Quality comes from all angles: the value of corporate services staff

Quality comes from all angles: the value of corporate services staff: It’s a hard time for managers in the health service. They don’t just have the pressure to deliver with less, but they have to do this difficult task against a backdrop of organisations, policy makers and the media challenging the value of spending time doing anything that isn’t direct care for patients, says Penny Pereira. The Health Foundation

QIPP and lean running dominate the operating framework

QIPP and lean running dominate the operating framework:

The operating framework under which CCGs will make their way to authorisation in April 2013 contains few surprises, according to a briefing from PCC. Managing the NHS’s finances remains a top priority and CCGs are warned to expect a running cost allowance at the lower end of the range suggested in last year’s operating framework. NHS Networks

Industrial action on Wednesday 30 November

Industrial action on Wednesday 30 November:

Emergency and critical care services will be operating normally and 999 calls will be responded to, during industrial action in the NHS on Wednesday 30 November.

Accident & Emergency Departments and 999 services are for medical emergencies only.

The NHS Direct telephone service is available for patients with urgent needs: 0845 46 47 , as well as online symptom checkers. Further health and wellbeing information is available on NHS Choices. Department of Health

DoH will not release documents about NHS reform risks

DoH will not release documents about NHS reform risks: The DoH will not release documents about the risks of the NHS reforms as ministers fear it would 'seriously undermine confidence' in the reorganisation. GP Online

Patient records access standard urged

Patient records access standard urged: New research on patient records access recommends a set of national standards for implementation, training and promotion and a centralised IT support service. E-Health Insider

NHS reform 'set to cost £3.4bn' - The Press Association

NHS reform 'set to cost £3.4bn' - The Press Association:

shropshirestar.com

NHS reform 'set to cost £3.4bn' The Press Association Coalition reforms of the NHS will cost nearly £3.4 billion, Labour has claimed. Shadow health secretary Andy Burnham accused the Government of "burying" the true scale of the cost of the reorganisation in papers setting out the technical details of the ... NHS reform 'set to cost £3.4bn'Belfast Telegraph all 196 news articles »

The Press Association

NHS culture avoids blame when the priority is avoiding deaths, says report

NHS culture avoids blame when the priority is avoiding deaths, says report:

NHS Alliance, an independent medical lobby, wants a system that will study errors so that lessons will be learnt

Out-of-hours GPs and other primary care organisations are failing to admit potentially fatal mistakes or use formal alert systems designed to prevent similar accidents, according to a new report.

There is a "culture of avoiding blame" when the emphasis should be on avoiding deaths, the report, published by the NHS Alliance, said.

The alliance represents doctors, managers and commissioners, and is trying to persuade about 100 organisations providing emergency evening and weekend GP care for 7 million people a year in England to join an anonymous system.

This is being piloted by 10 organisations following the scandal involving Daniel Ubani, a German doctor who accidentally killed a 70-year-old patient in Cambridgeshire with a 10-fold overdose of the painkiller diamorphine.

An NHS investigation into the incident accused Take Care Now, a now-defunct out-of-hours provider, of systemic failings, including not heeding national safety warnings on the administration of drugs or sharing information on poorly performing doctors.

The NHS Alliance, backed by the Department of Health, the Royal College of GPs and national safety watchdogs, is trying to develop a new anonymised website and teleconferencing system to highlight errors and ensure lessons are learned.

The need for better links between out-of-hours and regular GP services on the one hand, and pathology labs and A&E departments on the other, are among the issues that have been raised.

The report said that the Ubani case "highlights how slow we often are to learn from mistakes, both within organisations and across the wider urgent care system". It adds that there is still "a very low level" of recent incident reporting using official NHS channels "both from out-of-hours and primary care as a whole", and it hoped the initiative would "shift the way providers think about incidents, giving them cultural permission to admit that occasionally we mess up".

Rick Stern, who is in charge of urgent care for the alliance, said new rules and guidance were not enough. "One of the biggest failings is the culture of avoiding blame and the lack of good systems for sharing what has been learnt," he said.

The alliance did not want to replace official reporting systems even though they were poorly used, he added.

The NHS's National Patient Safety Agency, which runs the formal incident reporting system, is being abolished as part of the coalition government's closure of quangos, but it is in talks with Imperial College NHS Trust in London to run the system for two years before it becomes the responsibility of the NHS commissioning board. The Guardian

Some NHS hospitals should perform fewer procedures, senior figure warns

Some NHS hospitals should perform fewer procedures, senior figure warns: Hospitals should stop carrying out complex procedures they only perform occasionally, a senior figure in the Department of Health urges today, after figures showed that it can put patients at up to 70 per cent higher risk of dying. Daily Telegraph

RCN: risky and irresponsible staffing levels on older people’s wards

RCN: risky and irresponsible staffing levels on older people’s wards: The Royal College of Nursing has branded staffing levels on some older people’s wards as risky and irresponsible. Royal College of Nursing

A Better Life - what older people with high support needs value

A Better Life - what older people with high support needs value:

What do older people with high physical and mental support needs say they want and value in their lives?

Part of the JRF's A Better Life programme, this paper:

• explores the views of older people and the factors that help or hinder them; and



• proposes a model which demonstrates how their needs could be met.

The circular model combines aspects of well-being older people say they value with the factors that they claim help or hinder their quality of life. read more

Joseph Rowntree Foundation

Developing the new NHS Provider Licence: A Framework Document

Developing the new NHS Provider Licence: A Framework Document: This document aims to engage our stakeholders as we develop our thinking on a key element of our proposed new role, licensing providers of NHS services. Monitor

Response times being hit as patients transfer to Northampton General Hospital

Response times being hit as patients transfer to Northampton General Hospital:

AMBULANCE chiefs claim slow handovers of patients to Northampton General Hospital (NGH) are causing regular and significant delays in paramedics’ readiness for 999 calls. Northampton Chronicle and Echo

Top doctor baffled as death figures put Northampton General Hospital in the worst grouping

Top doctor baffled as death figures put Northampton General Hospital in the worst grouping:

A DEATH audit, set to take thousands of hours, is being set up by Northampton General Hospital (NGH) to figure out why its mortality figures are worse than average. Northampton Chronicle and Echo

NHS Pension Scheme calculators published

NHS Pension Scheme calculators published:

The Department of Health is publishing pension calculators for NHS Pension Scheme members to support their understanding of the proposed changes in pension relating to the Hutton reform. This follows the revised Government offer on 2 November, which was set out in a letter from the Secretary of State for Health, Andrew Lansley to NHS Chairs. The calculators have been produced with actuarial support.

See calculator for Agenda for Change staff, including special classes and Mental Health Officers

Calculators for consultants and GPs will be available shortly.

The calculators will provide an illustrative estimate of how the proposed reforms might affect your pension. If you need to find out how much pension you have earned to date, you should contact your scheme provider (whose details are on your latest pension statement).

However, please note that the final terms of the reforms are still being discussed and may change. Any changes will not happen until 2015. The calculator gives a result in today’s money, and does not include inflation or a change of earnings. Another calculator may produce a different result. The calculator does not provide a formal statement of your pension entitlements – it is provided to give a rough estimate only and the NHS Pension Scheme cannot accept responsibility for the accuracy of results from this or indeed any other calculator. Department of Health

How can we bridge the gap between knowledge and practice to deliver good patient experience?

