Central control of NHS finances needs to be tighter than before during the transition to the new system, according to Sir David Nicholson.

Addressing the Local Government Association, the NHS Chief Executive argued that the “turbulence” of rapid change combined with austerity measures made temporary centralisation of funding essential.

The current financial crisis of the South London Healthcare trust showed the importance of ensuring that all hospitals meet Foundation Trust criteria, he said.

The NHS reforms imposed by New Labour in 2004 had “lost control of the money”, Nicholson claimed, and that could not be allowed to happen this time.

The two economic priorities were that every hospital should be financially sustainable and every CCG should be free of legacy debts, he said, adding: “While much of the talk is about localism, in practice I have more national control over the money in the NHS than we have ever had.”

Nicholson also said the current NHS reforms would “shift the centre of gravity” towards local government, driving the integration of health and social care – and to assist that, the NHS was “committed to transferring resources to social care”.

The NHS was currently in discussion with the LGA to agree on a strategy for effective collaboration, he revealed.

Bolton Clinical Commissioning Group has allocated more than half a million pounds to pay for risks associated with the performance and financial position of Royal Bolton Hospital.

The CCG has set aside £669,000 to cover any penalties the hospital may incur after it previously missed a number of Government performance targets.

Dr Wirin Bhatiani, CCG chair, said the group is “aware there are some performance issues” but is working with the hospital to help make improvements.

The CCG called a meeting with hospital chiefs after Monitor, the independent health watchdog, published a report criticising its management.

In the meeting, reassurances were requested by the CCG’s board that everything was being done to address performance issues. Commissioners now say they will now work alongside the Trust to ensure targets are achieved in the future.

The hospital had failed to meet the Government’s 18-week waiting time target for treatment between April 2011 and April 2013. The A&E target was also not achieved. However, the hospital says both of these targets are now being met.

“We are working alongside them every step of the way,” said Dr Bhatiani. “We are aware there are some performance issues causing concern and areas that need work, but we have seen significant improvement in the last two months in many of these areas.”

A host of community projects have taken advantage of more than £200,000 funding from NHS Wirral Clinical Commissioning Group to improve the quality of life for carers.

A total of 23 projects have been selected for funding that meet the requirements of the Group’s aim to improve the health and wellbeing of carers in the region.

Projects include a club to improve the employability prospects for black and minority ethnic people with mental health issues, a food and thought programme and a project to improve health support for people with cerebral palsy.

Doctor Phil Jennings, Chair of Wirral Clinical Commissioning Group, said the projects were all “extremely worthy causes” and he looked forward to witnessing their development.

Voluntary and community health organisations were invited to apply for funding of up to £10,000 for projects which align with the CCG’s vision.

“I was delighted to see so many applications for funding,” said Dr Jennings. “It highlights how many voluntary and community organisations there are out there working hard to improve the lives and health of Wirral people and carers.”

A host of NHS trusts received bailouts totalling more than £1 billion in the last six years, a report from the National Audit Office (NAO) has shown.

The Department of Health was forced to issue four struggling foundation trusts and 17 other trusts the money between 2006 and 2012 to pay creditors and staff.

Amyas Morse, Head of the NAO, said that it was clear “parts of the service are under strain.”

Research found that South London Healthcare NHS Trust – which recently became the first to go into administration – needed a total of £356 from the DH to break even over the last six years. It is yet to pay back the money.

Barking, Havering and Redbridge University Hospitals NHS Trust also required £195 by the DH to cover its debts.

Last year, trusts needed £253m from the DH, the report found – a huge increase from the £76m requested between 2010 and 2011.

The NAO now estimates that NHS trusts and foundation trusts will need approximately £300m more in bailouts next year to cover ailing finances – despite a surplus of £2.1bn across the NHS.

Meanwhile, official figures from the Department of Health showed ten NHS hospital trust recorded deficits last year.

Mid Yorkshire Hospitals was £19m in the red, Surrey and Sussex Healthcare ended with a £6m deficit, Mid Essex Hospital Services Trust ended up with £2m debts and Newham University Trust recorded losses of £200,000.

Hospital trusts in the capital struggled to control finances more than any other part of the country with the region finishing £96m in the red overall.

Sir David Nicholson, NHS Chief Executive, said the “demands of an ageing population and increased costs owing to developments in drugs and advancing medical technologies present challenging financial conditions in a constrained economic environment.”

He added that “all parts of the NHS” will need to take “bold, long-term measures” to meet financial challenges.

A host of NHS trusts received bailouts totalling more than £1 billion in the last six years, a report from the National Audit Office (NAO) has shown.

The Department of Health was forced to issue four struggling foundation trusts and 17 other trusts the money between 2006 and 2012 to pay creditors and staff.

Amyas Morse, Head of the NAO, said that it was clear “parts of the service are under strain.”

Research found that South London Healthcare NHS Trust – which recently became the first to go into administration – needed a total of £356 from the DH to break even over the last six years. It is yet to pay back the money.

