Health Secretary Jeremy Hunt has pointed the finger of blame at GPs for rising A&E admissions and the added pressure placed on emergency services.

Speaking to MPs, Hunt said that “poor primary care provision” was behind some four million additional people unnecessarily visiting accident and emergency services.

But the General Practitioners Committee called Hunt’s claims “nonsense”.

A Department of Health spokesperson played down Hunt’s accusations insisting the Health Secretary was “clearly not blaming GPs” and that he was referring to procedures set by the former Labour government.

Hunt was responding to figures published by Labour that showed the NHS had missed its national A&E waiting times each week for the past six months.

He claimed this was down to poor alternatives to primary care which was the result of changes introduced by Labour to the GP contract.

“The reason that there is so much pressure on A&E is because of the disastrous GP contract that was negotiated,” he told the House of Commons. “That is what is causing the huge pressure. That is what we are determined to put right.”

The Health Secretary said the solution to the rising number of A&E admissions was to analyse the GP contract, introduce alternatives to secondary care and integrate health and social care services.

In the first of a new series, Pf’s John Pinching meets Novartis’ Senior Brand Manager and Pf reader, Caroline Armstrong. A franchise coffee house in Farnham sets the scene, as she orders an exotic latte, while he opts for an invigorating Americano (with three sugars).

When I meet Caroline – winner of the prestigious Joint Working Award at the Pf Awards 2012 no less – she exudes confidence, charm and style. Indeed, she immediately draws my attention to a famous local sculpture and points out that, viewed from a certain angle, it resembles something entirely unexpected.  I conclude that it must be ‘attention to detail’, which sets this career-climber apart.

What is your background, Caroline? I come from Newcastle and did a degree in Biomedical Science at the University of Newcastle Upon Tyne. During my time there I worked in a lab at Proctor and Gamble. After approximately five minutes I knew it wasn’t the career for me! I needed to do more than just take microscope slides out of a washing machine for the rest of my life.

How did you embark on a career in the selling side of pharmaceutical drugs?
I attended a recruitment drive, was impressed with the potential opportunities and became a medical sales representative, first at AmDel, then Altana Pharma. I know it’s a cliché, but in order to fulfil my ambitions I had to be out there, ‘carrying the bag’; it’s the best way to build a network and discover how the industry really works.

Do you remember your first gig? Yes, it was pretty nerve-wracking. As soon as I arrived at the surgery, I was taken straight to the GP, without any time to compose myself. It was a steep learning curve, but I soon gained confidence and was able to apply my personality when describing products. Showing your human side in medical sales is vital.

How did that enable you to progress further? I joined Novartis initially as a Vaccine Account Manager, before getting the chance to go on a marketing secondment. I really felt like the company believed in my ability and this ultimately led to my roles as the UK Influenza Brand Manager and Travel Vaccines Senior Brand Manager.

What were the most satisfying aspects of your new Novartis ventures?  Getting involved in really broad campaigns was very exciting. With influenza it’s not just a case of painting patient pictures, you are convincing people to purchase products there and then; sign on the dotted line. From a marketing view, delivering an effective strategy is essential, but from a sales view, you’ve effectively got twenty minutes in front of a healthcare professional to deliver, not just a generic pitch, but one that demonstrates empathy, understanding and confidence in your proposition. There’s only one chance, so you have to make every interaction count.

Does it make you appreciate the impact you’re having on society? It’s pretty amazing to think that last year the number of vaccines given through pharmacy alone could fill St. James’s Park. That really puts the number into perspective.

Do you support Newcastle United, by any chance? Yes, I used to go with my dad, when David Ginola was playing (judging by the wistful expression, I think Caroline may have been a great admirer of the aforementioned Frenchman).

I digress, what programmes are you putting into place in preparation for the dreaded reform act? We have been very passionate about implementing vaccination programmes, which enable a more community-based approach to health. We’re training pharmacists to vaccinate in local pharmacies, enabling many more thousands of people to access healthcare. It will certainly relieve some of the pressure from GPs. People will have the convenience of being able to pick up their weekly shop and a vaccine, all in one place.

How do big companies react to changes enforced by new political policies? From an industry perspective you can’t plan too far in advance because you simply don’t know what the NHS will look like in a few years. If Labour get in all the changes might be reversed and we’ll end up going round in circles.

You’re still young, but seem to have ascended up the ranks rapidly I enjoy what I do and like to do it well; then I’m ready for the next challenge. When you reach milestones in your career it’s so important that you have a story to tell, making sure that it’s as fulfilling and successful as it can be. Some people are satisfied to do the same thing for years, but I want each chapter to represent a new adventure and an opportunity to make a difference.

