A trust struggling to meet the Government’s efficiency savings targets is being forced to do without full time cleaners as hospital bosses continue to cut costs, a new report claims.

Nurses at Mid Yorkshire Hospital Trust are being forced to clean and tidy dirty working environments as it struggles to meet the £20bn Nicholson Challenge and the QIPP agenda.

The report by a former inspector at the Department of Health said the nurses being forced to clean impacts patient care and is something that requires “urgent attention”.

The investigation by Brian Duerden, a former inspector of microbiology and infection control at the DH, found that nurses were mopping and cleaning beds despite not being trained to do so.

The Trust was forced to reduce the hours of professional cleaners earlier this year to just two days per week in measures to control finances. The cash-strapped trust is seeking to save £24m in the next financial year to meet Government targets.

A spokesperson for Mid Yorkshire Hospital Trust insisted the practice of nurses cleaning up wards was not reserved to the hospitals it controls. She said that the need for nurses to clean certain wards was not due to cost-cutting practices but to meet levels of high demand.

NHS Chief Executive Sir David Nicholson recently said the health service had enjoyed a “remarkable year” after it made £5.8bn in savings through the QIPP agenda.

However, those comments were in contrast to Jim Easton from the NHS Commissioning Board who insisted that cuts should not represent QIPP savings.

The DH plans to retain some PCT and SHA staff for up to a year after April 2013, when those bodies are abolished.

New DH guidance allows for staff retention “in agreed posts” to help manage the transition process.

The staff in question may number several hundred nationally, and may be housed by an existing arm’s length body.

The measure builds on the Retention and Exit Terms Scheme agreed with the health unions, whereby many staff will be redeployed in new NHS organisations including commissioning support services.

According to Retention Terms for Business Critical Staff, a PCT or SHA can request for “an individual or group of individuals” to be kept on if they are “required to close down a particular activity”.

The transitional roles must be ones that “if not filled, will result in an unacceptable risk to the organisation concerned” because the staff have “scarce skills and knowledge” or the roles would be difficult to outsource.

These roles may include financial activities, as well as areas of expertise (such as risk management) that need to be handed over to new organisations.

Staff in these ‘business critical roles’ will be paid bonuses for taking on “additional responsibilities or a wider portfolio” as part of the transition.

John Restell, Chief Executive of health management union Managers in Partnership, commented: “Some of our members are already managing with much reduced staff, and maybe this is a bit too late for them.”

There was more likely to be widespread use of interim management during the transition, he said.

Cancer patients across England may be denied essential treatment due to their GPs missing symptoms and delaying referrals to specialists, a study has found.

Figures from the National Cancer Intelligence Network (NCIN) found that some doctors are referring three times more patients than other GPs to see cancer specialists.

Sarah Woolnough, Executive Director of Policy and Information, Cancer Research UK, said the findings are “very worrying” and the process of referrals and poor practice needs to be addressed.

Official figures found that 1,000 GP practices referred more than 2,550 people per 100,000 but sent fewer than 830 patients per 100,000 for further tests.

The individual GP practice with the highest referral rate – 5,591 patients per 100,000 – was in Sefton, Merseyside; however, one practice in London referred only 89 patients per 100,000.

Unsurprisingly, PCTs areas with the highest referral rates – in the north west and south west – have the highest rates of cancer in England.

The study also found the proportion of patients who were referred that went on to be diagnosed. The ‘conversation rate’ across England was almost 11%. But this again varied and highlighted the fact that some GPs are missing essential symptoms or being overly cautious.

Professor Sir Mike Richards (pictured), National Cancer Director, said that anybody with persistent symptoms should be referred “urgently” to increase chances of survival. “Where differences have been exposed, GPs should consider their referral practices, which will help to drive up standards of care for everyone.”

The study calculated that if cancer survival rates in England matched the European average more than 5,000 lives could be saved each year through earlier diagnosis and better treatment. If survival rates matched the best across Europe, around 10,000 lives a year could be saved.

Professor Richards added that the Government has invested more than £450m to achieve early diagnosis rates and to support GPs to assess and diagnose cancer symptoms better as part of its cancer strategy.

