This week, the Chief Executive of NHS Improvement, Jim Mackey, admitted that “critical” financial targets for the progress of the NHS’s Five Year Forward View will not be met during this year. Mackey said the NHS provider sector will not break even again in 2017/18, and that it lies beyond the control of trusts if the NHS will reach financial balance in 2018/19 or not.
In May last year, the NHS stated that bringing the provider sector back to the planned position in 2016/2017 was of paramount importance, if closing the funding gap is to be achieved. NHS trusts are forecast to end 2016/17 with a deficit of £873 million, way beyond the target of £580 million.
In other news, Labour has challenged the Government’s basis for downgrading of NHS treatment targets, stating that such changes contravene patients’ legal rights under the NHS Constitution. In an interview with Sky News, Labour’s Shadow Health Secretary Jonathan Ashworth said he would ask Health Secretary Jeremy Hunt to clarify the legal reasoning underpinning the move.
Simon Stevens also said he expects waiting times for elective operations to increase marginally as a “trade off” for improvement in other areas, such as hitting the four-hour A&E target. The NHS target is for 92% of patients to be treated within 18 weeks of referral. On meeting treatment targets, Ashworth said he thought the NHS needed up to £5 billion extra funding this year, suggesting the Government should scrap tax cuts in order to pay for the health service.
House of Lords Committee publishes report on long-term sustainability of NHS
On Wednesday, the House of Lords Committee on the Long-Term Sustainability of the NHS published
its report, which was critical of the failure of successive governments to plan effectively for the longterm
future of the NHS. The Committee concluded that a tax-funded, free-at-the-point-of-use NHS is
the most efficient way of delivering health care and stressed that such a system should remain in place
now and in the future.
For that to be feasible, the report recommended that several aspects of the NHS and the delivery of
adult social care must change. This includes the establishment of a new, independent Office for Health
and Care Sustainability, which would investigate health and care needs for the next 15-20 years and
report to Parliament on the impact of changing demographic needs, the workforce and skills mix in the
NHS and the stability of health and social care funding relative to demand.
The report stated that previous funding to the NHS has been “too volatile and poorly coordinated
between health and social care”, resulting in poor value for money and resources being allocated in
ways which don’t meet patient needs. The Committee argued that future health funding will need to
increase at least in line with growth in GDP, and that NHS financial settlements should be agreed for
an entire Parliament to enable effective planning.
The Committee expressed its concerns on the absence of any long-term national plan to “secure the
appropriately skilled, well-trained and committed workforce that the health and care system will need
over the next 10–15 years.”
The Committee made 34 recommendations for change including:
- The Government should commission an independent review to examine the impact of pay on
morale and retention of health and care staff;
- The Government should do more to incentivise the take-up of innovative approaches, and
make clear that there will be funding and service delivery consequences for those who
repeatedly fail to engage;
- National and local public health budgets should be ring-fenced for at least the next ten years,
as cuts to the public health budget are shortsighted and counter-productive;
- The NHS Constitution should be redrafted to emphasise that access to the NHS involves patient responsibilities as well as patient rights;
- Budgetary responsibility for adult social care at a national level should be transferred to a new Department of Health and Care; and
- NHS England should engage with GPs to examine alternative GP models, including direct employment, as the traditional small business model is no longer fit for purpose.
Responding to the report, Jeremy Hunt rejected the claims that the handling of the NHS has been too shortsighted, saying that the Government has “shown we are willing to take tough action to protect the public’s health – introducing standardised packaging of cigarettes and a soft drinks industry levy, and launching a world-leading childhood obesity plan.”
Elsewhere, Unite’s national officer for health, Sarah Carpenter, praised the report, describing it as both “well-balanced and thought-out, with pragmatic action points”. She called on Hunt to consider the report’s warnings over low pay following last week’s “measly” 1% pay rise for NHS staff. Chris Hunt, Chief Executive of The King’s Fund, also responded positively saying, “‘This bold and thoughtful report should serve as a wake-up call to politicians from all parties to initiate a long overdue debate about how to pay for health and social care in the future”.