Barking, Havering and Redbridge University Hospitals NHS Trust also required £195 by the DH to cover its debts.

Last year, trusts needed £253m from the DH, the report found – a huge increase from the £76m requested between 2010 and 2011.

The NAO now estimates that NHS trusts and foundation trusts will need approximately £300m more in bailouts next year to cover ailing finances – despite a surplus of £2.1bn across the NHS.

Meanwhile, official figures from the Department of Health showed ten NHS hospital trust recorded deficits last year.

Mid Yorkshire Hospitals was £19m in the red, Surrey and Sussex Healthcare ended with a £6m deficit, Mid Essex Hospital Services Trust ended up with £2m debts and Newham University Trust recorded losses of £200,000.

Hospital trusts in the capital struggled to control finances more than any other part of the country with the region finishing £96m in the red overall.

Sir David Nicholson, NHS Chief Executive, said the “demands of an ageing population and increased costs owing to developments in drugs and advancing medical technologies present challenging financial conditions in a constrained economic environment.”

He added that “all parts of the NHS” will need to take “bold, long-term measures” to meet financial challenges.

Epilepsy patients in Dumfries and Galloway will benefit from a unique partnership between the Scottish NHS, pharmaceutical companies and the voluntary sector.

The cross-sector collaboration will deliver specialist nurse training for local health professionals to develop their expertise in managing epilepsy across all care environments.

NHS Dumfries and Galloway will work with charity Epilepsy Scotland and pharma companies Eisai, GSK and UCB Pharma to develop the service.

Epilepsy, which affects over 1,500 people in the region, poses challenges to both primary and secondary care: medication is often poorly tolerated and acute episodes are dangerous.

Epilepsy Scotland will provide a specialist nurse for three days a week to ‘upskill’ health professionals, while the three pharma companies will support the training with software, printing and other resources.

The partnership will run for three years and, according to Epilepsy Scotland Chief Executive Lesslie Young, will create “a legacy of epilepsy care in this area”.

It will enable the region’s NHS Board to address an identified lack of expertise, and to provide services directly that it had previously outsourced.

Young commented that the project is “an original model of cascading epilepsy expertise” that “sets a new benchmark in joint working” towards the shared goal of “better patient-centred treatment”.

“This innovative proposal allows the research-led pharmaceutical industry to work with our partners to improve the delivery of healthcare and focus on improving outcomes for patients at a time of significant financial challenge,” noted Gordon Lundie, UCB’s Government Affairs & Market Access Director.

Jeff Ace, Chief Executive of NHS Dumfries and Galloway, said the project was “a milestone collaboration”.

Dr Mark Porter has been elected the new Chairman of the British Medical Association’s UK Council.

A consultant anaesthetist in Coventry, Dr Porter has been Chairman of the BMA’s Consultants Committee since 2009.

Dr Porter was elected from a shortlist of three candidates by the 34 voting members of the BMA Council at the Association’s annual conference.

He replaces Dr Hamish Meldrum, who has served as BMA Chairman since 2007.

“I’m excited and privileged to be taking on this role at what is clearly a particularly challenging time for the NHS and the medical profession,” Dr Porter said.

“The BMA will continue to work to help its members do the best for its patients during a time of huge change, and often huge financial difficulty, for the NHS.”

In his closing address as Chairman to the conference, Dr Meldrum urged doctors not to let their frustration with Government policy discourage them from negotiation.

More than a quarter of NHS and social care services in England are not delivering appropriate care, according to the first Care Quality Commission ‘market report’.

Medication errors and poor drug stock control were highlighted as widespread problems, while lack of staff was identified as the main reason for inadequate care.

Urgent measures used to address failings included the barring of new admissions to a nursing home in north London because of inaccurate medication records.

Other case studies included staff shortages in a Cambridgeshire NHS district nursing service and “chaotic” record-keeping at a Retreat psychiatric hospital.

In 14,000 inspections the CQC identified 130 services that needed urgent intervention, while thousands of lesser cases were addressed by requiring managers to draw up action plans for improvement.

The CQC found failure to meet its 16 quality standards in 22% of 581 NHS services; 18% of 850 private healthcare providers; and 28% of 12,000 care homes and home care services.

Inadequate staff training to handle complex medication regimes for patients was highlighted as a recurrent problem in the social care sector.

Jill Finney, CQC Deputy Chief Executive, said: “We want providers to look closely at this report in order to assure themselves that they are taking all steps necessary to protect people from poor care.”

The CQC will provide a similar health and social care market report every three months.

Clinical commissioning groups will be given free specialist expertise and advice from April 2013 to maintain high standards of public health.

A series of recommendations have been issued by the DH to support CCGs in delivering public health objectives through its Healthcare Public Health Advice Service.

Guidance to support the Provision of Healthcare Public Advice to Clinical Commissioning Groups outlines how local authorities should support and work alongside commissioners in tasks such as making Joint Strategic Needs Assessments and identifying areas for disinvestment.

Recommendations that the service should offer at various stages of the commissioning cycle are suggested in the document, such as interpreting and understanding primary and secondary care clinical data and advising CCGs on prioritisation and processes.

