HSJ Live 04.03.2014: Voluntary redundacies unavailable to CSU staff

5.17pm South Devon Healthcare Trust has given a brief update on the investigation into chief executive Paula Vasco-Knight and director of workforce and development Adrienne Murphy.

Ms Murphy has been suspended along with Dr Vasco-Knight while the investigation is underway.

Acting Chair David Allen said: “Formal processes have commenced to investigate the actions of our chief executive, Paula Vasco-Knight, and director of workforce and organisational development, Adrienne Murphy. As a neutral act and to protect the interests of all parties, both executives are suspended from their duties while the investigation is underway.

“I have pledged to be as open and transparent as employment law permits me and will ensure the outcome is publicly available. I cannot currently put a timescale to this, but it is important to ensure that processes are conducted fairly and thoroughly and I am hoping it will be a matter of weeks.”

5.00pm The cost of specialist neurological care may outweigh any financial gains in the short term but it makes more sense to have a long term view and invest in rehabilitation services, argues neurological care expert Jan Flawn.

4.49pm Michael White’s latest politics article is now online. In the piece Michael argues that we have a confused attitude to public health in the UK.

4.28pm The Guardian has an interesting article and videos clips by Saleyha Ahsan, an emergency medicine doctor and film maker who has made a film depicting the pressures within the A&E departments of two hospitals.

Ms Ahsan says that “being a doctor in accident and emergency has at times resembled being a medic in a war zone”. She says she was driven to make the film because she “wanted to make something honest and reflective of the reality” of A&E.

4.01pm The Unite union has announced two more strikes in the coming weeks by paramedics and ambulance staff in Yorkshire over shift changes.

Unite’s 375 members at the Yorkshire Ambulance Service Trust will hold two five-hour strikes on Friday 7 March and Monday 10 March.

The union’s members previously took strike action in relation to the issue on 1, 3, 14, 17 February 2014, and 2 April and 7 June last year.

3.42pm Further to the news below about the Nursing Technology Fund, HSJ’s Nick Renaud-Komiya, who’s currently at the NHS Expo, has this additional update:

“NHS England is to unveil a league table in the coming weeks of those working in primary care by how well they use clinical IT systems.

“A similar Digital Maturity Index has already been launched to compare every acute trust in England based on a similar measure.

“Those deemed to have the best grasp of using clinical IT and the most sophisticated systems are placed on the top of the table.”

3.34pm NHS England has announced the first round of investment to be awarded toseventy five NHS trusts across the country to buy technology for nurses, midwives and care staff.

At the NHS Expo today, Beverley Bryant, NHS England director of strategic systems and technology, unveiled how £30m of the £100m ‘Nursing Technology Fund’ will be allocated.

The funding will be used to buy technologies such as digital pens, tablets and clinical software to support nurses and midwives to develop modern practices and do their jobs more easily.

Trusts applying for the funding had to demonstrate how their technology projects would deliver real improvements to patient care and safety.

3.20pm One more comment on the Oldham commission, this one from Professor Karen Middleton, chief executive of the Chartered Society of Physiotherapy:

“We welcome the Oldham report’s recognition that community services are crucial for keeping people well.

“Too many people end up in hospital for avoidable reasons, which is expensive for the NHS and costly for the individuals involved, especially those who become unable to live independently as a result.

“Community services, such as physiotherapy, allow people to leave hospital quickly and continue their rehabilitation at home.

“Just as important is the role they play in avoiding unnecessary admissions in the first place through services like falls prevention programmes and ongoing support for people with long-term conditions.”

2.55pm Dr Mark Porter, chair of the British Medical Association council has this to say:

“Rising demand from an ageing population with increasingly complex illnesses means if the NHS is to be sustainable in the future, we have to rethink how this country is to provide both health and social care for its people.

“The greater integration and coordination of health and care services proposed in this report would not only benefit patients, by ensuring they have access to the right care for their needs, but might deliver savings to the NHS in the long-run.

