News / News review July 2015
With the dust settled after the election, the Department of Health in England and its various offshoots got down to business in June. Typically, this focused on the next five years and the delivery of the forward view, including the efficiency savings needed to maintain the service financial position, and included measures such as the clampdown on agency staff costs, managers’ pay and procurement spending.
NHS England chief executive Simon Stevens (left) set out three priorities for the health service – financial sustainability, redesigned care and a focus on prevention. Speaking at the NHS Confederation annual conference in Liverpool, Mr Stevens said the service had to move to practical ‘route maps’ for action and fundamentally redesign care. He issued a call for volunteers for urgent care vanguards and announced the first three areas of the new NHS success regime, which will support the most challenged health economies. ?
Later, NHS England fleshed out the details of the success regime outlined in the Five-year forward view. It said the regime would support the most challenged areas in three respects:
- Short-term improvement against agreed quality, performance or financial metrics
- Medium and longer-term transformation, including the application of new care models where applicable
- Developing leadership capacity and capability across the health system.
The first three areas are Essex; North Cumbria; and North, East and West Devon.
Outside the success regime, health secretary Jeremy Hunt launched new financial control measures, which will include curbs on ‘excessive’ executive pay. Mr Hunt said he would introduce guidelines on senior managers’ pay to ensure that ‘rates remain reasonable and fair to more junior staff who have faced pay restraint in recent years’.
Mr Hunt also put forward a new deal for GPs in England if they help make seven-day access to higher quality primary care services a reality. The measures include the previously announced funding for premises upgrades, the recruitment of 5,000 additional GPs, mostly to under-doctored areas, and 1,000 physicians’ associates to work in general practice by September 2020.
The Nuffield Trust said financial incentives to improve GP services are not the best way to encourage lasting change and widespread reform. In a briefing, Transforming general practice: what are the levers for change?, it argued that a more sophisticated approach was needed to implement the forward view. There was a risk that financial incentives were being over-used, it claimed, and called for financial rewards to be complemented by measures to build skills, allow time to redesign services as part of transformation programmes and understand the impact of changes. ?
NHS England announced it had taken over work on safe staffing levels from the National Institute of Health and Care Excellence (NICE). In one of its final acts at the helm, NICE endorsed Allocate Software’s safe staffing toolkit. NICE said the software could be used with its safe staffing guidelines for adult acute inpatient care to determine safe nursing staffing levels in real time and as part of planning and establishment setting. This is only the second safe staffing toolkit NICE has endorsed. Last October it backed the safer nursing care tool, developed by the Shelford Group, to be used with its guidelines on setting establishments.
There were important appointments in parliamentary scrutiny of the health service. Sarah Wollaston, who has been a hospital specialist and GP, was elected chair of the House of Commons Health Committee. And Meg Hillier has been elected chair of the Commons Public Accounts Committee. She has been a member of the committee for four years. ?
NHS funding promised by the government will support transformation, but social care directors claimed their services were being ignored. The Association of Directors of Adult Social Services published its annual budgets survey results, which the directors’ body concluded had shown an urgent need for ‘sustained and substantial’ funding. President Ray James (above) said expanding NHS spending at a time when social care budgets are shrinking is a folly. Though it was right to increase NHS funding, he said social care spending decreased by more than 10% between 2010/11 and 2015/16, when it should be protected and enhanced.
Monitor took further regulatory action over foundation finances. Lancashire Teaching Hospitals NHS Foundation Trust and Norfolk and Suffolk NHS Foundation Trust have agreed recovery plans following Monitor investigations. Both had been found in breach of their licences – the former reported a £2.8m deficit in 2014/15 and predicted a £46.8m deficit for 2015/16, while the latter predicted ?a £9.4m deficit for 2015/16. Monitor will appoint an improvement director at both trusts. Monitor is also investigating the financial sustainability of Southend University Hospital NHS FT. The trust recorded a? larger than planned deficit in 2014/15 – £9.8m rather than £7.8m. Meanwhile, the focus of an investigation at Taunton and Somerset NHS Foundation Trust has shifted from waiting times to finance. And, as well as finances, the regulator is examining waiting times at Warrington and Halton Hospitals NHS Foundation Trust and Wirral University Teaching Hospital NHS FT. ?
Tim Kelsey, NHS England director for patients and information, said technology and better use of data could save up to a third of the predicted £22bn of savings needed over the next five years. NHS England also said its National Information Board will look into making all NHS buildings free wi-fi zones.
Wales health minister Mark Drakeford announced more than £8m of new investment in adult mental health services. The money will be used to support people with dementia (£4.5m) and improve access to psychological therapies (£2m). Mr Drakeford said £1.5m would be allocated to improve mental health outcomes for women with perinatal illnesses, their babies and other children. A further £230,000 would support implementation of the Mental Capacity Act. ?
Innovation and transformation are needed to deliver world-class health and social care, according to Northern Ireland health minister Simon Hamilton. He said they were required with the NHS facing an ageing population and rising patient expectations, along with increasing financial constraints.
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The month in quotes ‘We need to redesign the way our urgent care system works. The current system is confusing the public. We have to do a better job of joining it up. We need to simplify the urgent care spaghetti so we can manage the demands being placed on us.’ ‘Technology has a hugely important role to play in delivering the productivity challenge – the shorthand for which is the £22bn. I’d put a health warning on some of the figures being talked about, but the use of technology and data along with new models of care could save as much as a third.’ ‘Protecting the NHS is an important policy objective. But the health service itself agrees that an important part of that equation is the simultaneous protection and enhancement of social care budgets.’ ‘We must look to innovation. Enabling technologies that put patients at the centre of healthcare is a fundamental driver of change and one that we must embrace.’ |
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In the media June was a busy month for the Department of Health and the HFMA was well represented in coverage of the key stories – the Carter review on efficiency and the continuing debate over seven-day services. The HFMA study on the costs of implementing seven-day services was mentioned in an article in the influential House magazine – parliament’s in-house publication. Lord Hunt, the Labour Lords spokesperson on health, said the study had shown the need to invest in clinical staff in hospitals. He added the trusts in the study had pointed out primary and social care services must be expanded in parallel with those in hospitals. The association also commented on the interim findings of the Carter review (see p26). The report said the NHS could save up to £5bn a year by 2020. HFMA director of policy and technical Paul Briddock (below)was quoted by the online versions of the Health Service Journal and Public Finance. He welcomed the interim findings, but added that the proposed savings were only a small part of the solution. Mr Briddock also wrote an opinion piece for the July/August issue of Public Finance. Introducing the HFMA Healthcare Costing for Value Institute, he said better cost and business information was needed in the NHS. This would support better measurement of the outcomes of health spending to achieve best possible value. |
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