News / News review February 2015

Funding, the use of the private sector and the effect of winter pressures were the dominant healthcare themes in December and January. They neatly bookended the period as first the autumn statement handed out extra funds for 2015/16 and A&Es faced some of their most demanding periods in late December and January.

 The Scottish and Welsh governments handed out extra funding to help their services cope with the additional winter pressures.  Health boards in Scotland were given an extra £10m to help deal with seasonal pressures and tackle delayed discharge. The Scottish government said this winter resilience fund was in addition to the £18m previously announced for unscheduled care and delayed discharge. NHS Wales received £40m to help it deal with winter pressures. The Welsh government said the funding, to be drawn from its reserves, is the equivalent amount for Wales of the additional £700m given to NHS England for winter pressures. ?

 As emergency demand rose to new record levels, NHS England published details of how some of the additional £700m winter pressures funding has been spent. This included schemes increasing 24/7 access to pharmacy, tackling delayed discharge, extending urgent care
centre opening hours and recruiting more emergency department doctors. However, A&E attendances put huge strain on the system – over the two-week Christmas period, for example, attendances grew by almost 9% compared with the same period last year.

 NHS finance staff have learnt they must look at the funding of other public services to give them early warning of pressures on their partners and possible impacts on the health service. Local government finance is chief among these – in 2015/16 the council finance settlement will mean an average reduction in councils’ spending power of 1.8%. The Department for Communities and Local Government (DCLG)said spending power included funding from the NHS – NHS funds to support social care and resources for public health. The DCLG said no council would face a spending power reduction of more than 6.4%, while funding for homelessness, health and early intervention services would be protected. However, the Local Government Association said councils across England would receive 8.8% less funding from government to run local services and insisted that social services were still ‘chronically underfunded’.  Integration and the use of pooled funding, such as the better care fund, to transform services are seen as part of the solution. The King’s Fund and the Health Foundation are developing a proposal for a transformation fund to smooth the way. The King’s Fund argued for the creation of such a fund in its report The NHS productivity challenge. A dedicated fund would help meet the costs of developing community-based services and double-running during the transition to new models of care. The project will explore: the level of resources required; how the existing resources tied up in surplus assets and estates might be released to support a transformation fund; and how a fund should be administered. The final report should be released in the summer.

 Monitor asked foundation trusts to share details of initiatives they have used to reduce agency staff use. The regulator is reviewing the increase in agency staff spending, which reached £2.4bn in 2012/13. In addition, it will issue a mandatory information request to all foundations asking for more detailed data on their agency spending. The National Institute for Health and Care Excellence (NICE) suggested minimum nurse to patient ratios in A&E. These are based on the severity of a patient’s condition. With demand in emergency departments liable to change rapidly, in draft guidance NICE also recommended managers allow for enough nursing staff to cover higher than the average number of patients who attend the A&E each day. This would allow them to cope with spikes in demand and give flexibility to move staff to where they are needed. The draft guidance is out for consultation until 12 February. ?

 Meanwhile, Health Education England (HEE) has set out plans to increase adult nurse training numbers by 1,649 per year to 13,748 – forecast to produce the highest output from nurse training ever. The plan will see more than 13,000 additional nurses available for the NHS, in hospitals or in the community, by 2019. This increase of 555 places this year (4.2%) on top of the 9% increase last year delivers growth of over 13% in the two years since HEE was created.

 Arguments on the role of the private sector in providing NHS healthcare are never far from the surface. The latest was sparked in December when a British Medical Journal study claimed a third of the contracts for NHS clinical services awarded since April 2013 have gone to the private sector. The BMJ looked at 3,494 contracts awarded in England after the Health and Social Care Act 2012 came into force up to August 2014. Non-NHS providers won close to 45% of contracts, including 33% to commercial bodies and 10% to voluntary and social enterprises. ?

 The study was published just after it emerged that independent healthcare firm Circle had entered talks with the NHS Trust Development Authority to withdraw from its contract to run Hinchingbrooke Health Care NHS Trust. The firm said the position had changed since it took on the contract – demand for A&E services was unprecedented and its funding had been cut by 10% in the current financial year. Further investment was needed at Hinchingbrooke, together with reform in the wider health economy, it said. And, while it supported the Five-year forward view vision, the reforms were ‘too far in the future’. Shortly after, the trust was placed in special measures after the Care Quality Commission (CQC) gave the trust an overall rating of ‘inadequate’. Circle disputed the CQC findings.

 New organisational forms were the subject of a review by Salford Royal NHS Foundation Trust chief executive Sir David Dalton, who published its interim findings in December. He said that even the best NHS providers must look outside traditional organisational boundaries if they are to ensure clinical and financial sustainability. The review suggested five themes: there should not be a ‘one size fits all’ approach; faster transformational and transactional change was needed; ambitious organisations with a proven track record should be encouraged to expand; overall sustainability of the provider sector is a priority; and a dedicated implementation programme is needed to ensure change happens.