London CCG pursuing prime provider model for MSK (HSJ: 31 March 2016)

Camden CCG will be advertising for a five year, fixed term contract with a lead provider for integrated MSK services on Thursday.

The CCG confirmed to the HSJ it would be issuing a pre-qualification questionnaire for bidders at the end of March.

Based on current spending the contract would be capped at an annual spend of £15m. In the second year, 20 per cent of this would be dependent on outcomes...read more

 

CCGs consider sweeping restrictions to plug £25m hole (HSJ: 21 March 2016)

A group of clinical commissioning groups in the Midlands have outlined proposals for wide ranging restrictions to NHS services in order to close a £25m funding gap.

The ideas include restricting access to knee and hip operations, no longer providing hearing aids for people with mild hearing loss, and restricting access to some treatments “for patients who have unhealthy lifestyles”.

Redditch and Bromsgrove, South Worcestershire and Wyre Forest CCGs said they would spend £25m more than their combined budgets in 2016-17 if they did not make changes.

The CCGs said they needed to “find ways of reducing costs in some areas… to protect other essential services”.

The groups are carrying out a survey of the changes they are considering, but stressed they were “just ideas” and no decisions had yet been made...read more

 

NHS England stalls plans for HIV prevention drug (The Guardian: 21 March 2016)

Charities and campaigners have reacted with anger and disbelief that plans to roll out a widely anticipated HIV prevention drug have been stalled by NHS England.

The sector had been waiting for the announcement of the first ever public consultation on the use of pre-exposure prophylaxis (PrEP) in the UK, now overdue by a month. Instead today NHS England announced it was not their responsibility to commission the drug.

The HIV treatment pill Truvada containing PrEP can be taken on a daily basis – in a similar way that women take the contraceptive pill – by men who have sex with men to dramatically reduce the risk of HIV transmission. In February 2015, a Proud (pre-exposure option for reducing HIV in the UK: immediate or deferred) study reported that PrEP had effectively reduced the risk of HIV infection by 86%.

Terrence Higgins Trust, the largest provider of HIV and sexual health services in the voluntary sector, expressed shock and disbelief as structured plans for introducing the drug were shelved...read more 

 

Health minister admits Government risks not delivering on GP recruitment goal (Pulse: 21 March 2016)

A health minister has admitted that there is a ‘risk’ around whether the Government will achieve its commitment to find 10,000 new GP or GP equivalents, and that failure to achieve the target would make it ‘difficult to deliver our ambitions’.

Lord Prior – who was chair of the CQC before becoming minister for NHS productivity last year – has cast doubt on health secretary Jeremy Hunt’s commitments on GP numbers, which included increasing the workforce by 5,000 GPs by 2020.

The minister said that the Government has increased the number of training places to 3,500 from this year. But Pulse has revealed that there has been a 5% decrease in applications this year, which would lead to only 2,630 places being filled based on last year’s 2,769 filled posts...read more

 

Eye risk from 'overstretched NHS' (BBC News: 16 March 2016)
 

Eye specialists say hundreds of patients suffer irreversible sight loss every year in England because services are overstretched and under-resourced. The president of The Royal College of Ophthalmologists, Prof Carrie MacEwen, writing for the BBC's Scrubbing Up, warns the NHS is struggling to keep up because of a "perfect storm" of increased demand, caused by more eye disease in an ageing population which requires requiring long term care.

She says the current treatment targets fail to reflect the critical importance of follow-up appointments, which may be delayed for months or even years...read more

 

 

 

 

Jeremy Hunt urged to act against avoidable deaths from epilepsy (The Independent: 12 March 2016)

The Epilepsy Society has launched a new campaign calling on the Health Secretary Jeremy Hunt to act against avoidable deaths from the condition.

Although sufferers are at greater risk of premature death, almost four in 10 of those deaths are avoidable, according to the charity, which says better care, treatment and services are urgently needed. It has also launched an online campaign urging MPs to write to Mr Hunt requesting that a National Clinical Audit into the condition take place – for the first time since 2002. 

[...]

The Epilepsy Society said the most worrying aspect is the postcode lottery for the 500,000 people in England living with the condition. Data from the Office for National Statistics shows that rates of premature death vary vastly: for example, someone with epilepsy is 49 per cent more likely to die prematurely in West Yorkshire than in Cheshire...read more

Charity warnings over clinical reference group cuts (HSJ: 11 March 2016)

Charities have written to NHS England raising concerns about plans to cut the number of clinical reference groups and reduce their membership, HSJ has learned.

