News / News review - December 2016

Health news in November centred on the many calls for the chancellor to allocate extra funding for health and, in particular, social care when he delivered his autumn statement. Pressure groups and think-tanks said a shortfall in social care funding was placing additional pressure on the NHS in the form of increased activity and delayed transfers of care. But ultimately it was fruitless as Philip Hammond did not even mention health or social care, never mind give them additional funding.

A related argument broke out over just how much extra funding the government had given to health. In late October, Commons Health Committee chair Sarah Wollaston wrote to the chancellor to criticise the government’s continued claims that it had increased health spending by £10bn up to 2020/21. She said this did not stand scrutiny as the money was allocated only to NHS England and the £10bn figure could only be reached by adding an extra year to the spending review period. The increase was funded by cuts in other parts of the Department of Health budget and, taking into account the spending review period only (2015/16 to 2020/21), overall health spending will rise by £4.5bn in real terms, she said. 

Mr Hammond (right)  hit back,
defending the government funding record and insisting the £10bn figure was correct. He said the money had always been intended for the NHS, not the Department as a whole, to ensure additional funding was prioritised for frontline services. The £10bn figure had been calculated using the 2014/15 baseline, which was also used as the baseline year in the Five-year forward view. In line with the service’s request, £6bn of the additional £10bn would be given to the NHS by the end of 2016/17, he added.

While this seemed, increasingly, like an argument for economic anoraks and Whitehall obsessives, the British Medical Association and MP Jonathan Ashworth asked the UK Statistics Authority for clarification. It concluded that both were correct, though it acknowledged there was some confusion over the figures. It said the NHS England budget will rise by £10bn between 2014/15 and 2020/21 (£8.4bn over the spending review period). However, it estimated that in constant 2015/16 prices, the Department of Health budget will rise by £4.5bn in real terms over the spending review period. The authority said it would ask the Treasury to investigate whether it can in future present estimates for NHS England and total health spending separately. It would also work with officials to explore other ways of producing the figures to ensure greater clarity on sources, time periods and what is being measured.

Rising demand is one of the key
reasons behind the calls for additional funding and, according to the latest monthly figures, activity in the NHS in England continued to rise in September. Emergency admissions were up 2.6%, diagnostic tests 3.8% and A&E attendance 4.9% compared with the same month in 2015. Consultant-led treatment over the last 12 months was 4% higher than in the preceding 12 months. NHS Constitution standards were not met in A&E, referral to treatment, diagnostic tests and the 62-day target for urgent GP referral to treatment for cancer. In A&E, 90.6% of patients were treated within the four-hour target, below the 95% standard.

The Northern Ireland Audit Office called on the local Department of Health to provide ongoing support to health and social care providers to avoid unnecessary hospital admissions and delayed discharges. A report from the auditors said progress had been made on avoiding admissions in recent years, but that emergency admissions were costly and frequently avoidable. In 2015/16 Department figures suggested that 16% of emergency admissions may not have been necessary. 

The Local Government Association argued that
more care should be moved out of formal healthcare settings altogether. In a report, Helping people look after themselves, it called for a ‘new culture of care’ with individuals with minor ailments looking after themselves rather than visiting their GP or A&E. The LGA said 57 million GP consultations and 3.7 million A&E attendances were for minor illnesses, costing the NHS more than £2bn a year. These included 5.2 million GP visits for blocked noses, 40,000 for dandruff and 20,000 for travel sickness. Some 19% of all A&E visits were for self-treatable conditions, the LGA said, and self-care could save GPs an hour a day and reduce the pressure on social care.

 The devolved governments in Cardiff and Edinburgh announced winter funding to support services during the traditional rise in demand. The NHS in Wales will receive £50m, though health secretary Vaughan Gething and head of NHS Wales Andrew Goodall urged patients to choose the right service to save time and to reduce pressure on emergency services. The Scottish government announced funding of £10m to support improvements in waiting times for first outpatient appointments. The funding will provide an estimated 40,000 additional appointments over the next few months, easing the pressure on outpatients in the winter months, the government said. The government also announced an additional £3m to help health boards prepare for winter by improving patient flow and supporting people back to their own homes as quickly as possible.

Vale of York Clinical Commissioning Group insisted it had not imposed a blanket ban on surgery for patients with a body mass index (BMI) of 30 or higher. It is introducing new criteria asking patients whose BMI falls into this category to reduce their BMI to less than 30 or lose 10% of body weight, or postpone their elective surgery for 12 months. Smokers would be asked to quit for at least two months or postpone their elective surgery for six months. There would be support for patients and a number of exclusions, with a draft list including those requiring emergency surgery or with clinically urgent need and patients receiving surgery for cancer or suspected cancer.

NHS England outlined three actions it will take in the wake of the Court of Appeal ruling on the funding of the HIV-preventative drug PrEP. The court ruled that NHS England had the power to fund the drug – NHS England had previously insisted local authorities should fund PrEP (pre-exposure prophylaxis) due to their remit for preventative healthcare. NHS England said the court had decided it had the power but not the obligation to commission the drug. However, it would now formally consider whether to fund the drug, discuss with local authorities how it could be administered and seek to lower the cost.