News / News review - July 2016

 NHS Confederation chief executive Stephen Dalton summed up the mood when he said the service had broadly benefited from the UK membership of the union and the full implications of exit were yet to be clearly understood. NHS organisations would be anxious to see how it would impact on recruitment, economic stability, transformation of services and legislation. NHS Employers said it was important EU nationals working in the NHS know they will continue to be valued and welcome – a message reinforced by NHS England and health secretary Jeremy Hunt.

The NHS in England awaits a new government in the autumn, but earlier in June those in Scotland and Northern Ireland heard more of their new administrations’ plans. New Northern Ireland health minister Michelle O’Neill (right)  welcomed an extra £72m for health and social care, allocated as part of in-year adjustments to budgets. But she insisted the focus must remain on long-term reform. Only structural reform would secure an efficient and effective health and social care service. An expert panel on the reform of health and social care had told her service delivery must change. She added that the in-year funding would be spent across the system, including unscheduled care, additional social care provision and ICT.

 Scottish health secretary Shona Robison said primary, social and mental health care will be given ‘an increasing share’ of the NHS budget. In advance of the first health debate of the new Scottish parliamentary term in early June, she pledged to increase funding for frontline services each year. Ms Robison also announced a government review of NHS targets to ensure they are delivering better outcomes for patients and best use of resources. The review will look at targets in the context of the shift in delivery of care from hospital to the community, she said.

In Wales, new health minister Vaughan Gething welcomed a survey that shows high overall patient satisfaction with the local NHS. The Fundamentals of care survey found 99% of patients felt they were treated with dignity and respect, while 98% said they were given help to be as independent as possible. Some 95% of patients said they were given full information about their care, while 98% said they were made to feel safe. Mr Gething said the findings were positive, though he acknowledged that there was work to be done – for example, to ensure patients got enough sleep.

Concern over the NHS financial challenge is not going away, but, according to Nuffield Trust chief executive Nigel Edwards, it may be obscuring a problem that is at least as serious – a crisis in the NHS workforce. While he accepted finance was a major issue, Mr Edwards said inter-related workforce problems included low morale, bullying and a looming shortage in some specialties. The thinktank’s survey of 100 health leaders reported rising concern about staff morale and the role of deteriorating finances in this. Increased workload was the number one cause of declining morale, exacerbated by staff shortages and pay restraint, Mr Edwards said. These have combined to fuel staff interest in agency work.

The transformation of services and greater integration are two responses to the funding challenge, and health and social care leaders warned faster integration was needed. The NHS Confederation, Local Government Association, Association of Directors of Adult Social Services and NHS Clinical Commissioners said unprecedented pressure on funding has put at risk plans to improve patient care and raised questions over the sustainability of the health and social care sectors. Their report, Stepping up to the place: the key to successful integration, described how a fully integrated, transformed system should look. Their recommendations included a call for national leaders to redress funding shortfalls, particularly in public health and community services. Locally, managers must look beyond individual organisations to ensure integration and transformation happen quicker.

Research examining the reorganisation of stroke care in London and Manchester kept the focus firmly on service transformation. The work, funded by the National Institute for Health Research to draw out lessons for major system change, said service standards linked to financial incentives should be used to ensure major reorganisations deliver the best possible care. Explaining outcomes in major system change said ongoing achievement of service standards should be linked to financial incentives. It said new service models should be simple and understood by staff and the public.

Manchester should have a single acute NHS provider covering the city, according to a recommendation in a review of hospital services. The new provider would bring together Central Manchester University Hospitals NHS Foundation Trust and University Hospital of South Manchester along with the services provided on the North Manchester General Hospital site by Pennine Acute NHS Trust.

NHS Employers published the terms and conditions of service and indicative pay summary for the new 2016 doctors and dentists in training contract. The contract remains subject to a referendum of relevant British Medical Association (BMA) members. Under the proposed deal, doctors in training will be paid for all work done, with an average increase in basic pay of 11%. Pay for extra hours worked will include enhanced rates for unsocial hours, a weekend allowance for those who work more than six weekends a year, on-call availability allowance and pay for hours worked on call.

The NHS in England failed to meet access standards in A&E, elective care and ambulance response times in April, despite rises in activity. Summary figures published by NHS England showed six of the eight elective cancer standards were achieved, but others were missed. Activity was up compared with 12 months earlier – emergency admissions rose by 3%, diagnostic tests were up 6.4%, A&E attendances 2.3% and consultant-led treatment 3.9%.