Plans to introduce a Health Bill that cements the coalition’s vision for the health service were unveiled in last month’s Queen’s Speech. The Bill, which will be put before Parliament in around 18 months’ time, will propose an NHS run by clinicians and free from political interference. A flagship component will be the creation of an independent NHS Board, which will be responsible for apportioning resources and providing commissioning guidance. It will also give GPs power to purchase services for their patients.

Other measures include increasing the responsibilities of the Care Quality Commission and giving new powers to Monitor to act as an economic regulator “to oversee aspects of access and competition in the NHS”. Further attempts to improve efficiencies within the service will see a reduction in the number of health quangos in a bid to cut administration costs in the NHS by a third.

The Health Bill – at a glance

Purpose:

To build a sustainable national framework for the NHS.

To support a patient-led NHS focused on outcomes.

To reduce bureaucracy.

Benefits:

An NHS led by clinical decision-makers that is more responsive to patients.

A system that drives up standards of care, eliminates waste and achieves outcomes.

A service where patients have greater choice and control in decisions about their care.

Policy:

The establishment of an independent NHS Board to allocate resources, provide commissioning guidance and allow GPs to commission services.

Strengthening the Care Quality Commission and developing Monitor into an economic regulator to oversee access and competition in the NHS.

A reduction in the number of health quangos, cutting the cost of NHS administration by a third.

Targeting key priorities

The Queen’s Speech followed hot on the heels of the coalition’s Programme for Government, which was unveiled by Prime Minister David Cameron and Deputy Prime Minister Nick Clegg shortly after the new Government was formed. The Programme guaranteed a “real term” increase in health spending in each year of the parliament and an end to “top-down reorganisations of the NHS” that it said had “got in the way of patient care”. The Government pledged to stop the “centrally dictated closure of A&E and maternity wards” and give people better access to local health services.

Other measures outlined in the Programme include:

• NICE reform and a move to value-based pricing, so that all patients can access the drugs and treatments their doctors think they need.

• Establishing a Cancer Drugs Fund.

• Strengthening the power of GPs as “patients’ expert guides” through the health system by enabling them to commission care on their behalf.

• Prioritising dementia research within the health R&D budget.

• Setting health targets in key areas such as cancer and stroke survival rates and reducing hospital infections.

• £10 million a year from 2011 to support children’s hospices.

• A new per-patient funding system for all hospices and providers of palliative care.

• An extension of best practice on improving discharge from hospital –maximising the number of day care operations, reducing delays prior to operations and enabling community access to care and treatments.

• Helping elderly people to live at home for longer through home adaptations and community support programmes.

• The development of a 24/7 urgent care service throughout England.

• Giving every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.

Local decision-making

The Programme’s commitment to end an era of top-down NHS reconfigurations and instead give power back to local communities has been highlighted as a key component of change. Health Secretary Andrew Lansley said: “We are committed to devolving power to local communities – to the people, patients, GPs and councils who are best placed to determine the nature of their local NHS services. Local decision-making is essential to improve outcomes for patients and drive up quality.”

Lansley said he expects decisions on NHS service changes to:

• focus on improving patient outcomes

• consider patient choice

• have support from GP commissioners

• be based on sound clinical evidence.

Local NHS organisations that have started to look at changing services will need to ensure their plans match these criteria. Lansley had said he was looking to NHS London, the biggest authority in the health service, to lead the way in working with GP commissioners in their reconfiguration of NHS services. However, the head of NHS London, former GSK Chairman and CEO Sir Richard Sykes, resigned from his position late last month following the new government’s decision to halt a wave of hospital reorganisations. Sykes was said to be furious at the Health Secretary’s decision to scrap a review of healthcare in the capital. The review included the possible closures of some A&E and maternity units.

A mixed reaction

Commenting on the new Programme for Government, ABHI said that the coalition appeared to have dropped the Conservative pledge to scrap NHS targets such as the ‘18 week wait’ but questioned its pledge to stop top-down reorganisations. “The programme does contain significant changes in the shape of an NHS Board and GP commissioning – measures which could have serious implications for NHS structures,” it said.

