hospital," she added. Ms Marshall conceded changes are "very unsettling" for staff and says that, wherever possible, nurses and health workers based in affected wards will be retrained or re-deployed. But workforce leaders have urged managers to hold off the plans for a year or until the queues of patients waiting in A& E for beds had been tackled. The ward closure programme is needed for the opening of the area's new £400 million superhospital in 2012. That hospital will contain 25 per cent fewer beds than the existing 1,200-bed Hartshill complex.
  
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Healthcare republic
Healthcare republic

• BMA launches consultation on public's priorities for general practice. The BMA has launched a consultation to ask the public, patient groups, health charities and the medical profession about their priorities for general practice. The BMA hopes Striking a balance: what matters most in general practice will encourage debate on what the long-term strategy for general practice should be. It covers four key areas, including access to GPs, out-of-hours care provision, continuity of care, and the ‘evolving practice team' - which includes issues such as the suitability of the partnership model and the preferred practice size. The consultation document said: 'While public expectations of health care are increasing, the money available to pay for health services and the rest of the public sector is limited. 'Policy makers, the public and GPs will therefore be forced to choose which aspects of care are most important to them.' GPC chairman Dr Laurence Buckman said: ‘There are 300 million consultations in general practice in the UK every year. For most people it's their only contact with the health service and we want it to work well for them. ‘But with so many challenges ahead we need to develop a long-term strategy for general practice now, because there are real tensions between what people say they want the service to provide and what it can provide.' He added: ‘There is a pressing need to have an honest debate about what the focus for general practice should be. I would encourage the public to respond to our consultation because, that way, we can ensure general practice evolves in line with patient and public priorities.'
  
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Daily Gazette

• Union leaders in talks as Colchester Hospital looks to cut costs. Hospital bosses have not ruled out job cuts as they struggle to balance the books Colchester Hospital University NHS Foundation Trust has announced a five-step plan to reduce spending by £7.7million in the next ten months. Directors say action is needed after the trust made a loss of £547,000 in April, the first month of the 2010/ 11 financial year. The trust, which runs Colchester General Hospital and Essex County Hospital, aims to concentrate on staffing costs, its second biggest area of its £218million expenditure. It hopes to reduce staff expenditure by £5million – the equivalent of the cost of about 140 posts. Bosses say they will work hard to avoid compulsory redundancies, but say they cannot rule out the “possibility of a small number of non-clinical posts being affected”.
  
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Friday 28th May 2010

Belfast Newsletter

• Unions at Antrim Area Hospital protested about the ability of the accident and emergency department to cope with additional patients following the downgrading of services at Whiteabbey and Mid-Ulster hospitals. Joe McCusker, regional organiser with UNISON, said UNITE, NIPSA and the RCN were all represented at the lunchtime protest. While the trust's head of emergency medicine believes the recent "reprofiling of services" at Whiteabbey and Mid-Ulster will improve levels of service at Antrim by centralising resources, public representatives are concerned that the unit will simply be unable to cope.
  
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Financial Times

• Conflict of interest for NHS regulator. The planned new economic regulator for the NHS will face a conflict of interest between its duty to promote competition and oversee the financial health of foundation trusts, the head of the trusts’ watchdog conceded on Thursday. Under the coalition’s plans for the NHS, an independent board is to be created to oversee the commissioning of care. The current inspectorate, the Care Quality Commission, is expected to hand over its licensing of health organisations to Monitor, which currently oversees foundation trusts. Monitor is expected to expand to become “a full-scale economic regulator” for the NHS, according to Steve Bundred, chairman. This, he said, would involve controlling exit and entry to the market for NHS care through its licensing powers, responsibility for setting the price the NHS pays public, private and voluntary providers for care, along with a duty to promote competition. At the same time, however, Monitor would remain responsible for overseeing the health of foundation trusts – which are self-governing organisations, in theory no longer directly answerable to the secretary of state for health. Critics have argued that such a sweeping role would create conflicts of interest for the new regulator. It would be responsible for overseeing the fortunes of foundation trusts, as well as for setting the price they are paid for care. It would also have a duty to promote competition which at times could harm the prospects of foundation trusts.
  
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Pulse

• Health Bill to cull NHS management and give GPs power to commission. The Government has revealed plans for a massive shake up of the NHS which will see GPs given a far bigger role in running trusts and a huge cull of management. Under a new Health Bill unveiled in yesterday’s Queen’s Speech, the coalition revealed sweeping proposals to slash NHS bureaucracy and allow clinicians more power to run services. It will lead to a big reduction in the power of both PCTs and SHAs, with the latter set to be downgraded to become outposts of a new independent health board. The bill is also expected to be the signal for an even greater round of job losses than has been previously planned in NHS management, while the Department of Health confirmed that the Government was also planning to increase the severity of cuts in the health service this year despite it not featuring in the brutal round of cuts revealed earlier this week.
  