What does the future hold for you? I’m starting a new job in Basel! (Caroline is making the pilgrimage to Switzerland and she’ll be working as Business Franchise Manager in Novatis’ Ophthalmology business unit – which is nice).

That’ll be incredible Yes, I’m going there with my partner and it will certainly be a great experience. It’s a global role so it will be really interesting to see how other health services, like Australia and Canada, operate compare to ours. I hope they don’t have as many acronyms.

There’ll also be some cultural differences in Switzerland too? Yep, for a start, they only serve wine in 100ml measures and that will take some getting used to!

What will you miss? The higher your position, the greater potential there is for you to be removed from the ‘patient’.  I think I will miss the daily coal face interaction you get when you work in a local market, close to the actual health provision. That is why I think it is so important to remember what it is like when you are on the road, bringing products to life. Ultimately, whether you are in a local or a global role, everything you do is still for the patient.

The Care Quality Commission (CQC) was formed in 2009 to replace three separate inspection bodies: the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. Since October 2010 all providers of healthcare and social care, whether in the public or private sector, have had to register with the CQC – which now regulates more than 21,000 providers.

This massive registration task was divided into phases: the Commission registered NHS secondary care providers, then re-registered adult social care and independent healthcare providers, then registered primary dental care and independent ambulance providers. Its next challenge is to register all GP practices. Most importantly, it will need to continue monitoring the quality and safety of all these providers’ services.

The CQC’s declared purpose is to eliminate poor quality care, defend patients’ rights and ensure that care is centred on people’s needs. Initially it adopted a ‘risk-based’ strategy of using evidence of potential danger to determine the frequency of inspections. In 2011/12 it shifted to annual inspection of all care providers. Next year, however, it will revert to a ‘riskbased’ approach – as well as participating in local Quality Surveillance Groups, alongside CCGs and local Healthwatch.

These changes follow a year in which the CQC has faced criticism of its leadership and its overall performance. The Mid Staffordshire Foundation Trust enquiry led to criticism (for different reasons) of its Chief Executive, Cynthia Bower, and its Chair, Dame Jo Williams. The recent scandal of sustained patient abuse at Winterbourne View Care Home led the CQC to be accused of failing to conduct regular inspections and respond to ‘whistleblowers’.

In March a Commons Public Accounts Committee concluded that the CQC had “a long way to go” before it could be considered an effective regulator. The recent resignations of Bower and Williams have reduced the shadow over the leadership. The new CQC Chief Executive, David Behan, has a background in social care rather than healthcare. But can the problems of regulating provider quality in the new health and social care system be solved by such changes, or are they systemic issues beyond the scope of the CQC?

In safe hands
The CQC’s annual report for 2010/11 noted that by April 2010 it had licensed all 378 NHS provider trusts, and had required 22 trusts to take specific actions to improve their services. By October 2010 it had re-registered 12,000 adult social care and independent health providers, and had required almost 1,000 care homes to put in place qualified managers. By July 2011 it had registered 18,000 dental care and independent ambulance providers. The inclusion of primary medical services will add 8,000 providers to the list.

Each provider is accountable for each separate ‘regulated activity’ it provides, and must show that the service meets acceptable standards of quality and safety. CQC standards cover these areas:

• Informing patients and involving them in decisions about their care.
• Personalised care, treatment and support.
• Safeguarding and safety of the care environment.
• Suitably qualified and capable management and staff .
• Risk management and incident reporting.

A further responsibility of the CQC is to respond to complaints about services – and in particular, to provide a safe and responsive port of call for ‘whistleblowers’: care provider staff who report failings in quality or safety.

Winter in social care
Financial pressure was a feature of the CQC’s role from the outset. Its initial budget was 30% less than the combined budget of the three organisations it had replaced. The Labour Government set a ‘light-touch’ agenda for inspection: unless there was evidence of risk, providers would be left uninspected for
up to two years.

The coalition Government’s review of arm’s length bodies in July 2010 reinforced the CQC’s role as regulator for health and social care. However, it was not exempt from the general requirement that the NHS ‘do more with less’. Its annual budget for 2010/11 was set at £16.4m – £10m less than it had told the DH it needed to cope with the combined task of registering and inspection.

As a result, the number of inspections carried out by the CQC fell by 70%. Concern over its performance came to a head in the Winterbourne View scandal, where action to stop the mistreatment of learning-disabled patients in a care home run by private firm Castlebeck had been unacceptably slow. The regulator had failed to act on information from a ‘whistleblower’, and only a BBC Panorama report had brought the abuses to public attention.

