Comment / News review

Health news in April was dominated not by the arrival of new commissioners and the newly rebranded NHS England and National Institute for Health and Care Excellence, but by a measles outbreak and a row over clinical quality and service reconfiguration, which may have repercussions for those hoping to implement quick service change.

The debate over the consolidation of children’s cardiac surgery has raged for years, but the conclusions of the ‘Safe and sustainable’ review last year were challenged by parents of children treated at Leeds General Infirmary, one of the centres earmarked for closure. In March a parents’ action group won a judicial review on the decision, but just a day later NHS medical director Sir Bruce Keogh presented data to its parent, Leeds Teaching Hospitals NHS Trust (left), suggesting a death rate twice the national average. The surgery was stopped at once.

Campaigners and local politicians cried foul. John Gibbs, a former cardiologist at Leeds and chair of the Central Cardiac Database, which supplied the figures, described the data as ‘work in progress’ and their release ‘rings of politics rather than proper process’. Sir Bruce said the timing was unfortunate but he had no choice but to act, particularly after three clinicians (not based at Leeds) had contacted him to express concern over the outcomes at the unit.

About 10 days after surgery was halted, NHS England announced the trust would be allowed a phased restart. This followed an independent clinical review that provided reassurance on the safety of the service. A further review is ongoing and the trust has been asked to improve its data. It was confirmed that  National Institute for Cardiovascular Outcomes Research (NICOR) director Sir Roger Boyle, one of the clinicians who expressed concern to Sir Bruce, would take no further part in the Safe and sustainable review team after he said he would not want his daughter treated at Leeds. He later resigned from NICOR. A week after surgery resumed, NHS England announced it would appeal the High Court decision on the heart services review.

Just as NHS England announced its appeal, the Care Quality Commission (CQC) published its strategy for the next three years. Raising standards, putting people first said the CQC will consider appointing a third chief inspector covering primary and integrated care. The inspector would work with the previously announced inspectors for hospitals and social care and support. The CQC would also introduce radical changes to ensure providers of NHS services offered safe, effective, compassionate and high-quality care. It would publish better information, develop fundamental standards of care and carry out more in-depth reviews of hospitals with significant or long-standing problems.

The CQC also published the results of the NHS inpatient survey of the experiences of more than 64,500 patients admitted to NHS hospitals in 2012. It noted improvements in areas such as cleanliness, but said there was room for ongoing improvement. There was no statistically significant change since 2011 in key aspects of care, such as help with eating, involving patients in decisions and discharge arrangements.

A measles outbreak in the Swansea area led to a mass vaccination programme as the number infected rose to almost 1,000 and one man who died was shown to have measles. In one week more than 10,000 people received the MMR (measles, mumps and rubella) vaccine. Some doctors linked the outbreak to parents’ unwillingness in the late 1990s to immunise their children because of research that linked the triple vaccine to autism. That research was discredited, but many children were never vaccinated.

The public remain committed to the current way of funding the health service, but could support the introduction of charges in some circumstances, according to the King’s Fund. How should we pay for healthcare in the future?, published with pollster Ipsos Mori, reported on two one-day events exploring the public’s attitude to paying for healthcare. Participants backed the founding principles of the NHS (such as access based on need not ability to pay), but there was support for some charges – treatments not clinically necessary (cosmetic surgery, for example); treatment needed as a result of inappropriate lifestyles (smoking or obesity); and top-ups for non-clinical aspects of care, such as private rooms.

The King’s Fund also offered 10 tips for commissioners in April. It said commissioners’ priorities should include active support for self-management, secondary prevention and managing emergency activity. The King’s Fund document, first published in 2011, has been revised to take account of the new commissioning landscape. Meanwhile, NHS England published new clinical commissioning policies to underpin the commissioning of specialised services. The policies define what should be in place for providers to offer evidence-based, safe and effective services and set out a nationally consistent approach to commissioning to ensure equitable access to services across the country. ? 

The family nurse partnership programme is to be expanded to cover 16,000 families in England, the Department of Health announced. Under the programme, currently provided to 11,000 families, a specially trained family nurse visits mums-to-be under the age of 20 from early pregnancy until their baby is two. The programme has led to improvements in smoking cessation, more breast feeding and improved self-esteem. A partnership of the Tavistock and Portman NHS Foundation Trust, Impetus Trust and the Social Research Unit at Dartington have been awarded a £17.5m contract to take the programme forward. ?

In Scotland, the government announced that patients, visitors and health service staff had saved more than £13m since NHS car parking charges were abolished in 2008. Charges remain at car parks run under the private finance initiative at three hospitals. Scottish health secretary Alex Neil said he would like to abolish these charges too, but the local NHS boards were locked into long-term contracts with the operators.