How can we bridge the gap between knowledge and practice to deliver good patient experience?: Bev Fitzsimons, asks whether a new patient and family-centred care programme can help improve patients' experience. (Blog, 25 Nov 2011) King's Fund

Guidance on norovirus updated

Guidance on norovirus updated:

The Department of Health welcomes the updated guidance on norovirus published today.

Developed by the British Infection Association with other professional bodies, the updated guidance provides a more flexible approach to outbreak management and advocates that, where clinically appropriate, an outbreak can be managed by closing bays to new admissions.

The new guidance is an important addition to the evidence base on how to manage and control outbreaks of norovirus effectively. The guidance also emphasises the importance of NHS organisations having systems in place to deal effectively with norovirus as part of their winter preparedness plans.

About norovirus

Illness caused by norovirus is generally mild and people usually recover fully within two to three days.

However, outbreaks can be problematic in hospitals and it is important that NHS organisations have systems in place to deal effectively with norovirus as part of their winter preparedness plans. Department of Health

Strike means delayed operations

Strike means delayed operations: Hospital managers say Wednesday's public sector pensions strike means thousands of non-emergency operations will be postponed. BBC News

VIDEO: Weekends 'more risky' at hospitals

VIDEO: Weekends 'more risky' at hospitals: Being admitted to hospital in England at the weekend is risky, according to a study by Dr Foster. BBC News

Small CCGs look set to merge after £25 per head management allowance

Small CCGs look set to merge after £25 per head management allowance: Small clinical commissioning groups (CCGs) look set to be forced to merge after the DoH confirmed groups would receive just £25 per head per patient for running costs. GP Online

Payment by Results in mental health

Payment by Results in mental health: Payment by Results for adult mental health services will be introduced in the NHS in 2012/13. An independent readiness review was commissioned by strategic health authority mental health leads through the Mental Health Network. NHS Confederation

Dr Foster report backs the case for change in NHS

Dr Foster report backs the case for change in NHS: Responding to the Dr Foster Hospital Guide, NHS Confederation deputy chief executive David Stout said the report's data helped make the case for tough decisions to change how care is offered. NHS Confederation

National audit of psychological therapies for anxiety and depression: national report 2011

National audit of psychological therapies for anxiety and depression: national report 2011:

This report into the care received by patients with anxiety and depression across more than 350 NHS-funded psychological therapy services in England and Wales has revealed good overall standards of care, but substantial variation in quality. The audit collected data from 357 services and over 10,000 people in therapy for anxiety and depression and measured ten standards, including patient satisfaction, effectiveness of therapy, waiting times and number of treatment sessions offered.

• Report


• National Audit of Psychological Therapies


• Royal College of Psychiatrists - press release

NHS not making the break for carers: a report on the implementation of the Carers Strategy by primary care trusts

NHS not making the break for carers: a report on the implementation of the Carers Strategy by primary care trusts:

This research shows that spending on carers by PCTs has fallen by £2.4m this year. In November 2010 the Government allocated an extra £400m over four years to provide support for carers and this report seeks to establish how PCTs have invested the added funding this year. It also finds that PCTs have defied Government by not publishing plans and budgets as was requested – only 26% have published updated plans, and 13% have published budgets for 2011/12. It also finds that only 4% of PCTs have not budgeted any investment in services for carers in 2011/12.

• Report


• Crossroads Care - press release

The Princess Royal Trust for Carers and Crossroads Care

NHS Operating Framework 2012/13: responses and comment

NHS Operating Framework 2012/13: responses and comment:

• Alzheimer's Society


• Cancer Campaigning Group


• Centre for Mental Health


• Mental Health Network


• NHS Confederation


• Nuffield Trust


• Royal College of Physicians

NHS PFI debts rising by 5pc a year

NHS PFI debts rising by 5pc a year: Taxpayers face paying five per cent more per year for hospitals built under the Private Finance Initiative (PFI) because the debts are linked to inflation, the BBC1 programme Panorama has found. The Telegraph

New advice available on the Single Equality Act

New advice available on the Single Equality Act: The RCN has published a new briefing on the Single Equality Act. Royal College of Nursing

Guide rates best and worst hospitals in 2011

Guide rates best and worst hospitals in 2011:

The full guide is available on the Dr Foster web site. 


The Daily Telegraph has today revealed the findings of the latest Hospital Guide. The guide, published annually, closely scrutinises a range of healthcare data to measure hospital performance and detect trends that could save lives.
As well as listing the hospital trusts in England that score above and below average on a range of different mortality measures, this year’s guide also found that:

• The rate of patient deaths in England is 20% lower than it was 10 years ago, in part because of improved hospital care.
• For certain conditions, patients admitted to hospital at the weekend are less likely to get treated quickly and have a higher chance of dying.
• Hospitals that perform certain operations infrequently pose a significantly greater risk to patients than those which carry out high numbers of the operation.
• Patient comments and ratings, such as those gathered by NHS Choices, provide a valuable insight into standards of hospital care.
• Rationalisation and networking of hospital services, to create 24/7 centres of expertise in areas such treatment for stroke, saves lives.

The report also shows that hospitals highlighted as having the best performance measures were generally in the south of England, while those found to be the poorest performers were mostly in the north. However, the report did not examine why this is the case.

Who is Dr Foster?

Dr Foster Intelligence is a joint venture between the Department of Health and Dr Foster Holdings LLP and their research partners at Imperial College London. It aims to improve the quality and efficiency of health and social care through better use of information. It provides comparative information on health and social care services to health professionals and organisations to help improve the standard of healthcare.
The 2011 report is the tenth Dr Foster Hospital Guide to be published.

Which hospitals have the highest mortality rates?

Despite overall improvements in mortality, some hospitals have consistently higher mortality rates than others.
For the first time, the Hospital Guide used four measures of mortality:

• Hospital Standardised Mortality Ratio (HSMR): a measure of in-hospital deaths based on 56 conditions which account for 80% of deaths (a higher ratio indicates problems)
• Summary Hospital-level Mortality Indicator (SHMI): any deaths occurring in the 30 days following discharge from hospital treatment
• Deaths after Surgery: surgical patients who have died from a possible complication – this may raise questions over the safety of surgical procedures, or whether operations should have taken place at all
• Deaths in Low-Risk Conditions: deaths from conditions where patients would normally survive

Four indicators give a more balanced view than a single indicator. Using these indicators, the report found that no trust is higher than expected on all four mortality measures, but two trusts – Hull and East Yorkshire Hospitals and University Hospital of North Staffordshire – are higher than expected on three out of four.
The following 19 hospital trusts have higher than expected mortality rates based on two measures – HSMR and SHMI:

• Blackpool Teaching Hospitals NHS Foundation Trust
• Buckinghamshire Healthcare NHS Trust
• Burton Hospitals NHS Foundation Trust
• Dartford and Gravesham NHS Trust
• George Eliot Hospital NHS Trust
• Hull and East Yorkshire Hospitals NHS Trust
• Isle of Wight NHS Primary Care Trust
• Medway NHS Foundation Trust
• Mid Cheshire Hospitals NHS Foundation Trust
• North Cumbria University Hospitals NHS Trust
• Northampton General Hospital NHS Trust
• Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
• Shrewsbury and Telford Hospital NHS Trust
• The Dudley Group of Hospitals NHS Foundation Trust
• The Royal Wolverhampton Hospitals NHS Trust
• United Lincolnshire Hospitals NHS Trust
• University Hospitals of Morecambe Bay NHS Foundation Trust
• Worcestershire Acute Hospitals NHS Trust
• York Teaching Hospital NHS Foundation Trust

Overall, 24% of trusts have higher than expected SHMI, 15% have higher than expected HSMR, 3% higher deaths in low-risk conditions, and 1% higher deaths after surgery.

