Comment / News review

Good news: the UK has the best healthcare system of 11 developed nations, according to the Commonwealth Fund, a respected US-based foundation that examines the performance of health systems. The NHS ranked first on eight of the 11 measures the fund examined, including efficiency and all four measures of quality (effective, safe, coordinated and patient-centred care). It spent the second lowest amount per head (£2,008; New Zealand was lowest with £1,876). However, the report, Mirror, mirror on the wall, was not completely positive. Using its measure of healthy lives, it said the NHS could do better on mortality rates and life expectancy. The UK came 10th in this category, although the authors accept this is not solely influenced by the healthcare system. The report was widely welcomed, but British Medical Association leader Mark Porter said demographic pressures, staff shortages, the funding squeeze and political interference were undermining the NHS.

Transformation is the service response to many of those challenges and, also in June, the NHS Confederation called for financial certainty to help the NHS get on with the job. At its annual conference chief executive Rob Webster called on ministers to take the radical step of giving the health service a 10-year funding deal and a transition fund of at least £2bn to support the move to sustainable models of care. He said the confederation had a number of ‘key asks’ of policy makers. As well as clarity of funding for a decade and the transition fund, these 'asks' included accelerated reform of the payment system to ensure funding was directed to where it is needed and unblocking the foundation trust pipeline.

Also at the confederation conference, NHS England chief executive Simon Stevens underlined potential changes in the payment system that he said would help commissioners ‘unleash more health and care bangs for the buck’. In partnership with Monitor, new models of reimbursement for some elective conditions, long-term conditions and urgent and emergency care would be piloted, he confirmed. Incentives, including CQUIN, the quality and outcomes framework and the quality premium, would also be examined. He would be pushing for a steady increase in the proportion of payments tied to performance, quality and outcomes for all NHS-funded services. And there would be a spectrum of approaches to sharing utilisation risk for particular services – from volume-based payments to delegated capitated budgets.

Truly transformational change will only happen if the NHS allows new entrants to the provider landscape, the Reform thinktank said. This would bring in lessons from industry to tackle the problems of finance and quality. A report, Going with change, written by former Labour health advisor Paul Corrigan and Care UK chief Mike Parish, said much of healthcare was delivered in organisations that had changed little in 50 years. High fixed costs meant these organisations were not agile enough to develop new ways of providing services. New entrants would transform the sector by rapidly changing patient care, it argued.

Health secretary Jeremy Hunt announced an incentive scheme for hospitals to recover the cost of treating overseas visitors. Mr Hunt said the aim was to recover more money than ever before from treating European Economic Area (EEA) visitors and migrants. While treating visitors and migrants from the EEA costs about £300m a year, the NHS recovered just £29m through the EHIC reciprocal scheme. More accurate recording of patients would result in the recovery of an extra £200m, he said. To encourage trusts to submit information on EEA visitor or migrant treatment, hospitals will receive an extra 25% on top of the cost of every procedure for these patients. The scheme will be introduced in the autumn.

Politicians’ influence over the NHS was on the King’s Fund agenda. Government ministers’ relationship with the NHS must be more clearly defined to leave local health service leaders with the space to innovate and lead service change, it said. In a report, Reforming the NHS from within: beyond hierarchy, inspection and markets, the fund said ministers should be confined to determining funding, establishing priorities and providing accountability to Parliament. It added there should be greater devolution in the NHS and a more proportionate approach to regulation.

Planning is becoming increasingly important and the Accounts Commission urged public bodies in Scotland to focus on priorities and develop longer-term financial plans. In Scotland’s public finances: progress in meeting the challenges, the commission said public sector bodies had coped well so far with reduced budgets. Bodies, including those in the NHS, had cut staff costs but this was not sustainable. With demand for services set to rise, they must develop longer-term plans based on different funding scenarios.

Public sector staff who are compensated when leaving their jobs – with a redundancy payment, say – will be subject to a clawback process if they return to a post in the same sector within 12 months under legislation proposed by the government. The planned law was outlined in the Queen’s speech. It is understood the rule would apply to those earning more than £100,000.

Monitor said it is content for the Royal Free NHS Foundation Trust to go ahead with its proposed acquisition of Barnet Chase Farm NHS Trust. The regulator came to the decision having considered the risks of the transaction in accordance with its risk assessment framework. It added that, should the acquisition proceed, it will work with the foundation trust to ensure required improvements in finances and patient services are delivered as expected.

All change at the Commons health committee as Stephen Dorrell stood down as its chair and ceased to be a member of the committee. He said he was standing down because in the run-up to the general election he felt he could contribute more effectively to debate on the NHS from ‘a less overtly political position’. He has been succeeded by another Conservative MP, Sarah Wollaston. Dr Wollaston trained as a GP and is MP for Totnes.