News / News review – NHS reforms; pensions; and implants

Health news in December and January was dominated by three stories: the continuing row over the government’s proposed reforms of the NHS in England; the future of NHS pensions; and the debate over who should pay to remove the sub-standard PIP breast implants from up to 40,000 women in the UK.

The controversy over the French PIP breast implants, said to include industrial-grade silicone, moved on quickly from whether they should be removed to who should pay for removal and replacement. The NHS in England, which carried out 5% of the operations, has offered to remove and replace implants fitted by the health service. Health secretary Andrew Lansley insisted private clinics had a moral obligation to do the same, though the major private providers – who blame the Medicines and Healthcare Products Regulatory Agency for approving the implants – said they would go bankrupt if they did so. The NHS in England will remove, but not replace, implants fitted privately if the clinics refuse or have gone out of business.

In Wales, health minister Lesley Griffiths (left) announced the NHS would offer replacement implants regardless of whether they received the implant privately or from the health service. ?In Scotland, where up to 4,000 women are thought to have the implants (all in private clinics), the NHS will remove them if the provider refuses or is no longer in business. Replacements will be given if deemed clinically necessary. It is understood that no woman received the implants in Northern Ireland, but a few may have had the procedure elsewhere. In these cases the health service will remove all implants where desired, but only replace those fitted for health reasons.

Before the Commons health committee highlighted the impact of planned reforms on efficiency plans (news, p3), two clinicians’ bodies stated their opposition to the health and social care bill. The British Medical Association had called for the bill to be significantly amended or withdrawn, but it is now calling for it to be abandoned. Doctors’ concerns included the planned removal of the private patient income cap and ‘a continuing over-reliance on market forces’.?The Royal College of Nursing (RCN) insisted nurses’ concerns had not been addressed. It said implementing the reforms at a time when up to 48,000 NHS jobs were going in England was ‘virtually impossible’. All the major health unions now oppose the bill.

The RCN’s stance drew a barbed response from Mr Lansley (right). He said the union agreed with the reforms in principle but was using its opposition as a stick to beat the government over proposed changes in the NHS pension scheme and recent pay freezes. Whether the minister is right or wrong, the unions have expressed concerns over the reforms from the outset. And there is genuine anger over the proposed pension changes.

The strength of this anger will be gauged over the next month in an RCN ballot. At this stage the vote will decide whether to accept or reject the government’s offer. The BMA and Unite have rejected the offer – the BMA’s council is to meet on 25 February to consider balloting on industrial action. Unison continues to negotiate with the government. Any deal will be put to its members and it has not ruled out further action.

The unions could be further angered later this year, after chancellor George Osborne (right) asked the NHS Pay Review Body to consider how to differentiate health service pay according to local market conditions. Its findings will be submitted by 17 July and the government could use these in its evidence for the 2013/14 pay round. The body will consider a number of things, including the most appropriate zones or areas by which to differentiate pay; affordability; and whether proposals should apply to all staff or just new entrants.

In England groundwork for the reforms continues. Emerging clinical commissioning groups (CCGs) have been given £100m in extra funding to improve local services and reduce winter pressures on the NHS by avoiding admissions to hospital. The Department of Health said the funding (£2 per head of population) would be spent directly by CCGs – the first time they have been given money to spend on services. Primary care trusts are to receive a one-off allocation of £150m for immediate transfer to local government for investing in social care services that benefit the NHS.

The NHS Commissioning Board Special Health Authority held its inaugural board meeting in December, appointing Paul Taylor (right) interim finance director. The Department outlined its plans for the governance of the NHS Trust Development Authority (NTDA). The NTDA will have five board directors, including a finance director, and will be a small organisation with about 150 staff. Back-office functions, including payroll and IT, will be provided through shared services arrangements.

At the start of the year, thinktank and pressure group minds were focused on the future of the NHS. NHS Confederation chief executive Mike Farrar said the NHS must convince the public to let go of the ‘outdated hospital-or-bust’ model of care and shift resources into community, early intervention and self-care. Meanwhile, the Nuffield Trust and King’s Fund said integrated care should be the top priority for the NHS. A joint report, Integrated care for patients and populations, recommended reform of financial incentives to ensure payment systems reward good outcomes for patients rather than encouraging hospital admissions.

A review of health and social care in Northern Ireland recommended a 5% (£83m) shift of funding from hospitals to the community and a reduction in acute hospitals from 10 to between five and seven ‘acute hospital networks’. Transforming your care, backed by health minister Edwin Poots, proposed 17 integrated care partnerships to encourage closer working between and within hospital and community services.

Finally, in these austere times there’s news that HFMA members may be sitting on a goldmine – 60th anniversary pin badges are on sale on eBay at a starting bid of £2.99 (£1.50 postage). An item to add to your watch list.

The month in quotes

‘The trade union aspect of the Royal College of Nursing has come to the fore. They want to have a go at the government – I completely understand it – but they want to have a go about things like pay and pensions.’

Andrew Lansley insists the RCN opposition to planned reforms are the result of concerns over pay and pensions

‘We utterly reject the claim that the RCN's decision to oppose the health and social care bill was based around the proposed pension changes. Nurses want to provide the highest possible standards of patient care and it is at the heart of everything they do. However, members up and down the country are telling us that this bill is seriously destabilising the NHS.’

RCN chief executive Peter Carter responds

‘There would be major potential to deliver better value for money and keep the NHS on a sustainable footing. We all know that quality of care will fall victim to a financial crisis.’

NHS Confederation chief executive Mike Farrar outlines the case for relinquishing the ‘outdated hospital-or-bust’ model

‘Private sector providers with large volumes of patients do not have the resources to ensure the removal and re-augmentation of all PIP implants free of charge.’

Nigel Robertson, head of cosmetic surgery firm Transform, tells the BBC that government policy on the implants is ‘unworkable’