This week, winter pressures have begun to take their toll on the health service as thousands of patients are set to face delays in having surgery. NHS England has told hospitals to delay elective procedures – such as cataract removals and hip and knee replacements – until mid-January in an attempt to avoid a full-blown crisis in capacity over the winter. The national commissioning body has told NHS trusts already facing “high levels of operational pressure” to convert space normally used for such procedures into overflow areas with beds for patients in need of acute care. National Medical Director Bruce Keogh said the move would be necessary in some parts of the NHS to ensure “care for our sickest patients”, while the patient charity National Voices called the development a “sorry state of affairs”.

Meanwhile, the first of two recent applications for judicial review of accountable care organisations has been granted permission to proceed by the courts. The claim for a review made by campaign group 999 Call for the NHS was approved by Justice Males on Thursday on the issue of “whether proposed [whole population annual payment] is a scheme of payment for NHS services which is permitted under the Health and Social Care Act 2012.” The campaign group believes payment systems through accountable care will constitute a breach of the national tariff system.

Incontinence data discussed in parliamentary question

Jackie Doyle-Price, the Minister for women’s and children’s health, answered a written parliamentary question from Dr David Drew, Labour MP for Stroud on the availability of data on children with incontinence problems. Specifically, Dr Drew asked the Health Secretary if he would “instruct NHS trusts and Clinical Commissioning Groups to start compiling data on the numbers of children with incontinence problems.”

The Minister said there are “no plans” to instruct local health organisations to collect such data. However, Doyle-Price confirmed that in its business planning for 2018/19, Public Health England “is reviewing whether the new section dedicated to child and maternal health on their Fingertips digital platform would be a suitable place to make data about childhood continence available at a local level.”

NHS England orders cut back on over-the-counter scripts

NHS England is proposing to cut free prescriptions for a range of products which can be accessed over-the-counter at pharmacies, in an attempt to reduce the burden on general practice. It has released a consultation entitled, “conditions for which over the counter items should not routinely be prescribed in primary care”, which has suggested reducing such prescriptions for 33 “minor, short-term health concerns” which NHS England deem to be “self-limiting”, and only requiring self-care. Dependent on
the outcome of the consultation, the resulting commissioning guidance “will need to be taken into account by CCGs in adopting or amending their own local guidance to GPs in primary care.”

The Patients Association has criticised the move, with chief executive Rachael Power saying the move threatened to negatively impact the doctor-patient relationship. While agreeing it is “counterintuitive for the NHS to be paying pounds for something that the individual can buy for pence”, Reeves argued that GP appointments may begin to feel like “a benefits assessment, where (patients) wait to find out at the end whether they will receive support or not.” Helen Stokes-Lampard, Chair of the Royal College of GPs, offered a more measured response saying it was imperative that GPs “retain the right to make clinical decisions about prescribing appropriately for our patients based on the unique physical, psychological and social factors potentially impacting on their health.”

The Guardian reports that the plans will restrict prescriptions to treat health concerns including cold sores, conjunctivitis, mild indigestion, dandruff, haemorrhoids, mouth ulcers, dandruff, head lice, headaches and back pain. NHS England Chief Executive Simon Stevens backed the proposal, arguing the consultation, “gives the public the opportunity to help family doctors decide how best to deploy precious NHS resources.” He said it was essential to free up money to be reinvested in “modern treatments for major conditions such as cancer, mental health and emergency care.”

NHS Improvement to “deliver a balanced NHS budget”

The Department of Health has published a letter to NHS Improvement from Health Minister Philip Dunne, outlining its objectives for the financial year 2017-18. In the letter, Dunne highlights that “key to NHS Improvement’s success will be its delivery of a balanced NHS budget whilst driving improvements in the efficient use of resources and increasing productivity in NHS providers”. The DH ministerial team will hold the organisation to account through a series of formal meetings, as well as mid-year and end of year accountability meetings. The specific objectives set for 2017/18 include:

  • Implementing the recommendations of the Carter Review to boost operational productivity through better use of staff resources and management practice;
  • Providing streamlined support for local health economies by developing and implementing Sustainability and Transformation Plans and other models of accountable care;
  • Seeking to reduce the aggregate deficit for the NHS provider sector to £496 million, on total revenue of around £81 billion;
  • Supporting DH and NHSE to support the Five Year Forward View with the ambition of delivering 2-3% improvements in efficiency each year; and
  • Working with NHS England to roll out the four priority clinical standards for seven-day hospital services to 50% of the population by April 2018 and to the whole population for five specialist
    services (vascular, stroke, major trauma, heart attack and paediatric intensive care) by November 2017.

Update on Brexit and EU (Withdrawal) Bill

The EU (Withdrawal) Bill on has its final committee session on Wednesday, in which amendments to the Bill were discussed and six voted on. After last week’s defeat in Parliament, Mrs May decided to drop on the idea of enshrining the exact date and time of Brexit – March 29, 2019 – in the Bill. The resulting compromise will allow Brexit to be delayed in “exceptional circumstances”. The Committee Stage of the Bill has now been concluded, but the Government still faces two further stages in the Commons before it faces a new challenge in the House of Lords.

In particular one amendment to try and make the UK stay permanently in the customs union saw Labour leader Jeremy Corbyn’s biggest party rebellion to date, with 62 Labour MPs backing the amendment against the Labour whip.

Brexit Minister Steve Baker, also discussed amendments and clauses designed to oblige the Government to publish reports or assessments on specific policy areas ahead of Brexit. In particular, clause 48 of the bill calls for a strategy for the certification of UK and EU medical devices by UK bodies in order to maintain a close-relationship with the EU in the field of medical regulations. Baker highlighted to the chamber that this is the aim of the Government’s strategy and that the UK intends to maintain current close relationships with the EU in this area. This clause was not voted on so will not be part of the bill moving forward.

The bill will now move to the report stage, which gives MPs an opportunity to speak and suggest new amendments to the bill. It will then be discussed at third reading, where MPs will vote on the bill in its entirety. If MPs vote in favour it will sent to the House of Lords to undergo the same process it has been through in the Commons. In the unlikely event it is rejected it will be returned to committee stage in the Commons.

Meanwhile, the Committee on Exiting the European Union has published a series of “sectoral reports” produced by the Government. The Department for Exiting the EU (DExEU) produced the reports as analyses of the current state of important sectors which might be impacted by Britain’s departure from the EU, but emphasised that these are not “impact assessments”. There are 39 reports in total, for sectors ranging from ‘Aerospace’ to ‘Wholesale Markets and Market Infrastructure’, and there is a dedicated 20 page report on Life Sciences included in the release.