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• Leaked report into patient death exposes failings of private provider. A Department of Health initiative to transfer care from hospital to privately run services in the community exposed patients to ‘significant clinical, managerial and administrative failings’, a confidential report reveals. An internal NHS investigation concludes a catalogue of blunders and system failures contributed to the death of an elderly patient, whose condition was allowed to deteriorate without her GP being alerted. Patient X, died unexpectedly within 24 hours of being transferred against her family’s wishes from hospital to the care of the company, according to the March 2010 report. The investigation by NHS London in co-operation with Clinicenta, one of a number of companies signed up across the UK by the DH on fixed-term contracts to provide out-of-hospital care, lifts the lid on a series of safety incidents. Its findings will prompt major questions over the previous government’s decision to sign long-term deals with private firms to accelerate the shift of care from hospital. Clinicenta’s contract was suspended in November, and NHS London planned to set the company tough safety targets. But a senior NHS source said managers were so concerned about the costs of cancelling the contract – estimated at about £10m – they intended to reinstate the company. The leaked report lists 24 separate failings. The report also exposes problems at other Clinicenta sites. NHS London and PCTs had expressed concerns about the company. The report warns learning processes ‘critical in maximising patient safety’ had failed and recommends ‘a review of referral processes by Clinicenta and PCTs’. A source said a Care Quality Commission inspection – revealing staff often did not provide evidence of healthcare qualifications, criminal record checks or immigration status – had ‘barely scratched the surface’: ‘The CQC was not thorough enough. It only looked at five or six reports but there are more than 100. NHS London cannot terminate the contract unless a threshold of default is reached. Clinicenta has been issued a rectification plan with 15 [compulsory] topics. So far it has completed zero.’ Dr Michelle Drage, joint chief executive of Londonwide LMCs, said ‘the chickens were coming home to roost’ on NHS private-provider contracts: ‘Clinicenta is but one example of what we see happening. It’s clear the main driver of the tendering process was not quality.’
  
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• GP practices face an uphill struggle to sustain profits in the face of savage cuts to health spending, the new chair of the Association of Independent Specialist Medical Accountants (AISMA) has warned. Bob Senior, director of medical services at accountants RSM Tenon, who takes over from David Clough at the helm of the organisation, said his aim was ‘to help AISMA members drive home the message that GP practices need to improve efficiency if they are to sustain profits in these difficult economic times’. He added: ‘Despite government pledges to maintain frontline services, doctors will inevitably feel the pinch as health service cuts begin to bite. Combined with the tax changes that lie ahead doctors are going to be affected, some quite dramatically.' Under Mr Senior’s leadership, the national network of accountancy firms, which provides advice to medical practices, sessional GPs and hospital doctors, said it will continue to work hard with the BMA to influence policy.
  
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• NHS London chairman steps down in Lansley protest. NHS London chairman Sir Richard Sykes has resigned after the new Government scrapped the SHA’s plans to dramatically reshape the landscape of primary and secondary care in the capital. Sir Richard had been chairman of NHS London since 2008 and is said to be furious at health secretary Andrew Lansley for announcing an immediate halt to the review of healthcare in the capital. Other members of the NHS London board are said to be also considering their positions, and chief executive Ruth Carnall has admitted scrapping the plans will leave the SHA – the country’s largest – with a £5bn black hole. The review by NHS London, the evidence for which was revealed in an analysis by US consultancy firm McKinsey, included possible closures of accident and emergency departments and a shift of up to 60% of secondary care work from hospitals and into the community.
  
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Tuesday 25th May 2010

Healthcare Republic

• PCT pulls plug on Sainsbury's GP practice. The first in-store GP practice set up by supermarket giant Sainsbury's has closed two years after opening, due to the project's high cost. NHS Heywood, Middleton and Rochdale is withdrawing funding from the project in Heaton Park, Manchester, as local GPs are now providing extended hours at a lower cost. The practice was opened in early 2008 as part of a government drive to introduce competition in primary care and improve access.
  
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Monday 24th May 2010

Echo

• Southend Hospital job cut details to be finalised says boss. Hospital chief executive John Gilham stressed the plan to cut staff is still in draft form and details are yet to be finalised. He said in a statement: “As a trust we recognise NHS South East Essex has less funding, as do all NHS organisations in the current economic climate. “In the coming years, we fully expect to be working differently, particularly as the trust moves to provide more services in the community. “Naturally our staff will be affected, but the trust’s principal approach is to manage this through natural turnover and redeployment. “Southend Hospital has a duty to work with NHS South East Essex to achieve positive changes in care for all our patients. The trust will support NHS South East Essex in its ambitions.” Mr Gilham said Dr Tony O’Brien, one of the hospital’s lead consultants, will spend several months during the summer working to find out how to provide better care in the community for more elderly patients. He added the plan also aimed to improve patient experience for people with learning difficulties, as well as patient discharge and waiting times overall. However, refurbishment of the outpatient department is still planned for later this year.
  
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Pulse

• GPs take back community services in radical commissioning shake-up. GPs have come up with a radical new business model to keep community services based in primary care, which would see them take control over the acute and community budgets of their PCT. ESYDOC, a partnership of 20 practices in Surrey, has put forward proposals under the Department of Health’s Transforming Community Services programme aimed at taking charge of budgets across the community, acute and social care sectors, which they claim would be the first deal of its kind in the country. Their plan is the latest example of GPs trying to wrest back influence over community services in the controversial Government money-saving shake up. The Surrey partnership, which already manages a £135m budget across primary and secondary care, says it has the backing of its local acute trust and community nurses and that it wants to buck a national trend which has seen most community services transferred to either acute or mental health trusts. Dr Joseph McGilligan, chairman of ESYDOC, which includes 72 GP partners, said: ‘The community nurses want to work in the community. They don’t want to work in acute.’ He said the proposals would see more than 25 community nurses, plus health visitors and specialist nurses in COPD and diabetes services come under a new integrated care organisation, with GPs at the helm. He added: ‘We’re seizing the intiative.’ GPs in PCTs including Dudley and Somerset have also put in bids to take on community services.
  
