Sir David Nicholson will retire from his role as Chief Executive of NHS England, and from the NHS altogether, in March 2014.

The announcement of his retirement will relieve the pressure on him to resign following the Francis report, which implicated him in the Mid Staffordshire tragedy.

It also means that he will not have to deal with growing anger over revelations that the ‘Nicholson challenge’ of cutting £5bn from the NHS budget each year means an absolute cut in the NHS budget.

A former Communist Party member, Nicholson has been a strong supporter of current Conservative health policy: he began implementing the Health and Social Care Act prior to its approval by Parliament.

However, last autumn he warned that “carpet bombing” the NHS with private sector providers would lead to “misery and failure”. NHS reform needed to support clinical decision-making, he argued.

The Francis report into the unnecessary deaths at Stafford Hospital between 2005 and 2009 found that Nicholson, as head of the region’s SHA, had not acted on warnings about the hospital’s high death rate.

While the Francis report blamed inadequate staffing levels and bad management for the tragedy, Nicholson pinned the blame on the Labour Government’s infection control and waiting time targets.

Nicholson has worked in the NHS for 35 years, and was NHS Chief Executive for almost seven years. In April this year he became Chief Executive of NHS England, a role effectively continuous with his previous one.

In a letter to Professor Malcolm Grant, Chair of NHS England, Nicholson declared his continued support for the NHS reform process: “I still passionately believe in what NHS England intends to do. My hope is that by being clear about my intentions now [I] will give the organisation the opportunity to attract candidates of the very highest calibre so they can appoint someone who will be able to see this essential work through to its completion.”

Nicholson’s retirement will quieten the controversy over his role in the NHS reforms of this and the last government, and allow recognition of his lifelong commitment to the NHS.

NHS Wales has failed to meet its target for timely treatment of urgent cancer cases.

Only one of the seven Welsh local health boards has met the target of 95% of urgent cases being seen by a specialist within 64 days.

The Welsh Government has attributed the delays to the impact of unhealthy lifestyles and an ageing population.

In the quarter ending June 2012, only 88% of urgent cancer patients were seen (marking the start of treatment) within the two-month target time.

By contrast, 98% of non-urgent patients were seen within the 31-day target time for that class of patients.

There was marked variation between local health boards: Aneurin Bevan was the only one to meet the urgent cancer treatment target, while in Abertawe Bro Morgannwg only 74% of patients started treatment on time.

Welsh Conservative health spokesman Darren Millar said: “Cancer waiting time targets have not been met once since Carwyn Jones became First Minister and have actually got worse.

“Commencing treatment promptly is critical to the patient’s prospects for a successful outcome.”

A Welsh Government spokeswoman commented: “We will be looking to see improvements in the 62-day performance over the coming months.

“However, our population is ageing so the number of people diagnosed and living with cancer is increasing, and it seems that the number of cancers related to lifestyle choices may be rising.”

The Welsh Government launched a five-year plan, Together for Health: Cancer Delivery Plan, in June 2012.

A Stevenage independent sector treatment centre is facing pressure to close after reports that only 50% of its patients are treated within 18 weeks.

Two local Conservative MPs have called for Clinicenta, part of the Carillion group, to lose its contract running Lister Hospital’s Surgicentre (pictured).

The company claims the long average wait time per patient is an artefact of its recent focus on “eliminating patients with long waits”.

Stevenage MP Stephen McPartland said “time has run out” for Clinicenta and it “should not be involved” in providing surgery.

McPartland and Welwyn Hatfield MP Grant Shapps recently met Health Minister Simon Burns to discuss the performance of the centre, which was criticised by the CQC in April.

NHS Hertfordshire had “worked very closely with Clinicenta” to improve the service, said the trust’s Chief Executive Jane Halpin.

“We will continue to take the necessary measures to ensure services to the public are safe and that standards are met,” she added. “We also expect the CQC to be issuing their determination, following further assessments, in the near future.”

A spokeswoman for Clinicenta said the surgery centre was “eliminating patients with long waits” – as a result, over 50% of the patients it had seen in the last month had waited over 18 weeks, but in reality “waiting lists are reducing”.

NHS services for management of chronic pain are inadequate to the needs of many patients, according to a report following the first UK ‘pain summit’.

The report, produced by a coalition of medical experts, identifies lack of clear guidelines, delayed referrals, long waiting times and suboptimal medication as problems affecting pain management services.

It recommends that the planned NICE quality standard on pain management include nationally agreed commissioning guidelines and a data strategy.

