News / News review – new government health policies, Labour team wipe-out and healthy savings

‘Dear chief secretary, there’s no money left.’ The note left by the ever-affable Liam Byrne to David Laws, his successor as chief secretary to the Treasury, will go down in political folklore. But the new Conservative- Liberal Democrat government was in no mood for gallows humour and wasted little time getting down to work on tackling the shortfall.

The hung Parliament that led to the coalition being formed was delivered in an election on 6 May that all but wiped out the incumbent Labour government’s health team. Only the former health secretary – and now prospective party leader – Andy Burnham (left) kept his seat, as the electorate disposed of Mike O’Brien, Gillian Merron, Phil Hope and Ann Keen.

Long-time bridesmaid Andrew Lansley – shadow health secretary for seven years – became David Cameron’s first health secretary, backed by a ministerial team including one Lib Dem, Paul Burstow. NHS finance staff can expect to hear a lot more of Earl Howe, now parliamentary under secretary of state for quality in the Department of Health. A former banker and shadow health spokesman in the Lords, he will oversee finance, commissioning reform and the review of arm’s length bodies. Simon Burns, junior health minister in 1996 and 1997, and Anne Milton complete the team. One other notable appointment at the Department was Professor Dame Sally Davies (left) as interim chief medical officer following the retirement of Sir Liam Donaldson.

The Department of Health was protected from almost £6bn of additional savings to be made this year in the public sector, though NHS managers in the devolved nations will wonder if they will have to implement further cuts this year. While the NHS in England might have breathed a sigh of relief, Mr Lansley hinted of more pain to come and that NHS chief executive Sir David Nicholson’s call for £15bn-£20bn in efficiency savings over four years might not be enough.

Challenged on Radio 4’s Today programme on the £20bn figure, Mr Lansley (below), said: ‘Of course we need to do that and we may need to do more because of increases in demand and the need to improve outcomes.’ The NHS would also have to control pay and prices over the coming years. Later, in a statement on the Department of Health website to mark his appointment as health secretary, Mr Lansley said the NHS needed leadership and highly effective management and promised to back the service with real terms increases in resources.

Some managers might feel the new health secretary is tying one hand behind their backs. He said decisions on service changes must meet four new criteria. New proposals, and those in train, must focus on patient outcomes, consider patient choice, have the support of GP commissioners, and be based on sound clinical evidence. Mr Lansley said he wanted NHS London, which is in the throes of implementing Darzi reforms, to lead the way in engaging GP commissioners in the reconfiguration of services. This was widely interpreted as putting a halt on the capital’s reconfiguration programme.

According to some papers, the NHS has already put in train a ‘brutal round of cuts’ dominated by staff redundancies. For those still looking for inspiration on savings, one solution drew on the British love of cookery as Nottingham University Hospitals NHS Trust switched to such a menu full of fresh, local ingredients. The trust said the daily plate saving is £2.50 per patient or more than £6m a year. Trust catering manager John Hughes told the BBC that up to £400m could be saved each year if the scheme were rolled out across the NHS.

More traditional cuts were on the mind of Daily Telegraph columnist James Delingpole. Number five in his blog 10 reasons to be cheerful about Dave’s new coalition of the unwilling was: ‘If you work for a bloated management team in the NHS there’s no need to cancel that holiday in the Maldives’. Certainly, holidaying strategic health authority staff may have been tempted not to come back after it was reported SHAs would be abolished by 2012. Liberal commentator and executive vice-chair of the Work Foundation Will Hutton is to examine the gap between the lowest-  and highest-paid public servants, and how the gap could be limited.

Lest we forget amid all this talk of axes falling, the NHS efficiency drive is meant to combine with (or be led by) a quest for ever-higher quality. There has been news on quality this month. The NHS Information Centre said more than 50% of patients eligible to complete patient reported outcome measures (PROMs) questionnaires took part in the initiative between April and December 2009. Some 99,740 pre-operative questionnaires were completed during the period and almost 68% of these were linked to hospital episode statistics. Knee replacements had the highest participation rate at 61.7%, varicose vein procedures the lowest at 40.6%.  ?

The Care Quality Commission published the results of a survey drawing in the opinions of more than 69,000 inpatients at 162 NHS hospital trusts. While it found big improvements in hospital cleanliness and mixed-sex accommodation, it has asked the NHS to address rises in the proportion of patients saying they did not receive enough information about medication. Only 2% of patients rated their care as poor; 44% as excellent.

Clinicians continue to play their part in the efficiency and quality agenda. Fourteen leading doctors from the medical royal colleges and faculties and NHS Confederation wrote to The Guardian fearing political debate and media coverage was overlooking the cogent arguments for service change that will bring long-term benefits for patients. They called for greater clinician involvement in decision making and backed service reconfiguration based on sound clinical evidence.

Rising demand reared its head in a report on stress in a financial squeeze. Finance managers might  think this was about them, but the report, from mental health charity Mind, found one in 11 British workers had been to see their GP for stress arising from the financial squeeze. NHS finance managers will hope this is one aspect of the downturn they can avoid.

The month in quotes

‘If the NHS is to cope with the financial pressures it is going to face under any government without resorting to indiscriminate and damaging service and staffing cuts, large-scale planned service redesign and reconfiguration based on clinical evidence will have to be at the heart of the strategy.’

Clinical leaders, including Professor Sir Neil Douglas, in a letter to The Guardian

‘If you work for a bloated management team in the NHS there's no need to cancel that holiday in the Maldives.’

Daily Telegraph columnist James Delingpole engages in manager bashing

‘I think it is pretty clear headcount will drop. The NHS is facing a brutal time.’

NHS Alliance chief executive Michael Sobanja sees dark times ahead in a BBC interview

‘You are actually going to invest in local communities and the local suppliers you want to develop. On top of that it's going to save the NHS millions of pounds a year.’

Nottingham University Hospitals NHS Trust catering manager John Hughes

'We recognise that if other public bodies and local government are facing cutbacks, the health service must be equipped to deal with any unintended consequences and the additional demands on it. Wherever cuts have to be made, the frontline services people depend on day in, day out, must be protected.'

Peter Carter, chief executive of Royal College of Nursing, responds to the government’s announcement of an additional £6.2bn in savings this year