In the aftermath of the scandal, a Health Select Committee report accused the CQC of devoting too much of its resources to registration, a sign of “distorted priorities”. However, Kings Fund Director of Policy Anna Dixon observed: “It is no good preaching the virtues of light touch regulation, and then blaming the regulator for not taking a more interventionist approach when problems emerge.”

The later Commons Public Accounts Committee report highlighted several CQC failings: lack of inspections,
failure to fill key vacancies in its inspection team, and the decision to scrap a helpline for whistleblowers. The committee said the CQC risked becoming a mere “postbox” for complaints.

Jo Williams described the Winterbourne View case as a “watershed moment” for the CQC, triggering its abandonment of the ‘light touch’ approach. The regulator asked for – and got – a £10m increase in its budget for 2012/13 to increase its number of inspectors by 15%, enabling it to adopt a policy of inspecting each provider at least once a year.

Crisis of leadership
The issues affecting the CQC leadership reflect some of the conflicts of interest that can arise for care regulators. The Mid Staffordshire inquiry – the greatest hospital safety scandal in the NHS’s history – concerned events that took place before the formation of the CQC. However, Cynthia Bower was head of the West Midlands SHA at that time, and the inquiry was critical of her role.

The Healthcare Commission (HCC) had warned the SHA about the unusually high mortality rate at Stafford General Hospital. According to the Guardian, Bower responded by commissioning a known critic of the HCC at Birmingham University to write a report on the HCC’s methodology. When the CQC was formed, Bower disbanded the HCC’s inspection team.

The Mid Staffs inquiry led to severe damage within the CQC. Senior operations analyst Rona Bryce claimed the testimony of CQC Board members was “aspirational”. Board member Kay Sheldon contacted the enquiry to voice concerns she said she had raised internally without result. Dame Jo Williams then asked the Health Secretary to dismiss Sheldon, but he declined. Williams also commissioned a third-party investigation of Sheldon’s mental health.

The way forward
David Behan, who took over as CQC Chief Executive in July 2012, had been Director General of Social Care at the DH since 2006. His appointment suggests a shift towards greater focus on social care regulation. The DH has set three core goals for the CQC going forward: to become more strategic in its approach and define quality more clearly in terms of outcomes; to make its Board stronger and more accountable; and to make the regulatory process more systematic and proportionate to risk.

The reversion to a risk-based approach is clearly driven by the cost-cutting agenda. However, Behan promises a “more ambitious” use of performance data to highlight success as well as failure, helping to drive widespread improvements in care. He also plans a “differentiated regulation” of health, mental health and social care providers.

In addition, from April 2013 the CQC will work alongside CCGs and local Healthwatch to develop a network of local and regional Quality Surveillance Groups. According to the NHS Commissioning Board, this system will “act as a virtual team” across health and social care, and will “need to manage itself ” without governance. It will use a ‘risk summit’ model to deal with problems, but who takes primary responsibility will depend on the circumstances.

These changes show the CQC becoming more devolved, but also more able to assist the integration of health and social care. However, as providers become more diverse while funding both for inspection and for care becomes steadily tighter, the future is unlikely to be problem-free for the regulator. The CQC will need to continue walking a tightrope between a ‘light touch’ agenda and urgent reactions to healthcare disasters – its success will depend primarily on getting better at it.

Nearly three-quarters of NHS staff who have been made redundant as part of the health reforms are female, research has found.

Figures show that of 74% of staff who have lost their jobs as part of the health shake-up are women.

Jamie Reed, Labour’s Shadow Health Minister, said the “Government is letting women bear the brunt” of its controversial reforms.

Data from the report prepared for the NHS Commissioning Board on the DH’s ‘people tracker’ revealed that employees over the age of 40 also were more likely to be made redundant than younger colleagues. Research found that 77% of staff who were received redundancy packages were over the age of 40.

Between 1 April and June 30 this year, figures show that 105 staff were axed from primary care trusts and strategic health authorities. Fifty of these were compulsory redundancies, 77% were women and 78% were aged over 40 years old.

“As the Government's reorganisation inflicts chaos on the NHS, its women employees who are being hit hardest,” said Jamie Reed.

Labour plans to scrap the Government’s controversial NHS reforms if they win the next general election, Shadow Health Secretary Andy Burnham (pictured) has said.