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Friday 21st May 2010

Daily Telegraph

• Alex Salmond told to come clean on NHS cuts. Four of Scotland’s 14 health boards have so far revealed they plan to axe 4,300 posts, with thousands of nurses and midwives losing their jobs. Iain Gray, Labour’s Holyrood leader, called for the immediate publication of the other 10 workforce plans, which have been submitted to Nicola Sturgeon, the health minister, for her approval. “Over the last week, drip by drip, we've discovered that there are 500 posts going in Tayside, 600 jobs to go in Grampian, 1,200 in Glasgow and 2,000 in Lothian,” Mr Gray told MSPs at First Minister’s Questions. Mr Salmond said the documents would be published when Miss Sturgeon was sure the plans complied with the SNP administration’s three main criteria. He said quality of health care must be protected, there must be no compulsory redundancies and there must be more NHS staff by next May’s Holyrood elections than when the SNP took power in 2007. There are currently almost 10,000 more health service workers than three years ago, but the cuts look set to wipe out most of this increase. A dossier produced by Labour suggests all Scottish health boards are already making cuts to prepare for a sharp reduction in public spending. The accident and emergency unit at Victoria Hospital in Kirkcaldy, Fife, has been temporarily shut between 8pm and 8am due to a shortage of doctors. NHS Forth Valley plans to downgrade community hospitals in Falkirk and Stirling, the document states, while Ayrshire and Arran health board is cutting mental health care. Grampian health board needs £34m to balance its budget and last week invited staff to apply for voluntary redundancy. NHS Greater Glasgow and Clyde plans to cut 500 cleaning hours per week as part of its drive to fill a £62m black hole in its budget. NHS Highland and NHS Lothian need to find £17.7m and £31m of savings respectively, the dossier states, while there is a £30m black hole in Tayside health board’s finances.
  
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Healthcare Republic

• LMCs seek cuts to IT, NHS Direct and Darzi centres. GPs' union representatives are set for two days of largely anti-government debate when they meet next month in London for the annual conference of local medical committees.Virtually all the 803 individual and composite motions express anger, frustration and bitterness against the policies and practices of the last government - and fear of what is to come. The GPs are set to ask their union leaders - the GPC - to publish a list of projects and services, many front-line, that could be axed or run down to save money. These include Darzi centres, NHS Direct, ‘costly IT projects' and private finance initiatives. In combative mood, they ‘insist' that the government tells patients honestly about front-line cuts, reduces their expectations and makes sure primary care organisations (PCOs) implement cuts equally. They insist that primary care should ‘not be targeted' for cuts. GPs will debate whether scrapping practice boundaries will be ‘deeply flawed', costly, destructive, destabilising and discriminatory.
  
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Pulse

• GPs will lose cash despite rising patient survey scores, BMA warns. GPs face potentially damaging income losses despite outperforming last year's access scores on the controversial GP patient survey, the BMA has warned. The first yearly survey results for 2009/ 10 show that GPs comfortably performed better than last year on key access questions linked to QOF pay. In Scotland's GP access survey, which publishes its results ahead of the rest of the UK, 95% of respondents were able to obtain 48 hour access to their GP, compared to 90% last year, with 84% of patients able to obtain advance access, compared to 75% last year. The figures come despite survey results for the first three quarters in England, which will publish its full annual results next month, suggesting that overall access scores would be worse than last year, when practices across the UK lost £35m in total. But although GPs north of the border have fared better than anticipated, the BMA warned that the variation in individual practice results means many will again be hit financially, and has called for GP funding to be less attached to ‘subjective’ patient views. The BMA has called on the Government to put in place measures to support practices that are finding it hard to improve access.
  
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• Lansley orders halt to all Darzi plans nationwide. Health secretary Andrew Lansley has revealed all top-down reconfigurations of GP services into so-called polysystems are to be scrapped, as he brought plans spearheaded by former health minister Lord Darzi crashing to a halt. In a dramatic reversal of PCT-led moves to shifts of huge amounts of hospital care to GPs, Mr Lansley said the halt to plans for 100 polyclinics in London and the re-organisation of GPs across the capital was just the start of a major rethink of policy under the new coalition. The announcement came as documents based on a secret report by American consultants McKinsey revealed NHS managers had vastly overestimated the ability of polysystems to handle the shift in care from hospitals and revolutionise GP care. The documents, released by NHS London after being kept under wraps for months, reveal that the changes brought about under the hugely controversial Healthcare for London plans, including the opening of seven polyclinics in London since April last year, have actually cost far more money than they have saved. The resources in reality, the report reveals, did not exist to support the hugely ambitious scheme. The documents, which had been kept secret despite repeated demands from politicians and health campaigners , confirm that NHS chief in London had planned massive cuts in primary care, despite the focus on polyclinics bailing out the hospital spending crisis.
  
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Tuesday 18th May 2010

Financial Times

• UK private hospitals ready for business. Private hospitals are expecting a rise in business if, as expected, the Conservatives go ahead with their promise to scrap Labour’s waiting-time targets. Andrew Lansley, the health secretary, has pled­ged to scrap Labour’s NHS targets, including the maximum 18-week wait for treatment, replacing targets with outcome measures of care. However, without the pressure to keep within limits, “waiting times will go up”, according to Jill Watts, chair of the NHS Partners Network, which represents private suppliers of NHS care. “If people want a procedure they have a choice: they can wait or they can look to pay,” she said. Private hospitals have had a big increase in work paid for by the NHS over the past year or so as the service worked first to hit and then maintain the 18-week promise in England. Last year, some of the bigger private hospital groups had approaching 30%, and in one case more than 40%, of their work from the NHS. But as NHS budgets start to be squeezed, “we are already seeing evidence of people trying to stop work coming to us as a way to solve those financial pressures”, Ms Watts said. Private hospitals have also started to report small rises in patients paying out of their own pocket, having had a sharp fall in such cases as the recession hit. The potential of patient choice “remains large”, Ms Watts said, and the private sector is looking for “a fresh start” with the coalition government after the difficulties of recent months. Those have included huge delays in renewing contracts for independent sector treatment centres and Andy Burnham’s “preferred provider policy” for NHS organisations. “We would like to see it spelt out that [preferred provider] has gone,” Ms Watts said, and that the coalition remains committed to “any willing provider” being able to supply NHS care.
  
