Weekly political news round up – 20th February 2015

February 20, 2015 in News by Whitehouse

Around the sector

The Welsh Government has announced that the number of qualified nurses working in the Welsh NHS has exceeded 22,000 for the first time. The news comes following an announcement last week by Welsh Health Minister Mark Drakeford of an £80m investment to create extra training and educational places in 2015-2016.

NICE Chief Executive rejects claims that treatments recommended by NICE are too expensive

Sir Andrew Dillon, the chief executive of NICE, has responded to research published by the University of York’s Centre for Health Economics, which argued that NICE’s threshold for determining whether a treatment was cost effective in providing a quality-adjusted life year (QALY) – a measure of how much it would cost to give a year of healthy life – is too high at £30,000. The researchers suggested that a figure of £13,000 is more appropriate, as treatments which exceed this cost result in less money being available to be spent on treatments for other conditions.

Dillon commented that a threshold of between £20,000 and £30,000 per QALY represents a reasonable compromise between ensuring everyone has fair and equitable access to the NHS and enabling access to new and innovative treatments. He noted that reducing the threshold to £13,000 per QALY was unrealistic unless device manufacturers and drug producers were prepared to lower their prices in an “unprecedented way”.

Speaking on the Radio 4 Today programme, Dillon called for medical device manufacturers and drug producers to “give the best price they possibly can” in order for the NHS to provide services in a more cost effective way.

The King’s Fund publishes report on implementing the Five Year Forward View

Influential health think-tank The King’s Fund has published a paper which outlines some of the changes necessary in order to ensure the smooth implementation of the Five Year Forward View. In particular, it focuses on how: services are commissioned and paid for; how the NHS is regulated; how improvements in care are delivered by local leaders; and whether a transformation fund could contribute. The report found that one of the key challenges is the fragmentation of responsibility for the NHS at a national level saying that it “desperately needs” high-quality and consistent leadership at the centre to avoid conflicting signals being given by national bodies.

In terms of how services are commissioned and paid for, the report found that innovations in commissioning were still in development and it was too early to draw firm conclusions. The report notes that choices need to be made by commissioners as to whether to commission for specific diseases, care groups and whole populations, as well as the types of contact that will best support the delivery of services. To address this, the report suggests that Commissioners will need practical support and opportunities to learn from each other through a community of practice as they take work forward, which should be in provided by national bodies.

The report also criticised the ways in which care delivered within the NHS is currently paid for, notably the wide range of systems used to pay for different aspects of care, for example Payment by Results for acute hospital activity, block contracts for community and mental health services, a tariff for specialised services and the variety of ways in which GPs are paid. The report found that these payment systems reinforced the fragmented nature of NHS provision, and results in conflicting incentives. As such, the report suggests that NHS England and Monitor accelerate the development of new payment systems such as capitated budget (payment by population enrolled), pooled budgets (from different funding streams) and integrated personal commissioning.

It was also noted that the CQC needed to change the way in which it assessed the experiences of people with complex needs who require help from different providers. The report assessed the CQC’s current approach to inspections as one that forced providers to focus on their own performance regardless of the impact on other providers in their area. Subsequently, the recommendation was made that patients and service users should be surveyed in order to understand their experiences of whether care was well co-ordinated.

Weekly political news round up – 13th February 2015

February 13, 2015 in News by Whitehouse

Around the sector

The Royal College of Nursing (RCN) has announced that its Chief Executive and General Secretary, Dr Peter Carter, will be leaving the organisation. Dr Carter will stay in his post while a successor is appointed.

Health Service Journal has reported that NHS England Chief Executive Simon Stevens favours a “mixed model” of health economy accountability, in which some clinical commissioning groups could delegate responsibilities to local authorities or providers of new care models. Stevens said that, although he did not want the NHS to be distracted by organisational questions, he favoured the mixed model ahead of any one organisation type being in charge of the health economy.

Education Secretary Nicky Morgan has announced that the Department for Education will be investing over £6 billion to improve the condition of the school estate. She said that an investment of £2 billion will be made for rebuilding and major refurbishment projects to address the needs of school buildings in the poorest conditions. £4 billion will be provided to schools, local authorities, academy trusts and voluntary aided partnerships to fund the improvement and maintenance of schools.