STPs to be told how to make integrated care savings
NHS England has commissioned the Midlands and Lancashire Commissioning Support Unit to provide a tailored report to each STP by the end of April, specifying how financial resources can be saved by improving preventative physical and mental health care in local NHS services.
In May 2016, the NHS Planning Guidance asked every local health and care system in England to come together to create their own ambitious local plan for accelerating the implementation of the Five Year Forward View. The blueprints, known as Sustainability and Transformation Partnerships (STPs), focus specifically on long term place-based needs of local populations.
The new reports will support STPs and commissioners to develop smart investment strategies for improving preventative healthcare services, to ultimately save money on emergency care. The reports will contain data sets to help local health services distinguish what areas to focus on, in line with the key priorities set out in the NHS’ Five Year Forward View for Mental Health.
Nursing degree applicants down 23%
Recent figures revealed by the Universities and College Administrations Service (UCAS) show that the number of people applying to study nursing at university in England this year was 23% lower than last year. The drop in nursing students has been slightly sharper in England than in the rest of the UK, which showed an overall decrease of 19% in nursing students last autumn, and has been linked to the replacement of NHS bursaries for nursing students with tuition fee loans.
The decline in mature nursing students, over the age of 25, has been cited as being especially worrying, as these students not only bring highly valued experience to the NHS but are often attracted to jobs within the health care sector that are the hardest to find employees for. The Royal College of Nursing’s Chief Executive, Janet Davies, said that “Plans to transform mental health care rely on these nurses and the government must not allow services to be hampered by the fall.” Davies also criticised the Government’s failure to amend its approach to nursing bursaries despite opposition from the sector, stating that “Tomorrow’s nursing workforce, especially older applicants with young families, have been deterred at the very moment the NHS needs them most.
The figures were published in the same week that the Department of Health’s workforce modelling report was leaked, suggesting that the NHS could be short of more than 40,000 by 2026 as a result of leaving the EU.
New primary care model linked to lower A&E attendance
New data on the “primary care home” model (PCH) for general practice, developed by the National Association of Primary Care (NAPC), shows that areas testing the model have sharply reduced A&E attendances and lower GP waiting times. The model organises health care practices into ‘hubs’ covering 30,000-50,000 patients and builds on interdisciplinary thinking where ‘multidisciplinary teams’ provide patients with more holistic health care services.
Whilst the report does not confirm a causal link between the model and reduced pressure on A&E admissions, NHS England has said it seeks to incorporate the model over the next two years. The NAPC’s Chair Nav Chanan said: “This report provides confidence that the PCH model is helping to make a much needed difference to patients and staff as well as easing pressures on the wider health care system.”
Following this week’s report by the House of Lords Committee on the Long-term Sustainability of the NHS, and increased calls for a more holistic approach to health care provision, the PCH model follows the trend of advocating focus on holistic and preemptive health care to save money for the NHS. The size of primary care hubs advocated by the model was also reflected in the NHS’s next steps for the Five Year Forward View, published last week, which suggested that GP practices should look to come together in networks with 30,000-50,000 patients.
GP practices close in record numbers
Data from NHS Digital has revealed that a record number of GP practises closed last year, forcing more than 250,000 patients to move surgery – representing an increase of 150% from 2014. Of the 92 practices that shut, 58 did so completely, while 34 merged with other local surgeries to pool resources.
The increase has come despite NHS England establishing a £500 million ‘turnaround package’ last year to help prevent practices closing. In November, Health Minister David Mowat pledged that 1,000 practices would receive support in the current fiscal year from a £16 million tranche of the GP resilience fund that CCGs would have to spend by the end of March. However, the NHS has been criticised for not distributing this funding before the end of the 2016/17 financial year.
Replying to the latest figures, GPC deputy chair Dr Richard Vautrey said: “This is yet more evidence of the crisis facing general practice right around the country and is a direct result of unsustainable and unsafe workload pressures, and failures to attract enough doctors in to general practice so that it’s increasingly hard for practices to replace retiring GPs.” He also highlighted that many patients will worry about losing their relationship with their own GP.