News / News Review - Seamus Ward assesses the past month in healthcare finance

The NHS seemed to have got into the spirit of the Charles Dickens at 200 celebrations with its own version of A Christmas carol – encountering its own ghosts from the past, present and future as the government continued to be haunted by uncertainty over the health and social care bill and its plans to revise NHS pensions.

As the bill completed its Lords stages, voices from the health service past were heard. Former health secretary Alan Milburn warned in The Times that the bill would not help the NHS meet tomorrow’s needs. The way services are delivered, and the types of service delivered, had to change. The NHS must ‘explicitly’ shift spending away from hospitals, while there should be a ‘whole care’ system without division between primary, community, secondary and social services…

… And, after a You Gov poll for Unison found that 62% of the public did not trust the government to handle the NHS, former NHS chief executive and Department of Health permanent secretary Lord Crisp said the reforms were a mess and would set the NHS back.

As for the ghost of NHS present, it would show itself to health secretary Andrew Lansley as growing opposition to his reforms. The Institute of Healthcare Management and some clinical commissioning groups joined the British Medical Association, the Royal College of Paediatrics and Child Health and others in calling on the government to withdraw the bill. Announcing its decision, IHM chief executive Sue Hodgetts (left) said: ‘The health bill, together with the approach to the implementation of the bill, has both angered and frustrated the membership of IHM, leaving them fearful of the future, specifically in relation to patient and client care.’

Taking the role of the ghost of NHS future, BMA chair Hamish Meldrum said the government’s proposed pension reforms would affect all doctors, but especially those embarking on their medical careers. He warned that if changes were not made to the proposals many doctors over 50 would simply walk away from the NHS. The BMA is to ballot members on industrial action, though it insists it will limit the impact on patients and has ruled out a strike.

For now, the government continues to fight on both fronts – reform and pensions. Sensing the need to give a public show of support for his health secretary, David Cameron held a Number 10 summit on the reforms. Critics pointed out that dissenting voices, including the growing list of clinical professional bodies, were not invited, though Mr Lansley (right) was ‘handbagged’ by an elderly protestor outside the gates of Downing Street. The Foundation Trust Network warned that the government had to implement reforms or risk leaving providers in a no-man’s land as structures fell apart.

The government appeared to be taking criticism seriously that the reasons for the reforms had been poorly communicated. Ministers took to the airwaves to defend their plans. The health secretary insisted emerging clinical commissioning groups (CCGs) were already making a difference to emergency hospital admissions. He said there was a 0.5% decline in hospital emergency admissions in 2011, compared with 4.6% and 3.3% rises in 2009 and 2010 respectively.

Health minister Simon Burns (right) published 10 reasons why we need a bill to make these reforms work on the Department’s website. But media outlets reported that sources within the government and Conservative party, including three Tory ministers, had told them of mounting concern over the bill.

The government has introduced amendments to the bill, including giving Monitor express power to set and enforce licence conditions to enable integration and co-operation; provision for seven-year reviews of the effectiveness of competition; and giving responsibility to the NHS Commissioning Board and clinical commissioning groups to support training.

Far from the madding crowd, as Dickens’ contemporaries might say, NHS deputy chief executive David Flory (left) wrote to health service organisations to keep their eye on their duty to comply with referral to treatment waiting times in 2012/13. While overall the service continued to deliver expected standards (90% of admitted patients and 95% of non-admitted to begin consultant-led treatment within 18 weeks of referral), performance in some areas had fallen. In November 47 commissioners and 30 acute trusts failed to meet the 90% admitted standard; performance in some treatment areas, particularly trauma and orthopaedics, needed to improve. ?

The Care Quality Commission was also told to improve. A capability and performance review said its regulation, including inspections, must become more systematic, consistent and proportionate to risks. The review also said the CQC’s board must be strengthened, it must become more strategic and the Department of Health must do more to support it. CQC chief executive Cynthia Bower resigned in the wake of the report, saying that after nearly four years at the helm it was time for her to move on. She will remain in post until the autumn.

NHS prescription costs in England are to rise by 25p from 1 April to £7.65, while charges for basic dental treatment will rise 50p to £17.50. Prescription charges do not apply in Scotland, Wales or Northern Ireland.

The Scottish government announced pay for senior managers and executives in NHS Scotland will be frozen. A circular said there would be no change to the pay ranges for grades A to I with effect from 1 October 2011. There is no provision for non-consolidated performance payments for 2010/11, it added, and consolidated pay progression for senior managers and executives in grades D to I will be set at zero.

Finally this month, more than 90% of the public want the NHS to be more sustainable and a third believe this should be achieved even if it costs money. An Ipsos Mori survey of more than 1,100 members of the public for the NHS Sustainable Development Unit also found 52% were likely or fairly likely to accept reissued medicines that had been safety checked.