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Pulse

• GPs set to split risk of commissioning with private firms. GPs are set to partner up with private companies to share the risk under the new Government’s commissioning plans, under which practices will be asked to take on responsibility for out-of-hours services. The Tory-Lib Dem coalition has confirmed its intention to press ahead with a renegotiation of the GP contract, to give GPs hard budgets and the job of commissioning a wide range of services, including out-of-hours care. A new analysis by the London School of Economics suggests many GPs are likely to hold joint budgets with private firms under the new plans as a way of splitting the risk and workload, while companies themselves said they were already preparing to forge partnerships with the profession. Humana, which has worked with the NHS Alliance in offering commissioning support for GPs, said GPs would ‘welcome the idea’ of holding joint-budgets with private firms, as it would give them greater purchasing muscle.
  
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BBC News

• Could US health firm hold key to NHS reform? The health systems in the UK and US are about as different as you can get. But one of the leading health firms in the US could well hold the key to making the NHS more productive. A team of executives from Kaiser Permanente is in the UK to advise health managers on new approaches to healthcare. They are holding a three-day conference to exchange ideas. It has attracted worldwide interest for its success in preventing unnecessary - and expensive - hospital admissions. Kaiser Permanente is a not-for-profit company based in California with almost nine million members across the United States. The focus with Kaiser is on care of chronic conditions, working from the principle that unplanned hospital admissions are a sign of system failure. So that means concentrating on keeping people healthy, and ensuring effective links between hospitals and the community. There are critics who say you cannot really compare the different health systems with different types of patients and that success in the US does not necessarily mean success here. John Lister, from the union-backed campaign group Health Emergency, is sceptical. "I'm not sure how appropriate it is to bring companies in to tell people that integrated care is a good thing, whereas forward-looking people specialising in older people's care have been arguing that for a very long time. And that could be developed on the basis of local knowledge and expertise we already have." But Kaiser's ideas are beginning to take hold, with schemes in Devon, Birmingham, Northumberland and Lothian, drawing on their experience. The Department of Health says it expects to be in close contact with Kaiser to learn from its success.
  
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Monday 17th May 2010

Pulse

• GPs face sanctions on A&E attendance under scorecard scheme. GPs who work in areas with high attendance at A& E are being handed red ratings that could put their contracts at risk under the Government’s hugely controversial traffic-light scorecard scheme. An investigation executed by Pulse shows practices are being rated on balanced scorecards by local A& E attendance, levels of emergency and elective admissions and their referral rates. Of 28 PCTs that have now completed balanced scorecards of local practices, a third have included specific indicators scrutinising A& E attendance, while almost half are rating GPs on emergency admissions and referrals. The crackdown comes as new figures show that record numbers of people are attending A& E departments in England, with 20.5 million people attending in the last year. Pulse revealed last month that GP practices were facing a series of punitive measures including suspension of contracts and threat of closure as trusts escalated use of the scorecards, with 80% planning to have them in place by the end of this financial year. But the scrutiny of A& E admissions and referrals has been criticised by both GPs and academics as particularly unfair, for blaming GPs for factors beyond their control. Dr Richard Vautrey, GPC deputy chair, warned trusts they were treading into ‘difficult waters’ by comparing practices on hospital activity. ‘The problem is scorecards are often very simplistic, and don’t interpret the local context sufficiently for patients to be able to make a considered judgement.’ ‘Many practices feel there is a limited amount they can do to change admission rates. Often it’s to do with where a practice is located geographically rather than what’s happening within the practice itself.’ Dr Rod Jones, statistical advisor at Healthcare Analysis and Forecasting, has carried out research suggesting primary care is being unfairly blamed for soaring hospital activity. He told Pulse including A& E attendance on GP scorecards was indicative of ‘a whole agenda that primary care is the problem’.
  
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The Telegraph

• NHS spending cuts plan could impact super-hospital. Fears have been voiced that Peterborough’s new super-hospital might be a victim of health chiefs’ plans to cut multi-million pound overspending. The alarm has been sounded after it was revealed that part of NHS Peterborough’s business plan to reduce costs by £33million will involve urging GPs to refer fewer patients for hospital care and discourage patients with minor ailments from using the accident and emergency unit. An unexpectedly high number of people using hospital services has been blamed by health chiefs for much of the overspend. Details of the plan will be unveiled at Wednesday’s meeting of the NHS Peterborough board when health chiefs will be told that the amount they need to save has jumped from an expected £27million to £33million. And bosses of Peterborough and Stamford Hospitals NHS Foundation Trust, which will run the £335million super-hospital in Bretton, which opens in November, say they are uncertain about what impact the plan will have on user numbers. The trust relies on income from NHS Peterborough for services commissioned at its hospitals.
  
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BBC News

• Fears jobs may go as NHS sets aside £2bn 'change' fund. Several major hospitals have already said posts will go and more announcements are expected soon. The BBC has learned a £2bn pot is being set aside in England to pay for one-off costs, such as redundancies and redeployments, to help fund the cuts. Managers were told by the Department of Health before the election to hold the money back from the front-line. Staff working in hospitals are particularly vulnerable because much of their budget - two-thirds in some cases - is accounted for by labour costs. While many trusts are thought to have been waiting until after the election to make announcements, some have already been made public. Southampton Hospitals Trust is shedding 400 posts this year and 200 next. And in a briefing to staff, seen by the BBC, bosses warned there could be similar levels of cuts from the 8,000-strong workforce in years to come. In his first interview after being appointed health secretary, Andrew Lansley told the BBC last week the coalition government wanted to see efficiency savings, but claimed this did not necessarily equate to cuts. But the existence of the £2bn fund in England has prompted speculation that staff are set to face the brunt of the measures.
  