The document replaces the draft guidance published by the DH back in February 2012. As a result of the NHS reforms and the “shift of local leadership on public health to local authorities”, the report says, “it is critical that NHS commissioning continues to benefit from public health advice”.

The service, which will be provided by local authorities, will be the only means available to commissioners in obtaining public health expertise.

As part of the Health and Social Care Act 2012, CCGs will have access to public health advice, information and expertise in relation to the healthcare services that they commission and will be provided by local public health teams based in local authorities.

CCGs will have the freedom to determine how to organise public health arrangements depending on local requirements.

The NHS operating framework provides the blueprint for the NHS in England. Pf examines its objectives around quality and reform.

The Operating Framework for the NHS in England 2012/13 is an important document for UK medical sales professionals. It outlines the national priorities, system levers and mechanisms that the NHS in England must focus on to improve patient care. The strategic framework details expectations for the NHS’ ongoing efficiency challenge and the transition to the new commissioning and management system. It sets out the planning, performance and financial requirements for NHS organisations and the basis on which they will be held to account. With QIPP imperatives at the heart of the strategy, proactive pharmaceutical companies that can demonstrate an ability to help NHS customers deliver efficiencies and improve qualities in areas of national priority will be best placed to succeed.

The Framework identifies four key themes for NHS organisations in 2012/13:

1. Putting patients at the centre of decision making in preparing for an outcomes approach to service delivery
2. Completing the final year of transition to the new system
3. Accelerating the delivery of the QIPP challenge
4. Maintaining a strong grip on services and financial performance.

Quality - a focus on outcomes

The Operating Framework says that the NHS’ model of delivery must be overhauled in 2012/13 to become a system driven by quality and outcomes. It identifies the Outcomes Framework as the catalyst for this – with its focus on clinical outcomes and the reduction of health inequalities driving changes in culture, behaviour and service delivery. The Outcomes Framework sets out the improvements against which the NHS
Commissioning Board will be held to account from 2013/14.

These measurements are set out within five domains:

Domain 1: preventing people from dying prematurely.

Domain 2: enhancing quality of life for people with long-term conditions.

Domain 3: helping people recover from episodes of ill health or following injury.

Domain 4: ensuring people have a positive experience of care.

Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm.

The Operating Framework details a range of indicators for each domain, all of which are explored in the NHS Outcomes Framework. These will be supported by NICE quality standards, which provide definitions of what high-quality care should look like for a particular pathway of care. The document also advises NHS organisations to meet the service specific outcomes strategies that have already been published in areas such as mental health, cancer, COPD, asthma and long-term conditions.

Each domain in the NHS Outcomes Framework has a strong relevance to pharma, whether through the development of medicines to treat disease in priority areas, or via collaborative service design to move care closer to patients’ homes and reduce hospital admissions. Organisations that are able to show how their innovations can improve a care pathway or be used as part of a redesigned service will enjoy
more positive NHS engagement.

The Operating Framework identifies dementia and care of older people as a key priority, and sets clear goals to integrate health and social care. It also highlights examples of initiatives where NHS organisations have successfully improved services in line with each of the four key elements of QIPP; quality, innovation, productivity and prevention.

Reform - the transition blueprint

The Operating Framework outlines the key milestones for the reorganisation of the NHS. Whilst the headlines are widely known, it is interesting to track current progress against a timetable that was set out many months before the Health & Social Care Act was passed. The Framework notes that by
the end of 2012/13:

“The NHS will have transformed the commissioning landscape into one focused on local clinical decision
making, with the development and authorisation of CCGs, assisted by commissioning support vehicles and overseen by the NHS Commissioning Board. Local authorities will take the lead role in public health, alongside the new Public Health England. Central to the new system will be the establishment of Health & Wellbeing Boards (HWB), who will provide local systems leadership across health, social care and public health. Alongside this, developments will continue to the provider landscape, through the extension of Any Qualified Provider (AQP), progress with the NHS Foundation Trust (FT) pipeline and the establishment of the new NHS Trust Development Authority.”

Key 2012/13 objectives in the transition are as follows:

• PCTs and SHAs will remain statutory organisations until April 2013. They will be held to account on delivering performance and support the development of new organisations for clinical leadership. Clinical Senates and networks will be established
• PCTs will support CCG authorisation and the transition of power before March 2013
• HWBs will be established in shadow format, becoming statutorily operational from April 2013. They will act as the local system leader through JSNA and HWB Strategies
• CCGs must be coterminous with a single HWB ‘as far as possible’
• CCGs must: play an active role in planning and budgeting, develop relationships with local partners
  including social care, deliver their share of the QIPP agenda and identify how to secure commissioning support services in line with their running cost allowance
• Public Health England will become a statutory executive agency from April 2013
• NHS Trusts are expected to achieve FT status by April 2014
• PCT clusters should start to offer patients choice of AQP in at least three services that are local priorities. There should be a presumption of choice for most services from 2013/14.