Comment / News review

Two of the longest-running health service controversies drew closer to a conclusion during March, as the future of services currently based at Mid Staffordshire NHS Foundation Trust became clearer and the South West Pay, Terms and Conditions Consortium published its final report.

It came as little surprise that Monitor’s team of experts concluded that services at the Mid Staffordshire trust should be split. The contingency planning team, appointed by the regulator to look at the trust’s future, said the trust is not clinically sustainable because the level of patients and staff are insufficient to meet standards of emergency surgery and critical care long term. The team proposed there should be two smaller hospitals, providing services for four-fifths of current patients. Specialised and serious care should be provided at other local hospitals, including University Hospital of North Staffordshire, Royal Wolverhampton Hospitals and Walsall Healthcare trusts. Monitor took the decision in principle to put the Mid Staffordshire trust into special administration last month.

Launching its final report, the South West Pay, Terms and Conditions Consortium insisted its work aimed to encourage national solutions, wherever possible, to balance pay and other pressures on the NHS. Consortium chair Chris Bown (left) said there were no proposals to implement regional pay in the report. The consortium had generated debate, encouraged national agreements and identified areas where changes must be made, he said. The recommended approach for consortium members included working with national bodies to lobby for changes to reduce costs in return for benefits for employees. It has also published a paper that examines ways of making the most of existing pay, terms and conditions for all staff groups. Health unions claimed victory, saying three of the consortium’s 19 member trusts had indicated they would not be involved should the consortium be revived.

The government was forced to redraw its proposed competition regulations. The amendments followed an initial proposal in February to allow contracting out under the Health and Social Care Act 2012. Various groups, including GPs and coalition members, had voiced concern that the government had dropped its commitment to allow commissioners alone to decide whether services should go out to tender. A clause limiting commissioner scope to award a contract without competition was dropped. The Department of Health said Monitor will have no power to compel the competitive tendering of services.

Also in Parliament, the Lords committee on public service and demographic change warned the NHS and other public services were ‘woefully underprepared’ for the rapidly ageing population. A committee report said that between 2010 and 2030, England will see a 50% rise in over-65s and a 100% increase in over-85s. Health and social care services will need a radically different model of care to support the ageing population in their homes and community, it added. The newly named NHS?England has reminded clinical commissioning groups (CCGs) of the incentives to

roll out the friends and family test (FFT). From

1 April, all patients in acute inpatient hospital wards and A&E departments in England should be asked to complete an FFT. It is a requirement of the NHS standard contract and attracts 12.5% of the CCG quality premium, as well as being one of the national CQUIN (commissioning for quality and innovation) goals for 2013/14 and a key indicator in domain 4 of the NHS Outcomes Framework.

Quality of services to patients and incentives dominated a National Audit Office report into GP out-of-hours services ?in Cornwall. The NAO said commissioners should review the contract for the provision of out-of-hours GP services to make a clearer link between financial incentives and the achievement of quality standards. The report on the services, provided by Serco, was prompted by concern that insufficient staffing was making it unsafe. While Serco regularly did not have enough staff to fill all clinical shifts during 2012 and had not consistently met Department of Health-set quality standards, the report said the company had taken action and performance was improving. ?

More than a third of GPs on the boards of clinical commissioning groups (CCGs) have a conflict of interest as a result of directorships or shares held in private companies, according to the British Medical Journal. The study said more than a third (36%) of the 1,179 GPs in CCG executive positions have a financial interest in a for-profit private provider other than their own practice. These range from small local businesses offering diagnostic tests and out-of-hours care to holding shares in large private healthcare providers. ?

New Wales health minister Mark Drakeford (below) pledged to examine health board finances and learn the lessons of 2012/13. Mr Drakeford, appointed to succeed Lesley Griffiths in a reshuffle in March, said there would be consequences if health boards failed to balance their books. His predecessor had threatened to sack managers if their organisations did not live within their means. In a BBC interview, he said he could see a ‘persuasive case’ for asking boards to balance their books over a three-year period, but wanted safeguards to ensure the NHS would not rack up huge deficits over three years.

NHS?England said two commissioning support units (CSUs) are to merge. West Yorkshire CSU and South Yorkshire and Bassetlaw CSU will form West and South Yorkshire and Bassetlaw CSU. There are now 19 CSUs across the country. ?

And, ahead of the formal launch of the new commissioning structure this month, NHS?England authorised the final wave of 48 clinical commissioning groups (CCGs). It said 10 CCGs in the final wave have been fully authorised, while 38 have been authorised with conditions that they should be able to discharge shortly. Seven of these 38 CCGs have been issued with legal directions and will receive formal support from NHS?England. It added that 106 of the 211 CCGs were authorised without conditions; 105 with conditions; and 14 with legal directions.