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Friday 14th May 2010

Greenock Telegraph

• Health board to axe 1,200 jobs. Worried health workers across Inverclyde are reeling after it emerged NHS Greater Glasgow and Clyde will axe more than 1,200 staff. It was revealed in the Scottish Parliament that more than 1,252 workers will be shed by the health board between now and next March as part of a major workforce review - with over half of them nurses and midwives. The shock news has left health staff at places like Inverclyde Royal Hospital fearing for the future. The Scottish Government asked the health board to look at their workforce last month and make future projections. Board bosses have responded with a plan which would see nursing, midwifery and clerical staff numbers hit.
  
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Pulse

• More GPs to hold budgets with commercial sector under Tory-led Governmment, health economist forecasts. An increasing number of GPs will hold joint commissioning budgets with large commercial firms under the new coalition Government, a leading health economist has forecast. Zack Cooper, researcher for LSE Health at the London School of Economics and Political Science, and author of a pre-election paper on NHS spending, predicted GPs will increasingly enter into partnerships with the independent sector when the new Tory-led coalition hands them commissioninng responsibility. The Tories have pledged to write commissioning responsibility into the GP contract, although the precise nature of how the plans will work following their coalition deal with the Liberal Democrats have yet to emerge. But Mr Cooper said he expected large corporate firms to take a far more prominent role in determining how NHS cash is spent under the new administration, given that not all GPs had the capacity or the inclination to manage real budgets on their own. He said: ‘I think that [GPs working with companies] is very likely. One of the things we will see is companies coming and helping to manage GP practices. Some GPs want to do it themselves, some don’t. So the ones who don’t will say: ‘let’s bring in somebody else. I’ll focus on the medicine, you focus on doing the commissioning’. I think we’re going to see some of the larger companies who have more experience coming in and competing.’
  
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• Coalition set to increase £20bn NHS efficiency savings target. Health Secretary Andrew Lansley has said the Conservative-Liberal Democrat coalition is set to introduce even greater efficiency cuts in NHS spending than the £15-20 billion already ordered under Labour. Mr Lansley said that the increases in spending under the previous Government were ‘not sustainable for the future’. Mr Lansley renewed the Conservative’s election pledge that the party would ‘secure the NHS’ by ensuring that resources increased each year in real terms. However, asked if the Government would match the savings ordered by Labour, he said: ‘That implied about 3% efficiency savings in the NHS. Of course we do need to do that, but we may need to do more because we have increases in demand in the NHS and a need to improve outcomes.’
  
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• Lansley confirms plans to revamp GP out-of-hours. Health secretary Andrew Lansley has confirmed that the new coalition Government will push ahead with Tory plans to make GPs responsible for commissioning out-of-hours services. Mr Lansley said a new GP contract would be negotiated in order to facilitate the changes. But he ruled out a return to the old out-of-hours system where GPs had to be on call to provide 24-7 out-of-hours provision. Instead, he said GPs in local groups or PBC clusters will either commission services, or provide them if they choose through co-ops.
  
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• Polysystem plans 'may not deliver savings'. Independent research by NHS chiefs has undermined the evidence behind moves for a major shift in hospital care to GP polysystems. It has emerged that several PCTs in the capital have questioned whether the size of the shift in workload targeted by NHS London is realistic. Trusts have also expressed fears that their trusts could be left in the red if the expected shift in care closer to the community does not hit the expected capacity. It comes with the Conservatives having promised to bring a halt to the plans for polysystems in London and elsewhere across the country, until their has been a full series of local consultations with GPs. A report by NHS City and Hackney says it own research has shown the sums do not add up in its area. It says: ‘It was identified that PCTs had made different assumptions about the level of care that could be managed effectively in primary care settings. As a result, PCT leads are under pressure to align their plans by using Healthcare for London assumptions and ensure a single offer is available to patients.’ But it goes on to say that a review of six clinical specialities to test the Healthcare for London model had shown they did not believe such a shift could be met. The trust, which said the results were ‘locally sensitive’, admitted it feared it could be forced into debt if it has to follow more aggressive NHS London plans. In March a report by the Primary Care Foundation claimed assumptions that 60% of A& E cases could effectively be dealt with in primary care were wildly optimistic, with the real figure it claimed being more like between 10% and 30%. NHS Westminster feared the plans could end up costing more money than they save.
  
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Thursday 13th May 2010

HSJ

• The election outcome leaves London’s plans for significant cuts in hospital capacity on a knife-edge - and some trusts heading for deficit. The NHS in the capital – where there have been glaring problems with care and productivity for years – has well developed plans for moving activity out of hospitals to networks of GPs and health centres. But the prospect of closing accident and emergency and obstetrics units sparked outcry ahead of the election, fuelled by political battles around inner-London marginal seats, even before plans had been agreed or published. Kingston and Whittington hospitals were particular flashpoints. Their local seats remain marginal with contests involving the three main parties. Senior sources in London told HSJ they accept major changes need political support so, with a change of government, will have to be open to alternatives to their approach so far. They plan to press on with primary and community improvements, including 30 new health centres – now unlikely to be known as polyclinics – this year. Sources said delays to major change would see some London hospital trusts go into deficit, potentially as early as this year, as commissioners use strengthened powers to withhold payment for emergency care. Without reform London as a whole may face deficit in 2011-12. If trusts run out of money they may decide themselves to run down and close loss-making services. Sources said this would be a risk to safety and, as a route to change, less likely to improve services than clinically led reconfiguration.
  
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Pulse

• NHS funding is to rise in real terms for each of the next five years, the new coalition Government has announced. A document setting out the agreements reached between the Conservatives and Liberal Democrats in forming a coalition reveals that the Tories' key manifesto pledge to ringfence NHS funding will be upheld, despite the swingeing budget cuts forecast in other Government departments. The document states: 'The parties agree that funding for the NHS should increase in real terms in each year of the Parliament, while recognising the impact this decision would have on other departments.' Meanwhile BMA chair Dr Hamish Meldrum has promised to work 'constructively and positively' with the new health secretary Andrew Lansley - but warned that frontline services must be protected from efficiency savings cuts. 'There are extremely difficult decisions ahead and more than ever, we need a period of stability and a working environment that encourages partnership and co-operation,' he said.
  