According to Beverly Collett, chair of the coalition, “chronic pain is not being taken seriously” though it impacts powerfully on general health.

Collett also argued that the conventional “analgesia staircase” was developed primarily for cancer patients and is less effective in patients with other types of chronic pain, who would benefit from a wider range of drug and non-drug therapies.

The report was produced by the Royal College of General Practitioners and the Faculty of Pain Medicine of the Royal College of Anaesthetists, together with the British Pain Society (a professional organisation) and the Chronic Pain Policy Coalition (an industry-sponsored group).

Chronic pain (persisting for more than three months) affects one in eight people in the UK, and has many causes.

According to the report, patients who would benefit from early intervention are often not referred to a specialist or face long waits for treatment, with reliance on suboptimal medication being the norm.

The report calls for:

• Clear national standards for the identification, assessment and initial management of chronic pain, forming the basis of the NICE quality standard.

• Nationally agreed commissioning guidelines to reduce service variation.

• A data strategy to collect and share information about the extent, severity and medical impact of chronic pain.

• Better education of medical students, clinicians and the public in pain management.

The NHS is broadly meeting its financial and quality targets, but the national figures “mask significant local variation”, according to a King’s Fund report.

The proportion of patients spending over four hours in A&E has increased by a quarter since 2011, but other key performance indicators were more stable.

A survey of NHS finance directors showed that more than half were pessimistic about their local health economy in the coming year.

The Kings Fund quarterly monitoring report How is the NHS performing? combines national data on performance against key targets with survey feedback that shows the NHS is highly uneven in how (and how well) it meets the QIPP agenda.

Of 23 NHS finance directors responding to a survey, 7 said they were not confident of meeting their productivity targets for 2012/13 (the King’s Fund notes that the sample is not statistically representative).

The national figures indicate that waiting times for treatment are stable, but the NHS is narrowly failing (by 1%) to limit the proportion of patients waiting over 18 weeks to 8%.

Delayed transfers of care – a common problem for elderly patients – are also stable overall, but nearly half of the survey respondents reported an increase.

The proportion of patients spending over four hours in A&E has fallen over the past year, but remains overall more than 25% higher than in 2010/11. There is evidence of considerable variation between providers.

As Health Secretary Andrew Lansley has pointed out, that does not mean that 25% more people are not being seen within four hours. However, an increase in waiting times is undoubtedly the underlying cause of the difference.

John Appleby, Chief Economist at the King’s Fund, commented: “Overall, the NHS continues to perform well, despite the spending squeeze. However, this masks growing pressures in hospitals and significant performance issues in some NHS organisations.”

Of the 23 survey respondents, only 16 were confident of meeting their QIPP targets for this year, while 18 were using service rationing and/or rationing of GP referrals to help meet these targets.

A report from the Department of Health shows that the NHS is on track to deliver up to £5.9bn savings this financial year, ahead of its annual target of £5bn cuts per year.

The Quarter 2 report claims that the NHS has maintained or improved the quality of services in eight key quality areas, including infection control.

However, the report does not acknowledge the impact of ‘red lists’ in rationing NHS treatments.

The report sets out NHS financial and quality performance from July to September 2011, and claims key quality successes:

• MRSA infections were reduced by 33% and C. difficile infections by 16% relative to the same quarter last year.

• The 18-week waiting time target continued to be achieved for 90% of inpatients and 95% of outpatients (though increases in waiting times have been reported by many NHS trusts).

• The NHS has continued to meet key cancer treatment standards.

The report predicts a year-end surplus for the NHS of about £1.2bn for 2011/12. PCTs estimate that they can achieve £5.9bn savings in this financial year – a major improvement on the £4.3bn saved last year.

The DH pointed to examples of local NHS initiatives to shift healthcare into the community and give patients more control over their own care, including:

• a home nursing service for children and young adults with asthma in South East Essex

• individual care plans for frequent ambulance callers developed in Kirklees for use by ambulance crews and A&E clinicians.

David Flory, Deputy Chief Executive of the NHS, commented: “The NHS is in the early stages of its plans to deliver up to £20bn of efficiency savings by 2014/15 whilst maintaining or improving quality. The results from the second quarter of 2011/12 are encouraging, showing the NHS continues to deliver strongly for patients while maintaining a healthy financial position.”

However, the health impact of the Audit Commission’s ‘red lists’ of drugs and procedures, restricting availability to the most severe cases, is not discussed in the report since outcome targets do not refer to care that is no longer provided.