ABHI highlighted the appointment of Earl Howe as Parliamentary Under Secretary of State for Quality as being significant for industry. The position gives Howe responsibility for medicines, pharmacy and industry, NICE, R&D and innovation. ABHI recently met with Earl Howe to discuss the medical technologies industry and says it looks forward to continuing its dialogue.

Reaction to the recent announcements has been varied. Anna Dixon, Director of Policy at think tank The King’s Fund, said the proposals confirm that the NHS is embarking upon a period of significant change. “Strengthening the role of doctors and the voice of patients will create some difficult dilemmas,” she said. “In setting up an independent NHS board, careful thought will need to be given to the relationship between its responsibilities and those of ministers, who will remain accountable to Parliament for NHS expenditure.

“We welcome the acknowledgement of the critical role played by GPs within the NHS and the clear signal that changes are needed to improve the quality of general practice. If, as expected, these changes include transferring budgets to GPs, it will be important to learn from the previous experiences of GP-led commissioning in the United Kingdom and other countries to ensure it delivers benefits for patients and efficiency savings across the health system while ensuring accountability for public expenditure.”

But analysts have warned of the dangers of giving financial accountability to clinicians. Dean Arnold, Head of Healthcare Practice at Deloitte, said: “Putting patients first is always a positive thing to do, so too is empowering clinicians. However, this requires some caution as clinicians are not specialists in cost management – a skill that will become increasingly important. With power comes greater accountability. Patients should be able to hold clinicians to account. It can be argued that today healthcare managers and executives are far more accountable to patients than clinicians. It will be vital to get the right ‘checks and balances’ if we are to put the NHS in the hands of clinicians.”

Coalition health team

The Government’s new Health Ministers and their portfolios are as follows:

Minister of State for Health – Simon Burns

Responsible for: Legislation, NHS Performance, Health Services, Reconfiguration of Services, Patient Safety, Application of Quality Regulation and Connecting for Health.

Minister of State for Care Services – Paul Burstow

Responsible for: Long Term Care Reform, Carers, Personal Health Budgets, Safeguarding Vulnerable Adults, End of Life Care, Long Term Conditions (including cancer and diabetes), Dementia, Physical Disabilities and Learning Disabilities.

Parliamentary Under Secretary of State for Public Health – Anne Milton

Responsible for: Public Health, Blood and Transplants, Fertility and Embryology, Children’s Health, Maternity Services and Nursing and Midwifery.

Parliamentary Under Secretary of State for Quality – Earl Howe

Responsible for: NHS Constitution, NHS Commissioning Reform, Primary Care, NICE, R&D, Finance, Innovation and Medicines, Pharmacy and Industry.



With the government intent on retaining the requirements for registration by both NHS and private practices, the poll shows that – with only six months to go – 22% of those surveyed by admitted to being unprepared for registration.

A further 19% did not even know what CQC meant.

There is much debate in the profession as to the necessity for further regulation by the Care Quality Commission, which many in the profession arguing that it will simply duplicate procedures already performed by other bodies such as the GDC (revalidation) and the BDA's Good Practice Scheme.

And last week, the CQC's own annual staff survey exposed low staff morale revealing a lack of employee confidence in the organisation's management.

Nevertheless, with the new government ‘s recent commitment to retaining registration for dental practices, those who do not fulfil the requirements run the risk of having their licence to practice removed.

The CQC took over from the Healthcare Commission on 1 April this year and dentists are part of a second wave of health professionals required to register with the watchdog.

This will be in addition to registration with the General Dental Council (GDC).

The intention is that the new CQC will operate as a ‘one-stop-shop' for health and social services regulation in the UK and, under the new framework, all providers will be expected to conform to a single set of safety and quality requirements, with legislation in place to support this.

CQC registration becomes a legal requirement for all primary dental care providers by April 2011.

Dentists have until then to register in order to avoid breaking the law.

Any practices failing to comply with the agreed CQC standards could be reprimanded.