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Tuesday 11th May 2010

Financial Times

• Direct payments for social care spark fears. The growing use of personal budgets and direct payments for social care may prove a way of quietly cutting services, a study published by Unison, the health service union, warns. Labour has been pushing councils to introduce personal budgets and so-called direct payments, whereby individuals are given public money with which to buy social care. All the political parties favour such services, which they say give people more choice and control. Recipients “use the money frugally and imaginatively”, according to Hilary Land, emeritus professor of social policy at Bristol University, and Susan Himmelweit of the Open University, the authors of the study. But the study says there have been widespread variations in the amount local authorities give in direct payments. Some have provided recipients with enough money to pay care staff above council rates, with others receiving less. There have also been large variations in the amount spent supporting direct payments. Given the forthcoming huge squeeze on public spending, “it will be easier for local authorities, and indirectly the government, to fail to raise direct payments and individual budgets in line with rising wages, than to cut services directly”, the study says. This would push the problem of cuts in care onto recipients.
  
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Lancashire Telegraph

• Fears Calderstones may need to cut 220 jobs. Unions fear more than 200 jobs could be lost at Calderstones NHS Trust as part of cost-cutting measures. The trust, which is based near Whalley, employs 1,587 people, provides specialist services to both in-patients and out-patients with learning disabilities. It has said it must save around £5 million over the next three years – the equivalent of 220 jobs. Unison representatives said they were already concerned at the pressure on services with current staff levels and argued that the cuts could mean a reduction in normal earnings for staff, with bosses considering removing unsocial hours payments. But health chiefs said they did not want job losses and would be looking at other options first. Graham Jowett, director of work service and development at Calderstones, said two formal meetings had been held with union representatives last month to discuss 'modernisation' changes. He said: “We are no different from any other NHS organisation or public sector body and we do face significant challenges over the next few years “What we have here is a nursing workforce where some of the working practices have not changed for decades and in order to develop greater efficiency together we need to look at how we deploy our staff.” Unison said the trust's new staffing model for on-site services would mean less qualified and unqualified staff, particularly at night and weekends, which would risk patient and staff safety, while rotating day and night teams 'would put increased stress on staff'.
  
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People Management

• Training funds for doctors 'must be protected', says BMA. Training for NHS doctors must be protected in the wake of predicted public funding cuts to ensure quality services, a junior doctors’ leader has warned. Dr Shree Datta, chair of the BMA’s Junior Doctors Committee, called on the incoming government to end the erosion of doctors’ training to safeguard quality of staff and services. Datta said: “The NHS prides itself, quite rightly, on its highly trained staff, but the quality of doctors it produces depends on the quality of training provided. “Alarmingly, our training is now under threat on many fronts." Datta highlighted research that shows four in 10 junior doctors are working on understaffed rotas and that they are increasingly working more anti-social hours, in which training opportunities are scarce. “Almost half of UK doctors surveyed by the BMA are missing out on essential training. Working extra shifts to prop up understaffed rotas means less time to learn new procedures, less time to practice our skills, less time to learn and less time to become better doctors,” she said. She pointed to the inquiry into the failings of the Mid-Staffordshire NHS Foundation Trust, which she said emphasised the important role of education and training in the hospital workplace and showed that training “is not an optional extra”.
  
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Monday 10th May 2010

Daily Mail

• The number of women suing an NHS hospital over botched bladder operations carried out by an overworked surgeon has soared to more than 200, it has emerged. Managers at Liverpool Women's NHS Foundation Trust are accused of allowing consultant George Rowland to continue operating because they were desperate to meet Government targets. He had told management that he felt 'overwhelmed' by his work load. The hospital is now facing one of the largest class actions in British medical history, which could leave the NHS facing a compensation payout of up to £20million. Although around 200 women are seeking damages, that figure could more than double after investigators found problems with 30 per cent of Mr Rowland's 1,500 cases. Many patients, who were operated on for incontinence problems, were left with chronic pain and weaker bladders following his intervention. According to an independent report Mr Rowland, who performed surgery on women between 2000 and 2007 while working at the Aintree Centre for Women's Health, over-diagnosed women as suffering from stress incontinence and performed unnecessary surgery. The doctor said he had been worried about his own ability as long ago as 2002. He claimed he warned the hospital medical director, Dr David Richmond, that he felt 'overwhelmed' and 'isolated' by his workload, but his cries for help were ignored.
  
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BMA

• Future of NHS threatened by training cuts, says junior doctors' leader. In a speech to the BMA’s annual conference of junior doctors, Dr Shree Datta, Chair of the BMA’s Junior Doctors Committee, will call on the incoming government to stop the erosion of training for doctors and safeguard the quality of the NHS medical workforce. She will say: “The NHS prides itself, quite rightly, on its highly trained staff, but the quality of doctors it produces depends on the quality of training provided. Alarmingly, our training is now under threat on many fronts. By the 20 billion pounds worth of efficiency savings – politician speak for cuts; by the understaffed rotas one in four of us now have to work on; by a haphazard review of training funding and by the fractured implementation of the 48 hour week." Dr Datta will highlight research that shows 4 in 10 junior doctors are working on understaffed rotas and that they are increasingly working more anti-social hours, in which training opportunities are scarce. Dr Datta will say: “Almost half of UK doctors surveyed by the BMA are missing out on essential training. Working extra shifts to prop up understaffed rotas means less time to learn new procedures, less time to practice our skills, less time to learn and less time to become better doctors. Without proper training junior doctors will not be able to gather the skills, experience and knowledge needed to be the GPs and consultants of tomorrow. "
  
