Comment / News review

February kicked off with the NHS digesting the health secretary’s decision to dissolve South London Healthcare NHS Trust by October, its three hospitals taken over by neighbouring trusts. Lewisham Healthcare NHS Trust, caught up in the wider reconfiguration of services across the patch, asked the Department of Health for more details on its decision to downgrade its A&E and maternity departments. It launched a campaign to tell local people that the hospital was open for business as usual and that no changes would happen overnight. 

However, the spotlight quickly shifted to Staffordshire, where Robert Francis gave his verdict on the failings at Mid Staffordshire NHS Foundation Trust. Mr Francis’ report on the trust was a chastening moment for the health service as a whole. It detailed individual and systemic failings and made far-reaching recommendations that could radically alter NHS culture, regulation and nurse training (see ‘Plain speaking’, page 21). While ministers agreed with many of Francis’ proposals, they immediately appeared to rule out one of the key recommendations – the creation of a single regulator by transferring Monitor’s responsibilities to the Care Quality Commission. A full government response is due this month and Staffordshire police are to examine the report to identify whether there is potential for criminal charges.

Not surprisingly, in the wake of the report many announcements were geared to the agenda Mr Francis had set. Health secretary Jeremy Hunt (right) asked the NHS Confederation to lead a review of bureaucracy, to improve clinical outcomes and free up time to care. In a speech he added that the installation of a chief inspector of hospitals at the CQC – a move suggested by David Cameron in his initial response to Francis – would put quality of care on a par with financial stability in terms of the priority given by trust boards. Mr Hunt said the inspector would draw the many NHS inspection regimes together.

From next month, there will be a new system for assessing the hospital environment. Annual patient-led assessments of the care environment (PLACE) will replace patient environment action team (PEAT) inspections. PLACE will maintain a focus on privacy and dignity, cleanliness, food and building maintenance but under the auspices of Healthwatch. Patients and representatives will make up at least 50% of the assessment team. As before, the new assessment does not cover clinical care provision or staff behaviour.

It was impossible not to view other announcements through the prism of Francis, even though his report was quickly overtaken in the national psyche by the horsemeat scandal. Marrying concerns over nutrition and food, the Campaign for better hospital food said governments had wasted more than £54m over the last 20 years on failed initiatives to improve hospital meals, many of which were fronted by celebrity chefs. The campaign was joined by some well-known cooks previously hired by the Department of Health to improve NHS meals, including Loyd Grossman and Albert Roux. The campaign’s report, Twenty years of hospital food failure, called for mandatory nutritional standards, similar to those set for schools. These should be introduced within the next 18 months, it said.

Away from the headlines, the transformation of the NHS in England continued. The NHS Commissioning Board (NCB) authorised a third wave of clinical commissioning groups (CCGs) to begin operation on 1 April. Six of these have been authorised with no conditions, 56 with conditions – many of these should be discharged soon. Five CCGs have been authorised to take full control of their commissioning budgets, but with more intensive support. This will be provided by the NCB and will be underpinned by legal directions. In total, 163 CCGs have been authorised so far, with the remaining 48 due for authorisation this month.

Commissioning support units (CSUs) were urged to offer greater support to CCGs to allow them to deliver service reconfiguration. A recent NHS Commissioning Board/ NHS Clinical Commissioners event, attended by CCG and CSU leaders, agreed CSUs must respond to the emerging policy for CCGs, which puts QIPP (quality, innovation, productivity and prevention) and lessons learned from the Francis report at the heart of what they do. There was strong support for a procurement framework from which CCGs could call off services, but the commissioning leaders said priority should be given to transformational support.

Seemingly oblivious to the arguments about its future, Monitor continued business as usual – releasing details of its licence and publishing work on costing while also regulating foundation trusts. The regulator told Rotherham NHS Foundation Trust it must improve its finances urgently. Monitor found the trust in significant breach of its terms of authorisation as it had significantly underperformed on its financial plans, including savings. The regulator removed Wirral University NHS Foundation Trust from significant breach, saying it had significantly reduced elective waiting times and improved the way the trust was run.

Scottish health secretary Alex Neil (below) confirmed that territorial health boards will receive an extra 3.3% in 2013/14, an increase of 1.3% in real terms. Overall, all health boards will see expenditure totalling £9bn, a 2.9% rise but will have to make efficiency savings of at least 3%. Meanwhile, Audit Scotland called for greater management and scrutiny of NHS waiting lists. This follows its audit of the management of waiting lists after manipulation and misreporting of performance was revealed at NHS Lothian in 2011.

The month ended with a proposed shake-up of services in another part of London. The boards of University College London Hospital NHS Foundation Trust (UCLH) and Barts Health NHS Trust agreed a proposal put forward by clinicians to combine specialist cardiovascular services at St Bartholomew’s Hospital from April 2014. Under further proposals for cancer services, complex bladder and prostate surgery will be based at UCLH, while complex renal cancer surgery will be based at the Royal Free London NHS Foundation Trust.