The actual procedure for registration needs to allow time for processing which means that some practices will be given a window for registration that could be as early as October.

But a large number of practices are seemingly unprepared. 



New legislation

This new requirement is the result of legislative change that sees the Care Standards Act 2000 repealed by the Health and Social Care Act 2008, and the National Minimum Standards succeeded by the 28 Essential Standards of Quality and Safety.

All adult social care and independent healthcare providers carrying out regulated activities must be registered with the CQC in order to be able to continue to provide these services from 1 October.

Existing registered providers have been going through the registration process since April as there is no automatic transfer of the existing Care Standards Act registrations.

Some services that involve the delivery of personal care by way of prompting and supervision have not previously been regulated. The new act introduces a broader definition of ‘personal care’ in the regulations which govern regulated activities.

Who must register?

The services most likely to require registration are those where service users are prompted and supervised with eating, drinking, using the toilet, washing or bathing, dressing, oral care or the care of skin, hair and nails.

The prompting and supervision must be for a person who is unable to decide whether to perform such activities themselves without this support. Existing domiciliary care providers already registered to deliver personal care may find they have additional services that must be included in their registration. The location of these services will be the places from which they are managed rather than individuals’ homes where they are provided.

Enforcement

If a provider continues a regulated activity from 1 October without being registered, the CQC has the a whole range of enforcement powers which would include the ability to prosecute the person carrying on the regulated activity.

The CQC has said that it will be proportionate in its response and will consider the public interest when deciding to use its enforcement powers. It has indicated it will take into account the following factors: if the activity was carried out as a one-off response to unexpected and rare circumstances, the failure to carry out the activity would have led to serious potential for harm, injury or death and assuming that no actual no harm resulted from the activity having been carried out.

Such instances are likely to be exceptional and to avoid the risk of prosecution providers should make sure they don’t get left out in the cold by missing deadlines for registration.



Inspectors from the Care Quality Commission (CQC), the independent national watchdog, descended on four out of six community hospitals in Worcestershire as part of a series of surprise visits to check staff were keeping the wards, patients and equipment clean to protect against potentially deadly superbugs like MRSA and C.difficile.

The visits took place at Pershore Community Hospital, Evesham Community Hospital, Tenbury Hospital and The Princess of Wales Community Hospital in Bromsgrove, on Tuesday, May 25.

The results of the unannounced visits were presented to the board of NHS Worcestershire.

During the inspection commodes were taken apart to look for evidence of ‘soiling’ while inspectors finger tested dust levels and checked cleaning rotas.

Teresa French, director of provider services, said: “The inspection was incredibly thorough.

“It was quite a traumatic day for all concerned. I would like to pay tribute to staff at this point.

"They were incredibly professional and incredibly knowledgeable about the issues.”

She said the inspectors had made some suggestions for improvement, but the feedback was generally very positive especially concerning infection control standards.

The CQC has significant powers of enforcement ranging from imposing action plans to fines or even closing a service down.

But in Worcestershire there were ‘no concerns’ about 13 out of the 14 standards for infection control with the one standard drawing a ‘minor concern’.



A smaller hospital just five miles away from the Newcastle Trust – South Tyneside NHS – recorded only 19 cases.

The results for MRSA infection will also cause concern. Leeds Teaching Hospitals NHS Trust recorded 33 patients contracting the deadly bug, putting it at the top of the league table. It was ­second top of the C. diff table, with 264 cases.

But Southampton University Hospitals NHS Foundation Trust, which treats roughly as many patients as in Leeds, reported just four MRSA cases – eight times fewer than Leeds.


Small trusts in Poole and Basing­stoke recorded no cases of MRSA at all, putting the larger units to shame. Other trusts performing badly in both infection tables were University Hospital of South ­Manchester NHS Foundation Trust, Pennine Acute Hospitals NHS Trust, Western Sussex Hospitals NHS Trust and Tameside Hospital NHS Foundation Trust.

No hospital managed to record zero cases of C. diff.