The Brain Tumour Charity and Sarcoma UK have sent a letter to Simon Stevens, the chief executive of NHS England, warning that the move will “dilute” the specialist advisory knowledge currently provided about different cancer types.

Charities are worried about specific CRGs being merged into a broader “cancer surgery CRG”

The Neurological Alliance and the British Kidney Patient Association have also said that reducing CRGs’ membership will impact their ability to represent patients.

Last month NHS England announced it was planning to cut the number of CRGs from 71 to 38. The groups are responsible for advising NHS England on how it spends its £14bn specialised services budget, and help it to develop commissioning policies and service specifications...read more

 

Staff shortages spark CQC warning for mental health trust (The Nursing Times: 23 March 2016)

North Staffordshire Combined Healthcare NHS Trust has been given an official warning about community mental health services for young people, after inspectors found there were not enough staff to provide quality care.

The trust’s child and adolescent mental health services (CAMHS) community provision was rated “inadequate” by the Care Quality Commission following an inspection of all core services in September last year.

Inspectors found staffing levels in community CAMHS were “not safe” because of staffing shortages in various disciplines, including nursing, with “excessively long” waits for treatment.

“There were not enough consultant psychiatrists, nurses, psychologists, or therapists,” said the CQC report. “We found staff on maternity or long-term sick leave were not replaced by temporary staff.”

Inspectors also found risk assessments of young clients were not always completed or safety plans put in place...read more

 

Junior doctors to withdraw emergency care in escalation of action (Pulse: 23 March 2016)

Junior doctors will fully withdraw their labour, including emergency care, in an escalation of their industrial action, the BMA has announced – the first instance of this ever happening in the NHS.

A statement from the BMA said that the 48-hour industrial action planned for 26 April will now change to full withdrawal of labour between 8am and 5pm on 26 and 27 April. This will follow earlier action – a 48-hour walkout on 6 April – which will continue as planned.

The chair of the BMA’s junior doctor committee Dr Johann Malawana said the Government had left them with ‘no choice’.

The committee had planned earlier this year to withdraw all emergency cover, but did not go through with the action as talks with the Government were progressing...read more

Hospital shuts beds after CQC raises staffing ratio concerns (HSJ: 21 March 2016)

Southend University Hospital Foundation Trust has been forced into significant bed closures after inspectors raised concerns about staff ratios and its stroke services, HSJ has learned.

The Care Quality Commission’s final report on the trust is not due until next month, but concerns raised by inspectors in preliminary feedback in January were set out in a report from the trust’s February board meeting.

The report said the CQC had raised “concerns over the trust’s ability to maintain registered nursing staffing levels to the ratio as indicated in [the National Institute for Health and Care Excellence] guidance”.

The report added: “While all of the issues noted by the CQC are important the CCG and partners have agreed that the priority areas for immediate action are bed capacity, staff to patient ratios and maintaining safe effective stroke services.”

The report also revealed the trust’s lead commissioner, Southend Clinical Commissioning Group, called an “emergency health care system meeting” just days after inspectors visited...read more

 

Alarm raised over trust's 'risky' proposal to run A&E without specialist consultants (HSJ: 21 March 2016)

Health leaders in Yorkshire are considering options for running an emergency department without dedicated consultants.

Scarborough Hospital, which is run by York Teaching Hospital Foundation Trust, has long struggled to recruit emergency medical consultants, commonly known as A&E consultants, and is exploring options to make its services sustainable.

Senior clinicians believe a new model can be devised whereby patients could initially be seen by “advanced clinical practitioners”, who have typically trained as nurses or paramedics, but then passed on to the specialty consultant in the relevant department more quickly.

The Royal College of Emergency Medicine has raised concern over the proposal, describing it as a “highly risky strategy”...read more

 

Hundreds more hidden patients waiting 52 weeks for treatment (HSJ: 17 March 2016)

At least 378 more patients than previously thought have been waiting a year or more for planned treatment, HSJ has uncovered. The most recent official NHS England data, for January, shows 722 patients in England waiting 52 weeks or more for treatment. However, this does not cover waiting lists at nine hospital trusts which have been allowed to stop reporting data.

HSJ revealed earlier this month that 1,015 patients were waiting more than a year for treatment at Barking, Havering and Redbridge University Hospitals Trust at the end of January.

We have now established that, across six of the other non-reporting trusts, there were a further 378 patients in this category...read more 

 

Private health provider goes into administration (Northern Echo: 15 March 2016)

PATIENTS are facing an uncertain future after a private company that runs health care services in east Cleveland revealed it was in financial difficulty.

