Ruislip Residents' Association

NHS National News

National issues affect us all and in 2011, with the Health and Social Care Bill progressing through its parliamentary stages, we face an uncertain future ahead.  This page will be used for information on any NHS issue with national impact.


From Hillingdon Hospital's Board Meeting in public June 2016: 
1. Worsening NHS morale: A recent survey of health leaders by the independent think tank The Nuffield Trust found worsening NHS morale over the last six months, largely due to workload and financial pressures.  Returning to financial balance and eliminating overspend are both legal requirements of the NHS and a central plank of NHS England’s instructions for planning, yet just 6% of respondents agreed that they wouold be able to deliver this in the current financial year.  Overall the NHS is short of 50,000 staff out of a front line workforce of just over 800,000.  Only 31% of respondents said there was enough staff for them to do their job effectively.

2. British Medical Association’s report on the use of Locum GPs: Some CCGs struggle to recruit GPs because their areas are not seen as desirable places to work, but overall there are not enough doctors to go round.  NHS England says it plans to recruit an extra 5,000 doctors to work in general practice by 2020.

3. National Audit Office Report on Discharging Older Patients from Hospital: The number of older people admitted to hospital as an emergency increased by 18% between 2010-11 and 2014-15 and the percentage of older people admitted to hospital after attending A&E was 50%, compared with 16% for those less than 65 years old.  NHS spending has grown by 5% in real terms in that time, but local authority spending on adult social care has reduced by 10% in real terms since 2009/10.  The NHS spends around £820m a year treating older patients who no longer need to be there.  Health and social care providers have made limited progress in adopting recommended good practice on managing the discharge of older patients.  Community health providers and local authorities are not incentivised financially to speed up receiving patients discharged from hospital.
First published on 05 July 2016.  Last updated on 05 October 2016

NB   The notes below are only items of particular interest  – not a summary of the agenda.

1.  Chief Executive’s report: Simon Stevens looked at the criteria outlined in his last report for assessment of the recent Spending Review.  His request for a front-loaded long-term commitment had been met, with £3.8bn of the five year £8.4bn agreed as the NHS allocation for next year, also his request for long-term goals and acceptance that NHS needs cannot be met entirely by internal efficiencies, plus acknowledgement that prevention, public health and social care are vital factors in NHS success – although these factors are not yet in place.

2.  NHS funding allocations for the next five years: This 28 page document took up much of the meeting.  Much of the document required detailed awareness of the current allocations.  The CCG funding formula was at no point challenged, but it was agreed that next year no CCG will be more than 5% below its target allocation under that formula.  There was also time spent on an analysis of current inequalities and the complexities of the specialist service allocation.  This remains a highly complex aspect of the NHS, which the majority of lay people is unable to comprehend in detail.

3New mandate to NHS England and the NHS in England: On the day of the meeting the Government published its new Mandate to NHS England, based on the Forward View and the Spending Review.  This lays out long-term goals and 2016/17 deliverables as well as identifying areas for partnership action by NHS Improvement, Public Health England, Health Education England, Department of Health and NHS England.  It aims to (i) Implement the Forward View, (ii) Restore financial balance across commissioners and providers and (iii) Deliver core standards for patients.  Every health and care system will be asked to create a local blueprint to achieve those goals.

4.  NHS Performance report: Data for October showed that 92.3% of A&E patients were admitted, transferred or discharged within four hours.  There were 470,313 emergency admissions in that month, 2.1% more than in the same month last year.  Ambulance performance data was little changed in comparison with last year.  NHS 111 services had an average of almost 35,000 calls per day.  Referral to Treatment Waiting Times was met for 92.3% of patients within 18 weeks but the total of patients waiting for treatment at the end of October was just over 3.3million.  All cancer waiting time targets were met in October except for the 62 day standard.