The Department of Health has published guidance for the collection of 2014 to 2015 reference costs from NHS trusts and NHS foundation trusts between 22nd June 2015 and 1st August 2015. Reference costs are the average unit cost to the NHS of providing secondary healthcare to NHS patients.

Healthcare regulator Monitor has published costing principles and guidance for providers of NHS-funded services. The guidance sets out the requirement for collections of 2014/15 data, and incorporates costing principles for NHS care and guidance for this year’s patient level information and costing systems (PLICS), the ‘Reference costs guidance for 2014/15’ and the Healthcare Financial Management Association’s (HFMA) ‘Acute health clinical costing standards 2015/16’ and ‘Mental health clinical costing standards 2015/16’.

Department of Health launches consultation on updating the NHS Constitution

The Department of Health has launched a consultation on proposed modifications to the NHS Constitution, which includes changes to enhance patient safety and choice, as well as to increase transparency amongst healthcare providers. The changes to the Constitution are being made in advance of the requirement that all healthcare providers adhere to the new fundamental standards of care from April 2015 onwards.

The Constitution sets out the rights to which patients, the public and staff are entitled, and the responsibilities owed to each other to ensure that the NHS operates fairly and effectively. The first version of the Constitution was published in 2011, and it was subsequently strengthened in 2013 in response to the Francis report into the failings at Mid Staffordshire NHS Foundation Trust.

The consultation asks a series of 10 questions on additions to the Constitution, as well as changes to existing text. The areas covered relate to the new fundamental standards of care, the recommendations made in the Francis report, the Government’s ambition to increase the provision of mental health service, the desire to increase transparency, and special provisions for the armed forces.

Although the recommendations are not condition specific and therefore do not specifically mention continence, there are several which are of interest to the PCF. Please see a summary of these below:

  • Question 2 – We would like to change the current wording to: ‘Patients will be at the heart of everything the NHS does.’ (Annex 2, Change 2). Do you agree?
  • Question 3 – We would like to include the following wording for staff: ‘You should aim to provide all patients with safe care, and to do all you can to protect patients from avoidable harm.’ (Annex 2, Change 12). Do you agree?
  • Question 4 – We would like to include the following wording for staff: ‘You should aim to help patients find alternative sources of assistance, when you are unable to provide the care or assistance a patient needs.’ (Annex 2, Change 14). Do you agree?
  • Question 5 – We would like to include the following wording for staff: ‘You should aim to follow all guidance, standards and codes relevant to your role, subject to any more specific requirements of your employers.’ (Annex 2, Change 13). Do you agree?
  • Question 6 – We would like to include the following wording for patients: ‘You have the right to an open and transparent relationship with the organisation providing your care. You must be told about any safety incident which, in the opinion of a healthcare professional, has caused, or could still cause, significant harm or death. You should be given the facts, an apology, and any reasonable support you need.’ (Annex 2, Change 11).
  • Question 7 – We would like to include the following wording for patients:
    • ‘You have the right to receive care and treatment that is appropriate for you, meets your needs and reflects your preferences.’ (Annex 2, Change 4)
    • ‘You have the right to be cared for in a clean, safe, secure and suitable environment.’ (Annex 2, Change 5)
    • ‘You have the right to receive suitable and nutritious food and hydration to sustain good health and wellbeing.’ (Annex 2, Change 6)
    • ‘You have the right to be protected from abuse, neglect, and care that is degrading.’ (Annex 2, Change 8)
    • ‘You have the right to be involved in planning and making decisions about your health and care with your care provider, including your end of life care, and to be given information to enable you to do this. Where appropriate this right includes your family and carers. This includes being given the chance to manage your own care and treatment.’ (Annex 2, Change 10). Do you agree?
  • Question 8 – We would like to include the following wording for patients: ‘You have the right to transparent, accessible and comparable data on the quality of local healthcare providers, as compared to others nationally.’ (Annex 2, Change 9). Do you agree?

