Health bill concessions after days of ‘panic’
Several days of ‘panic’ and an unprecedented attack on the health bill by three key health sector publication editors has been followed by 137 further amendments. The government has proposed the extra changes as it battles to advance the bill through the report stage, which begins in the Lords next week.
The proposed amendments come after more sustained criticism, including a joint editorial by the editors of the British Medical Journal, the Health Service Journal and the Nursing Times who say it is ‘an unholy mess’ and ‘so badly thought out’ that it will leave ‘an unstable system that is only partially fit for purpose’.
Pulse claimed that scrapping the bill would save £1 billion in 2013 alone. Reports in the Guardian claimed that a threatened Lords revolt had led to a ‘sheer panic’ in which the government threw together a hasty series of amendments and the BBC reports that health minister Simon Burns has said that he found the criticism from GPs ”baffling”.
Health minister Earl Howe said the changes simply reaffirmed the government’s commitment to putting patients at the heart of the NHS and handing power to GPs and nurses. The proposed amendments include:
- Asserting the Secretary of State’s responsibility and accountability with respect to a comprehensive health service.
- The NHS Commissioning Board and clinical commissioning groups having stronger duties to promote patient involvement in their own care.
- The NHS Commissioning Board and CCGs having new responsibilities to support education and training.
- Annual reporting on progress in tackling health inequalities.
- Ensuring that Monitor can require providers to promote integration of services.
NHS in good shape says quarterly health check
English NHS performance against key indicators, including waiting times and infection rates, shows that a decade of continuous improvement is ongoing.
The latest quarterly monitoring report from The King’s Fund shows that the number of patients experiencing delayed transfers of care has fallen to its lowest level since this data has been collected. Fifteen of the 23 finance directors, who contribute to the survey, expect their organisations to meet productivity targets, despite concerns about the financial position of the service as a whole.
However, the Academy of Medical Royal Colleges (AMRC) suggests that if the NHS is to achieve the very best for patients a consultant-led service is required, demanding a significant increase in numbers. The AMRC says the key benefits of consultant-delivered care include rapid and appropriate decision making, improved outcomes, more efficient use of resources and better access for GPs to the opinions of fully trained doctors.
New shape of NHS IT control
The future control of IT developments in the NHS has become a little clearer. EHI reports that the Chief Technology Office and some functions of the DH Informatics Directorate will transfer to the new NHS Commissioning Board.
The Patient Engagement, Insight and Informatics’ Directorate will have at least 91 staff, with up to 70 more transferring from the DH and DHID. It is likely to have a budget of around £40m.
However, a report on the funding of the NHS Commissioning Board states that funding is going to be halved – raising concerns about its effectiveness. The future funding and positioning of NHS Connecting for Health (CfH), and some of the functions CfH took over from the old NHS Information Authority, remain unclear.
Mergers and takeovers
Several key developments have taken place in the accelerating number of health service mergers and takeovers.
- A leaked email revealed that Northumbria Healthcare NHS Foundation Trust is to take over the running of Cumberland Infirmary in Carlisle and the West Cumberland Hospital in Whitehaven from the troubled North Cumbria Hospitals NHS Trust.
- Circle has now formally become the first private firm to start running an NHS hospital – Hinchingbrooke Hospital, Cambridgeshire, which had been threatened with closure as it grappled with £40m of debt.
- St George’s Healthcare Trust in south London has withdrawn its bid to take over St Helier Hospital (subscription required), part of Epsom and St Helier Hospitals Trust – throwing the future of £1bn of services into doubt.
Meanwhile private acute health providers are failing to prosper according to Laing & Buisson’s Healthcare Market Review. Revenues for independent hospitals providing medical treatments in 2010 were flat at £3.84bn. However, competition is increasing. There are now 515 independent medical hospitals compared with 454 in mid-2010.
Competition versus collaboration – rival models for the NHS
Two reports out this week look at the rapidly diverging models of healthcare north and south of the border. Public Service covers a two-year study by Nottingham University Business School into the Scottish NHS, where services have been brought together to increase collaboration.
The authors state that a ‘mature and positive’ approach to industrial relations has helped underpin NHS Scotland’s ‘commitment to high-quality patient care’. Not only that, but the health service north of the border represents a ‘leading-edge example’ and offers ‘important lessons’ for public services throughout Britain.
The report claims that NHS Scotland’s decision to engage staff as fully as possible by developing partnership agreements at national and board level had been key to its success. As a result, all levels of the organisation had a common agenda that helped deliver better healthcare.
HSJ (subscription required) covers a report from the Office of Health Economics which looks at the pros and cons of greater competition in England. This states that the use of fixed prices to prevent competition driving down care quality could become ‘increasingly problematic’. It says that some price competition might be beneficial – but warns that it could lead to falling standards of care and to cherry picking of lucrative areas.
The Royal College of Nursing in Scotland has just accused the Scottish Government of breaking its promises, with further large cuts in nursing numbers.
News in brief
- Scottish Council Fined: Midlothian Council has been slammed with a £140,000 penalty after disclosing sensitive data on children and their carers to the wrong recipients five times in just a few months reports Public Service.
- EMIS unveils new patient.co.uk: EMIS has re-launched its patient information website with a new look and plans for a series of apps; including one that will let patients book an appointment from their smartphone, reports EHI.
- GPs want 111 pilots scrapped: Doctors have called for the suspension of NHS 111 urgent help services after leaked DH data revealed a sharp rise in emergency hospital admissions in pilot areas. GP online says that in four pilot sites, ‘non-elective’ admissions rose by up to 7% in the last quarter of 2010/11.
- Pathology transformed: The electronic requesting and reporting of pathology tests is about to be revolutionised, says the Guardian Healthcare Network, by the National Laboratory Medicine Catalogue (NLMC). This unique data set will standardise systems and address a series of safety and quality issues.
- Nokia mobile wellbeing advance: Finnish trials have shown a positive response to a mobile Wellness Diary App by Nokia, which offers decision support for patients and members of high risk groups to help promote a healthier lifestyle.
- Humber wants mobile Lorenzo: According to EHI, Humber NHS Foundation Trust has put its hand up to be one of the first to trial the mobile version of Lorenzo.
Blogs
The latest blog from Dr Jennifer Dixon, director of the Nuffield Trust aims to continue building momentum in its campaign for integrated care, and payments reform. She highlights new case studies of organisations trying to develop integrated care as ‘accountable care’.
‘They are striking in that all are trying to do similar things: case management; care co-ordination; disease management; predictive risk modelling; use of hospitalists; developing the electronic health record across providers; close analysis of utilisation cost and quality at patient level; clinical leadership; developing easy access electronic portals for patients; bearing more financial risk appropriately; and pay for performance based on quality and shared savings models.
‘All not wildly new, but very instructive on the extent to which infrastructure is being developed as well as the methodical and serious way it is being implemented.’
Where have all the tech savvy hospital doctors gone asks Dick Vinegar – aka the Patient from Hell?
‘Something happens to deprive doctors of their appetite for being the champions of technical change. It may be they are blocked by the obstruction of administrators and superiors …. The system gets them down in the end. Since 2002, they have probably felt that all IT systems are imposed on them by Connecting for Health, and there is nothing they can do to object to bad IT, let alone devise better systems themselves.’
Highland Marketing blog
Matthew Shelley considers the vast technological tsunami rolling across the Atlantic.
