News / News review March 2015

Whistleblowing, safety and quality and their relationship with the culture of the NHS were the hottest health topics in February. The latest report from Sir Robert Francis – this time on whistleblowing – recommended a new national whistleblowing guardian, with local guardians in each NHS organisation. The NHS Trust Development Authority, NHS England and Monitor should help whistleblowers get alternative employment, it added. The government intends to consult on the recommendations.

 Monitor chief executive David Bennett wrote immediately to foundation trust managers to emphasise the importance of the Francis report on whistleblowing. He said Freedom to speak up should prompt managers to ensure all their staff were aware that they were expected to come forward and raise concerns.

 Alongside this document, the Department also published a report on culture change in the NHS and a consultation on financial sanctions for health service bodies that fail to comply with the NHS duty of candour. The proposed penalty would allow the NHS Litigation Authority to recover part of a trust’s indemnity cover for claims where the statutory duty of candour about patient safety has been breached. The proposal was set out in the government’s initial response to the Mid Staffordshire inquiry.

 Monitor updated its guidance for trust special administrators (TSAs), including reforms to the TSA regime set out in the Care Act 2014. TSAs will now be allowed to recommend service changes that may affect other trusts and services. The change is a response to the overruling of proposed changes at the (then) Lewisham Hospital NHS Trust in 2013, made in the TSA’s report on neighbouring South London Healthcare NHS Trust. The guidance does not give TSAs carte blanche to propose changes in other trusts; wider recommendations must be ‘necessary for and consequential on’ proposed changes at the trust in administration. The guidance also updates the Care Quality Commission’s role in the regime, giving it powers to recommend a trust be moved into administration.

 Health economists said the threshold used by the National Institute for Health and Care Excellence (NICE) to gauge new drugs’ cost-effectiveness was too high. Economists from the University of York Centre for Health Economics said NICE approval for medicines was doing more harm than good as other patients were disadvantaged as a result. They also said the NHS was paying too much for new drugs. ?

 While the York economists said thresholds were leading to a form of rationing, the Nuffield Trust said growing financial pressures were exposing a messy system of NHS rationing ‘fudges’. In a briefing for current and prospective MPs, it said policymakers, commissioners and clinicians had ‘muddled through’. This had led to compromises that meant some treatments were not available in some areas – and it was not clear why – while nationally cancer drugs had been prioritised over other treatments. Rationing in the NHS said greater transparency was needed.

 The Department of Health confirmed new payment rules for overseas visitors needing NHS treatment, as part of efforts to recoup up to £500m a year by 2017/18. The rules, to be implemented in April, will apply to migrants and visitors from countries outside the European Economic Area and Switzerland. The charges may also apply to former UK residents – if they live outside the EEA or they now live elsewhere in the EEA but are not working and under UK retirement age. Those without a European Health Insurance Card or who do not have insurance or qualify for an exemption will be charged at 150% of the tariff. Treatment by GPs and at A&E will remain free. ?

 An extra £127m will be allocated to frontline healthcare in 2015/16, Scotland deputy first minister John Swinney said in his Budget statement in February. The funds will mean health spending in Scotland will rise by £383m in the next financial year, he said. The total NHS budget will be more than £12bn. The £127m comes from Scotland’s health consequentials (under the Barnett formula) following the rise in NHS England spending announced in December’s autumn statement.

 February saw more evidence of the changing face of commissioning. NHS England said 64 clinical commissioning groups would take delegated responsibility for commissioning GP services from April. Under the arrangements, CCGs will commission general medical services.

 The coalition government’s NHS reforms have been ‘damaging and distracting’, the King’s Fund said. Some changes were positive, such as GPs’ closer involvement in commissioning and giving responsibility for public health to local authorities. But, The NHS under the coalition government: part one, NHS reform said the new structure was unwieldy, regulation too complex and had created a vacuum in system leadership.

 The Wales Audit Office said the NHS accounted for 11% of early departure schemes across Welsh public bodies. The WAO said NHS bodies used the schemes to reduce their workforce costs. A report, Managing early departures across Welsh public bodies, said NHS organisations had spent £36.6m on just over 1,200 early departures, estimated to have generated £33m in recurrent savings.

 NHS England has revealed the organisations that will join its commissioning support lead provider framework. Clinical commissioning groups will be encouraged to use the framework to retender service-level agreements with commissioning support units, many of which expire in April 2016. NHS England has offered free legal and procurement support to CCGs using the framework, which it said would cut the procurement process to three months. There are three categories: end-to-end commissioning support; medicines management; and supporting continuing healthcare and individual funding requests. The successful organisations include CSUs and private sector providers. ?

 St George’s Healthcare NHS Trust has been awarded foundation status. In December, Monitor announced a short delay in the trust’s bid to become an FT to give the trust time to complete new borrowing arrangements.