All systems should have in place best practice actions to prepare for the coming winter and all have been required to submit winter capacity plans to cover:

  • Acute beds
  • Mortuary capacity
  • Community care beds
  • Intermediate care provision
  • District nurses and community matrons
  • Allied health professionals
  • Mental health

5. Improving Access to Psychological Therapies: The NHS Mandate requires at least 15% of people with common mental health disorders to be provided with timely access to treatment - patients may regard that as a pitifully low aspiration - but in August 2015 only 13.5% was achieved.  The rate of recovery remains stable, but falls short of the ambition of 50%, although 25 CCGs achieved over 55%.
6. Dementia: The estimated diagnosis rate at the end of October was 66.5% with 428,443 registered dementia patients in England.

7. Planning for Christmas, the New Year and early January: All systems had been reminded of their obligations and the need to have adequate plans in place.

  1. 8. Finance: At end of October the year’s expected expenditure was £101,333m, £35m above plan.  A full year forecast showed a near breakeven position.


Next meeting: Thursday 28th January  2016, at Southside, Victoria Street, London

.                                      

Published on 04 January 2016

Female Genital Mutilation Legislative Requirements:  From 31st October 2015 healthcare professionals must alert the police if they treat a girl under 18 who has had female genital mutilation.

Proposed Changes to the National Tariff:  The marginal rate for emergency admissions to hospitals, above the level agreed with the local Clinical Commissioning Group, is proposed to change in 2016 from 30% to 70%.  This would hugely benefit acute hospitals such as the Hillingdon Hospitals NHS Foundation Trust, which currently suffers from having to provide emergency services for which it receives only 30% of the normal tariff.

Revalidation of Registered Nurses and Midwives:  New regulations are to require revalidation at three year intervals.  Evidence of a range of factors will be required, to show that the individual is keeping up to date and getting current practice.  The new requirements come into force in April 2016.

Published on 04 January 2016

NB   The notes below are only items of particular interest  – not a summary of the agenda.

1.  Chief Executive’s report: Simon Stevens looked at the criteria outlined in his last report for assessment of the recent Spending Review. His request for a front-loaded long-term commitment had been met, with £3.8bn, of the five year £8.4bn, agreed as the NHS allocation for next year, also his request for long-term goals and acceptance that NHS needs cannot be met entirely by internal efficiencies, plus acknowledgement that prevention, public health and social care are vital factors in NHS success – although these factors are not yet in place.

2.  NHS funding allocations for the next five years: This 28 page document, copied to Mervyn Stone, took up much of the meeting.  Much of the document required detailed awareness of the current allocations. The CCG funding formula was at no point challenged, but it was agreed that next year no CCG will be more than 5% below its target allocation under that formula.  There was also time spent on an analysis of current inequalities and the complexities of the specialist service allocation.  This remains a highly complex aspect of the NHS, which the majority of lay people is unable to comprehend in detail.

3New mandate to NHS England and the NHS in England: Today the Government publishes its new Mandate to NHS England, which is based on the Forward View and the Spending Review.  It lays out long-term goals and 2016/17 deliverables as well as identifying areas for partnership action by NHS Improvement, Public Health England, Health Education England, Department of Health and NHS England.  It aims to (i) Implement the Forward View, (ii) Restore financial balance across commissioners and providers and (iii) Deliver core standards for patient.  Every health and care system will be asked to create a local blueprint to achieve those goals.

4.  NHS Performance report: Data for October showed that 92.3% of A&E patients were admitted, transferred or discharged within four hours.  There were 470,313 emergency admissions in that month, 2.1% more than in the same month last year.  Ambulance performance data was little changed in comparison with last year.  NHS 111 services had an average of almost 35,000 calls per day.  Referral to Treatment Waiting Times was met for 92.3% of patients within 18 weeks but the total of patients waiting for treatment at the end of October was just over 3.3million.  All cancer waiting time targets were met in October except for the 62 day standard.