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Pulse

• Funding cuts are forcing PMS practices to start slashing their opening hours – sabotaging the Department of Health drive to extend access. Pulse has learnt that one practice in Surrey, which has seen its funding slashed by 12.5% after the trust brought in a new across the board PMS funding deal of £75 per patient, say they have been left with no option but to make deep cuts to opening hours. Dr Stephen Jefferies, a GP at the Leith Hill Practice, near Dorking, said it had made the decision to begin closing its branch surgery at 1pm instead of 5.30pm and reducing the hours of its main surgery by an hour each day. ‘We’ve all taken a massive cut in personal income and we’ve all agreed to cut our hours so we can maintain the quality of our services," he said. Shelley Eugene, head of primary care contracting at NHS Surrey, told Pulse the PMS review had brought ‘equity across the county’ in GP funding, adding: “The standardised contract includes a common global sum equivalent for practices, which is still higher than the current GMS average. This has meant an increase in funding for practices below the global sum equivalent and a reduction of payments to higher paid PMS practices phased over the next five years.’ However, Surrey and Sussex LMCs told Pulse that 90% of PMS practices had lost out.
  
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• NHS spends millions on promoting polysystems to patients. The NHS in London could be landed with a bill of up to £2m in the next financial year for a ‘branding’ exercise to make polysystems attractive to patients. All 31 PCTs in the capital have been told by NHS London that getting the PR message right is key if polysystems are to win support. Eight PCTs in North West London have already committed to coming up with new marketing strategies to promote polysystems. A report by NHS Hillingdon said it alone planned to spend up to £70,000 in the next 12 months. ‘The overall programme requires clear and consistent branding [to] enable the public and local opinion formers to understand how community-level delivery will impact positively on local healthcare access and provision,’ the report states. ‘An early priority will be to develop a ‘core script’ for advocates of the system.’ There are also plans for NHS managers to use social networking sites such as Facebook and Twitter to spread a consistent message about the shake-up of GP services.
  
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New Statesman

• Don’t go to market. Fascinating though this election campaign has been, the debates on health have been largely predictable. No politician wins votes by promising to close hospitals or take away services, so it's not surprising that all three parties have, more or less, pledged to protect the NHS, promising to save huge amounts of money without affecting front-line services, and without giving much in the way of detail. But away from the campaign trail, the axe is already being sharpened. Strategic health authorities have been told to achieve efficiency savings worth £20bn and staff are starting to see the consequences. More than half of GPs in a recent survey said cutbacks to local services had begun. Since we the British Medical Association (BMA) launched our election manifesto in December, we have pointed out the folly of "slash-and-burn" cuts, arguing that during a time of financial difficulty, health care is even more important. The BMA asked the three candidates for health secretary to explain where they stood on the role of profit-making companies in the NHS. All three continued to advocate private provision of NHS care, albeit with slight differences in emphasis. That this consensus exists is perhaps surprising. Surveys of the public show little appetite for private provision of NHS services, and there is scant evidence that the market experiment in England has improved standards or efficiency. It is worth noting that every eight cases diverted to an independent-sector treatment centre cost the taxpayer the equivalent of almost ten cases dealt with by the NHS. So what's our message to the next government ? Naturally we'd like you to give NHS staff a greater say in determining policy and services. But we also urge you to abandon this obsession with market "reforms" that continue to divert public money away from the front-line services you have promised to protect. - Chairman of the BMA council
  
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Friday 7th May 2010

Pulse

• A private provider, whose services aimed at slashing GP referrals were suspended after fears over patient safety, is to be hit with tough new quality targets. NHS managers are drawing up an ‘assurance framework’ to satisfy the Care Quality Commission that Clinicenta, whose contract with 20 London PCTs has now entered a sixth month of suspension, is fit to start treating their patients again. Clincenta's contract across the capital was shelved last November, after NHS London launched an investigation into the death of one of its patients and a CQC probe claimed it may have put patients at risk. Pulse subsequently revealed how the commission’s investigation found the firm - brought in to provide treatment including cardiac rehabilitation, acute home care out of hospital and end-of-life care - provided a ‘zero-star service’ and failed to ensure staff were adequately trained, or even if they were qualified to work in the UK. An NHS London spokesperson said: ‘Our first priority is patient safety and services will remain suspended until we have absolute assurance that all the issues raised have been addressed. ‘As the suspension has gone on, some PCTs have sought alternative providers as an interim measure. The money to pay for this will be taken out of the value of the Clinicenta contract. Clinicenta is not being paid for any Out of Hospital services while it is suspended.’
  
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Thursday 6th May 2010

Pulse

• Polysystem roll-out hit by patient concern over continuity of care. Patients value continuity of care far more than having access to GPs in polyclinics, weekend and evening appointments or being able to register with practices close to their work, according to a consultation run by NHS managers. NHS Kingston released results of a wide-ranging consultation over its plans for two polysystems as part of NHS London’s comprehensive overhaul of GP practices, seen by many as a model for the future of general practice. But when given a list of services that could be provided in polyclinics, fewer than 3% of patients said they wanted GPs there, with the majority happy with the care provided by existing practices. Patients said they valued the relationship with their individual GP more highly than other Government initiatives, such as extended hours and getting rid of practices boundaries. When asked which elements of the health service they most wanted to preserve, patients most commonly said easy access to good GPs (19.2%), closely followed by caring, high-quality staff, especially the personal relationship with a GP (18.3%). The consultation concluded it was ‘evident people were happy with GP services available locally’. Having access to a health centre closer to work – the policy of all main parties - was rated as ‘unimportant’ by most patients.
  
