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.
- a. NHS Five Year Forward View: This was launched by the Chief Executive of NHS England, Simon Stevens, on 23rd October. It is a collaboration between six leading NHS groups including Monitor, Health Education England, the NHS Trust Development Authority, Public Health England, the Care Quality Commission and NHS England. Its focus is action on four fronts:
- Tackling the root causes of poor health: Obesity, alcohol and other major health risks.
- Giving patients more control over their own care: Also new support for carers and volunteers.
- Breaking down boundaries: Family doctors/hospitals; physical/mental health; health/social care
- New models of care: More investment - in workforce, technology, innovation / local flexibility.
- b. 80% of acute Foundation Trusts are in deficit: Shane DeGaris, Chief Executive The Hillingdon Hospitals FT, reported to his Board in October that nationally 86 FTs were recording a combined deficit of £227m. The activity pressures on the NHS had a clear impact on operational performance with the sector overall breaching the target to treat 90% of admitted patients within 18 weeks of referral, as well as the four hour A&E and 62 day cancer targets.
- c. Industrial action: The Government’s 2014/15 pay award led to industrial action on both 13th and 20th October, but hospital trusts and staff co-operated to minimise disruption to patients.
Launch of MyNHS website: (HSJ 19.10.14) This is hosted on the NHS Choices website. Patients can compare many public health factors as well as a range of hospital factors including quality, cleanliness and food. Data on clinicians, GP practices and mental health services will be added later.
Cuts to public health budgets: (HSJ 19.10.14) Local authorities’ core public health funding will be cut in real terms in 2015-16. They will get the same sums as in 2014-15 but inflation is expected to be around 2% in 2015. However, in 2015-16 councils that meet performance indicator targets will receive a share of an additional £5m incentive pot.
NB The notes below are only items of particular interest – not a summary of the meeting1. Focus of the agenda: The focus was mainly on forward planning, with some historic feedback. There was no item on the agenda for input from the public and no opportunity for questions was provided.
2. Chief Executive’s report: Simon Stevens noted:
a. Introduction of standards for mental health services: For the first time, standards are to be introduced on a phased basis, from next year, on access to mental health services and waiting times.
b. Cancer issues: Last year’s drug fund budget of £200m is to be increased to £280m this year and next, with consultation on how best to use it to the benefit of patients. Funding has been agreed with Cancer Research UK for four new cancer research clinical trials, as well as joint work with Macmillan on encouraging earlier diagnosis of cancer.
c. Proposals for Clinical Commissioning Groups to take responsibility for primary care: CCGs are finalising their proposals, which will be subject to formal approval by NHS England.
d. Health / social care integration: Work will continue to join-up health and social care. This includes the “Integrated Personal Commissioning Programme”, offering ‘year of care’ health and social care budgets for individuals. This is under review by political leaders and is on trial at five test sites.
e. 2015/16 tariff for acute services: A pre-consultation document has been issued jointly by NHS England and Monitor, with a discussion paper on reform of funding for urgent and emergency care. A consultation on hospital food and nutrition is expected.
f. Re-employment of senior NHS managers whilst they are in receipt of redundancy payments: Consultation is expected on this issue.
3. NHS priorities for the next six months: This too formed part of the Chief Executive’s report
a. A&E, emergency admissions and ambulances: With rising demand, providers may need to open extra winter capacity ahead of expected time, for which £400m has been allocated early this year.
b. Elective waiting times: Extra funding was awarded earlier this year to meet waiting time standards. If those standards have not now been met then CCGs may need to buy operations elsewhere.
c. Cancer: Referrals are up by an estimated 19% over the past year Provision must be made for fast-track waiting time standards to be met.
d. Positioning for 2015-16: System-wide efficiencies must match the new service requirements, with a pragmatic approach to operation of the Better Care Fund. NHS England will be cutting its own running costs by March 2015. The document “Everyone Counts, Planning for Patients 2014/15 – 2018/19” was published in December 2013.
e. Publication of the NHS “Five Year Forward View”: This is planned for October 2014. The future challenges faced by the NHS include changing health needs, rising expectations and constrained public resources. This five year view sets out how these challenges can be met.
f. Scope of the 2015/16 planning: Guidance will include meeting the NHS Constitution standards, meeting the new requirement for mental health services, meeting the CCGs five year plans and achieving financial stability, as well as the key themes from the Five Year Forward View, particularly:
i. Co- commissioning of primary care
ii. Future commissioning models for specialised services
iii. The introduction of integrated personal commissioning, starts in April 2015. This will allow personal choice about how individualised budgets will be spent either by the person involved through direct payment, or by the council, the NHS or a third party provider on their behalf. This ‘year of care’ payment model aims to shift incentives towards prevention and coordination of care, in contrast to current financial models which reward NHS and social care activity and crisis services. However no individual service user would face an arbitrary cap on the unplanned services they may need. 4. Performance report: Across 211 CCGs there is a small forecast overspend of £13m. Five CCGs are reporting overspends against plan, including two CCGs with unplanned deficits. Over and above the forecast position. The risks identified b CCGs, Area and Regional teams and the national team amount to £381m, mainly related to specialised commissioning, the Cancer Drugs Fund and historic continuing healthcare provisions. The next meeting: This will be in Leeds on 6th November 2014. Joan Davis
a. New penalty rules would slash trust fines: (Extracted from Health Service Journal 2 May 2014). New NHS rules include a 2.5% penalty cap on providers’ total monthly revenue. Analysis applying the new rules to last year’s performance data for trusts that breached NHS targets showed that they would face less than £87m under the new rules, against the £227m estimated as their bill last year – one trust’s uncapped fines of £8.3m would be reduced to £2.6m.