The figures, released by the Department of Health, come days after the Government announced that all hospitals will have to ­publish weekly infection rates
as part of a drive to increase NHS transparency. Until now, trusts supplied monthly updates. Eventually, the Government aims to publish infection rates by each hospital ward, which would make all staff accountable.

Health Secretary Andrew Lansley said: ‘The NHS should aim for a zero-tolerance approach to all healthcare-associated infections. We are publishing infection data weekly so people can see which trusts are doing well and which ones are lagging behind.’

The figures relate to 12 months between April 2009 and March this year. The ten hospitals with the highest number of both superbug strains were all large units, many of them affiliated with ­universities. The ones with lowest infection rates were the smallest, specialist hospitals.


TRAGIC MOTHER WAS SENT HOME

A mother readmitted to hospital only five days after being discharged died after receiving 'conservative' treatment for a life-threatening illness, an inquest heard.

But the Department for Health was unable to say last night whether the scheme would be extended nationwide.

Around 3 per cent of people carry MRSA on their body without ill effects. Simple swab tests can pick up the infection, which can then be treated.

The Government has already ordered the weekly publication of MRSA and C.diff infection rates for every hospital in the country.

Officials are now looking at extending the scope of the data to include individual departments or even wards, and other bugs.

Hospital deaths from superbugs soared under Labour despite a string of initiatives to being infection rates down.

In 2008 C.diff was mentioned as a contributory factor in 5,931 deaths, while MRSA was associated with 1,230 deaths.

Derek Butler, of campaign group MRSA Action UK, last night welcomed Mr Lansley's comments, but said more detail was needed on how the policy would work.

He also warned that action to tackle superbugs would have to be extended beyond hospitals to GP surgeries and home care.

Mr Lansley also used yesterday's speech to confirm plans to tackle emergency hospital readmissions.

Under a scheme to be introduced next year, hospitals will not receive funding for the emergency treatment of patients who have been discharged in the previous 30 days.

The move is designed to end the scandal of 1,500 NHS patients a day being returned to hospital after apparently being discharged

too soon. Mr Lansley said Labour's waiting time targets put pressure on hospitals to discharge patients too soon to free up beds.

He indicated that hospitals would receive additional funding for ensuring patients received appropriate treatment in the community following discharge.

But critics warned the move might result in 'unforeseen consequences'.

Dr Hamish Meldrum, of the British Medical Association, said: 'One risk is that we get a situation where decisions about discharge are based not on a judgment about what is best for the patient, but on an attempt to avoid additional costs.

'This could result in patients being kept in hospital longer than necessary.'

The King's Fund think-tank said the scheme would work only if sufficient care in the community was made available. 

He added: “Our top priority is to ensure that residents at the home are receiving the appropriate care.”

CQC inspectors found that the plans which determine what kind of care Good Companions residents receive were inadequate.

Medicines were not managed properly and there was evidence to suggest some doses had not been administered.

There had been two ‘extremely serious’ incidents between residents which had not been reported to social services or the CQC, which is a breach of regulations.

The report explained that the manager had been spending a considerable amount of time away from the home.

Staff, who had not received all the necessary training, had not been passing on information about residents or complaints from their relatives.

The building itself was criticised for being way below national minimum standards.

There was damp on the walls, mould in the shower area and taped up windows which could not be opened.

There were also concerns that there weren’t enough cleaners or enough carers on night duty to look after residents.

Mr Newby told the News & Star that staff were bitterly disappointed by the CQC rating – especially since the home received the highest three-star rating at its last inspection.

He said that all of his team are completely focused on addressing the problems identified by the CQC.

Mr Newby added: “Hopefully everyone with regular contact will know that Good Companions strives to deliver an individual high quality service.

“Unfortunately the recent report indicates we have fallen below expectations particularly with regard to some aspects of our original building, with communication and with some of our recording practices.

“We fervently hope there has not been an actual reduction in the quality of personal care received by our residents.

“As owner of Good Companions I would like to apologise to each and every one of my customers and to assure and reassure you that no stone will remain unturned until we are judged to be excellent again.”