Addenbrooke’s shows flaws among elite 25 September 2015 The Care Quality Commission’s decision to classify the renowned Cambridge University hospitals foundation trust, which runs Addenbrooke’s hospital, as inadequate is only the latest example of specialist hospitals running into serious problems with their district general hospital (DGH) services. Imperial College healthcare NHS trust was designated “requires improvement” last December, with concerns over cleanliness, weaknesses in the safety culture and “markedly varied” leadership in its hospitals. The famous John Radcliffe hospital, part of Oxford University hospitals NHS trust, was similarly judged “requires improvement” in May 2014 in light of a failure to learn from “never” events and problems in surgery, while senior doctors were said to be alienated from the board. In January 2014 the CQC issued University College London hospitals foundation trust with four compliance notices over the risk of unsafe surgery, serious problems in A&E and poor record-keeping on its wards. Read the full article on the Guardian Healthcare Network __________________________________________________ Hunt sounds death knell for foundations 11 September 2015 There is a growing sense of urgency – if not yet panic – at the Department of Health about the pace of reform in the NHS. With overwhelming evidence (pdf) that virtually nobody in the health service believes the target of £22bn of efficiency savings has any chance of being achieved, and an underlying accumulated deficit among providers close to £2bn, the health secretary, Jeremy Hunt, is trying to hit the accelerator. He told the Health Service Journal bluntly that there are “too many trusts as independent organisations”, and is driving providers towards the model proposed by Salford Royal foundation trust chief executive Sir David Dalton of the biggest and best providers having chains and franchises of organisations and services. There are some brave assumptions here – that senior managers who are good at leading one organisation will be good at leading several, which doesn’t follow, and that there will be sufficient capacity and support to deliver robust improvements in clinical quality without destabilising services in the host organisation, which is far from certain. But despite the difficulties, it is vital that fast, scalable ways to spread excellence are developed. Read the full article on the Guardian Healthcare Network __________________________________________________ Corbyn is right: PFI was a costly mistake 28 August 2015 There can’t be many issues that unite Jeremy Corbyn and Andrew – now Lord – Lansley, but the impact of the private finance initiative on the NHS is one of them. Corbyn has called for a fund to be established to bailout NHS trusts saddled with PFI schemes. In 2012 Lansley gave seven NHS trusts whose PFI deals were unaffordable access to a £1.5bn fund. All the deals had been negotiated under the Labour government. Last year an inquiry by the public accounts committee into the financial stability of NHS organisations laid bare the huge burden that PFI deals for building and operating NHS facilities is imposing. Almost a third of providers have a PFI scheme, costing the NHS a total of £1.8bn year. Trusts with the highest charges were most likely to have poor financial results – in 2013-14 four of the six trusts with deficits of more than £25m had a PFI scheme. Read the full article on the Guardian Healthcare Network __________________________________________________ Will some patients have to pay for care? 14 August 2015 With NHS providers on track to run up deficits in the region of £2bn this year, the spectre of patients paying for more services again looms over the NHS. Last year’s combined deficit of £822m across the provider sector hid an even more serious truth: add in the extra £250m from the Treasury and another £650m transferred from capital budgets and the underlying deficit was nearer £1.7bn. With little prospect of finding the required £22bn of efficiencies, and the Health Foundation and King’s Fund pressing for even more money on top of the additional £8bn already promised by the chancellor, George Osborne, one way or another we are going to have to find other ways to pay. We can thank the Germans for all but killing off one idea that used to be touted – paying to see your GP. In 2004 Germany introduced a €10 quarterly payment but the Bundestag unanimously scrapped it eight years later. Predictably, the cost of administration almost outweighed the money collected, and there is some evidence that it deterred people on low incomes from seeing their doctor. The strongest argument against charging to see a GP here is that it would destroy the best thing about the NHS – that it is free at the point of need. But there are other ways the edges of that principle could be blurred. Read the full article on the Guardian Healthcare Network __________________________________________________ Lords defeat reveals devolution’s limit 31 July 2015 A little reported Lords defeat for the government over its plans to devolve powers to major cities has major implications for local control of the NHS. Last week an amendment was moved successfully by Labour peer Norman Warner to the cities and local government devolution bill which stops the transfer of NHS regulatory functions held by national bodies. Crucially, if the amendment is not reversed in the Commons, it will ensure any devolved services adhere to national service standards and are still nationally accountable. The bill, part of the “northern powerhouse” drive to devolve responsibilities to major cities, has become the vehicle for devolving £6bn of health and care spending to Greater Manchester. The amendment underscores Labour suspicions that the Conservatives want to whittle away the health secretary’s ultimate responsibility for providing a national health service. This caused a row during the passage of Andrew Lansley’s NHS reforms during the last parliament, when the government had to accept an amendment spelling out the requirement for the health secretary to remain accountable no matter how much control was passed to NHS England. Read the full article on the Guardian Healthcare Network __________________________________________________ Hunt’s NHS vision is already in difficulty 17 July 2015 Jeremy Hunt’s “25-year vision” for the NHS, unveiled this week, is an amalgam of rapid change, inspiring transatlantic collaboration, another round of institutional demolition, a gimmick and a plan for the release of dodgy patient safety data. The ultimatum to the BMA over seven-day working – forcing through new seven-day contracts – reflects frustration at the excruciatingly slow progress towards achieving this key patient safety goal. Getting it in place has been dogged by questioning of the mortality data, demands for more money and arguments over the out of hours availability of support services. While all these have their merits, they do not amount to a justification for endless prevarication. It is a tough deal for doctors, but it will drive through a crucial and long overdue cultural change. But forcing through the gradual adoption of new contracts does not mean it can be done for free. The contracts will not be enough to deliver the change in hospitals sliding into deficit. It is possible that some trusts will find efficiencies from seven-day working but most will need sizeable up-front investment. Read the full article on the Guardian Healthcare Network __________________________________________________ What Hunt can learn from predecessors 2 July 2015 What do you learn from taking on the toughest job in government, secretary of state for health? At the Institute for Government three former secretaries – Conservative Stephen Dorrell and Labour’s Alan Milburn and Patricia Hewitt – shared their wisdom alongside incumbent Jeremy Hunt, who was apparently keen to learn from the wise words of his predecessors. Co-hosted by the Health Foundation, it followed the publication of Glaziers and Window Breakers, interviews with 10 former secretaries of state, which was the first document Hunt found on his desk on returning to the Department of Health’s Richmond House headquarters after the election. The fact that even the passing of decades has not diminished their fascination with the role says a great deal about the hold the post has over those who occupy it. As Dorrell pointed out, there is nothing new that health secretaries have to deal with – a unique mix of policy and management. While the plan to devolve healthcare powers to Greater Manchester is portrayed as an innovation, 70 years ago Nye Bevan and Herbert Morrison were debating within the cabinet of Clement Attlee the tensions between local and national control of healthcare. Read the full article on the Guardian Healthcare Network __________________________________________________