b. Variation in length of hospital stay depending on admission time: (Extracted from HSJ 2 May 2014). According to new analysis, admission to hospital later in the day often leaves patients spending several days longer on wards. The average length of stay is shortest for admissions at 9am – 10am, at around 3.25 days, peaking at about 9pm, at around 6.25 days. The most likely explanation is the greater presence of medical consultants earlier in the day. There is usually less senior medical cover in the evening and at night, when junior doctors have a more significant role. Also patients admitted earlier have a greater chance of a care plan drawn up by a consultant, and diagnostic tests too are more likely to be available on the same day. Junior doctors – with more responsibility later - are more likely to seek tests than consultants, which can cause discharge delay for patients.
c. New dental charges from 1st April: (From NHS leaflet)
Band 1 costs £18.50 - examination, diagnosis scale and polish and similar preventive treatments
Band 2 costs £50.50 - all Band 1 items plus fillings and extractions
Band 3 costs £219.00all - Band 2 items plus crowns, dentures and bridges
From 1st April 2014 NHS prescription charges in England will be increased from £7.85 to £8.05 for each drug / appliance.
However, the cost of a prescription prepayment certificate is £29.10 for a 3 month certificate, or £104 for a year’s certificate, which provides savings for those needing four or more items in 3 months, or 13 or more items in a year.
- Band 1 costs £18.50 – examination, diagnosis scale and polish and similar preventive treatments
- Band 2 costs £50.50 - all Band 1 items plus fillings and extractions
- Band 3 costs £219 – all Band 2 items plus crowns, dentures and bridges
Dr Andrew Howe, Director of Public Health for the London Boroughs of Barnet and Harrow, was guest speaker at the May 2014 meeting of The Community Voice. The main points of his address were:
- a. There have been many recent changes in the delivery of Public Health, which is about the whole system, not the individual patient. It aims to prevent disease, prolong life and improve health across the population by working in partnership with the NHS, Local Authorities, and the voluntary sector. Research and education are central to this aim. The ten year gap in life expectancy for babies born in different locations must be addressed.
- b. Public Health also aims to keep the public away from GP surgeries and to address the major issues of smoking, obesity and high blood pressure. Many factors are involved in good health, including socio-economic factors – lifestyle and genetics, education; where you live; happiness, self esteem and sense of purpose; age; marital status; income and employment; social networks and support.
- c. Responsibility for Public Health has moved from the NHS to Local Authorities and there have been other changes in responsibilities. Public Health England oversees prevention of infectious diseases and produces large amounts of data for local Councils. NHS England commissions GPs and specialised health services and is responsible for screening and immunisation programmes – from October 2014 it will also be responsible for Health Visitors.
- d. Health & Wellbeing Boards, based in Local Authorities, are responsible for strategic planning of local health services, with a duty to improve local health. Local Healthwatch have replaced Local Involvement Networks in representing the public in health services, with Health Watch England co-ordinating their work.
- e. As illustration, the speaker focused on Harrow, with Harrow Council’s £9m budget for Public Health.
- f. On the positive side, Harrow has a high life expectancy compared with the England average. It does have a high rate of diabetes, but outcomes are generally good. It has one of the lowest rates for smoking, and its rates for alcohol problems and adult obesity are also low. These factors and improved life expectancy for both men and women are achieved despite high child poverty levels. Post war diets are credited with the decline in cancer and heart disease.
- g. In contrast, Harrow suffers increasing health inequalities for men, but less so for women. Major challenges include childhood obesity as the number of obese children in Harrow doubles between the ages of 5 and 11 years – perhaps too little physical activity and sport, and too long sitting down. Tuberculosis and diabetes rates are high. Oral health is poor.
- h. Harrow Public Health priorities are to fight cancer, mental health problems, dementia and other long term health conditions, alongside reducing unemployment. It commissions health checks, also addiction, sexual health and school nursing services. It works with Harrow Clinical Commissioning Group on strategic needs assessment, immunisation and other health improvement services. It also introduces new services such as work with community pharmacies to identify alcohol problems; the promotion of fruit and vegetable use in schools; walking programmes; a winter-well programme etc. Work in progress includes a focus on children’s mental health and preparation for health visiting services becoming the responsibility of Public Health in October 2015.
- i. Despite demographic growth, technological changes and the current financial climate, Public Health continues to combat health inequalities and to focus on prevention of health problems
The speaker answered many questions and was warmly thanked for his address by Jon Spain, the Hon. Treasurer, which was endorsed by audience applause.
Healthwatch funds missing: Nearly a quarter of the funding for local Healthwatch groups has gone missing, according to research by the national body representing them. England’s 148 local Healthwatch groups were allocated £43.5m by the Department of Health last year, but research by Healthwatch England has found the groups receiving only £33.5m – leaving £10m not accounted for. The Department for Communities and Local Government was tasked with distributing the money to Councils to give to their local Healthwatch groups but it is unclear whether the DCLG passed on the full amount, or whether Councils passed on the full amount.
The Healthwatch money was added to the Council’s baseline budgets without a ringfence and Councils were free to decide how much to allocate to their local Healthwatch group. Healthwatch England is now calling for clarity about where the money has gone (Health Service Journal 14 Feb. 2014)
Better care fund news: Health and local government ministers have insisted better care fund cash will not be diverted by Councils into non-health projects. It was just “wrong” to suggest the programme would allow Councils to use NHS funds to fill potholes.
The better care fund will take effect in 2015-16, building on £1.1bn that is already being transferred from health to social care. However, the Department of Health has scrapped plans to withhold money from areas that fail to deliver performance improvement through joint commissioning with local authorities. Instead the DH, with NHS England and the Local Government Association, will offer 'support' where the £3.8bn better care fund does not lead to improved performance on metrics including delayed transfers of care and reduced emergency department admissions. (Health Service Journal 14 Feb. 2014)