Comment / News review

The end of the calendar year is busy in many industries and the NHS is no exception, with the triple announcements of commissioners’ funding, tariff and planning guidance for the coming financial year. After December’s whorl of circulars and formulae, in January the NHS was taking stock and looking forward.

The new year began on a positive note. Despite dire warnings, the service appeared to cope reasonably well with winter pressures, perhaps aided by the preparatory work, additional resources and relatively warm, wet weather. However, NHS England deputy chief executive Barbara Hakin (left) warned against complacency amid concern over rising emergency admissions.

Clinicians’ and managers’ leaders, including the Foundation Trust Network, British Medical Association, NHS Confederation and Royal College of Nursing, sought to be positive too. They issued a joint statement calling for a new start – replacing last year’s headlines about poor care with a more balanced view of the service provided by the NHS. While failures must be addressed, doing so meant, in the words of Professor Don Berwick's review of patient safety, leaving ‘fear, blame, recrimination and demoralisation’ behind.

The NHS Alliance, which represents commissioners and providers in primary care, was also optimistic. It launched an annual index of public confidence in the health service, the NHS temperature check. And despite the failings highlighted in the Francis and Berwick reports last year, 53% of the 1,886 adults polled said their feelings were no different than a year earlier. They still trusted the NHS to look after them. While 8% said they trusted the NHS more, 20% said they had lost confidence in the NHS.

However, the National Audit Office warned value for money is being undermined by problems with elective waiting time data and inconsistencies in the way patient referrals are managed. Its report, NHS waiting times for elective care in England, highlighted the increasing challenge of meeting the 18-week standard and the importance of reliable performance information and shared good practice. The recent strengthening of the standard appeared to have had a ‘significant’ effect, reducing the number of patients waiting longer than 18 weeks. But the NAO said published waiting times should be treated with caution as there were inconsistencies and errors in the recording of the data.

Recommendations were made on the future of the services provided by Mid Staffordshire NHS Foundation Trust, source of many negative headlines over the past year. The trust special administrators (TSAs) said the trust should be dissolved and its hospitals run by University Hospital of North Staffordshire NHS Trust and the Royal Wolverhampton NHS Trust. The transfers would begin by autumn 2014 and could take three years. Commissioners will make available deficit funding of £14.9m in 2017/18 – if nothing was done the deficit in that year could be more than £40m, the TSAs said. They estimated the transition costs up to 2017/18 could total £90m, while capital funds of £130m will also be required. Monitor has backed the TSAs’ proposals and passed them to the health secretary, who will make a final decision by 26 February.

The headline message from research by the York University Centre for Health Economics was upbeat. It said NHS productivity grew for two consecutive years, rising by more than 2% in 2010/11 to 2011/12. Growth was 2.13% to 2.38%, depending on the calculation method used. But it added that recent productivity growth is a function of below-average output growth combined with a substantially below average growth in inputs. ?

Up to a fifth of the NHS's work does not benefit patients and could cause harm, Wales health minister Mark Drakeford (left) said. He told the Welsh NHS Confederation annual conference in January the health service should adopt ‘prudent medicine’ that prioritised evidence-based care. Every health board has a list of interventions not usually on offer and he wants this to be a national list – for instance, tonsillectomies only offered if considered beneficial to the patient, limiting the amount of drugs used for chronic pain management, and reducing the number of antibiotics prescribed by GPs.

The Welsh confederation used its conference to issue a plea for urgent action to safeguard the future of the local health service. From rhetoric to reality – NHS Wales in 10 years’ time warned that the service faced a stark choice between radical, managed change now or ‘potentially chaotic decline’. But the public and politicians did not understand the scale of changes required to deliver financial and clinical sustainability. A YouGov survey of 1,000 people found most felt changes were driven by finance, not by a desire to improve quality.

In his budget bill for 2014/15, Scottish government finance secretary John Swinney reiterated that the local NHS budget would be protected. His draft budget last September said overall healthcare funding would increase to £12bn (a rise of £138m), while territorial health boards will be allocated an increase of 3.1%.

The Scottish government also announced NHS Scotland had saved and reinvested more than £1bn over the past five years. NHS boards exceeded their 3% efficiency target in 2012/13, saving £270m. Health secretary Alex Neil (left) said the NHS was on target to meet the required efficiencies this year. He also announced a clampdown on the use of the private sector to treat NHS patients – all significant health board private sector spend would have to be agreed by the Scottish government. NHS Scotland spending on independent healthcare was £28m in 2012/13.

Up to 70% of NHS contracts awarded since April 2013 have been won by the private sector, according to pressure group the NHS Support Foundation. In its sample of 56 contracts, 38 were awarded to private companies, 15 to the NHS, two to charities and one shared between public and private sectors.