All systems should have in place best practice actions to prepare for the coming winter and all have been required to submit winter capacity plans to cover:

  • Acute beds
  • Mortuary capacity
  • Community care beds
  • Intermediate care provision
  • District nurses and community matrons
  • Allied health professionals
  • Mental health

5. Improving Access to Psychological Therapies: The NHS Mandate requires at least 15% of people with common mental health disorders to be provided with timely access to treatment - patients may regard that as a pitifully low aspiration - but in August 2015 only 13.5% was achieved.  The rate of recovery remains stable, but falls short of the ambition of 50%, although 25 CCGs achieved over 55%.
6. Dementia: The estimated diagnosis rate at the end of October was 66.5% with 428,443 registered dementia patients in England.

7. Planning for Christmas, the New Year and early January: All systems have been reminded of their obligations and the need to have adequate plans in place.

8. Finance: At end of October the year’s expected expenditure was £101,333m, £35m above plan.  A full year forecast shows a near breakeven position.

Next meeting: Thursday 28th January  2016, at Southside, Victoria Street, London

.                                    

First published on 17 December 2015.  Last updated on 19 February 2016

NB   The notes below are only items of particular interest – not a summary of the agenda.

CCG Co-commissioning: Nearly 150 CCGs will be co-commissioning primary care either through delegation or collaborative commissioning arrangements.

Personalised medicine: This is a move away from “one size fits all” approach to the treatment of patients with a particular condition, to one which uses emergent approaches in areas such as diagnostic tests, functional genomic technologies, molecular pathways, data analytics and real time monitoring.  Inherent to any Personalised Medicine Strategy is the recognition that many of the currently available drug treatments are only effective in between 30% - 60% of treated individuals.  Adopting a personalised medicine approach will allow appropriate intervention for the individual, reducing costs and preventing adverse reactions in those who will not respond to certain treatments.  This shift is already underway. The NHS has contributed to the 100,000 Genomes Project and supports the NHS in becoming one of the most advanced healthcare systems in the world in relation to genomic medicine. This includes improved prevention based on underlying predisposition, earlier diagnosis of disease, more precise diagnosis, and effective treatments.

A healthy workforce: The Five Year Forward View commits the NHS to setting a national example in supporting its own staff to stay healthy.  NHS staff absence due to poor health is estimated by Public Health England to cost £2.4bn a year - around £1 in every £40 of the total budget.  Staff absence is linked to unsafe care of patients and poorer outcomes.  A large number of initiatives are being introduced to advance this policy – from yoga, weight management and physiotherapy, to including fruit in discounted meal deals.

Finance: The total planned NHS expenditure in 2015/16 is £101,333m.  At month 4 the full year forecast shows an overspend on the cancer drugs fund budget of £70m, offset by an underspend on other costs.  22 CCGs have planned deficits and no CCGs are forecasting unplanned deficits, although two are forecasting a position worse than their annual plan – both are closely monitored and are producing recovery plans.

Referral to Treatment times: The NHS Constitution gives patients the right to start consultant led treatment within 18 weeks of referral.  The referral to treatment standard from 1st October 2015 will be that 92% of those still waiting to start treatment have been waiting less than 18 weeks, with a sanction for incomplete pathways of £300 – replacing the earlier admitted and non admitted standards and sanctions.

Cancer waiting times: There are nine cancer waiting time standards, of which all but one were met in the first Quarter of 2015/16 – the 62 days for Urgent Referral to First Treatment standard was missed, achieving 81.7% against a target of 85%, which is attributed to the increasing number of urgent referrals for suspected cancer, currently growing at over 10% per annum.

Ambulance services: Trials are underway giving 999 call handlers an extra 2 minutes to assess calls other than those in the most urgent Red 1 category, before responding.  It is hoped that this will reduce the inappropriate dispatch of vehicles, which can then be available for the most urgent calls.

Access to mental health services: National waiting time standards are being introduced in 2015/16 – 75% of patients being seen within six weeks and 95% within 18 weeks.  £10m of non-recurrent funding has been made available to CCGs to support improved access to psychological therapies.

Also from April 2016, more than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral.

Children and Adolescent Mental Health Services: £1.25bn extra funding has been allocated over five years to improve these services and to tackle eating disorders in young people, with funding allocated to CCGs following regional assurance of their plans to transform services.