Which hospitals have the lowest mortality rates?

One hospital, Chelsea and Westminster Hospital, achieved low mortality rates across all four mortality indicators.
The following hospitals were low (i.e. performed well) on three measures – HSMR, SHMI and deaths in low-risk conditions:

• Imperial College Healthcare NHS Trust
• King’s College Hospital NHS Foundation Trust
• Kingston Hospital NHS Trust
• Newham University Hospital NHS Trust
• South London Healthcare NHS Trust
• The Whittington Hospital NHS Trust
• University College London Hospitals NHS Foundation Trust

Royal Devon and Exeter NHS Foundation Trust was low for three different measures – HSMR, SHMI and deaths after surgery.
The following trusts were low (i.e. performed well) on two measures – the HSMR and SHMI:

• Barnet and Chase Farm Hospitals NHS Trust
• Barts and the London NHS Trust
• Cambridge University Hospitals NHS Foundation Trust
• Epsom and St Helier University Hospitals NHS Trust
• Frimley Park Hospital NHS Foundation Trust
• Guy’s and St Thomas’ NHS Foundation Trust
• North West London Hospitals NHS Trust
• Royal Free Hampstead NHS Trust
• Sheffield Teaching Hospitals NHS Foundation Trust
• St George’s Healthcare NHS Trust
• University Hospitals Bristol NHS Foundation Trust
• West Suffolk Hospitals NHS Trust

Overall, 22% of trusts have lower than expected SHMI, 19% have lower than expected HSMR, 8% lower deaths in low-risk conditions, and 1% have lower rates of deaths after surgery.
Some trusts appeared to have both good and bad mortality results, which could potentially be due to the way hospitals record deaths. For example, the Aintree University Hospitals NHS Foundation Trust has both a lower than expected HSMR and higher than expected SHMI.
Dr Foster’s guide draws attention to this inconsistency, explaining that this may be due to including palliative care deaths within the HSMR. Different hospitals tend to code palliative care deaths in different ways, and higher rates of palliative care recording can lower a hospital’s mortality rate. If the relevant hospital has recorded their palliative care deaths, the HSMR adjusts for these deaths, which the report says makes it fairer on hospitals that care for terminally ill patients and who would otherwise be shown to have higher than normal in-hospital mortality rates.
Besides Aintree, nine other trusts coded a quarter of their HSMR as being palliative care cases. The SHMI measure, on the other hand, does not adjust for palliative care deaths. Dr Foster says it supports calls for palliative care coding guidelines to be made clearer.

Why are people at higher risk going into hospital at nights and weekends?

In general, hospitals with the fewest senior doctors available at weekends have the highest mortality rates. A 2010 study by the Dr Foster Unit observed that people admitted to hospital over the weekend with common cardiovascular emergencies or with cancer were 7% more likely to die than those admitted from Monday to Friday.
Key factors that can contribute to higher mortality rates outside of normal working hours are:

• lower availability of specialist community and general practice services, resulting in more terminally ill patients being admitted and dying in hospital
• reduced specialist in-hospital services being available at weekends, particularly diagnostic investigations such as MRI scans
• different out-of-hours staffing levels (for example, out-of-hours consultants are normally on call rather than on site and immediately available in the hospital)

The last point on staffing was considered to be a particular contributing factor that the report focused on. Dr Foster mapped senior staffing availability to the number of hospital beds against mortality rates for 130 trusts. They observed that more senior staff per bed at weekends is associated with a lower weekend mortality rate for emergency conditions, while more senior doctors (as a percentage of all doctors) is associated with lower rates.
The report noted nine trusts whose HSMR was within the expected range for people admitted Monday–Friday, but higher than expected for those admitted at the weekend:

• Doncaster and Bassetlaw Hospitals NHS Foundation Trust
• George Eliot Hospital NHS Trust
• Mid Cheshire Hospitals NHS Foundation Trust
• Northampton General Hospital NHS Trust
• Nottingham University Hospitals NHS Trust
• Scarborough and North East Yorkshire Health Care NHS Trust
• Sherwood Forest Hospitals NHS Foundation Trust
• The Royal Wolverhampton Hospitals NHS Trust
• Wrightington, Wigan and Leigh NHS Foundation Trust

The range of senior consultant availability at night was also wide. While almost a third of hospitals with an A&E unit had no consultants on site during the night, others had five or more consultants available in the hospital.
Of particular note is the risk associated with hip fracture at these times. Overall, patients who break their hip have a one in ten chance of dying, but the chance of surviving is much greater if receive surgery within two days. For those admitted on Friday or Saturday, there is a lower chance of prompt treatment. In-hospital mortality in 2010/11 was observed to vary from 3.2% to 16.3% between providers. Numerous studies have shown that organisational factors in the patient’s treatment play a major part in determining patient survival.
2010 statistics on hip fracture showed:

• Across hospitals, 30% of patients with hip fracture had to wait two or more days for surgical treatment.
• Across the country, the number of patients waiting more than two days for an operation was significantly higher (an increase of 4.8 per cent) in patients admitted on a Friday or Saturday compared with patients admitted from Sunday to Thursday.
• 11% of trusts were shown to have lower operating rates at weekends.

In the following five trusts, 50% of all hip fracture patients waited more than two days for an operation:

• Doncaster and Bassetlaw Hospitals NHS Foundation Trust
• Leeds Teaching Hospitals NHS Trust
• Pennine Acute Hospitals NHS Trust
• Royal Free Hampstead NHS Trust
• South Tyneside NHS Foundation Trust

How might weekend services be improved?

Dr Foster says the answer may lie not necessarily in increasing the number of out-of-hours staff and services, but in reorganising the resources available to target where they are most needed. An example is networking with other hospitals in an area.
London has reorganised its stroke care in this way. Instead of all A&E departments treating strokes, a small number of hospitals now manage all stroke patients at a very high standard, seven days a week, 24 hours a day. Before the reorganisation (in 2009/10), 10% of stroke patients died within seven days of admission if they were admitted at the weekend compared to 8% who were admitted on weekdays. For weekend admissions in 2010/11, mortality has dropped to 7.3% compared to 6.4% for weekday admissions.
The report provides examples of other trusts that have reconfigured their services to provide more consistent out-of-hours care.

Why are people at higher risk going into a hospital that performs fewer operations?

In general, patients treated in hospitals that perform operations rarely are more likely to die than in hospitals that perform a higher number of operations. This is particularly the case for major cardiovascular conditions such as an abdominal aortic aneurysm (a weakened section of the major artery that runs through the body, which has a very high mortality risk if it ruptures).
The risk of dying from major surgery used to treat this condition is 70% higher in hospitals that perform a lower number of these operations. Hospitals that perform fewer than 35 of these operations a year have a 13% patient mortality rate compared with 8% among hospitals that perform more than 35. (The report defines low-volume hospitals as those doing more than ten but 35 or fewer operations a year.)
Various factors may contribute to the difference in mortality across hospitals, including:

• the experience and workload of individual surgeons
• the organisational structure of the hospital and having surgeons in a dedicated speciality
• the fact that more experienced medical centres are more likely to use more advanced, less invasive techniques with lower rates of complications and mortality

The report lists the large number of trusts which performed 35 or fewer procedures for abdominal aortic aneurysm in 2010/11.
Surgery for abdominal aortic aneurysm is the only area covered by this report; i.e. it cannot be inferred that you are at higher risk if you go into a hospital that performs fewer operations than another for any other type of surgery.