Monitor has outlined its new functions as NHS economic regulator by publishing a consultation document on its new NHS provider licence.

The proposed licence conditions cover the means by which Monitor will set prices for NHS services, ensure patient choice and provider competition, support integrated care and help commissioners maintain service continuity.

It also translates Monitor’s current oversight of the governance of NHS foundation trusts (FTs) into the new framework.

The statutory consultation, which ends on 23 October 2012, invites stakeholders to comment on the draft conditions and vote for options in some cases.

Monitor expects to issue licences to FTs in April 2013 and to other NHS providers from April 2014.

The general licence conditions include requirements that providers should display “effectiveness, efficiency and economy” and set out appropriate patient eligibility and selection criteria.

The pricing licence conditions include compliance with the National Tariff and “constructive engagement” with commissioners regarding local tariff modification.

The choice and competition conditions are designed to ensure that patients can choose between providers, and to stop providers “preventing, restricting or distorting competition”. Monitor consults on the option of requiring providers to ensure that patients are offered impartial advice about their choices.

To support integrated care, Monitor proposes “a broadly defined prohibition”: that the licensee will not do anything “detrimental to enabling integrated care”. This, it says, will allow providers and commissioners to “take the lead”.

To support continuity of services – described explicitly in terms of a licensee becoming “financially distressed or insolvent” – Monitor proposes measures including co-operation between providers and restrictions on disposal of assets. It will set out a Risk Assessment Framework later this year.

The proposed licence conditions for FTs include provision of information to a new advisory panel and Monitor’s continued oversight of FT governance.

The NHS in Wales saw figures for emergency admissions for heart disease, respiratory conditions and diabetes fall by almost 12% last year.

Emergency re-admissions for the chronic conditions also fell by a quarter (23%) when compared to the same period the year before after improvements in community-based care.

David Sissling, NHS Wales Chief Executive, said in his Annual Report the results showed the health service is “making progress in shifting the balance of care from hospital to community settings.”

NHS Wales aimed to improve admission rates by improving the treatment of chronic conditions through better care in the community resulting in less reliance on hospitals to provide treatment.

The Chief Executive is now aiming to improve admission rates further after admitting more needs to be done.

“To continue to deliver better outcomes we need an even greater focus on community-based services – alongside specialist centres of excellence – which will provide better results for patients,” he said.

“In order to meet these challenges, we need to modernise our health services and over the coming months communities across Wales will get a chance to voice their opinions on changes to health services in their areas.”

Mr Sissling added that NHS Wales needs to be “more ingenious and innovative” when providing services.

However, these improvements will have to be made during a period of austerity for the health service. A recent report by the Wales Audit Office said the NHS needed to cut up to £1bn from its annual budget by 2015.

The Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) has promised to improve its record as a service provider following a critical independent review.

The review, commissioned by the region’s SHA, said that AWP was “centralist in style, with improvement required in clinical engagement and poor relationships with stakeholders”.

AWP, which has just gained a contract to co-provide autism diagnosis services in Wiltshire, responded that it had been through a “challenging period” and planned to improve.

The report led to the retirement of the trust’s Chairman and Chief Executive.

Tony Gallagher, the trust’s new Chairman, said: “We have started to change the way the trust is run and the way it relates to staff, service users, carers and other stakeholders.

“We will ensure that service users and carers are at the centre of what we do and that staff are enabled to make a real difference in the care we provide.”

NHS Wiltshire has said it may retender its mental health services due to its concerns about AWP.

However, the mental health trust has just gained a contract to co-provide autism diagnosis services, along with two other providers, for NHS Wiltshire.

One member of the NHS Wiltshire board questioned the trust’s suitability, but the board took the view that AWP had met the criteria to provide this specialist service and so could not fairly be excluded.

Doctors have indicated a wish to be consulted during the essential development stages of clinical commissioning groups, a new survey has found.

The Family Doctor Association survey revealed how GPs wish for further interaction during the development of commissioning groups and called for dialogue with these emerging groups.

Dr Peter Swinyard, Chairman of the Association, said the message was clear to CCGs that they must talk with member practices and “listen to them”.