NHS Outcomes Framework: 68 national indicators are in five groups that the NHS  is aiming to improve:

  • Preventing people from dying prematurely
  • Enhancing quality of life for people with long-term conditions
  • Helping people recover from episodes of ill health or following injury
  • Ensuring that people have a positive experience of care
  • Treating and caring for people in a safe environment and protecting them from avoidable harm
      Next meeting: This will be in London on Friday 20th November 2015.
Published on 06 October 2015

   The notes below are only items of particular interest  – not a summary of the agenda.

This is a long report, with the following sections:

  1. Launch of NHS Citizen website, on the day of the Board Meeting:
  2. Chief Executive’s report:
  3. NHS Performance report:
  4. Pressures on non-hospital services:
  5. Actions to support Urgent Care:
  6. Five Year Forward View update:
  7. Patients Online:
  8. Integrated Personal Commissioning:
  9. Personal Health budgets:
  10. Care.data Programme
  11. Proton Beam Therapy



  1. 1. Launch of NHS Citizen website, on the day of the Board Meeting:

The NHS Citizen model can be seen at www.community.nhscitizen.org.uk

It is currently a work in progress, but it is hoped it will eventually form a new culture of collaboration between NHS England and the public.

Quoting from the website:

“You will no longer be just an end-user of the NHS, but an active participant in its future. You will have the power to raise issues for discussion, connect with others who have the same interests, and even be able to hold the NHS England Board to account.    NHS Citizen will have three connected parts:

  1. Discover - find out what people are saying about the NHS
  2. Gather – have a discussion about what is important to you
  3. Assembly - work with others to make the NHS better”

The full NHS Board has a commitment to engage directly with citizens biannually.


2. Chief Executive’s report:
  • Simon Stevens thanked staff for sterling work across the very difficult period of Christmas and the New Year, despite the unprecedented demands on NHS services.
  • He identified NHS priorities as:
  1. Sufficient capacity
  2. Coordination of services
  3. Development of clinical processes
  4. Redesign of emergency services
  • The NHS is currently achieving the second highest patient satisfaction ever recorded, plus the lowest ever dissatisfaction.  These results are comparable across all three major political parties.
  • UK cancer survival rates are the highest ever recorded.
  • New models of care will be developed from April 2015, pilots for others to follow – joint models involving social care services, local government, Clinical Commissioning Groups and NHS England.

3. NHS Performance report:
  • 90% of patients are satisfied with 111 telephone advice services.  In an average week in 2014 the service received 230,000 calls – but in week ending 29th December 2014 439,000 calls were received!
  • A&E departments’ January waiting times improved to 92.4% of patients treated and discharged or admitted within four hours, but the 95% target was not achieved. Most breaches are for patients waiting to be admitted – those subsequently discharged from A&E tend to be seen and treated much more quickly.
  • Best and worst A&E departments were listed, including 18 Trusts with five or more waits of over 12 hours between the decision to admit and the actual admission – none in any of these categories are in NW London or SW Hertfordshire.
  • There are not enough ambulances.  Ambulance services are also facing recruitment problems.
  • Concern was expressed about A&E trolley waits – the patients must receive good clinical care
  • The Chief Medical Officer expressed the view that when NHS services are good for children and mental health patients, they are likely to be good for everyone.

4. Pressures on non-hospital services:

Over the past decade investment in primary and community services has not increased appropriately and in some places there is difficulty in recruiting GPs and other staff.  These constraints and pressures on social care lead to increased acute admissions and delays in patients being discharged.

Delayed discharges attributable to social care accounted for over a quarter of the total, with a further 7% attributable to both social care and the NHS. The largest proportional increase has been in “patients awaiting nursing home placement” followed by “patients awaiting care package in own home” .  £25m has recently been made available  for care home packages and £10m for domiciliary care.

5. Actions to support Urgent Care:

A total of £640m was allocated through CCGs  for operational resilience through the winter leading to extra beds and extra staff.  Significant support has also been given to ambulance services – London Ambulance Service receiving over £17m resilience funding.