NHS England announces seven sites to develop Patient Centred Outcome Measures for children and young people with health conditions

NHS England has announced that seven sites have been chosen to develop Patient Centred Outcome Measures (PCOMs) for children and young people with a range of health conditions. PCOMs allow patients, their families and carers, rather than clinicians, to decide which goals are most valuable for individuals

One of the sites, Great Ormond Street Hospital for Children NHS Foundation Trust, will seek to develop Goal Based Outcomes for psychological interventions as part of a children’s medical treatment, across a range of ages and medical conditions, including urology.

Another of the winning sites, Evelina London Children’s Hospital, will builds on work already undertaken to develop online mechanisms to engage with children. The project will involve the development of an online animated PCOM which will allow children aged 5-10 with chronic conditions who require admission to hospital to: a) identify the most important outcomes for them, and b) record how effective their treatment is in delivering these outcomes.

Weekly political news round up – 27th February 2015

February 7, 2015 in News by Whitehouse

Around the sector

The Health and Social Care Information Centre has published a data on hospital outpatient activity for 2013-14. Building on the previous summary report published in January 2015, which contained headline figures, the new data contains a breakdown of activity by main procedure/intervention, main specialty, primary diagnosis and treatment speciality. Provider level analysis will be published on 26th March 2015.

The Education Select Committee has launched an inquiry into the Priority Schools Building Programme. The Committee will be holding a one-off evidence session with Schools Minister David Laws, focusing on the formula used to allocate funding for the Priority Schools Building Programme and the effect that the allocation has on schools. The Committee is also asking for brief comments on a range of topics, including the impact on schools in need of repair or rebuilding that have not received funding. The deadline for submissions is Monday 9th March 2015.

Care Quality Commission publishes final version of guidance for providers on the fundamental standards of care

The Care Quality Commission (CQC) has published the final version of their guidance for providers of health and social care services on the fundamental standards of care. The CQC had previously consulted on a draft version of the guidance between July and October 2014, to which the PCF submitted a response.

The PCF’s response noted that the draft guidance made no references to continence at all, despite the fact that 22 of the 35 case studies in the Francis report related to poor continence care. In particular we noted that whilst regulation 9, which relates to person-centred care, states that providers must ensure that the service users receive a personalised service specific to their needs and preferences, no mention was made of the necessity to ensure that the intimate needs of people with continence problems were met.

Subsequently, the CQC amended the guidance for regulation 9 to state that:

Assessments should take into account specific issues that are common in certain groups of people and can result in poor outcomes for them if not addressed. These include diseases or conditions such as continence support needs and dementia in older people, and diabetes in certain ethnic groups.

In addressing our point about the lack of attention given to the case studies on continence which were mentioned in the Francis report, the CQC amended regulation 13, relating to safeguarding service users from abuse and improper treatment, to state that:

Providers and staff must take all reasonable steps to make sure that people who use services are not subjected to any form of degradation or treated in a manner that may reasonably be viewed as degrading, such as:

  • Not providing help and aids so that people can be supported to attend to their continence needs, and
  • Making sure people are not:
    • Left in soiled sheets for long periods.
    • Left on the toilet for long periods and without the means to call for help.
    • Left naked or partially or inappropriately covered.
    • Made to carry out demeaning tasks or social activities.
    • Ridiculed in any way by staff.

This list is not exhaustive.

Northern Ireland Department of Health, Social Service and Public Safety launches consultation on the recommendations made in the Donaldson Report

The Northern Irish Department of Health, Social Service and Public Safety (DHSSPS) has launched a consultation on the 10 recommendations made in Donaldson Report, published in late January 2015, which examined the application of health and social care governance arrangements in Northern Ireland

Below is a summary of the most relevant recommendations for the PCF:

Recommendation 2

We recommend that the commissioning system in Northern Ireland should be redesigned to make it simpler and more capable of reshaping services for the future. A choice must be made to adopt a more sophisticated tariff system, or to change the funding flow model altogether.

The consultation document subsequently asks:

  • Do you agree with this recommendation?

