Comment / News review

The final month of one year and the first of the next are often quiet for most parts of the economy, but not health. Winter pressures begin in earnest as the cold bites, the quarter three position is finalised, and draft payment by results arrangements for the new financial year are tested. Alongside these regular events, the end of 2012 and the arrival of 2013 were marked with rows that will have baffled many taxpayers and users of the health service.

The first was between Labour and the government over whether the latter had increased health spending in real terms each year, as promised when in took office in 2010. The opposition called in UK Statistics Authority chair Andrew Dilnot (below), who said changes in spending in 2010/11 and 2011/12 had been small and spending was lower in 2011/12 than in 2009/10, the last full year of the Labour government. Though he accepted the figures may be affected by different definitions and data sources, real-terms health spending had changed little over the first two years of the coalition government. The government hit back, insisting 2010/11 should not be used as a baseline year as spending had been set by the previous government. It preferred to begin in 2011/12, which showed a 0.1% real-terms increase. The row erupted a day before the chancellor’s autumn statement – perhaps prompting his announcement to raise health spending in the first year of the new spending review period.

The second argument came late in January, when a European Commission-funded study concluded there were flaws in the formula used by the National Institute for Health and Clinical Excellence (NICE) to decide whether to recommend NHS funds. The researchers said the QALY (quality adjusted life year) method was not scientific and should be abandoned. NICE and health economists defended the approach, though they accepted QALYs were not perfect.

Monitor insisted it would not be recommending the government exempt private sector healthcare providers from corporation tax. The tax is one issue being examined as part of the regulator’s fair playing field review and there was media speculation that a draft report proposed an exemption. Monitor denied a draft had been written and said while it had yet to decide on recommendations to the health secretary, a corporation tax exemption would not be one of them.

The regulator removed Gloucestershire Hospitals NHS Foundation Trust and James Paget University Hospitals NHS Foundation Trust from significant breach after improvements at both . Gloucestershire was placed in significant breach of its authorisation in September 2009 after persistent failures to meet A&E targets and weak financial performance. It had quickly tackled its financial problems, Monitor said, and made big improvements to delivery and oversight of emergency care. James Paget was placed in significant breach following Care Quality Commission concerns in late 2011 about nutrition standards and management of patient risk. Monitor said the trust was no longer in breach ‘having made substantial improvements.

Barts Health NHS Trust, formed in April last year, said one of its predecessor trusts – Barts and the London  – had overpaid staff by £995,000 in 2011/12 (0.25% of its total salary bill). Most had been recovered, with the £275,580 outstanding being pursued by the trust. It said the overpayments were caused by changes in staff circumstances – such as a reduction in hours – that were not passed on to payroll before the processing deadline. To stop this happening, the trust was piloting an electronic system that would allow managers to give payroll up-to-date information in a timely fashion.

Technology was on politicians’ minds this month. According to the Department of Health website, health secretary Jeremy Hunt (left) called on the NHS to go paperless by 2018 – the move would save billions, improve services and help meet the needs of an ageing population. He challenged the service to introduce some paperless systems by 2018, including giving all patients access to their online GP health records by 2015; sending referral notes by email rather than by post; and making digital information fully available across the NHS and social care services by April 2018. For now, it seems, appointment letters will still be sent by post.

Mr Hunt issued the challenge as he published two reports setting out the benefits of greater use of technology. ?The NHS could release more than £4bn of savings each year through the better use of IM&T, according to a report by PricewaterhouseCoopers, which said greater use of text messages, electronic prescribing and electronic patient records could improve patient care and allow clinicians to spend more time with patients. A further report said mobile technology could save money and raise productivity. The final report of the mobile health worker project, which examined the introduction of the technology at 11 pilot sites, said productivity improvements were reflected in ‘huge increases’ in patient contacts, reduced journey times and less duplication of data. The report listed cost savings at some of the pilots, achieved by cutting the number of referrals, admissions and ‘no access’ visits. ?

The Commons health committee said It was unacceptable the arrangements for value-based pricing had yet to be agreed. In its report on the National Institute for Health and Clinical Excellence in January, the MPs said the government opened its consultation on value-based pricing in December 2010, but those who would have to work with the new arrangements were still unclear about what value-based pricing meant in practice.

A fund to cover the cost of medicines to patients with rare conditions has been set up by the Scottish government. The £21m fund will be available from this March to April 2014 to pay for drugs to treat patients with a condition that affects less than one in 2,000.

Finally, the Department of Health said local authority areas in England with the worst health outcomes will receive up to 10% growth in their estimated baseline spend on public health in 2013/14 and 2014/15. Announcing the ring-fenced public health allocations to local authorities, the Department said average growth would be 5.5% in 2013/14 and 5% in 2014/15.