What steps can improve patient safety and mortality?

The report also discusses factors that can help improve patient safety and outcomes.
It discusses the difference the rapidly increasing use of percutaneous coronary angiography (PCI, a technique to open up heart vessels blocked during a heart attack) has made to mortality from heart attacks: mortality has decreased by 2.5% since 2006. According to the report, it normally takes an estimated 15 years from the discovery of a new treatment to its widespread use by doctors, but the faster this happens, the greater the benefit seen.
Another factor in improving patient safety and mortality is following best practice and cost-effective patient care (care that is the safe and effective for patients and at the same time makes the best use of the NHS budget). The report discusses hip and knee replacements, which have increased over the past five years due to the increasing age of the population. Trusts that perform the best for these procedures had fewer patients with a long length of stay in hospital, fewer emergency readmissions within 28 hours, and lower rates of re-operation (a repeat operation done within one year of the initial procedure). Good care can also cost less in the long term.
The Hospital Guide Questionnaire looked at how certain trusts were improving patient recovery and reducing length of patient stay after these orthopaedic procedures. This is known as the Rapid Recovery Pathway. Factors that can improve patient recovery are:

• pre-surgery education for patients to help relieve anxiety and increase understanding
• admission on day of surgery, reducing length of stay
• having a standardised anaesthetic protocol that helps with pain management and recovery
• multi-disciplinary recording of patient records, helping share information and reduce risk of complications
• orthopaedic physiotherapy services being available seven days a week, which improves recovery and length of stay
• using criteria-based discharge: a checklist that helps reduce error in the discharge process, reducing risk to the patient
• phoning patients in the 48 hours after their discharge to help reduce the risk to the patient and readmissions to hospital

What do patients’ comments tell us?

In addition to hospital mortality rates, another important indicator of hospital performance is what patients say about their treatment. Online patient feedback can provide information that is not always clear from statistics, and websites such as NHS Choices and Patient Opinion now feature thousands of detailed comments on how patients view their treatment. The Dr Foster report says that comparing reports on these systems with national patient surveys has shown a reasonable degree of agreement:

• NHS trusts that score well on these surveys also tend to score well on data collected by Patient Opinion and NHS Choices.
• Overall, over half of patients say they would recommend the place in which they were treated, a quarter said they would not recommend it, and 16% had no opinion.

The hospitals most often recommended (% of people recommending the hospital) were:

• The Cheshire and Merseyside NHS Treatment Centre Private (97%)
• North Downs Hospital Private (96%)
• Queen Victoria Hospital (East Grinstead) NHS (96%)
• Euxton Hall Hospital Private (95%)
• Fulwood Hall Hospital Private (93%)
• The Royal London Hospital For Integrated Medicine NHS (92%)
• Boston NHS Treatment Centre Private (91%)
• Emersons Green NHS Treatment Centre Private (86%)
• The Heart Hospital NHS (84%)
• Airedale General Hospital NHS (82%)
• Frimley Park Hospital NHS (82%)
• St Richard’s Hospital NHS (81%)
• Warwick Hospital NHS (80%)
• Princess Anne Hospital, Southampton NHS (79%)
• Royal Hampshire County Hospital NHS (77%)

Hospitals least often recommended were:

• Medway Maritime Hospital (35%)
• The Royal London Hospital (35%)
• Whipps Cross University Hospital (35%)
• Hull Royal Infirmary (32%)
• Royal Bolton Hospital (29%)
• Pinderfields General Hospital (27%)
• Croydon University Hospital (26%)
• Queen’s Hospital, Romford (26%)
• Newham General Hospital (21%)
• Queen’s Medical Centre, Nottingham (20%)

Where there was dissatisfaction, the five factors most likely to contribute to this were:

• not being involved in care decisions
• not being treated with dignity and respect
• hospital staff not seeming to work well together
• poor hospital cleanliness
• being treated in mixed sex accommodation

Private hospitals seemed to score well. It is difficult to tell the reasons for this. As these comments were registered on NHS Choices, they may reflect NHS patients being treated by private units. Also, the comparison between NHS and private may not be equal as private hospitals may be smaller and also manage less complex cases.
The report concludes with its Trusts of the Year, which had the best four mortality indicators and best scores in response to three questions on the national patient survey, which asked:

• Overall, how would you rate the care you received?
• Were you involved as much as you would like in decisions about your care and treatment?
• Did you feel you were treated with respect and dignity while you were in the hospital?

The four highest-performing hospitals according to these results were:

• Royal Devon and Exeter NHS Foundation Trust South
• University College London Hospitals NHS Foundation Trust London
• Cambridge University Hospitals NHS Foundation Trust Midlands
• Sheffield Teaching Hospitals NHS Foundation Trust

Only the Chelsea and Westminster Hospital NHS Foundation Trust scored low on all four mortality measures.

How can I choose and rate hospitals near me?

NHS Choices features a scorecard system that allows you to score the treatment you have received and leave specific explanations of what made your treatment good or bad. These opinions are publicly viewable, meaning you can read what other people have experienced before choosing where you want to be treated.
The service can be used to rate not only hospitals, but also a range of services, including GP surgeries and dentists. See our services finder to choose and rate your NHS services.
NHS Choices

International report confirms the NHS is performing well for patients

International report confirms the NHS is performing well for patients:

However, the report Health at a Glance by the Organisation for Economic Co-operation and Development (OECD) also shows that England still lags behind other countries on some patient outcomes for cancer, stroke and respiratory diseases despite spending more on healthcare than the OECD average. It also reiterates the increasing pressures on the NHS due to obesity and other lifestyle related diseases and long-term conditions. NHS Networks

New NHS operating framework published

New NHS operating framework published:

The new NHS operating framework setting out the business and planning arrangements for the NHS in England for the next year has been published today.

The Operating Framework for the NHS in England 2012/13 describes the national priorities, system levers and enablers needed for NHS organisations to maintain and improve the quality of services provided, while delivering transformational change and maintaining financial stability.

It sets out the practical steps that need to be taken to carry the NHS through a strong and stable transition over the next year, maintaining high quality standards and financial grip, as the NHS moves towards the new modernised system envisaged in Liberating the NHS. Department of Health

Safeguards for vulnerable questioned

Safeguards for vulnerable questioned: Mental health charities tell the BBC they fear Deprivation of Liberty Safeguards, designed to protect the vulnerable, are "not fit for purpose". BBC News

First baby at home 'higher risk'

First baby at home 'higher risk': Having a home birth carries a slightly higher risk for babies of first-time mothers but there is no difference in safety for further deliveries, says a study. BBC News

NHS in most dangerous time in history, NHS chief executive warns

NHS in most dangerous time in history, NHS chief executive warns: The NHS is in its most dangerous time in history as old structures 'fall apart' before the new system is up and running, the NHS chief executive has warned. GP Online

NHS pension strike will cost economy £500m warn ministers

NHS pension strike will cost economy £500m warn ministers: Strikes over public sector pensions could cost the economy over half a billion pounds, ministers have warned. GP Online

NHS told to get ready for info strategy

NHS told to get ready for info strategy: The Department of Health's annual 'to do' list for NHS managers has urged them to prepare for the elusive information strategy. E-Health Insider

NHS could be like '1970s car factory' says health committee chairman

NHS could be like '1970s car factory' says health committee chairman: Doctors and patients need to embrace the need for major cultural change in the NHS - to prevent it becoming like a redundant 1970s car factory, according to Stephen Dorrell. GP Online

New guidance on strike action and the deduction of pay

New guidance on strike action and the deduction of pay: Following a number of requests from employers, we have worked with DAC Beachcroft LLP to provide practical guidance on strike action and the deduction of pay.

