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.
NB This report notes only the highlights of the meeting - it is not a summary
1. Draft planning guidance: Sir David Nicholson presented this item and stressed its importance. It has a focus of moving services out of the acute sector into the community and integration of health and social care. In parallel it stresses the evidence for successful acute sector care to be in specialist centres serving a large volume of patients, possibly 30 to 50 centres across the country. These factors are a radical change of NHS direction but are already being recognised and worked towards within CCGs.
2. Allocation of NHS resources for 2014-15 and 2015-16: NHS England now allocates NHS funding. Its funding review team, including representatives from its Area Teams and CCGs, was advised by ACRA, who previously advised the Department of Health. It held four regional workshops, involving local authorities, CCGs and providers. It considered the balance between stability and action on underfunding, alongside population, age and deprivation factors, aiming at “equal access for equal need”.
The Board must allocate funding between five main commissioning areas – public health, primary care, CCGs, specialised healthcare, and the integration transformation fund – and the distribution of funds within localities in each of those commissioning areas, as well as the pace of change, since rapid change could destabilise sectors with reduced allocations.
The NHS uplift for 2014-5 has been set at 3.1% and for 2015-6 at 2.3%. All NHS sectors will be required to make substantial efficiency savings during that period. The Better Care Fund (BCF) becomes operational in 2015-6 with expected funding of £3.8bn raised from the Department of Health, the Department for Communities, Local Government, and CCGs. Over time this fund will shift the balance of resources from the acute sector into primary, community and social care.
The ACRA CCG funding formula was agreed as the basis for CCG funding. This includes factors for age, population, and deprivation. Inequality funding was a dominant issue in discussion, with adjustments of 10% to the basic CCG funding and 15% to primary care funding agreed. Unmet need was tied to the Standardised Mortality Ratio for those under 75 years, which is strongly correlated with deprivation. Market Forces Factor is included in the CCG formula. The formula and adjustments produce target allocations, which may differ widely from current allocations, for reasons such as changes to populations eg NHS West London is 36% above target on a per capita basis and NHS Hounslow 12% below target.
Various options for pace of change from current to target allocations were considered. It was noted that 16 of the 37 CCGs forecasting a deficit this year are on average 5% below the proposed formula target and 31 of the 37 are under target. Option 4 was agreed, which gives all CCGs an increased capitation of 2.14% in 2014-15 and 1.7% in 2015-16, with the maximum per capita growth of 2.64% in 2014/15.
Allocations within GP practices are based on age and recent diagnostic history from hospital records of each registered patient, with adjustments for claimant rate for key welfare benefits in the area and the prevalence in the area of key diagnoses linked with deprivation.
The Board Paper introducing this item is 28 pages long, so this report is very limited, however, a copy of the paper is available for circulation within Community Voice, on request to Joan Davis.
3. Winter pressures: This item covered organisational factors such as routine daily and weekly monitoring for crucial issues such as A&E pressures, handover times for ambulances, and bed occupancy levels. £221m has already been shared amongst 53 health systems to prepare for winter pressures, plus an additional £!50m announced in November.
4. Seven Day Working: There is significant variation in outcomes for patients admitted to hospitals at the weekend as shown by mortality rates, patient experience, length of hospital stay and readmission rates. This is due to variable staffing levels at weekends, fewer senior consultants on site and lack of support services such as diagnostics.This problem is not unique to England – it is echoed across the world.
New clinical standards were agreed for implementation by 2016-17 to ensure patients receive comparable care regardless of day of admission to hospital, in particular with early access to consultant appraisal; this will be challenging to achieve. Progress will be contingent on improving primary and social care services at weekends too.
Next meeting: This will be in Southside, Victoria Street, London on 24th January 2014.
The NHS England response was slow in coming and not very informative when it arrived. Click here if you would like to see it.
NB The notes below are simply highlights of particular interest to Community Voice of which Ruislip Residents' Association is a member – not a summary of the meeting.
1. Chief Executive’s Report
a. Publication of surgeons’ outcome data: On 28th June 2013 NHS England began publication of mortality rates for individual hospital consultants in ten specialties, covering around 3500 consultants. The data displayed on the NHS Choices website will show the number of times a consultant has carried out a procedure, mortality rates and whether clinical outcomes are within expected limits. Outside of cardiac surgery, it is the first time that the performance of individual surgeons can be viewed openly online. Data will be published on a phased basis over coming months and will be refreshed annually.
b. Re-launch of Choose and Book: Choose and Book was launched ten years ago to allow patients to choose the time and place of appointments. It has been re-launched with a five month consultation with healthcare professionals and patients. to simplify and expand the service.
c. Technology Fund: £260m is to be made available to hospitals to increase their use of technology and to move them towards paperless systems by 2018.
d. Review of mortality outliers: Following the Francis Report Sir Bruce Keogh, NHS Medical Director for England, has led a review of 14 NHS trusts that were persistent outliers on mortality indicators. His report was published on 16th July.
e. Funding in 2015-16: £3.8bn will be pooled for the integration of health and social care. £3.4bn of this will come from CCGs’ budgets (around 3% of CCGs’ allocations). CCGs will need to develop and begin implementation of plans in 2014-15 as substantial savings in other costs will be required. The funding will sit with local authorities, but be overseen by Health and Wellbeing Boards. Plans must be signed off by CCGs and local authorities before funds are released.
f. A new 80-bed medium secure unit at St Bernard’s Hospital Ealing: NHS England has supported the business case for the redevelopment of Broadmoor and a new medium secure unit at St Bernard’s.
g. AGM of NHS England: This will be on 12th September in London.