Recommendation 4

A programme should be established to give people with long-term illnesses the skills to manage their own conditions. The programme should be properly organised with a small full-time coordinating staff. It should develop metrics to ensure that quality, outcomes and experience are properly monitored. It should be piloted in one disease area to begin with. It should be overseen by the Long Term Conditions Alliance.

The consultation document subsequently asks:

  • Do you agree with the proposed focus on enabling people with long term conditions with the skills to manage their conditions?

Recommendation 10

Patient voice should be strengthened through giving organisations representing patients and clients with chronic diseases a more powerful and formal role within the commissioning process, with the precise mechanism to be determined by the DHSSPS.

The consultation document subsequently asks:

  • Do you agree that the organisations representing patients and clients with chronic diseases should be given a more powerful and formal role within the commissioning process? If so, do you have any comments on how this could be best achieved?

Below is an overview of the other recommendations:

  1. Some local hospitals must be closed as they cannot adequately meet demand with sufficient quality.
  1. The role of pharmacists and paramedics should be expanded in order to prevent an increasing number of people, often with multiple chronic conditions, accessing emergency services.
  1. Health care services should be more strongly regulated, with a focus on inspections to increase patient safety, clinical effectiveness, patient experience, clinical governance arrangement, and leadership.
  2. Incident reporting must be improved, including the introduction of a duty of candour and a portal for patients to make incident reports.
  3. A Northern Ireland Institute for Patient Safety should be established to carry out analyses of reported incidents, ensuring front-line staff have skills in recognising sources of unsafe care and the improvement tools to reduce risks, and initiating a major programme to building safety resilience into the health and social care system.
  4. Metrics should be established in order to allow for the benchmarking of clinical performance.
  5. A small Technology Hub should be established to identify the best technological innovations that are enhancing the quality of safety and care around the world.

Chancellor George Osborne announces devolved health spending for Greater Manchester

Chancellor George Osborne has announced that, from April 2016, Greater Manchester will become the first region in England to have full control of its health and social care budget. NHS England confirmed that discussions on the proposals were underway between 10 local authorities, 12 clinical commissioning groups (CCGs) and 14 NHS providers in Manchester, along with NHS England and the Government.

As part of the plans, a shadow Greater Manchester Health and Wellbeing Board will be appointed from April 2015 onwards, which will work with existing CCGs.

NHS England Chief Executive Simon Stevens said that “while this new model won’t necessarily be right for many other parts of England, for Greater Manchester the time is right and the conditions are right”.

Shadow Health Secretary Andy Burnham warned that the plans could lead to a “Swiss cheese” NHS, where “some bits of the system are operating to different rules”. He commented that “it does point further to the break-up of the idea of the NHS”.

Richard Humphries, assistant director at the influential health think-tank The King’s Fund, said that these would be reforms could be seen as “a triumph for local democracy”, but warned that it could create “real risks of yet another reorganisation of the NHS when it’s barely recovered from the last one”.

Shadow Health Minister Lord Hunt of King’s Heath discusses Labour’s position on health and social care

Speaking at the Nuffield Trust’s annual health policy summit, Shadow Health Minister Lord Hunt of King’s Heath discussed Labour’s plans for the health service should they win the election in May. Lord Hunt said that Labour’s post-election plans included a spending review of health funding in order to help address the deficit, which he believed would be a “formidable” challenge, but could be done through system efficiencies.

Hunt also discussed the role of health and wellbeing boards (HWBs) and clinical commissioning groups (CCGs), in which he said that CCGs could become advisors to HWBs.  In a blog post on Labour Lords, written to coincide with his speech, Lord Hunt said that increasing the role of HWBs would provide a greater link between health policy and all other local policies that have a bearing of health, including housing, planning and education. He said that these plans would help address the concerns associated with the increasing number of people with complex and multiple needs.

Lord Hunt’s comments on HWBs and CCGs build on comments made by Shadow Health Secretary Andy Burnham in October 2014, where he suggested that HWBs would be granted the power to sign off proposals developed by CCGs.