Industrial action - legal hotline launched: A free industrial action advice line to help NHS HR teams has been launched today. The advice line will be open from Thursday 24 November to 30 November inclusive and will be staffed by experienced lawyers from our legal advisers, DAC Beachcroft LLP.

NHS Employers

Mental Health Payment by Results Readiness Review

Mental Health Payment by Results Readiness Review: The development of a Payment by Results approach to provider reimbursement in mental health services has been going on for a number of years. NHS Confederation

NHS Confederation comments on 2012/13 Operating Framework

NHS Confederation comments on 2012/13 Operating Framework: David Stout, deputy chief executive of the NHS Confederation, says the framework shifts the NHS in to implementation mode and away from the political debate. NHS Confederation

NHS shakeup in danger of harming patients, risk assessments show - The Guardian

NHS shakeup in danger of harming patients, risk assessments show - The Guardian:

The Guardian

NHS shakeup in danger of harming patients, risk assessments show The Guardian But ministers blocked requests from Labour to release a confidential risk register, which outlines the perils for the NHS that reform entails. Last week the information commissioner, Christopher Graham, said the government was wrong to keep the ... and more »

Is reform bad for the NHS? | Martin McKee and David Skelton

Is reform bad for the NHS? | Martin McKee and David Skelton:

Martin McKee and David Skelton debate the OECD claim that constant 'reforms' are holding our health service back

Martin McKee: 'These changes will be cited as how not to make policy'

As the OECD points out in its report this week, the NHS has been changing, introducing innovative models of care that have been associated with some of the fastest improvements in health in any industrialised country. Our experience, and that of other researchers – such as those who have shown how hospital mergers set the new organisations back several years – confirms the OECD view that what is needed is institutional stability: and that this is what gives rise to effective innovation.

A few weeks ago we launched a major report on what makes some health systems work better than others. We were updating a seminal report undertaken 25 years previously by the Rockefeller Foundation entitled Good Health at Low Cost. The original report had identified China, Costa Rica, Sri Lanka and Kerala, in India, as places that had achieved much better outcomes than might be expected given their level of economic development. In our report we looked at their subsequent experience, which was mixed, but also at five states that had made substantial strides in health outcomes in the years since then. These were Bangladesh, Ethiopia, Kyrgyzstan, Thailand and, again in India, Tamil Nadu.

What did we find? Success was associated with a number of factors. These included: a clear vision of the desired outcome; good communication with those who had to implement it; reforms that were appropriate to the context in which they were taking place; and an ability to take advantage of events. But above all, they had achieved success because they had maintained the stability of institutions. The organisations that were designing and implementing the reforms had, in some countries, survived changes of government and even coups. They provided islands of stability in often rapidly changing circumstances, with institutional memories that minimised the risks of making the same mistakes over and over again, and which provided space to anticipate the future and develop appropriate responses.

The UK's Department of Health argues that the NHS must change because of the rapidly changing environment in which it is operating. But we are being given a disruption so great that, as the NHS chief executive has suggested "it can be seen from space", while the incoming chair of the National Commissioning Board faces the challenge of implementing a bill he describes as "completely unintelligible". In time, the current changes will be cited in textbooks as an example of how not to make policy and the result will be a health system that, as the just-published NHS London risk register confirms, is far less able to adapt to changing circumstances than it is now. Worse, there will be many casualties along the way.

• Martin McKee is professor of European public health at the London School of Hygiene and Tropical Medicine

David Skelton: 'The NHS must be nimble enough to evolve'

A National Health Service, delivering high-quality healthcare free at the point of delivery is, rightly, one of the institutions that British people are most proud of. However, in order to enhance this reputation and maintain quality of service it is vital that the NHS evolves to meet changing health needs, rapidly developing technological innovation and rising patient expectations.

The NHS cannot be preserved in aspic. It needs to be nimble enough to adapt to meet changing circumstances. The health needs that the NHS faces now are so very different to the health needs faced by Nye Bevan in 1948. Since Bevan's masterpiece was created, life expectancy has increased dramatically – male life expectancy has risen from 66 in 1948 to over 78. The challenge facing the NHS is now much more about dealing with long-term conditions, such as diabetes. Far more of the NHS's resources now need to be targeted on prevention – keeping people out of hospital in the first place.

The technology on which the NHS relies is evolving at a rapid rate. Emerging technologies are likely to have a dramatic impact on patient treatment, increasingly enabling patients to be treated at home, rather than spending too much time in impersonal hospital wards. Technology can have a huge impact on dealing with long-term conditions and help provide patients with the information necessary to make their healthcare choices. The number of patients seeking online health information in the UK is also rapidly rising. The NHS will only make the most of emerging technology if it is prepared to change with the technology. A static, reform-resistant NHS would not be able to do this, and so we should not take the conclusions of the OECD report as evidence that the service can simply be left alone.

The NHS also has to meet rising and changing patient expectations. Citizens are now used to using a variety of sources, including the internet, that help them make key decisions in their day-to-day life and raise the bar for NHS performance and responsiveness.

We are justifiably proud of the NHS. The NHS has evolved in the past and it must continue to do so in the future in order to deal with a changing healthcare environment.

• David Skelton is deputy director of Policy Exchange

The Guardian

Doctors' leaders declared all-out opposition to NHS shake-up

Doctors' leaders declared all-out opposition to NHS shake-up: Doctors' leaders have declared all-out opposition to the Government's NHS shake-up amid claims they will give too much influence to the private sector. The Telegraph

Cervical screening: sharp rise in test results sent out to women within two weeks of screening

Cervical screening: sharp rise in test results sent out to women within two weeks of screening: Nearly 83 per cent of test results in England were sent out by primary care organisations (PCOs) within a fortnight, compared to nearly 45 per cent in... NHS Information Centre

Self-service healthcare: the future NHS?

Self-service healthcare: the future NHS?: Jo Bibby blogs about the need to redesign healthcare by embracing the potential of modern technologies and mind-sets in order to create ‘self-service’ healthcare. Health Foundation

Generating savings by improving health and well-being: experiences in NHS trusts

Generating savings by improving health and well-being: experiences in NHS trusts:

The NHS is committed to reducing the costs of sickness absence by £555 million by 2013/14. Trust boards need to understand the variety of policies that can contribute to a reduction in sickness absence and embed those policies in the long term.