Speaking in Parliament during a debate opposing the reforms, Mr Burnham insisted the changes open the door to privatisation within the NHS and undermine the health service in general.

He said that Labour will “repeal the bill” if elected claiming it to be a “defective, sub-optimal piece of legislation” that has left the NHS with a “complicated mess”.

The Shadow Health Secretary added that it would be “irresponsible” to leave the Health Act in place if Labour were elected and added that the “gap between ministers’ complacent statements and people’s real experience of the NHS gets wider every week”.

“They are in denial about the effects of their reorganisation in the real world, it is dangerous complacency and it can’t be allowed to continue.”

Health Minister Simon Burns countered Mr Burnham’s claims by reminding the Leigh MP that Labour leader Ed Miliband had previously said he would keep clinical commissioning in place if elected as prime minister.

But the former Health Secretary insisted “it’s not about the organisations, it’s about the services they provide”.

“The existing organisations can be asked to work differently, as I would ask them to work differently,” he said.

“I don’t want those NHS organisations in outright competition, hospital versus hospital. I want them working collaboratively.”

The integrated health system adopted in Wales has allowed its NHS to make rapid improvements in its performance on emergency admissions, its chief executive has claimed.

David Sissling (pictured) told delegates at the NHS Confederation conference that the rejection of a split between commissioners and suppliers had resulted in improvements in a challenging environment.

However, he added that similar improvements in England are unlikely due to its fragmented and market-orientated NHS.

“We don’t work in a market,” he said. “We work much more on an integrated basis.

“We have a Labour administration in Wales that has made a very firm decision to move away from the market. That’s partly a political stance, partly what’s right for Wales,” he added.

The integrated approach in Wales sees seven health boards across the country providing both primary and secondary health care to set regions.

Mr Sissling said this approach allows primary and secondary healthcare staff to co-operate to improve standards of patient care without having to worry about financial repercussions.

This resulted in a reduction of emergency admissions for COPD by 16.5% and diabetes by 14.6% in a year, with emergency readmissions falling even further, Mr Sissling added.

These reductions, the chief exec said, took place at the same time as a severe financial squeeze on the Welsh NHS which saw its budget shrink in real terms.

Labour leader Ed Miliband has attacked the Government’s handling of the NHS reforms insisting they ignored the views of key healthcare professionals.

Speaking at the Royal College of Nursing conference, Mr Miliband accused the Government of pushing ahead with its controversial structural changes despite serious concerns from the RCN.

He said the Government had dismissed the RCN as “just a ‘vested interest’” but insisted they are actually the “defenders of the health service”.

“The government have been acting like they are the masters, not the servants, of the NHS,” said the Labour leader. “They are not the masters. Not this government. Not any government.

“Our health service is owned by patients, professionals and the people. And their voice – your voice – deserves to be heard.”

Mr Miliband added that he couldn’t promise to agree with the College on all matters but would not ignore them as the Government had done during the ‘listening exercise’ as part of the Health and Social Care Act.

Nurses were told that Mr Miliband wants to create a partnership with the College to address long-term challenges facing the health service. “I want to start working with you now to protect the values of the NHS and to hold the government to account for what’s going on,” he said.

“You are not just on the frontline in our NHS. You are the first line in the defence of our NHS.”

The Labour leader also revealed a new party initiative during his speech. NHS Check will allow staff and patients to report problems encountered by hospitals, clinics and GPs as a result of the NHS reforms.

The Government looks set to have won its battle over the Health and Social Care Bill after the last attempt to halt the legislation failed in the House of Commons.

An emergency debate by Labour to block the changes to the Bill until a risk register was published was defeated by 328 votes to 246.

Andy Burnham, Shadow Health Secretary – who pushed for the risk register to be published – said that the general public would “struggle to understand” how MPs had made “such momentous decisions” without considering all of the evidence on the reforms.

Final amendments to the controversial reforms were approved by MPs paving the way for Royal Assent for the Bill before the break for Easter next week.

Peers in the House of Lords approved the Bill on Monday evening.

The changes to the structure of the NHS will see Strategic Health Authorities and Primary Care Trusts abolished in favour of local Clinical Commissioning Groups. The move, which will see GPs given budgetary responsibilities and the opportunity to outsource services privately, has been widely opposed.

Mr Burnham admitted that the legislation becoming law was inevitable and the only hope left to defeat the Government’s plans would be a “change of heart” from the Lib Dems.

“We have given this fight everything that we had,” he said. “All I can say is our fight will go on to protect and restore this party’s finest achievement.”

