Comment / News review

The government’s full response to the Francis report (see After Francis, page 10) grabbed many of the headlines in the final days of November. But before and after the reply was issued, talk of NHS staffing dominated. Using nurse numbers as a proxy for the quality and safety of the service, shadow health secretary Andy Burnham insisted headcount had fallen by almost 6,000 since the coalition took office. The government countered by highlighting trusts’ plans to hire more than 3,700 nurses. But, as for most of the year, the issues of quality and safety raised by a discussion of the Francis report are often accompanied by debate about A&E.

NHS England medical director Sir Bruce Keogh released his review of urgent and emergency care (see page 6). Elsewhere, work trying to shed light on why A&Es face so much pressure continued. The number of avoidable emergency admissions is rising, according to the Care Quality Commission’s annual State of care report. The CQC called on GPs, care homes, community and acute providers and commissioners to work together to address avoidable admissions and provide care out of hospital where possible. In the NHS there was no overall improvement in treating patients with dignity and respect, it said, and highlighted concerns over nursing homes and home care agencies.

There is nervousness in Whitehall about the coming winter and shortly after the CQC report, it was announced that a further £150m would be handed to emergency departments across England. NHS England said this would help hospitals maintain their A&E services over the winter months and was in addition to the £250m targeted at the most at-risk areas in September. Areas not deemed at risk will be eligible for a share of the £150m. The funds will be drawn from NHS England’s expected 2013/14 surplus and allocated to 157 clinical commissioning groups based on capitation. Health secretary Jeremy Hunt said the £250m would give the NHS in England an extra 2,500 beds and the equivalent of 3,000 extra staff (temporary staff, extended hours for existing staff and new posts).

NHS spending on branded medicines will be fixed for the next two years and increase by less than 2% in each of the following three years, following the agreement of outline terms for a new pharmaceutical price regulation scheme (PPRS). The Department of Health said the five-year deal represented a significant saving, as branded medicines spending had grown by 5% on average in recent years. The deal would allow the NHS to increase access to the most clinically effective branded drugs without the risk that costs would spiral out of control, it added. The PPRS is voluntary, but pharmaceutical companies that do not take part in the scheme face a 15% cut in prices.

Like many households concerned about rising energy bills, the NHS must keep a firm grip on its fuel costs. The Department of Health said it was giving nearly 70 hospitals a total of £50m to help them cut their energy bills by £13.7m a year. The schemes to be taken forward with the money include the provision of electric cars, better insulation and a reduction in staff travel. The Department said the money saved should be redirected to patient care. As well as the financial savings, the initiative would reduce energy consumption by almost 200 million kilowatts. 

NHS boards in Scotland delivered efficiency savings of £270m in 2012/13, according to the NHS Scotland chief executive’s annual report – £6m over the 3% efficiency target. More than 75% of the savings were recurrent. The National Procurement agency gained an extra £39m in savings. The report said there was a big reduction in healthcare-associated infections, with C.diff levels at the lowest since records began. Interim chief executive John Connaghan said the NHS now had a long-term plan for improving both the quality of care and Scotland’s public health record.

The Foundation Trust Network (FTN) risked reigniting October’s row with unions when it called for no cost of living pay increase for NHS staff on agenda for change contracts in 2014/15. It said a pay increase was not sustainable, given the demands on the NHS. Though the FTN recognised the correlation between staff satisfaction and quality of care, pay awards had to be seen in a wider economic context and the need for reform of staff pay, terms and conditions, it said. ?

The NHS England review of incentives, rewards and sanctions recommended greater flexibility to support commissioners and providers trying to transform services through radically different contracting and payment models. This should include flexibility in commissioning for quality and innovation (CQUIN) and contract sanctions. A paper put before the NHS England board meeting in November said the structure of the national CQUIN scheme should remain broadly the same. There should be four CQUIN indicators in 2014/15, based on the friends and family test; dementia and delirium (acute trusts only); diagnosis coding and associated quality improvement (mental health trusts only); and the NHS safety thermometer. Each should be worth a minimum of 0.125% of the total value of the contract (excluding drugs and devices), it said. ?

The NHS England 2014/15 mandate put an additional focus on mental health. The mandate, released by the Department of Health, said the NHS must strive to put mental healthcare on a par with physical healthcare. It said there would be new waiting times and access standards for mental health from 2015. ?

Colchester Hospital University NHS FT was put into special measures after the Care Quality Commission said its cancer care was inadequate. Monitor found the trust had breached its licence and will appoint an improvement director. It will also ask a high-performing FT to offer support to improve the cancer pathway, and impose a licence condition to ensure there is enough management capacity to run the trust.

New leaders are coming to the NHS Confederation. Leeds Community Healthcare NHS Trust chief executive Rob Webster is to succeed Mike Farrar as chief executive. Mr Webster has held national roles in the Department of Health on access, primary care, finance and efficiency. He will be joined by new deputy chair Sir Andrew Cash, who remains chief executive of Sheffield Teaching Hospitals NHS Foundation Trust.