This briefing includes a variety of good practice examples from NHS trusts as well as a private sector business example. Also included is a useful checklist for managing sickness absence. NHS Networks

New Approaches to Supporting Carers’ Health and Well-being

New Approaches to Supporting Carers’ Health and Well-being:

This report, ‘New Approaches to Supporting Carers’ Health and Well-being’, presents the findings of an independent evaluation of the National Carers’ Strategy Demonstrator Sites programme. It was funded by the Department of Health who commissioned CIRCLE, University of Leeds to undertake the evaluation of 25 demonstrator sites around the country. These sites either developed new and innovative services for carers or extended existing provision where effective arrangements were already in place. Department of Health

NHS ''is doing well but must do better''

NHS ''is doing well but must do better'': ORCD report shows England is behind other countries on outcomes for cancer, stroke and respiratory diseases. Public Service

Training gaps drive up cost of musculoskeletal services

Training gaps drive up cost of musculoskeletal services: Opportunities to slash repeat consultations and improve outcomes for patients with musculoskeletal conditions are being missed because of gaps in education for GPs and patients, a GP specialist has warned. GP Online

NIGB urges CCGs to focus on data control

NIGB urges CCGs to focus on data control: Clinical commissioning groups must prepare to become data controllers and appoint a Caldicott guardian and a senior information risk owner to their boards, the NHS informatics watchdog has said. E-Health Insider

Social marketing for behaviour change

Social marketing for behaviour change: The National Social Marketing Centre has published an updated version of its Big Pocket Guide to using social marketing for behaviour change.

The guide provides an overview of the main issues in behaviour change and explains how social marketing can be used to encourage positive behaviours.

A PDF version of the guide can be downloaded for free using the link above. NHS Improvement Network

Themed inspection programme

Themed inspection programme: The Care Quality Commission (CQC) has announced that it is to carry out a themed inspection programme of home care services. The programme will help the regulator develop new ways to ensure these services meet the essential standards people have a right to expect and that people are being treated with dignity and respect. The programme will start in April and will cover about 250 providers of domiciliary care services. It will run alongside CQC's planned reviews of these services and focus on three outcomes: respecting and involving people who use services, care and welfare of people who use services and supporting workers. NHS Improvement Network

Coalition health bill will undermine NHS, says OECD thinktank

Coalition health bill will undermine NHS, says OECD thinktank:

Each reform costs years of improvements in quality, report suggests, but Andrew Lansley insists change is needed

The last thing the NHS needs is a large reform as it is one of the world's best health systems and has been improving patient care for years, says the author of the OECD's flagship report into international care and treatment.

The report by the Organisation for Economic Co-operation and Development thinktank, which is funded by wealthy governments, says the NHS has cut heart attack deaths by two-thirds since 1980; the public rarely has to pay to meet health needs; and citizens have comparable life expectancies to their neighbours on the continent. Among global diseases the UK also scores well: less than 5% of adults had diabetes in 2010, contrasting with 10% in the United States.

"The UK is one of the best performers in the world. But outcomes are not what you expect because there is a big reform every five years. We calculate that each reform costs two years of improvements in quality. No country reforms its health service as frequently as the UK," said Mark Pearson, head of health at the OECD.

When it was put to Pearson, a respected economist, that the NHS faces its biggest upheaval in 60 years with the coalition's health bill, he said: "The NHS is so central to the political process that every politician has to promise to improve the NHS. But there's no big reform that will improve it. Better to let it bed down and tinker rather than wondering about more or less competition. It is less the type of system that counts, but rather how it is managed."

However, the OECD does point out that mortality rates in breast, prostate, cervical and bowel cancer were higher than the developed world's average in 2009. For all cancers combined, the UK ranked 16th out of the 34 countries when it came to death rates. There were also more avoidable hospital admissions for asthma in the UK than the average. Typically, 52 out of 100,000 adults in OECD countries are admitted to hospital for asthma each year. In the UK, the figure is 74. Pearson said this could be down to "poor air quality".

The report highlighted the prevalence of drinking and obesity, which would, if unchecked, lead to "long-term problems, especially in the labour market, which could affect growth".

One feature was the high pay of British GPs – who take home 3.6 times the average salary, the second biggest multiple in the developed world. The NHS also ran a tight ship financially, which meant the UK had very few CT scanners: "There are absurd amounts of these in Greece, Japan and the US. Frankly most are not used."

Waiting times had come down dramatically under Labour – and the OECD had concerns about recent evidence that suggested patients were not being seen as quickly as before. In 2005, 60% of patients waited four weeks to see a specialist. By 2010 that was down to 28% – better than Sweden, the Netherlands and France.

The report also noted the large proportion of the over-50s looking after family – in the UK, 15% of those in this age group reported themselves "carers", almost double some Nordic countries. Pearson warned that having no "institutional set-up" to deal with social care would extract a high economic price – "Caring for family reduces a worker's pay, their hours of work, affects their health. It's a cost."

Andrew Lansley, the health secretary, argued the report made the case for reform. "It clearly shows that although the NHS is doing well in some areas, it is still lagging behind other countries in some key areas of patient care. Improving patient results is a top priority for me. We need to allow the NHS to focus on what really matters to patients; things like survival rates, recovery rates and whether people can live independently and with dignity."

Labour claimed that Lansley was "desperately talking down the NHS to justify his ill-conceived bill". The party's health spokesman, Andy Burnham, said: "This report confirms what others have been saying. The OECD, and the recent Commonwealth Fund report too, say that Britain has one of the best health services in the world, which begs the simple question, why is the government intent on turning it upside down and putting the progress at risk?" The Guardian

Nice-approved drugs banned by quarter of health authorities

Nice-approved drugs banned by quarter of health authorities: Cutting-edge drugs are being blacklisted by a quarter of local health authorities, even though they have already been approved by the NHS funding watchdog. The Telegraph

Ban on HIV-positive doctors and dentists set to be overturned

Ban on HIV-positive doctors and dentists set to be overturned:

The automatic ban on doctors and dentists with HIV carrying out procedures that might potentially lead to blood contamination could soon be lifted, the Department of Health is to announce. The Independent

Poor performers or a poor system?

Poor performers or a poor system?: When it comes to patient safety and errors made by healthcare staff, we can’t investigate and learn, and we can’t be open with patients, if we don’t understand what has happened and why professionals made sense of situations that subsequently look ridiculous, says Martin Bromiley. Health Foundation

New institute to help narrow the health gap

New institute to help narrow the health gap:

The UCL Institute of Health Equity, which will be led by Professor Sir Michael Marmot, will receive £1 million funding from the Department of Health over the next three years to take forward action that will reduce health inequalities in England.

The Institute, which will be independent, will also be supported by UCL, the British Medical Association and independently commissioned projects.

The UCL Institute of Health Equity will collect the latest evidence, provide expert advice and share best practice both locally and internationally. It will build on previous world-renowned research and reviews led by Professor Marmot such as The Whitehall Study and the Fair Society, Healthy Lives review, which underpinned the recent public health white paper. NHS Networks

Lansley defends looped NHS video

Lansley defends looped NHS video: Health Secretary Andrew Lansley defends a welcome message played on a continuous loop in hospitals in which he tells patients their care "really matters to me". BBC News

Home care 'breaches human rights'

Home care 'breaches human rights': The standards of basic home care for the elderly in England are so bad in some cases that they breach human rights, an inquiry says. BBC News

You can find the full report on the Equality and Human Rights Commission web site.

Slow paracetamol overdose warning

Slow paracetamol overdose warning: Experts are warning that taking slightly too much paracetamol day after day can lead to a fatal overdose. BBC News

Women can choose Caesarean birth

Women can choose Caesarean birth: Women who ask for a Caesarean birth should be allowed to have one, even if there is no medical need, new guidelines for England and Wales say. BBC News

Leading commissioner warns 'constrained' running costs could hinder quality checks

Leading commissioner warns 'constrained' running costs could hinder quality checks: Clinical commissioning groups (CCGs) may not be able to adequately monitor the quality of services because of their 'constrained' running cost envelope, a leading GP commissioner has warned. GP Online

NHS sustainability portal

NHS sustainability portal:

University College London Hospitals and Building Research Establishment have set up a web portal to help Trusts and other healthcare organisations cut carbon emissions, energy use and operate more efficiently. It will give healthcare organisations access to methodologies, processes and information inspired by and developed in the style of Marks and Spencer's Plan A.

