Comment / News review

In a month of significant retirements from world-renowned institutions, one stood out for the NHS. But unlike Sir Alex Ferguson, who retired in May after 26 and a half years at the helm of Manchester United, NHS England chief executive Sir David Nicholson has not waited until a few days before his retirement to make his announcement. To allow time for his superiors to find a successor, Sir David will stay in the job until March next year.

It’s a move that was not widely expected. Sir David (below) was criticised in the wake of the Francis report and many predicted he would bow out in the autumn. The timing of his departure is interesting – go too soon and it might affect the implementation of the commissioning reforms and leave the service without a leader in the run-up to winter. This way, the new commissioning structure has a year to bed in, and the new chief executive will not have to face winter pressures immediately.

The government’s legislative programme for the next year was outlined in the Queen’s speech, which includes a bill to close the Audit Commission. The care bill also featured, and later the Department of Health set out its legislative response to the Francis report. Launching the care bill, health secretary Jeremy Hunt (left) said he intended to make quality of care as important as finance. The Care Quality Commission would be given powers to put a foundation trust into administration if it became clinically unsustainable, he added. There would be a cap on care costs, Ofsted-style ratings for hospitals and care homes and there would be national eligibility criteria to ensure equity across the country. ?

The focus on quality of care and the NHS response to Francis continued with the publication of detailed data about the first four of the 14 hospitals involved in the Keogh Review into mortality rates. NHS England medical director Professor Sir Bruce Keogh’s national review is looking at the 14 hospital trusts that were identified in February as having had higher than expected mortality rates for more than two years. Sir Bruce (above) urged patients, staff and relatives to look at the data and share their experiences with the review. ‘Publicly available data

is really important, but it is never the end of the story. None of the information published can, in itself, tell us whether any hospital is doing anything wrong. The information acts as a warning light or smoke alarm – the review teams’ job is to investigate, diagnose whether there is a problem, and write the prescription for improvement wherever necessary,’ he added.

Mr Hunt also announced details of his plan to send senior civil servants from his department to the NHS front line. He said the initiative would help the Department change its culture – a key Francis’ recommendation. The Department’s permanent secretary Una O’Brien and its directors will lead the way by spending at least a month a year learning about patient experiences and understanding the impact of their polices on the front line. Other senior civil servants, policy staff and others will follow suit, with the time spent and experiences reflected in their performance assessments. The Department said the frontline experience could include accompanying hospital porters, listening to receptionists answer queries, or learning how nurses or healthcare assistants go about their business.

When those civil servants get to the front line, they will come across junior doctor shortages, according to the British Medical Association. According to a BMA survey of 376 doctors who graduated in 2006, more than one in four junior doctors feel that they do not have the time to deliver the quality of care that patients deserve. Half of the respondents said there is a problem with staffing shortages, which has an impact on care delivery. Trainees are also reporting rising levels of stress, with more than four out of 10 feeling their stress levels have got higher or much higher in the last year. The BMA is currently renegotiating the juniors’ contract.

Morale is high on the agenda in NHS Wales. Wales health minister Mark Drakeford (left) urged health service managers to respond to the recent NHS Wales staff survey. It said that only 19% of staff felt senior managers would act on the results of the survey. Only 25% of participants agreed that managers encouraged staff to suggest ways of improving services, while 21% said communication between staff and senior management was effective. ?

Former HFMA chairman Paul Cummings (below) has been temporarily seconded to the Northern Health and Social Care Trust to help lead the next stage of the trust’s turnaround. Announcing the appointment, Northern Ireland health minister Edwin Poots said Mr Cummings, director of finance and deputy chief executive at the Health and Social Care Board, would be the trust’s senior director of corporate management. He will be joined by Public Health Agency director of nursing and allied health professions Mary Hinds – also on temporary secondment – who will be senior director of turnaround. Mr Poots said the move was in response to the emerging findings of a turnaround and support team. Its initial report is due soon. ?

?Alliances between healthcare bodies work better than formal mergers, according to the NHS Confederation. Its report, Healthcare groups: an alternative to merger mania?, argued that the NHS had a poor track record of successful mergers. Working together – whether this is a collaboration on a particular function or service or a more formal federated model – could deliver economies of scale and benefit staff and patients, it added. ?

?Scottish government ministers have agreed new in vitro fertilisation  criteria to guarantee equal access to the service across the country by 31 March 2015. The changes include a guaranteed maximum of two full cycles for eligible couples where the woman is less than 40 years old. Where she is aged between 40 and 42, couples will be offered one full cycle. Public health minister Michael Matheson said the government was investing £12m over three years to support the strategy.