The survey questioned 100 doctors. It found that more than half felt they were able to influence decision making at their nearest CCG. However, 13% of respondents said they were unable to do so and felt disempowered by the reforms.

The survey also found that doctors had a wish to avoid the reinvention of PCTs with the “same faces and policies” following the reforms in the Health and Social Care Act. 

Children’s healthcare in England needs to be more integrated, timely and focused on individual needs, the Children and Young People’s Health Outcomes Forum has said.

The Forum’s recommendations, proposed as the basis of a national strategy, include a strong emphasis on pharmacovigilance and avoiding the use of off-label medications.

Other key recommendations relate to the goal of “joined up” care, seeking to address gaps in the consistency and continuity of children’s healthcare.

The report describes the view that children in England are well cared for as “sentimental and complacent”, and states: “the UK is worse than other countries in Europe for many outcomes that could be improved through better healthcare and preventative interventions”.

To address this situation, the report argues, it is vital for children and young people to be more involved in decisions about their care; for GPs and other clinical staff to have better training in paediatric care; and for healthcare to meet the changing needs of the young individual over time.

Four new outcome indicators are proposed:

• time from first NHS presentation to diagnosis or start of treatment

• integrated care – developing a new composite measure

• effective transition from children’s to adult services

• age-appropriate services, with particular reference to teenagers.

More generally, the report recommends that all NHS organisations “should take a life-course approach, coherently addressing the different stages in life and the key transitions instead of tackling individual risk factors in isolation”.

It also calls for better systems to allow sharing of information between care providers in different sectors, with “sentinel conditions and pathways” being selected to help identify “gaps in services, including prevention”.

The report notes high levels of medication error and use of off-label or unlicensed medications with children, and calls on the MHRA to prioritise these issues “in line with the new EU legislation effective in July 2012”.

To improve the evidence base for healthcare, it recommends breaking down health data for the first two decades of life into five-year age bands.

To improve clinical leadership, it says, the NHS Commissioning Board should appoint a National Clinical Director and CCGs should appoint a senior clinical lead in this area.

Finally, it recommends that the QOF and PbR systems for child healthcare should be developed and improved.

The Department of Health is drawing up plans to immunise teenagers and pregnant women against whooping cough after the biggest outbreak of the disease in two decades.

Almost 2,500 cases have been reported in the first six months of this year resulting in the death of five babies.

Dr Mary Ramsey, head of immunisation, Health Protection Agency (HPA), said they were “working closely” with the DH’s Joint Committee of Vaccination and Immunization (JCVI) to tackle the “ongoing outbreak”.

Whooping cough, which may be fatal in young babies, can lead to pneumonia and bronchiectasis.

Meanwhile, pensioners may also be immunised with a shingles jab under revised Government plans.

Health Ministers first announced a vaccination programme in January 2010 but have faced supply issues after pharmaceutical companies struggled with manufacturing difficulties and overseas demand.

However, revised plans to give more than 4.5 million pensioners the jab from next year have now been confirmed by the Department of Health following advice from the JCVI.

A spokesperson from the DH said they were “disappointed” enough vaccines were not currently available to introduce the immunisation programme sooner.

Three foundation trusts in London have outlined proposals to merge together to create the largest trust in England.

The boards of King’s College Hospital, Guy’s and St Thomas’ and South London and Maudsley have proposed to form a new organisation that would create an annual turnover of more than £2bn.

The proposal details how a “single organisation could make better use” of combined assets which would release funds for “new models of healthcare” in the capital.

The full business case will now be presented to the three boards, the board of King’s College London and university partners in early 2013. If accepted, a merger could be completed the following year.

Barts Health Trust is currently the largest foundation trust in England. It has a turnover of £1.1bn – the largest in the NHS.

Proposals suggest the super trust could save between 3% and 5% in non-clinical support functions.

However, the proposal states that a merger would be “unacceptable” and “fail” if it resulted in a “remote, centralised organisation”. “It would have to operate in a very different way to be effective,” said the proposal.

If completed, it would be the first time that foundation trusts had merged and would have to be approved by the Office of Fair Trading.