Weekly political news round up – 6th February 2015

February 6, 2015 in News by Whitehouse

Around the sector

The Department for Education’s charity partner 4children has announced that it has appointed Imelda Redmond as its new chief executive. Redmond, who is currently directory of policy and public affairs at Marie Curie Cancer Care, will take over from Anne Longfield when she becomes the new children’s commissioner for England on 1st March 2015. Before working at Marie Curie, Redmond was chief executive of Carers UK for 12 years and worked with disabled children in the 1980s.

NHS England has announced that a number of organisations have been approved to join the new Commissioning Support Lead Provider Framework. The framework seeks to enable Clinical Commissioning Groups (CCGs), NHS England and other customers to source some or all of their commissioning support needs. It covers three areas – end to end commissioning support, medicines management, and continuing healthcare and individual funding requests. It is anticipated that between £3-5bn of services will be procured through the framework.

The King’s Fund publishes report assessing the NHS under the coalition Government

Influential health think-tank the King’s Fund has published a report critically assessing the NHS under the coalition Government. The report argued that the 2010-2015 parliament had been “a parliament of two halves”, with the first half being focused on the debate around the Health and Social Care Bill, and the second half focusing on limiting the damage caused by the Bill. The authors of the report concluded that “historians will not be kind in their assessment of the coalition Government’s record on NHS reform”.

The report argued that Health and Social Care Act 2012 was a “distracting and damaging” top-down reorganisation of the NHS, with the resulting systems of governance being complex and confusing. The report also criticised the absence of local leadership, noting that it was increasingly problematic when the NHS needs to undertake major service changes.

Health Secretary Jeremy Hunt was praised in the report for “studiously ignoring many of the reforms promoted by his predecessor” and for “staking his claim as the defender of patients’ interests” in the wake of the Francis report into failures of care at the Mid Staffordshire NHS Foundation Trust. The report noted his “particular passion” for improving the safety and quality of care delivered in the NHS – as evidenced through strengthening the role of the Care Quality Commission and emphasising the need for transparency and accountability for performance.

Assessing the introduction of clinical commissioning groups, the report found that it is “too early to identify any real benefits of the new arrangements for commissioning”, but said that there is “some optimism in the way in which CCGs are beginning to work more closely with local authorities and through health and wellbeing boards”.

The report subsequently recommended that the next Government should continue the emphasis on patient safety and quality of care, but focus less on regulation and more on supporting NHS leaders and staff to improve care. The report also argues that further top-down reorganisations must be avoided, saying instead that evolutionary and bottom-up changes are need to reduce the complexity and confusion of existing structures and allow the implementation of the NHS Five Year Forward View.

Public Accounts Committee publishes report on the financial sustainability of NHS bodies

The Public Accounts Committee has published a report on the future financial sustainability of the NHS, in which they expressed concern over the current state of NHS funds. The report highlighted the fall in net surplus achieved by NHS bodies in 2013-14 to £722m, down from £2.1bn in 2012-13, as evidence of a worsening situation for the overall finances. Of particular concern to the Committee was the performance of NHS Trusts and Foundation Trusts, who have received an additional £1.8bn between 2006 and 2014 to help those under financial stress. The report also highlighted Monitor’s estimation that in the second quarter of 2014-15, up to 80% of Foundation Trusts providing acute hospital serves were running a deficit.

Other key recommendations from the report included:

  • A radical change is needed in the way services are delivered, such as the better utilisation of community and primary care services, if future efficiency targets are to be met. To achieve this national bodies need to invest in collecting more detailed cost data to measure the true impact new models of care will have across the whole NHS.
  • More effective collaboration between local bodies is needed to achieve value for money, whereby financial incentives are aimed at treating patients in the community rather than in acute settings. Payment mechanisms should help inform where a patient should be treated, meaning community service providers who have a block contract can treat a high volume of patients more cost effectively compared to a hospital using a payment by result scheme.
  • The reliance on temporary workers has seen the money spent on locum staff rise to £2.6bn in 2013-14, up from £2.1bn in 2012-13. There is significant scope to make savings through either hiring more permanent staff or negotiating block contracts with staffing agencies.
  • Surplus NHS land and assets should be sold off to fund investment in front line services, in particular new models of care.