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

In a month when doctors took industrial action for the first time in 40 years and it was revealed that the health secretary was considering the nuclear option over one trust’s finances, perhaps the most startling news came from the public. According to the British Attitudes Survey, public satisfaction with the NHS fell from 70% in 2010 to 58% in 2011. It was the biggest fall in a single year since the survey began in 1983, though still the third highest in the history of the survey.

The data, published by the King’s Fund, found satisfaction with individual services had also declined. Seeking explanations, some commentators blamed the unsettling effect of the reforms or rows between the government and clinicians, one of which (over pensions) resulted in June’s industrial action.

The King’s Fund said the results could be as a result of increased expectations or a surrogate vote – expressing dissatisfaction with the government’s policies in general, for example. And it suggested there could be an actual or perceived reduction in the quality of NHS services, with the latter fuelled by negative stories in the media. GP magazine found some evidence that services were being affected by the financial climate. A Freedom of Information Act request found that 90% of primary care trusts are imposing thresholds or limits on referrals for procedures deemed non-urgent or of low clinical value. The most common restriction was placed on tonsillectomies, but more controversially it found limits on cataract surgery in 66% of PCTs and hip and knee operations in more than half.

The Care Quality Commission (CQC) said Barking, Havering and Redbridge University Hospitals NHS Trust had improved, but serious concerns about the trust’s emergency department remained. Last October, the CQC said the trust’s emphasis on recovering its financial position had adversely affected patient care. It made 81 recommendations, but a June report found 27 had been met and 48 partly met. Staffing across the trust had to be improved and it was struggling to deal with increased complaints, though the CQC accepted the latter may have been caused by its investigation.

The government has great faith in the use of telehealth and telecare to improve the efficiency and quality of services. But it received a setback in June, when the final evaluation of Department of Health pilots concluded that telehealth produced only modest savings. The report, in the British Medical Journal, said telehealth was associated with lower mortality and fewer emergency admissions for patients with long-term conditions but did not reduce secondary care costs. The potential to reduce the use of secondary care had to be ‘tempered by the estimated scale of the difference in notional hospital cost savings for commissioners of care and the cost of intervention’.

In more positive news, the latest evaluation of the personal health budgets pilot said personal health budget holders are less likely to need GP services and prescriptions. It added they rely less on family carers and are more able to take part in family activities. Pilot sites differed in their approach to approved spending – while one allowed one budget-holder to pay for a theatre trip for herself and her mother, another refused a request from a man with mental health problems to use his budget to pay a support worker to help with shopping (this was deemed to relate to physical rather than mental health).

A no-fault compensation scheme for medical negligence could increase costs by 50%, a Scottish government study said. The study of medical negligence claiming in Scotland said lower end estimates indicated costs would be similar to the current system but at the higher end they could increase by a half. The work was produced to inform the No-fault Compensation Review Group, established in 2009 to consider the potential benefits to patients of the introduction of a no-fault compensation scheme in Scotland. Small claims might be better dealt with through a system that allowed a moderate level of payment, as the cost of dealing with a small claim often exceeded the award, it added.

In England, work on the new commissioning structure continued. The NHS Commissioning Board (NCB) said there would be 27 local area teams and 12 clinical senates in the new structure. The teams will act as local offices of the NCB, with functions including commissioning primary care services, such as general medical services. Ten local teams will lead on specialised commissioning, while a smaller number will commission prison and military health. Recruitment to the bodies is due to begin shortly. ?

Health secretary Andrew Lansley (pictured) said the first annual report to Parliament on the NHS, as required by the Health and Social Care Act, would be made in July. This would become a ‘budget for health’, held each July to mark the establishment of the NHS. It would include a debate on the NHS and set targets. Each report would launch the consultation on that year’s mandate to the NCB. The mandate will set out expected outcomes.

In Northern Ireland health and public safety minister Edwin Poots hit out at those who make hoax calls to fire and ambulance services. He said hoaxes cost about £3m a year – the cost of 250 coronary artery bypass grafts or more than 5,000 weeks in a nursing home for an elderly person. The figure is based on more than 26,000 suspected hoax calls from 2009/10 to 2011/12, 17,000 of which were made to the ambulance service.

Outgoing BMA chairman Hamish Meldrum (pictured) warned doctors not rush to take further industrial action over pension changes. In his final speech of his five-year term, he said doctors had shown a united voice but their battle was with the government, not patients, the public and NHS employers. Further action would risk losing the public’s trust. The Department said the number of doctors taking part in action was 8% of all doctors in England, with just under 10% of daily activity rescheduled.