News / News review – health and social care bill reaction; Scottish reform; ombudsman’s report

The month was again dominated by the government’s proposed reforms of the health service in England as parliamentary scrutiny of the health and social care bill began. While a media storm was whipped up over the return of price competition, the Department of Health was forced to put an end to speculation, with Sir David Nicholson’s categoric statement that there was ‘no question’ of a return to competition based on price. Competition should be based on quality, he said.

It has been a difficult month for the reforms. While the storm over price competition pervaded most of month, the government also responded to January’s Commons health select committee’s report on commissioning, insisting the reforms were needed to allow the NHS to respond to the £20bn efficiency challenge. It added that patient choice would not conflict with commissioning consortia’s clinical or financial priorities, and need not necessarily cost more.

King’s Fund chief economist John Appleby (left) questioned the government’s case that radical NHS reform was needed to drive up health outcomes. In a briefing in the British Medical Journal, Professor Appleby said the government believes its reforms are necessary because the country’s health outcomes are among the poorest in Europe. But he challenges the belief that outcomes are poor – comparisons are not straightforward, but deaths from myocardial infarction and breast cancer have fallen rapidly in recent years. If trends continue, it is likely the UK will have lower death rates for both than European outcomes star France, he said.

There was further criticism from eight charities, including Asthma UK and the British Heart Foundation, which said there must be a ‘defined route’ giving patients and the public input into decisions on services commissioned and what they look like.

Perhaps more worrying for ministers is the growing antipathy towards reform in the British Medical Association. While its leaders have criticised aspects of the reforms, there has been an assumption that the BMA would fall in line once it had won a few concessions. But a meeting to discuss the BMA’s stance on the proposals this month could prove stormy, with reports that some GPs are planning to unseat BMA chairman Hamish Meldrum (left) if he does not take a stronger anti-government line.

GPs remain to be convinced about the reforms. Nearly 50% believe the proposals will not lead to more cost-effective delivery of care, according to a Royal College of General Practitioners’ survey. About half the 1,800 GPs surveyed said the reforms would not reduce bureaucracy or transaction costs or improve patient care. Some 32% said care would be more cost-effective as a result of the changes, while 22% neither agreed nor disagreed with that. Less than a quarter said the reforms would cut bureaucracy, while one in five believed they would reduce transaction costs and lead to better care.

Away from the health and social care bill, the Audit Commission warned plans for its abolition could create significant governance and financial risks. In its submission to the Commons communities and local government committee inquiry into the audit and inspection of local authorities, the commission said public bodies that have tax-raising powers or spend large sums of taxpayers’ money should not be allowed to appoint their own external auditors. It said it was wrong to abandon some of its wider functions at a time when severe financial pressures increased the risk of financial or service failure in local public bodies.

The NHS Confederation and the Foundation Trust Network announced they would split from April. The move comes after FTN members voted the body should become independent. Foundation trusts will initially continue to be members of the confederation and the bodies will continue to work together.

Reform is not just the preserve of the English NHS. Scottish health boards and local authorities will adopt the lead commissioning model to work more closely in providing services for adults, especially older people. Public health minister Shona Robison (left) said lead commissioning, used successfully in some parts of England to commission adult social care, would cut through red tape and focus on patient need rather than whether a service was a health or social care issue. An implementation group would be set up to support partnerships across Scotland.

Scottish health boards’ 2011/12 allocations (see Healthcare Finance, December, p5) were confirmed after the Scottish Parliament approved the budget for 2011/12 this month. Revenue funding for the NHS will increase by £280m, with overall health spending rising to £11.4bn. Priorities will include the abolition of the prescription charge from April – at a cost of £25m.

In England, the Department of Health announced a further £400m to improve access to psychological therapies over the next four years as it launched its new strategy, No health without mental health. The cross-government strategy aims to ensure mental health is given the same importance as physical health. Funding will support treatments such as cognitive behavioural therapy and counselling for depression, and payment by results will be used for adult and children’s mental health services.

The expected shake-up in children’s cardiac services in England is to be confirmed in the autumn after a review of paediatric heart surgery recommended the number of NHS hospitals that provide heart surgery be cut from 11 to six or seven. The review said work should focus on units of at least four surgeons. Those that stop performing operations would continue with diagnostic, monitoring and non-surgical treatment.

Finally, a report from health service ombudsman Ann Abraham (left) said the NHS was failing to treat older people with dignity and respect. Ten investigations into complaints about the care of people over 65 showed they suffered unnecessary pain, indignity and distress, she said. Almost one in five of the 9,000 complaints made to the ombudsman last year were concerned with the care of older people.

The month in quotes

‘There is no U-turn because we never intended to introduce price competition. There has been incorrect reporting around this and Sir David’s letter simply sets that straight.’

A Department of Health spokesperson comments on reports that a letter from Sir David Nicholson marked a change in government policy

‘I warn David Cameron and the government: the ill-feeling he created over the forests will be as nothing compared to the real anger that will build about his dangerous plans for the NHS.’

Labour leader Ed Miliband predicts a backlash

‘Homeopathy is a relatively safe, inexpensive and effective treatment for many conditions, including chronic and multiple pathologies. Many PCTs are still funding it because it is popular with patients and provides a cost-effective alternative when conventional treatments have failed.’

The British Homeopathic Association launches a defence of homeopathy after a survey found a third of PCTs fund the treatments despite Department of Health guidance to the contrary

‘Successful surgery in these difficult cases can transform the life chances of a very sick child, which would otherwise be lost. If concentrating the very best skills in fewer locations is the price we have to pay to increase the chances of success, then it is a price well worth paying.’

NHS Confederation deputy policy director Jo Webber comments on the review of paediatric cardiac surgery