6. Five Year Forward View update:

Notable steps include:

  • Good progress on a national diabetes prevention programme.
  • A new cancer strategy is being developed
  • Sam Jones appointed Director of New Models of Care.  A limited number of partner sites will be developed in 2015-16, to develop prototypes easily replicated by others.

7. Patients Online:

This supports online services for patients in general practice, booking of appointments (91% of patients can do this), ordering of repeat subscriptions (88% of patients can do this) and access to summary information online, which in December 2014 was possible for 34% of patients – compared with 3% at that time in the previous year.

The aim is to have 95% of practices offering these online services by March 2015.

8. Integrated Personal Commissioning:

This aims to create a new voluntary approach to blending health and social care for individuals with complex needs, with an integrated “year of care” personal budget managed by people themselves, or on their behalf by councils, the NHS or a voluntary organisation.  Sites have now been selected and will submit plans for their local plan by March 2015.  A delivery support programme is being developed.

9. Personal Health budgets:

All CCGs have signed up to NHS England’s support programme and as of September 2014 nine out of ten CCGs were in a position to deliver Personal Health Budgets locally to people receiving NHS Continuing Healthcare.

The 2015-16 planning guidance expects CCGs to expand personal health budgets across health and social care for people with learning disabilities who have complex needs and children with special educational needs and disabilities as part of their integrated education, health and care plans.


10. Care.data Programme:

The care.data programme is commissioned by NHS Englandon behalf of the health and care system.  It aims to increase the range and detail of information that is collected across all NHS funded services for purposes beyond direct care to make it available to those who plan NHS services, as well as to researchers, medical charities and businesses that support the NHS to improve services.  The first phase is to collect and connect information securely from hospitals and GP practices.

The programme has been re-designed in the wake of concerns about who might have access to these linked data and for what purposes.  As part of the Care Act 2014 access to this data will only be allowed for the provision of health and care and the promotion of health.  The data cannot be shared for purely commercial purposes such as insurance or direct marketing.  There is commitment to full transparency and audit of all third party access to the data.

Six pathfinder CCGs in four areas of England have volunteered to test the new approaches to public and clinical engagement.  A panel led by Dame Fiona Caldicott will evaluate whether the success criteria for the pathfinder stage have been met.


11. Proton Beam Therapy:

Two hospital are to provide this therapy – University College Hospital NHS FT and The Christie Hospital NHS FT.  Contracts are expected to close in summer 2015.

Next meeting: This will be in Leeds on Thursday  26th March 2015.


 

Published on 30 January 2015

1.  Foundation Trust Sector’s target failures, to end of September 2014: These included:

  • For the third quarter in a row, the sector failed to admit or discharge 95% of patients from A&Es within four hours; major A&E departments breached the target for 23 consecutive weeks.
  • The FT sector again failed to meet the 90% Referral to Treatment target for admitted patients, and the 85% target for 62 day wait from GP referrals for the second quarter in a row.
  • The sector’s overall deficit was £254m - close to 80% of acute FTs were in deficit.

2.  National Tariff 2015 -16: The emergency care marginal rate will be uplifted to 50% from 30%.  Commissioners should adjust the 2008-09 baseline where providers have seen a material change in emergency admissions – and the funds retained must be invested in managing the demand for admitted emergency care, with investment decisions evidence based and communicated to all relevant stakeholders.

3.  Chancellor George Osborne’s Autumn Statement: An additional £2.2bn in 2015-16 will help to deliver the first year of the NHS Five Year Forward View.  To access such funding hospitals must have assured plans for greater efficiency and sustainability in the year ahead and be paperless by 2018.  Clinical Commissioning Groups that are below target allocation, such as Hillingdon CCG, will receive some additional funding.

4.  Launch of MyNHS website: This is on the NHS Choices website.  It seeks to enable people to compare their local hospital, their care services and their local authority – data includes food quality, staffing, patient safety, efficiency  and outcomes for individual consultants in some categories.