The recent amendments made by the Government to the Health and Social Care Bill are nothing more than minor tweaks, the BMA has said to its peers.

Amendments to the legislation, including that the health secretary will keep ultimate control over the NHS and that Monitor would be given more power, were not enough to satisfy the Association.

In a briefing paper to peers, the BMA argues that the whole approach to the reforms has not been “effectively managed” and has again called for it to be withdrawn as the Bill remains “fundamentally flawed”.

The Bill returns to the House of Lords on Wednesday 8^th February, ahead of the start of the Lords’ Report Stage.

Certain efforts have been made, the briefing paper acknowledges, by the Government to listen to the concerns raised by the BMA. However, issues including the speed of change and implementation, the complex nature of the reforms and the lack of consideration of the consequences has led to Dr Hamish Meldrum, BMA Chair, saying “the level of complexity and bureaucracy in the new NHS will be huge”.

“We recognise that some of the amendments recently set down by the Government suggest modest improvements,” he said.

“But these do little to address the issues which continue to cause us great concern, for example: an over reliance on ‘market forces’ remains at the core of the Bill, there is excessive control over commissioning groups, plans for incentives for commissioning are ill-thought through, and proposals to give hospitals more scope to generate income from private patients pose serious risks.

“It would be better to withdraw the Bill altogether and come up with a new plan – one that will actually improve care and make the NHS more efficient.  

The BMA’s call for the withdrawal of the Bill have also been echoed by Ed Milliband. The Labour leader, who claimed the money spent on the reforms would have saved the jobs of 6,000 nurses, said it’s not “too late to stop this Bill”.

“We have three months to prevent great harm being done to the NHS,” said Mr Milliband. “Now is the time for people of all parties and of none, the professions, the patients and now peers in the House of Lords to work together to try to stop this Bill.”

The Government is to introduce 60 new goals that NHS hospitals and doctors are to be judged against in a move it hopes will save thousands of lives a year.

Benchmarks such as preventing unnecessary early deaths and improving the quality of life for people with long-term conditions will replace the target system introduced by Labour to assess the success of the NHS.

In an interview with The Daily Telegraph, Health Secretary Andrew Lansley says the benchmarks will “define what the NHS is setting out to achieve”.

The new system will focus on patients’ experience of the NHS – and not the speed of which they were treated – in an attempt to drive performance levels.

The use of comprehensive data on hospital death rates, the performances of GPs and surgeons and surveys from patients to gauge their satisfaction of the standard of care they received and their speed of recovery will all be analysed to assess whether benchmarks have been met. The views of bereaved relations and children for the first time will also be obtained as part of the Government’s plans.

“This is literally saying to patients ‘if you were in hospital, if you were being looked after by your general practitioner was the service and experience you had good or not?’” said Andrew Lansley. “It’s not like some other kinds of medical model where you kind of treat people and they get better. This is different. This is really where you begin to kind of focus on the experience of care.”

“We’ll be undertaking a consistent national survey of the bereaved relatives of people who received end of life care,” Mr Lansley said. “Asking them, after a suitable passage of time, what was their loved one’s experience of care and how well were they looked after towards the end of life.”

If the new standards are to be achieved, the Health Secretary believes that up to 24,000 early deaths a year could be prevented from cancer and other long-term conditions. Mr Lansley also hopes the new measures will increase access to NHS dentists and see fewer people with long-term conditions treated in hospitals. Patients undergoing routine hip and knee operations will no longer be left in pain or unable to walk, the Health Secretary pledged.

Mr Lansley said that his time as Health Secretary will not have been successful if the new benchmarks do not improve the NHS by the next general election.

“We have to clear the decks and be clear this is what we are focusing on,” he said. “People say in three and a half years’ time, in 2015, at the next election, how will we know whether you’ve succeeded or not? The answer is ‘have the outcomes improved? It will be my failure if we haven’t improved them and the NHS should feel that it has not succeeded, that is what we are setting out to do.

“We’ve really got to get into the big picture, which is delivering improvements in the results we achieve for patients right across the board. We know that we can do it.”

The Government will also publish current performance data for the first time for each of the benchmarks in an attempt, Ministers hope, will force up standards.

Shadow Health Secretary Andy Burnham said the new measures would not be received well by those working within the NHS. “Doctors and nurses will roll their eyes in sheer disbelief at this news,” he said.

“The Government that promised to scrap NHS targets now loads 60 new targets on an NHS already under severe pressure. It will add red tape and bureaucracy just as the NHS is struggling to cope with the financial challenge and the biggest reorganisation in its history.”