The future of Marske Medical Centre is in doubt after the private healthcare company which took over less than a year ago went into administration.

The contract to run the centre - which had been under the control of the South Tees NHS Foundation Trust - was awarded to Doncaster-based Danum Medical Services Ltd (DMSL) in April last year.

A spokesman for DMSL said: “I can confirm that DMSL has gone into administration....read more

 

Why contracting out to private health providers doesn’t always work (The Guardian: 15 March 2016)

The NHS (Reinstatement) bill received its second reading in parliament last week. Its aim is to reverse the creeping privatisation of our health service.

The 2012 Health and Social Care Act opened up the NHS to competition. Since then, there has been a gradual privatisation of health services, some working well, others less so, covering a range of services from general outpatient work, to physiotherapy, ophthalmology, diagnostic and even children’s services.

In the last few years, in order to reduce waiting times, many of my patients who have been referred to gynaecology have been seen at Spire private hospital in Bristol. A few patients have also chosen to go a bit further away to a private hospital in Bath run by Circle for a wide range of specialities – although these are usually our more mobile patients as most prefer to travel locally to their hospital appointments. The general feedback has largely been similar to the local NHS hospital: overall patients have been happy with their experience.

However, there are other services such as hip and knee operations and general surgery offered on the NHS by private providers such as local treatment centres that have caused some worry among GPs and patients. There are fears that they “cream off” the easy work by seeing the well patients, leaving the more risky cases (needing longer inpatient bed days and with higher complication rates) for the local NHS hospitals. This has certainly been my experience of our local treatment centre run by Care UK.

Since it opened in 2009, communication has not always been effective and there is a general sense among GPs of fast patient turnover. The aftercare has not always been there – we have been asked as GPs to refer patients for physiotherapy after surgery when this would normally have been done automatically and in a timely manner if the patient had attended the local NHS trust. Most GPs have never had easy access to physiotherapy services and this has introduced delays and led to slower rehabilitation in patients....read more

 

GP practices face £20,000 losses as federation goes bust (Pulse: 15 March 2016)

A GP federation providing APMS services for 37,000 patients has gone into administration after running into financial difficulties leaving local GPs thousands of pounds out of pocket.

Danum Medical Services Ltd (DMSL) is a private limited company set up in Doncaster by the 23 local shareholding practices - which DMSL’s website says ’equates to 63 individual shareholding GPs’ - which holds APMS contracts for six practices in the Midlands and Yorkshire.

The company previously held major contracts for an extended hours hub and GP out-of-hours services in Doncaster, but hadn’t managed to secure them again when the contracts expired and went out to competitive tender last year.As a result, one shareholding practice told Pulse they were facing losses in the region of £20,000...read more

 

NHS struggling to plug a £22bn funding 'black hole', says report (The Guardian: 15 March 2016)

The NHS in England lacks a convincing plan to plug a £22bn “black hole” in funding within five years, according to parliament’s spending watchdog. A significant number of acute hospital trusts are in “serious and persistent financial distress”, there is a “spiralling” trend of increased deficits and the current payment system is “not fit for purpose”, the public accounts committee said. 

A report published on Tuesday found that reliance on agency staff, sometimes at “rip off” costs, had contributed to the dire situation and NHS trusts were also trying to meet unrealistic savings targets.

The conclusions followed a further examination of a National Audit Office inquiry into NHS finances, which was published in December.

Meg Hillier, the chair of the committee, said the government had done little to support trusts facing financial problems. “Without urgent action to put struggling trusts on a firmer financial footing there is further serious risk to services and the public purse,” she said.

“In particular, it is unacceptable for senior government officials simply to point to excessive agency costs as a source of trusts’ difficulties.

“It is the job of those officials to take action to control spending on agency staff, and to address its underlying causes. The use of agencies is a sticking-plaster solution to deep-rooted problems with NHS workforce planning.”..read more

 

Revealed: Failed Cambridgeshire provider asked for £34m bailout after just one month (HSJ: 10 March 2016)

The controversial Cambridgeshire older people’s services contract collapsed because the provider expected to be paid substantially more than had been agreed in the deal, an audit has found. 

The investigation into one of the largest deals ever awarded for NHS clinical services has also raised serious questions over the quality of advice received by Cambridgeshire and Peterborough Clinical Commissioning Group.

UnitingCare Partnership’s contract was worth £725m over five years. The contract, which was awarded to UnitingCare Partnership in November 2014, was worth £725m over five years, and collapsed after just eight months of operation in December.