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HSJ

• Royal College of Midwives warns against NHS cuts. Cuts being planned for the NHS could lead to the emergence of “baby factories”, the disappearance of some hospitals from cities and a general worsening of healthcare in the UK, the Royal College of Midwives trade union has said. The nursing body said many accident and emergency units, children’s departments and maternity services will be shut down and “centralised”, although the medical establishment insists that fewer centres of care will produce better treatment. The cuts are likely to mean more patients will have to travel further distances to receive their care, the RCM said. Union general secretary Cathy Warwick said the RCM does not oppose any reconfiguration of health services in principle, but she is worried that mega-centres of maternity care will end up being created in which 10,000 babies are born each year. “The danger is that we’ll get what I call baby factories: large and impersonal places where high numbers of women walk through the front door of a place that’s not welcoming and not friendly because it’s just too big. The size detracts from the ability to give individualised, personalised care,” she said.
  
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• Monitor discusses clinician business academy. Monitor has been in talks with foundation trusts and the Treasury over funding for a business academy to train clinicians for senior NHS management roles. The scheme is the idea of outgoing Monitor director of policy Robert Harris. He told HSJ the plan was about “putting people who are clearly clever in charge of these devolved budgets and incentivising them to manage”. He said: “Then we will get more for the same money or, Nirvana, more for less money.” But he added: “The spend-to-save argument is always a tough one to win, I have been on a charm offensive. As soon as the benefits are there to be seen, the vast majority of foundation trusts have said ‘we will fund that’.” As well as sounding out foundations, he said he had also been working for the last nine months with the Treasury to secure initial funding to set up the academy. Professor Harris said it would not be a bricks and mortar institution but would be delivered “in the field, where it is instantly valuable”. Although initially focussed on acute trusts he said the programme could be expanded to primary care managers.
  
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Tuesday 4th May 2010

Times

• General hospital under threat as NHS faces post-poll closures. The NHS is facing significant cuts in services across England and Wales despite election pledges from the main parties to protect health spending. Analysis has revealed that the number of health bodies preparing the ground for possible closures has increased. Those seeking advice on big changes to NHS services, including shutting down hospital units, has doubled over the past year. A total of 26 organisations across England approached the Independent Reconfiguration Panel (IRP), the group of experts consulted on service changes, over the past financial year about restructuring care in their area — up from 13 in 2008-09. The approaches illustrate a dramatic shift in attitude to the great NHS taboo of reducing the number of hospitals and beds. In recent weeks doctors, managers, patient groups and health service researchers have all advocated the strategy as a means of maintaining and enhancing healthcare in the current economic climate. It comes after warnings that the NHS needs to find £20bn of savings in coming years. Experts suggest that the NHS will be structured around fewer, larger hubs of specialist services, many more “outreach” units in local communities and less hospital-based care. The future of many medium-sized facilities, such as the traditional district general hospital, remains uncertain. A review of child heart surgery in England is seen by some as a model for safer and more cost-effective specialist services. The report sets out plans to have fewer centres, with more staff and facilities, by merging and relocating smaller units. Last month Reform, a free-market think-tank, called for some regions to cut more than a quarter of their hospital beds. It argued that the reduction in beds in English hospitals over the past 20 years, from 270,000 to 160,000, must continue and a further 30,000 beds should go. A recent report commissioned by the Department of Health from McKinsey, the management consultancy, concluded that up to £700m is spent annually on hospital procedures with limited clinical benefit, and about 40% of patients in hospital at any one time do not need to be there. Recent attempts to cut or relocate services have been opposed vociferously by patients’ groups and local MPs. Currently, patients are opposing the merging of paediatric units in the West Midlands and the consolidation of maternity units in Manchester and emergency services in London.
  
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Southport Visiter

• More Merseyside hospitals to cut staff to save money. Several Merseyside hospitals have revealed they are cutting jobs to prepare for tightening NHS budgets. Alder Hey children’s hospital is offering workers the option of leaving with a severance payment as a way to combat budget cuts. The Royal Liverpool and Broadgreen, Southport and Ormskirk and Arrowe Park hospitals all confirmed they have also introduced a “voluntary severance scheme”. Representatives from the Royal College of Nursing (RCN) union have taken out a formal grievance with Alder Hey because they are concerned about the scheme. Alder Hey said the scheme was implemented to avoid redundancies. Health trusts have signed up to the Quest for Quality and Improved Performance programme (QUIPP) to find savings forced by the economic recession.
  
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Monday 3rd May 2010

Express & Echo

• More questions have been put to health chiefs over controversial proposals to close an East Devon maternity unit. Under a Freedom of Information request, NHS Devon has been asked a number of questions about Honiton's hospital. Around-the-clock cover could be cut at maternity units in Honiton, Tiverton and Okehampton, although a final decision has not yet been made. The FoI request has come from campaigner and local councillor Roger Giles after he claims it was revealed that there has been a substantial drop in the number of East Devon women giving birth at Honiton Hospital. NHS Devon managers said this was due to a local shortage of midwives, rather than a permanent change. But at a recent public meeting former Ottery St Mary GP John Ackroyd said it was "disingenuous" of NHS Devon to say that there had been no changes made already. "I know the changes were made with immediate effect in February when staff were informed that they were transferring to the employment of the RD & E," he told the meeting. NHS Devon says the proposals are still open to consultation and that any changes, if implemented, would not take place until September.
  
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The Hunt Post

• Hinchingbrooke Hospital: Protest against private management gathers pace. Campaign groups opposed to plans to privatise Hinchingbrooke Hospital in Huntingdon have joined forces to gather public support for their fight. Members of Cambridgeshire Against the Cuts, Keep Our NHS Public, Huntingdon Trades Council and the Save Hinchingbrooke Hospital group met in Huntingdon on Saturday, April 24 to hand out leaflets and collect signatures for a petition against the plans. Mike Gough, from Save Hinchingbrooke Hospital, said: "The response from the public was fantastic and the mood weighed heavily against the