News / News review - November 2016

Paradoxically, October’s biggest health story stemmed from the parlous state of social care in England. The Care Quality Commission’s annual state of care report, which looks at both health and social care, highlighted the fact that funding cuts and rising demand in adult social care is having an impact on those who rely on the services and putting more pressure on the NHS. Greater demand for NHS care was in turn affecting trusts’ ability to meet their performance and financial targets, the Care Quality Commission (CQC) said.

In its annual State of care report, the CQC said
the adult socialcare market was fragile, with independent providers handing back contracts to local authorities and bed numbers static. About 1 million older people were living with unmet social care needs in 2015, and 81% of councils had cut social care spending in the past five years. There was much good and outstanding care in the NHS, it said, despite the financial challenges. But too much acute care was rated inadequate, especially in urgent care and medical services.

The pressure on social care and its knock-on effect on the health service is well known, of course, and NHS England chief executive Simon Stevens has said that any additional funding over and above that already promised by the government should go to social care. Some political commentators had wondered if chancellor Philip Hammond would find some additional cash in his first autumn statement on 23 November. However, according to reports, prime minister Theresa May has told Mr Stevens there will be no more money.

The Academy of Medical Royal Colleges published a list of 40 treatments of little or no value to patients. The treatments, from across 11 specialties, include putting a plaster cast on small wrist fractures in children – the academy said they heal just as quickly with a removable splint. The list is part of the academy-led ‘Choosing wisely’ campaign, which aims to inform discussions between doctors and patients and to challenge the belief that more is always better in the case of medical intervention.

Trusts could phase in the new junior doctor contract from October, though the British Medical Association asked them to hold off on implementation. BMA junior doctors’ leader Ellen McCourt said some trusts had decided against implementation in October. Not enough preparation time had been allowed and she urged trusts not to rush to meet a ‘politically imposed deadline’ .

Workforce is a growing issue. During the dispute,
which the BMA maintains is ongoing, the government promised a seven-day service would not spread the current doctor cohort more thinly. The lack of clarity over recruitment and retention of European clinical staff following the vote to leave the European Union has created further uncertainty. And more than four in 10 doctors who graduated nine years ago are planning to practise abroad, according to the BMA’s latest report in a 10-year study of the career paths and attitudes of 430 doctors. Its tenth and final report said one in 10 had taken steps to obtain a certificate of good standing to send to overseas regulators and employers. Doctors said work-life balance, shortage of doctors and paperwork caused most stress.

Measures to combat doctor shortages have been announced. Health secretary Jeremy Hunt said he would fund an additional 1,500 medical training places from September 2018. He said he would lift the cap on the number of students the schools can take – currently 6,000 a year. He would consult on implementing the proposals, along with a plan to increase the return for the taxpayer by requiring a minimum period of service in the NHS – any less and a doctor could have to pay back a proportion of their training costs.

Northern Ireland health minister Michelle O’Neill launched a 10-year plan to transform care. She said that if nothing was done, health would consume 90% of the Assembly government budget in 10 years. In the short-term, she promised a plan to tackle waiting lists, but there will also be clinically led service reconfiguration reviews, new structures to reform planning and administration and more care moved into the community.

Pay rises are unlikely to be a weapon to recruit or retain doctors, given the importance of keeping the pay bill down to deliver the £22bn efficiency savings by 2020/21. This was underlined in NHS Employers’ evidence to the pay review bodies, which said employers support giving the same percentage increase to all staff within the average 1% cap set by government.

The Scottish government promised a further £500m will be invested in primary care by the end of this Parliament. It will mean half of frontline NHS spending will be allocated to community health services, it said. This reflected its policy of moving more care out of hospital. The funding will support the development of a multidisciplinary approach, more staff and investment in GP services and health centres, first minister Nicola Sturgeon said.

NHS England also announced a boost to out-of-hospital services, saying its estates and technology transformation fund will support almost 300 schemes. In addition, clinical commissioning groups will receive £11m this year and £24m next year to offer psychological therapies to patients with long-term illnesses. Some £5m will be allocated to support GP indemnity costs, where they work in out-of-hours and unscheduled services, including NHS 111, to boost services in the winter period.

Researchers at the University of York Centre for Health Economics said new drugs for hepatitis C should be held in reserve when treating most types of the disease. The new drugs should be held back as second-line treatment for those not cured by the standard therapies, they said. There have been concerns about the cost of the new drugs, which ranges from £25,000 to £70,000 per treatment course but have the potential to cure more patients than the standard treatment.

The Care Quality Commission (CQC) proposed to increase its fees for most providers in 2017/18 to meet its requirement for full chargeable cost recovery. For NHS trusts with a turnover between £125m and £225m, this would mean this year’s fee of just under £137,000 would rise to slightly over £202,000 in 2017/18. The CQC said it was conscious of the impact of the proposed increase in fees on providers and it would continue to examine its costs.