5  Pressure on Accident and Emergency Departments:  Across the country there have been unprecedented demands on A&E Departments, with some Trusts in crisis as a result.

Published on 07 January 2015

NB   The notes below are only items of particular interest –  not a summary of the agenda.

1. Cancer Drugs Fund: The Department of Health agreed to increase this year’s budget from £200 million to £280 million, but on current trends this is expected to hit £380 million this year – an unsustainable overspend of £100 million on top of the already increased budget.

Therefore, following public consultation, apparently less effective drugs are being reviewed and companies invited to consider adjusting prices of drugs whose price appears to be out of line with their clinical benefit, thus creating head room for new and better cancer medicines, as well as other cancer treatments such as radiotherapy. In doing so, three important patient safeguards were established:

  • No drug would be removed if it were the only systemic therapy available for a particular indication
  • Patients already in receipt of a drug would continue to  receive it
  • If a drug had been removed, individual requests from a patient’s oncologist would be considered.
2. Allocation of resources to NHS England and the commissioning sector  for 2015/16: The Autumn Statement on 3 December 2014 will enable NHS England to deploy £1.98bn of additional funding next year for frontline health services and to help kick start the transformation agenda set out  in the NHS Five Year Forward View. The proposals for allocation of this funding suggest that:
  • £1.5 billion of the extra funding should be used to support  frontline services, and £480 million should be used to support transformation in primary care, mental health and local health economies.
  • Primary care funding should be increased by at least as much as local CCG-commissioned community and hospital allocations.
  • The extra frontline funding routed via CCGs should particularly be used to move parts of the country furthest below their ‘fair share’ of NHS funding towards it at a faster pace than was possible under the previously notified 2015/16  allocations.
3. Mental health: NHS England is committed to work towards parity of esteem between mental and physical health services. As part of this wider effort, in 2015/16 NHS England will invest £80m to deliver waiting time standards for mental health services for the first time.
  • £40m of this spending will be on Early Intervention in Psychosis services, and this will be funded through local contracts, requiring a combination of improved services and increased activity.
  • The remaining £40m is for improving liaison psychiatry services and reducing waiting times under the Improving Access to Psychological Therapies (IAPT) programme. This will be managed centrally and  targeted towards those areas with greatest need.
  • In addition, £30m of additional funding has been provided to improve treatment for children and young people with eating disorders, which will also be distributed on a national basis.
4. Better Care Fund: Changes to the delivery approach for the Better Care Fund (BCF) mean that at least £1bn of the £1.9bn additional NHS contribution to the BCF must be spent on NHS - commissioned services or linked to a reduction in total emergency admissions.

5. Performance: 90% of admitted patients and 95% of non-admitted patients should be treated within 18 weeks of referral and 92% of those still waiting should have waited less than 18 weeks. Activity from June to November did not reduce the backlog as intended but these targets should be met from December following £250m of additional funding.   99% of patients should have diagnostic tests within 6 weeks of request, but this standard is not yet being met. Other standards not being met include the cancer two month from urgent referral to treatment target, the four hour wait or discharge target for 95% of A&E patients, and ambulance targets - particularly the London Ambulance Service despite it having £17m resilience funding, but LAS is facing an outflow of paramedics eg to the 111 telephone service.

6. Dementia: The national aim is to identify 2/3rds of the estimated total cases by March 2015, to support carers, as dementia cannot be cured.

7. Winter pressures: Planning this year has been earlier and more complex and wide ranging.  £400m was provided in June for operational resilience and later £300m to increase staffing and beds.

8. NHS England’s Specialised Services: The annual cost is £14bn.  This year’s month 7 forecast is a deficit above £150m, mostly due to cancer drugs.  In seeking economies there are four principles:  transparent decisions /  priority for effective treatments / fair and equitable treatment / reasonable cost.

The next meeting:
This will be in London on 29th January 2015.                                                    
First published on 23 December 2014.  Last updated on 03 January 2015
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