• Sustainability portal


• NHS Sustainable Development Unit - news

Listening to experience: an independent inquiry into acute and crisis mental healthcare

Listening to experience: an independent inquiry into acute and crisis mental healthcare:

This report found that while excellent crisis care does exist, there are problems with inpatient hospitals and community crisis teams including people struggling to get help, staffing problems, poor quality care environments and not enough treatment provided to help people recover. It also sets out a series of recommendations on how crisis care should be improved to give the best possible treatment to some of the most vulnerable people in NHS care.

• Report


• Mind - press release

Mind

Joining in the conversation - social media and mental health services

Joining in the conversation - social media and mental health services:

This briefing looks at social media innovations underway in healthcare as a whole and highlights case studies from Mental Health Network member organisations.

• Briefing


• NHS Confederation - publications

NHS Confederation

Improving outcomes and experiences for older women with breast cancer

Improving outcomes and experiences for older women with breast cancer:

This briefing focuses on the key issues for older women affected by breast cancer and presents recommendations for service improvements in three main areas: early diagnosis; treatment and assessment; and information and support.

• Policy briefing


• Policy briefing - executive summary


• Breast Cancer Care - policy

Breast Cancer Care

New NICE guidance for the longer-term management of self-harm

New NICE guidance for the longer-term management of self-harm: NICE, the healthcare guidance body, has today published a new clinical guideline on the longer-term care of adults, children and young people who self-harm. NICE

Man with Down's Syndrome ignored after he was detained in hospital and locked up before he died

Man with Down's Syndrome ignored after he was detained in hospital and locked up before he died: A man with Down's Syndrome had his basic human rights ignored after he was detained in hospital and then kept locked up before he died, an investigation has found. The Telegraph

Midwife shortage linked to rise in Caesarean births

Midwife shortage linked to rise in Caesarean births:

Caesarean birth rates may rise from their present record levels unless urgent action is taken to address the "massive" midwife shortage, childbirth experts have warned. The Independent

Drug misuse: hospital admissions for mental health and behavioural disorders up 14%

Drug misuse: hospital admissions for mental health and behavioural disorders up 14%: Hospital admissions for drug-related mental health and behavioural disorders rose from 5,809 in 2009/10 to 6,640 in 2010/11 – a 14 per cent increase... NHS Information Centre

This will definitely affect your authorisation...

This will definitely affect your authorisation...:

I have a question for colleagues working in CCGs – how many times do you hear the phrase ‘this will affect your authorisation’? Once a month? Once a week? More? I think at present I hear this at least once a day. So far this week the things that I have to do or else my authorisation will be affected are: reconfigure 5 acute hospitals across the patch; ensure every GP practice in the county carries out Health Checks; lead the equality and diversity strategy for the county; land on the moon. I am dreading next week’s requirements!!

The issue seems to be one of control. CCGs have in many places been given control, through the delegation of budgets. Staff not working in CCGs feel the responsibility to deliver whatever their agenda is, but come up against people like me in CCGs who may have different ideas on what or how things should be done. They need to find a way of influencing me, and at present it appears to be beating me with the ‘this will affect your authorisation’ stick!

As CCGs we have a tendency to protect our independence. At the same time we do have new responsibilities and we do have to rise to them. We can’t pick and choose the responsibilities we want, but have to take on the whole range. We do however have the freedom to decide how we do things and how we prioritise things. Both of these may be (and are likely to be) different to what has gone before. A key challenge for us as CCGs is how we build confidence in those who are delegating responsibility to us that the way we want to work will be successful. The more we do this, the less others will feel the need to try and control us. So maybe I will take it as a marker of my success when I start to be told what will affect my authorisation slightly less often. Nene Commissioning

Public services will be hit on strike day

Public services will be hit on strike day:

Schools, hospitals, bin collections, libraries, job centres, courts, day centres and many other services are expected to be hit when public sector workers strike over pension reforms next week. Evening Telegraph

St Andrew’s hospital restructure putting jobs ‘at risk’

St Andrew’s hospital restructure putting jobs ‘at risk’:

A PRIVATE mental health hospital in Northampton could shed at least 20 staff. Northampton Chronicle and Echo

Getting personal? Making personal budgets work for people with dementia

Getting personal? Making personal budgets work for people with dementia:

It calls for the personal budget system to be adapted to meet the specific needs of people with dementia. More …. NHS Networks

Have your say in our webchat about health and care information

Have your say in our webchat about health and care information:

Using information help improve health, care and wellbeing is the hot topic for a webchat on Tuesday 22 November at 3.30pm.

NHS Future Forum leads Professor David Haslam and Jeremy Taylor will take part in the chat. They are looking for people’s views on the following issues:

• How can information be improved for users of service and professionals?



• How can we ensure information is available that enables people to take more control of their own care and enable shared decision-making?



• How can we ensure that information supports improved care and better integration of services while protecting patient confidentiality?



• How can we open up access to information and support people to use it?



• How would you like to see data used to improve the quality of NHS services?



• What are the benefits of giving patients access to their health care records in primary care?



• How can cultural and behavioural change be fostered to stimulate collection and use of data among all professionals?

David Haslam is National Clinical Adviser to the Care Quality Commission, an expert member of the National Quality Board and chair of their Quality Information Committee. Jeremy Taylor is chief executive of National Voices, the national coalition of health and social care charities.

Join the webchat

Urgent mental health care warning

Urgent mental health care warning: People with urgent mental health problems are struggling to get emergency treatment in England and Wales, campaigners say. BBC News

Cancer survival progress charted

Cancer survival progress charted: Overall median survival periods for cancer have risen from 12 months to nearly six years since the 1970s, but with little change in some cancers, figures show. BBC News

Home care firms face inspections

Home care firms face inspections: Companies offering home care services in England are to be subject to inspection from April, the Care Quality Commission (CQC) announces. BBC News

GPs may be stripped of responsibility to sign off long-term sick patients

GPs may be stripped of responsibility to sign off long-term sick patients: GPs should be stripped of their responsibility to sign off patients on long-term sick, a government-commissioned review is set to recommend. GP Online

DoH report backs incentivising practices to cut urgent care

DoH report backs incentivising practices to cut urgent care: Practices should receive financial incentives for cutting their patients' use of urgent care, according to the author of a DoH-sponsored report. Public Service

Industrial action FAQs and free legal advice line

Industrial action FAQs and free legal advice line: Dean Royles has written to HR directors in the NHS to highlight the latest resources we have made available to help employers plan and prepare for the proposed day of action on 30 November. NHS Employers

New service launched to help GP commissioners face their biggest challenge

New service launched to help GP commissioners face their biggest challenge: A new service for GP commissioners launched by the Mental Health Network and pharmaceutical firm Janssen will link up GPs using a social networking programme to help them commission mental health services more effectively. NHS Confederation

NHS patients in England face 'confusing mix' of urgent healthcare

NHS patients in England face 'confusing mix' of urgent healthcare:

Report from alliance of NHS workers says increased services at GPs and A&E units make it hard to know where to go

Patients face such a confusing mix of places to seek urgent health care or advice in England that their safety could be at risk, the government has been warned.

