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

October was party conference season and, as is traditional, the two main political parties traded blows over the health service. But beneath the brickbats, there were some interesting policy developments emerging.

Labour went first, with shadow health secretary Andy Burnham promising he would reverse the ‘rapid’ privatisation of hospitals in England if the party returned to power. The Health and Social Care Act would be repealed and national pay bargaining defended. While such political grandstanding is to be expected, other parts of his speech were more revealing about Labour’s NHS thinking. He said Labour would consider all options for closer working between the NHS and councils, including full integration of health and social care. Better results could be obtained by thinking of ‘one budget’ across health and social care.

At the Conservative conference, health secretary Jeremy Hunt (right) chose a familiar bogeyman – the NHS manager. Though he acknowledged there were many committed managers in hospitals and care homes, he said: ‘I need to say this to all managers: you will be held responsible for the care in your establishments. You wouldn't expect to keep your job if you lost control of your finances. Well don't expect to keep it if you lose control of your care.’

The Tories won lots of conference season headlines by announcing a £100m fund to purchase digital pens and handheld mobile devices to help nurses and midwives spend more time with patients. More interesting is how the fund will be structured. The money will be loaned to trusts but the level of repayment will depend on feedback from a new ‘friends and family’ test – whether you’d recommend a service or hospital to a friend or relative. Those with less positive feedback will have to repay a percentage of the loan. ?

The government has offered the Nursing and Midwifery Council (NMC) a one-off £20m grant to reduce the impact of a proposed registration fee rise. Nurses and midwives working in the UK must register with the NMC (£76 a year currently) but the planned rise would add an extra £44. Health minister Dan Poulter said the grant would allow the NMC to reduce the fee rise and tackle its backlog of fitness to practise cases.

Amid rumours the chancellor might revisit the NHS settlement in his autumn statement, there was much talk about healthcare cuts and rationing. A report from the Royal College of Surgeons and Age UK claimed the £20bn NHS efficiency drive in England heightened the risk that older people will be denied surgery. Access all ages: assessing the impact of age on access to surgical treatment said there was a danger this group would be disproportionately affected because of the perceived reduction in cost effectiveness when life expectancy is shorter. It said using age as a means of assessing suitability for surgery should be redundant; their ‘biological age’ should be the main consideration. ?

Information obtained by charity Action on hearing loss from 128 trusts showed 43% had seen cuts in the past 18 months. It found evidence of rising waiting times, less follow-up care and a lack of specialist staff for complex cases. Some trusts were  providing one hearing aid where two had been deemed necessary.

There was talk that management losses in primary care had gone too far. James Kingsland, GP and clinical lead for the NHS Clinical Commissioning Community, said that while some clinical commissioning group leaders were enthusiastic about the reforms, others were disillusioned. They did not want to be involved in contract management – managers should do this, but too many managers had been lost.

British Medical Association leader Mark Porter said the assumption that the NHS will be restricted to the same level of funding could be wrong. The government may need to raise funds to ensure the NHS can deal with the demographic challenge over the next few years. However, he dismissed other options for raising funds, such as greater co-payments.

While the Department of Health has insisted access to services should not be restricted by cost, some believe it should be restricted by residence. A BBC Panorama investigation found that 45 of the 133 trusts surveyed said they did not regularly check if a patient had lived in the UK for the past 12 months. Trusts are required to check this and in most cases charge overseas patients. The trusts said they had written off losses of more than £40m relating to the care of overseas visitors.

Though the Francis report on failings at Mid Staffordshire NHS Foundation Trust has been delayed to the new year, work on the trust’s future has begun. Monitor said an expert team has started examining options for providing services in Mid Staffordshire and will hold an engagement exercise to gauge the opinion of all interested parties. Monitor said there was no blueprint for the trust, but the solution must meet patients’ needs and be economically viable.

Improving the quality of care was a theme of the Joint Committee of Primary Care Trusts’ Safe and sustainable review of child heart surgery, which recommended ending the surgery at three units earlier this year. However, Mr Hunt has asked the Independent Reconfiguration Panel to look at how the decision was reached. It is due to report at the end of February, but could be put on hold pending a judicial review into the decision. This is being prepared by a campaign group protesting against the decision to end the surgery at Leeds General Infirmary.

Quality of a different sort is on the Department of Health’s menu as it seeks to raise the raise the standard of hospital food. As well as raising its quality, ministers wish to find out if there is a link between quality and cost. The Department’s figures show that the NHS is spending more on food than ever, but significant variation in the cost remains. The average cost per patient per day increased from £8.06 in 2009/10 to £8.58 in 2010/11 and then £8.77 in 2011/12. However, costs varied from £15.65 per patient down to about £10 less. The Department said financial incentives for hospitals that deliver ‘exceptional quality’ were being explored.