UnitingCare was a limited liability partnership jointly owned by two local trusts: Cambridgeshire and Peterborough Foundation Trust, and Cambridge University Hospitals FT.

An audit by West Midlands Ambulance Service Foundation Trust, carried out on behalf of the CCG, found that one month into the contract the provider asked for an extra £34.3m for the year. This would have been worth 23 per cent of the £152m contract value for the first year of the contract...read more

 

Charity warnings over clinical reference group cuts (HSJ: 11 March 2016)

Charities have written to NHS England raising concerns about plans to cut the number of clinical reference groups and reduce their membership, HSJ has learned.

The Brain Tumour Charity and Sarcoma UK have sent a letter to Simon Stevens, the chief executive of NHS England, warning that the move will “dilute” the specialist advisory knowledge currently provided about different cancer types.

Charities are worried about specific CRGs being merged into a broader “cancer surgery CRG”

The Neurological Alliance and the British Kidney Patient Association have also said that reducing CRGs’ membership will impact their ability to represent patients.

Last month NHS England announced it was planning to cut the number of CRGs from 71 to 38. The groups are responsible for advising NHS England on how it spends its £14bn specialised services budget, and help it to develop commissioning policies and service specifications...read more

Why are more children being prescribed antidepressants? Funding cuts (The Guardian: 11 March 2016)

New research published this week shows that between 2005 and 2013 there was a 54% increase in the number of children and young people prescribed antidepressants in the UK. The World Health Organisation’s director of mental health, Dr Shekhar Saxena, has expressed concern about the reasons behind this rise.

Antidepressants are not licensed for prescription for under-18s, with one exception. The National Institute for Health and Care Excellence clinical guidelines state that fluoxetine, a type of selective serotonin reuptake inhibitor, can be used in under-18s, but should not be prescribed without first referring the child for talking therapy. The two treatments should coexist and the child should be monitored carefully, particularly in the first few weeks after starting the drug, when the risk of the “major harm” Saxena speaks of is at its highest....read more

 

NHS records worst ever performance figures (The Guardian: 10 March 2016)

The NHS recorded its worst ever performance in the first month of the year as services struggled to cope with unprecedented demand for A&E care, hospital beds and ambulances.

Hundreds of thousands of patients were forced to wait longer than they should for time-critical care as the NHS missed almost all its key waiting time targets.

The latest monthly performance data, released on Thursday by NHS England, shows that hospitals buckled badly during January, partly because the traditional “winter pressures” arrived later than usual.

A total of 212,136 patients waited more than the maximum four hours to be admitted, transferred or discharged from hospital A&E units – the highest number ever. Hospitals only treated 83% of A&E patients within four hours, way below the 95% standard they are meant to achieve...read more

 

Patients suffering cardiac arrests left without help because maps did not work (Telegraph: 4 March 2016)

Patients suffering cardiac arrests were left without help because a scandal-hit ambulance trust used a failed maps system, an investigation has found.

Secret protocols authorised by Paul Sutton, the head of South East Coast Ambulance trust, meant that thousands of 999 calls were counted as receiving an 8 minute response, just because the patient was within 200 metres of a heart-starting device.

The unauthorised scheme meant that national targets were achieved regardless of when help was sent - and whether or not the patient could be helped by a defibrillator.

Now an investigation has been told that failings in the trust’s mapping system meant that call-handlers sometimes could not even tell callers where to go to find the life-saving equipment.

Incredibly, calls were counted as receiving an 8 minute response, simply because the caller was within 200 metres of the public access devices – even if they had almost no chance of finding it...read more

 

One in ten GP practices 'at risk of closure', warns BMA (Pulse: 3 March 2016)

More than 800 GP practices in England are at risk of having to close due to being ’financially unsustainable’, a major BMA survey has shown.

The survey of 2,830 practices found that 294 practices (10%) regard themselves as financially unsustainable within the next year.

It also shows that almost half of practices in England (46%) say they have at least one GP planning to retire, or leave UK general practice, in the next 12 months;The GPC says it has conducted the survey to supply evidence of the ‘state of emergency’ general practice is in, and the results follow the Special LMC Conference in January, which called on the GPC to consider canvassing the profession on potential mass resignation in six months...read more

 

700 community staff to be transferred twice in months (HSJ: 18 March 2016)

Hospital staffing crisis as 40% of consultant posts remain vacant (The Guardian: 15 March 2016

Warning overseas recruitment is only a 'stop gap' for nurse shortages (Nursing Times: 10 March 2016)

Prestigious teaching trust restricts access to heart service (HSJ: 1 March 2016)

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