The services that had proliferated between GP surgeries and A&E departments made it difficult to define who was responsible for care as patients moved across organisational boundaries within the NHS, according to the NHS Alliance, representing commissioners, and the Primary Care Foundation, a company that advises on best practice.

Calling for the system of 24/7 care outside hospital to be simplified, their report said: "In addition to NHS Direct [the phone and web advice service], general practice, emergency departments and the ambulance service, a host of new facilities, including walk-in centres, urgent care centres, polyclinics, equitable access centres and GP-led health centres all offer a slightly different range of services available at varying times."

Most people on average only used out-of-hours services once every six years and A&E every three years, but such fragmentation without clean lines of responsibility put both staff and public at risk, said the report.

It also challenged the idea that it was better for patients and for organisations that treatment was prioritised under triage arrangements, saying these were often used to cope with delays caused by poor planning. "There is a real danger that the assumption is made that the assessed patient is safe to wait when, in reality, the condition of some patients can change rapidly."

A new 111 service planned to merge with NHS Direct over the next two years could potentially undermine the role of GPs, said the report, while successive governments' demands for frequent retendering of out-of-hours GP services were criticised too. "Tendering is expensive (estimated as at least £100,000 for the commissioner and for each provider involved) and disruptive and in some cases may lead to too much focus on the tender price rather than the quality, patient safety and the overall cost to the wider healthcare system."

The report said: "If a provider is to invest in a service, the time horizon needs to be long enough to make it worthwhile – or at least five years. Short contracts and short-term extensions will discourage investment in training, equipment, staff and systems." The Guardian

Goverment planning to privatise swathes of NHS, claim GPs

Goverment planning to privatise swathes of NHS, claim GPs: GPs claim a leaked document shows that the Government plans to privatise large swathes of the NHS under its reforms. The Telegraph

Patients face drugs shortage as medicines sold abroad: inquiry launched

Patients face drugs shortage as medicines sold abroad: inquiry launched: NHS patients are facing a critical shortage of vital medicines as pharmacists and hospitals sell the drugs abroad for profit, MPs have warned as a major investigation into the practice is launched. The Telegraph

RCN calls for investment in community nursing

RCN calls for investment in community nursing: The Royal College of Nursing has called for a renewed investment in community nursing as a new RCN report highlights the value of community nurses. Royal College of Nursing

Advice on reducing the risk of carbon monoxide poisoning over winter

Advice on reducing the risk of carbon monoxide poisoning over winter: With the start of Carbon Monoxide Awareness Week, the Health Protection Agency is advising people to have their fossil fuel and wood burning appliances - such as boilers, heaters and cookers - checked by an appropriately registered engineer before the winter sets in. Health Protection Agency

Data blog: What's happening to NHS redundancies?

Data blog: What's happening to NHS redundancies?: James Thompson explores the figures behind this year's NHS redundancies in his data blog. (Blog, 18 Nov 2011) Kings Fund

EHI PC survey identifies CCG IT plans

EHI PC survey identifies CCG IT plans: Clinical commissioning groups have identified tools to compare GP practice data and to share data with secondary care as priorities for IT investment. E-Health Insider

Ministers deny claims of cutting clinical jobs in NHS

Ministers deny claims of cutting clinical jobs in NHS:

Royal College of Nursing attacked by ministers for saying 56,000 staff face the axe under coalition programme

The main nursing union was embroiled in a furious row with ministers last night after claiming that 56,000 doctors, nurses, midwives and other NHS staff have lost or are due to lose their jobs, despite David Cameron's pledge to protect front line health workers from the brunt of the cuts.

Analysis by the Royal College of Nursing, which warns of an impending crisis in the NHS, says clinical posts make up 49% of the 56,058 job losses in the workforce, with nursing posts accounting for 34% of the jobs already lost or earmarked to be cut.

David Cameron and Andrew Lansley, the health secretary, have promised repeatedly that frontline staff would be protected from the effects of £20bn in efficiency savings to the NHS being carried out over three years as part of efforts to reduce the national deficit.

In the run-up to the general election, Cameron said he would "cut the deficit, not the NHS". Accusing the government of making hollow promises in its election manifesto, the RCN says it has found evidence that 8% of qualified nursing jobs will be jettisoned under the trusts' plans and that patients' lives will be put at risk.

Dr Peter Carter, the union's chief executive and general secretary, said: "These figures reveal the deeply worrying acceleration in NHS post losses in recent months. It is only 18 months ago that we were concerned about losing around 5,000 NHS jobs. Now it is more than 10 times that figure. Cutting staff numbers by up to a quarter and axing a third of nursing posts will undoubtedly have a deep and potentially dangerous impact on patient care."

The figures emerged at the end of an embarrassing week for the government during which the health secretary was forced to make a U-turn on previous waiting list targets by issuing an extra care directive in response to fresh evidence that waiting times were creeping higher.

The RCN says Heatherwood and Wexham Park Hospital NHS Foundation Trust in Berkshire lost 280 staff in 2010-11 and plans to axe 533 more from 2011-2014 as part of its "transformation project". This equates to a loss of 25% of its total 2010 workforce. Kingston Hospital NHS trust in Surrey, the union says, plans to reduce staff numbers by 486 posts from 2011 to 2016. This is 19% of its total 2010 workforce.

The RCN's figures drew a furious response from the government last night. Simon Burns, the health minister, described them as "union scaremongering" and said the health department did not "recognise" them.

"Official government statistics show only a 1% drop in nurses since May 2010. This is only 500 less nursing staff than there were in September 2009. In contrast this government has taken tough action to slash the number of managers by 13%.

"It is simply untrue to suggest that it is impossible to make efficiency savings in the NHS. We delivered savings of £4.3bn in 2010-11, and patient care improved all the time. Waiting times are low and stable, mixed-sex accommodation has been reduced by 90%, and more treatments are being offered – including the 7,500 patients who benefitted through our cancer drugs fund."

The NHS Confederation, which represents health care organisations, also accused the RCN of taking an unbalanced approach. David Stout, its deputy chief executive, said: "Given that about 70% of the NHS budget is spent on people, it is unrealistic to expect staff to be unaffected. The RCN is counting the number of job losses and automatically assuming that any job going is bad for patients. That is just is not the case.

"We all need to be honest with the public, patients and staff that we have no pain-free option. Managing the financial challenge, while undergoing a huge structural reorganisation, is going to be tough. There is no doubt that many staff will find this personally very difficult," he added.

The RCN says it has found examples of cuts to preventative services, to the community health sector and to mental health services. In Birmingham and Solihull NHS Cluster it cites plans to decommission Birmingham Own Health, a healthcare service for people with long-term conditions which is run by NHS Direct. The service provides one-to-one advice and support to people in several languages to help manage their condition.

Southern Health NHS Foundation Trust's proposed redesign of inpatient adult mental health services in Hampshire would mean the closure of two hospitals – the Meadows and Woodhaven, the union says. This would result in a loss of 48 beds. The Guardian

Elderly care cut as councils divert £2bn cash to plug gaps

Elderly care cut as councils divert £2bn cash to plug gaps: Elderly people are suffering because councils are cutting hundreds of millions of pounds from their nursing and care home budgets, the Coalition admits today. The Telegraph