Comment / News review

The start of April marked the first anniversary of the implementation of the coalition government’s reforms of NHS commissioning in England. It also saw changes at the top of the national commissioning body, NHS England. New chief executive Simon Stevens (right) marked his first day in the post with a visit to Shotley Bridge Hospital, County Durham, where he started his NHS career as a trainee manager 26 years ago. Speaking later in Newcastle, Mr Stevens vowed to listen to patients and spoke of the importance of integration. He said at a time when resources were tight, the service had to tap into sources of ‘renewable energy’ – by boosting the role patients play in their care; supporting carers and volunteers; and ‘unleashing the passion’ that drives NHS staff to devote their professional lives to healthcare.

GPs expressed their opinion of the reforms, which aimed to engage and empower family doctors in commissioning. According to a King’s Fund/Nuffield Trust survey, fewer GPs feel fully engaged in clinical commissioning groups 12 months after the bodies were officially launched. Fewer than half of GPs said they felt CCG decisions reflected their views and just one in three felt the groups were owned by their members. However, an increasing number of GPs said CCGs had a legitimate role in influencing their practice, including prescribing, and they were positive about how CCGs could improve general practice. ?

In April, the Department of Health and NHS England outlined proposals to extend GP opening hours and enhance care of the elderly. They said that more than 7.5 million people in England would be offered access to their GPs seven days a week as part of year-long pilots. They added that 800,000 people with the most complex needs – mostly patients aged over 75 – would be included in the Transforming primary care programme of proactive, personalised care. ?

The King’s Fund set out to challenge widely held beliefs on urgent and emergency care. It published a ‘myth buster’ in response to confusion surrounding the debate on pressure in the urgent and emergency care system. It tackles five issues, including that A&E waiting times have risen dramatically. It said that while the proportion of patients waiting longer than four hours to be treated, admitted or discharged had risen in recent years, performance had broadly stayed within target (though the target has been relaxed). Even so, waiting times remained low compared with 2003. Figures published for the final quarter of 2013/14 show that 4.84% of patients waited longer than four hours – the first time since 2009 that this has improved compared with the same quarter the previous year. There is also wide variation for national figures, with stronger performances in walk-in centres and minor injuries units improving the national average. ?

Long waits in A&E and concerns about finances led Monitor to launch an investigation into Barnsley Hospital NHS Foundation Trust. The regulator said the trust had breached the national A&E quarterly target five times in 18 months. The trust’s financial performance had also deteriorated, resulting in a reported deficit of £2.3m in February 2014. Monitor is to look into whether these problems indicate wider issues with how the trust is run. ?Monitor also opened an investigation into the way Central North West London (CNWL) NHS Foundation Trust is run. The health regulator acted after the Care Quality Commission issued warning notices in March relating to care of mental health patients at some of the trust’s centres. Monitor’s investigation will examine whether the trust has robust and effective systems in place for identifying and rectifying any problems with the quality of care. ?

The regulator had better news for Poole Hospital NHS Foundation Trust. Monitor said it had closed its investigation into the trust as it had concluded it was taking appropriate action to improve its finances. The regulator launched its investigation last June after concerns were raised about the trust’s financial sustainability. However, Monitor said the trust board was taking the necessary steps to address its financial issues, including a new service efficiency plan. ?

NHS England approved funding for a new drug treatment for hepatitis C. The £18.7m investment will mean about 500 patients with acute liver failure and/or waiting a transplant could benefit from sofosbuvir. NHS England said its decision to fund the potentially life-saving drug proved its commitment to wider access to cutting-edge treatment.

NHS England and the Care Quality Commission have published guidance on publishing safe staffing data, including a timetable for action. The move on staffing transparency is part of the health service response to the second Francis report. Measures include boards receiving half-yearly reports on staffing capability and capacity (starting in June); every ward displaying information on staff present and planned on each shift; and each board discussing a monthly update on planned and actual staffing. The latter should be made public, according to the guidance. ?

The staffing guidance followed the launch of a patient safety campaign. Health secretary Jeremy Hunt (left) called on NHS trusts to sign up to his ‘Sign up for safety’ campaign, saying unsafe care was bad for patients and wasted funds. One study had claimed £1bn worth of bed days were wasted on preventable harm, he added.

The Nuffield Trust and Health Foundation published a report assessing the performance of the NHS on the quality of patient care in all four UK countries since devolution. It found performance improvements in all four countries, with particular progress in Scotland linked to tougher sanctions and targets. However, since 2010, waiting times in Wales have risen as austerity has set in. But researchers said overall the performance gap between the NHS in England and the rest of the UK had narrowed in recent years, with no country consistently ahead of or lagging behind the others. Health spending in each country doubled between 2000/01 and 2012/13, though in general it had slowed due to the economic climate – over the three years from 2010/11 to 2012/13, there was annual growth in Northern Ireland (2%) and England and Scotland (1%), and a 1% reduction in Wales.