“Crucially, any new system, however well integrated , would need to ensure the existing funding gap is closed so both the health and social care needs of patients are adequately met. It will not be right to further cut hard-hit health services to backfill and extend social care. 

“It is also vital that these reforms are delivered without repeating the wasteful and damaging top-down reorganisation forced on the NHS recently.”

2.48pm Here’s the Royal College of Nursing’s take on the Oldham commission, from RCN chief executive and general secretary Dr Peter Carter:

“The health service is facing its biggest ever challenge in the form of an ageing population with complex, multiple conditions requiring social as well as health care. This is an important report which contains a number of promising recommendations which deserve serious consideration.

“We are pleased to see the recommendation that more emphasis is placed on multidisciplinary team working to enable all members of the health care team to fully contribute to a patient’s health and social care.”

2.40pm There’s been lots of reaction to Sir John Oldham report on whole person care for the Labour party. Let’s start with the King’s Fund.

Richard Humphries, assistant director of policy at the think tank said:

‘The report makes a powerful case for change, adding further weight to calls for fundamental reform of health and social care to respond to the changing needs of patients and service-users. It is right to propose a new model of care with services co-ordinated around the needs of individuals, a stronger emphasis on prevention and more care provided outside hospital.

‘We welcome the proposals to extend the use of single budgets for health and social care. Wisely, the report suggests an evolutionary approach which builds on existing structures, rather than advocating another major structural reorganisation.

‘The next government will need to respond to significant financial and service pressures in the NHS and social care. Today’s report puts flesh on the bones of how Labour could approach this challenge if elected but suggests some changes which differ from the party’s current position – there is clearly a good deal of detail to be worked through before definitive policy proposals emerge ahead of the general election.”

2.24pm The lessons learnt from the medical and dental education commissioning system will be crucial to improve access to high quality education for the whole workforce, Gillian Hooper writes for HSJ.

1.26pm Hospital managers should “over-recruit” nursing staff by 10 per cent in order to ensure the best quality care for patients, according to a former nurse who now leads one of the UK’s leading acute trusts.

Dame Julie Moore, chief executive at University Hospitals Birmingham Foundation Trust, urged nursing directors to be bold and employ more staff, in her keynote speech to the Florence Nightingale Foundation annual conference on Friday, HSJ’s sister title Nursing Times reports.

12.50am NHS England has instructed commissioning support units not to offer voluntary redundancy to employees as they undertake a redundancy programme to cut 300 jobs, HSJ’s David Williams reports.

The directive went out late last month after NHS England delayed the publication of its voluntary redundancy scheme, which was originally intended to be used as part of a centrally coordinated CSU job cuts programme currently under way.

Now, senior figures in NHS England do not expect the scheme to be ready before CSUs finalise their redundancy programmes. It is expected that CSUs will aim to hand out redundancy notices before the end of 2013-14.

With no voluntary redundancy option available, CSUs will have to make the cuts using compulsory redundancies or by not filling vacancies.

12.40am East Riding of Yorkshire Clinical Commissioning Group is considering a “health campus model” of co-locating a wider array of services - some which are not health services - at a district hospital to ensure sustainability, HSJ has learned.

1.43am NHS England has told its local area teams they must impose a lower tariff price for mental health and community providers than for their acute counterparts. This is despite it previously indicated that clinical commissioning groups had the freedom to devise their own tariff level.

In a response to criticism over its joint decision with Monitor to impose 20 per cent higher efficiency cuts on non-acute trusts than on acute organisations, NHS England last month told CCGs they could exercise “local freedoms” when negotiating prices.

But HSJ has learned local area teams - which commission local specialised services on behalf of NHS England - have been told any negotiations must be based on the nationally imposed differential tariff.

10.58am Specialist emergency care doctors should be paid more to work in struggling hospitals, MPs have suggested.

A Public Accounts Committee report said the improvement of accident and emergency services has been “hampered” by the lack of emergency consultants.