2. Personal Health budgets: From April 2014 patients in England eligible for NHS continuing healthcare will have the right to ask for a personal health budget and CCGs will be responsible for offering that option. It will be legal for patients to receive Direct Payments to manage their health and care from 1st August 2013.
3. Consultation on the Government mandate to NHS England: Consultation started on 5th July. The revised mandate is expected to be published in October.
4. New review of congenital heart services: The safe and sustainable proposals for children’s congenital heart services have been replaced by a new and broader review considering the whole lifetime pathway of care for people with congenital heart disease. NHS England must bring forward an implementable solution by the end of June 2014. A fortnightly blog on the NHS England website will note meetings and summarise discussions and progress.
5. Advance of Genomics: Prior to the 100k Genome Project, launched last December, the Human Genome Strategy Group established by the Department of Health challenged the NHS to consider significant modernisation and development of genetic testing services. NHS England now proposes a network of genomic technology centres, biomedical diagnostic hubs and regional genetics centres. Whole genome sequencing technology has taken massive steps forward in recent years. The UK continues to be well placed with its integrated genome project to claim leadership in application of genomic medicine in a health system, but the substantial infrastructure investments being made in the US and China may give them a long term advantage if they are not matched. 100,000 whole genomes of patients in the NHS will be sequenced in the next 5 years to support their clinical care in the next 3-5 years and to drive research to support wealth creation. (Examples of impact: Breast cancer was believed to have three forms – genomics now differentiate over 40 types. Lung cancer treatment is now guided by genomics)
The next meeting: This will be in London on 13th September 2013.
This was the first meeting of the National Commissioning Board after assumption of its full responsibilities and change of name to NHS England on 1st April 2013. This meeting was held in its London Region office in Maple Street, a turning off Tottenham Court Road..The meeting was broadcast live on the NHS England website, which in a few days’ time will offer the option to view each agenda item as a separate video.
Although held in public, there were only three sets of papers available and there was no opportunity for even questions of clarification. The Community Voice, of which Ruislip Residents is a member, has written to the Chairman about these issues, also about better publicity for future meetings, and asking for meetings in public on local London issues.Key points from the previous minutes included:
In places where poor signals or high volumes of traffic make voice connections difficult, it may still be possible to send text messages - but that is possible only if the mobile 'phone has been registered in advance. Full details about the 112 service, including how to register a mobile'phone, are available on the short video accessed by clicking this link: http://www.youtube.com/watch?
The mandate has five key areas, which impact on local NHS hospitals and community services.
- Preventing people from dying prematurely
- Enhancing quality of life for people with long-term conditions
- Helping people recover from episodes of ill health or injury
- Treating and caring for people in a safe environment and protecting them from avoidable harm
- Ensuring that people have a positive experience of care
Patients expect all the listed items as a basic part of good health services. However, scandals and shortcomings about patient care hit the headlines from time to time, so the basic assumptions need to be reinforced.
From next April, all hospital in-patients and those attending A&E will be asked whether they would recommend the hospital to their own family and friends. Hoping for good survey results, local hospitals are urging staff to focus on the key areas in the NHS mandate, giving patients a good experience as well as good treatment. See the November report on our Hillingdon Hospital page for what is happening there.
Peter Appleton was the main guest-speaker at the September 2012 meeting of the Community Voice, of which we are a member. He is Clinical Leads Business manager within the Programmes and Operations Directorate of NHS Connecting for Health and he outlined the main features of the NHS programme called "Choose and Book".
- He gave a detailed run through of the development over the last 8 years, and said that approximately two thirds of all outpatients in England are now referred and booked using the system.
- 50% of all consultant led appointments are carried out through Choose and Book, plus another 15% to 20% on top of that for GPs with Special Interests, Allied Health Care Professionals and triage services.
- All clinics and all priorities can be sent through the system, and all clinics and appointments are controlled by the local NHS – not the national team.
- He explained that all patients have a legal right to choose where they go for treatment, and that this discussion should normally take place in the GP consulting room.
- There are sometimes locally agreed rules in place between a GP and the local commissioners (PCT) where local patients may not be offered a choice, but he said that these can be tactfully challenged.
- A patient should be able to choose any clinically appropriate hospital anywhere in England, although many want one of their local hospitals, with date and time being an important factor.
- A patient’s choice can include many private hospitals that now offer NHS care to patients; there is no cost to the patient and the hospital only receives the same amount of money as a NHS hospital.
- The patients choice may be determined by the GPs recommendation, or by hospital reputation, or length of waiting times or other factors that are important to a patient.
- All the key information is on the Choose and Book screen in front of the GP to help him or her agree with the patient the best choice, or choices that are appropriate.