They criticised both the Department of Health and NHS England for not having a “clear strategy for tackling the chronic shortage of A&E consultants”.

10.39am The benefits of better patient outcomes and billions of pounds of savings remain achievable from the delayed care.data project, Olaf Lodbrok argues in a comment piece for HSJ.

Mr Lodbrok, who works for big data company Reed Elsevier, writes: “Put simply, the furore over care.data would never have been witnessed across the Atlantic [in America], where the use of big data techniques to deliver improvements in care is well advanced.”

10.19am The majority of the public in England (65 per cent) believes that the case for the introduction of the care.data electronic database of all patient records from GP practices has not been well-publicised, according to a new opinion poll.

The survey, commissioned by the Royal College of General Practitioners (RCGP), also shows that two thirds of the public believe that patients’ right to opt out of having their records added to the electronic database has not been well-publicised.

In addition, the poll, carried out by ComRes, shows that support for the project is muted, with the percentage of those supporting the introduction of care.data (35 per cent) being outnumbered by the percentage who say they do not know whether they are in support of the project or opposed (38 per cent). The poll found that 27 per cent of people say they are opposed to the introduction of the database.

0.03am: The Labour shadow cabinet has today published the report of the Independent Commission on Whole Person Care, which it asked to make recommendations for its health and care policy. The group was chaired by Sir John Oldham, GP and a former Department of Health national director.

It is expected its report will contribute to the party’s proposals for health and care as the 2015 general election approaches.

The report does not propose major structural change: Clinical commissioning groups would be retained and largely keep control of their budgets, unless they decided to pool them. This is contrary to proposals made by shadow health secretary Andy Burnham early last year, who said CCGs’ budgets should pass to local authorities.

However, Sir John’s report does propose a greater role for health and wellbeing boards - which are based in councils. It also proposes a range of smaller structural and policy changes, aimed at focusing services on the “whole person”, including changes to competition regulation.

The commission sets out proposals aimed at “giving meaningful power to people using the health and care system” and “reorienting the whole system around the true needs of the population in the 21st century”. Its report says: “For too long health and social care have been considered separately. They are inextricably linked. However we do not believe the answer includes yet another major structural reform at this time.”

The reports proposals include:

• No major structural reorganisation, with CCGs remaining largely with their current powers. However, health and wellbeing boards would take on a great role, having “the collective system leadership for services for people with multiple long term conditions, disability and frailty”. They would “be responsible for a collective commissioning plan informed by the whole budget (locality pound) for this cohort of the population”, and health and care commissioners would have new duties to follow the plan. If they wished, areas could “formalise a single budget, with amended accountability arrangements”.
• There should be a development process for health and wellbeing boards during 2015-16, ensuring they are able to take on this role from 2017. This should be overseen by NHS England (renamed to Care England).
• NHS England should be renamed Care England, and made the “strategic lead” of health and care, ahead of regulators and the NHS Trust Development Authority.
• There should be “an independent National Conversation” review, looking at the future of health and care funding and entitlement, and also at the configuration of health services. It should be completed within a year of the general election, with legislation enacted to enable implementation from 2020 onwards.
• Section 75 regulations - which were introduced under the Health Act 2012 to govern procurement and competition - should be abolished, and “replaced with new regulations which support the development of whole person care”. The role of the Office of Fair Trading “in reviewing competition decisions should be removed”.
• The benefits should be “considered of a single regulator covering issues of both care and economics, whilst recognising that is not feasible at present”. Such an arrangement would see the functions of the Care Quality Commission and Monitor merged.
• Continued reform of payment systems, towards whole-person capitated approaches.
• “The continuation of clinical senates is of questionable value for whole person care and should be abolished.”

0.02am Good morning. Over in our Comment section the new chair of the Foundation Trust Network, Gill Morgan, says the NHS can only improve its quality of care and its culture if boards empower frontline staff.