PA Health Newsletter April 2013

January 2012 April 2013

UK HEALTH MONITOR Policy and NHS Developments NHS Commissioning Board Name Change The NHS Commissioning Board has been renamed as NHS England. Commenting on the name change, the Chairman of the new national body, Professor Malcolm Grant, said that the new name “gives people a greater sense of what the organisation is because it is more closely aligned to the responsibilities of the new organisation, which are to achieve real improvements for patients for every pound invested by the nation in the NHS”.

NHS England took on overall responsibility for the £95 billion NHS commissioning budget from 1 April 2013. The main aim of NHS England is to improve the health outcomes for people in England. It will set the overall direction and priorities for the NHS as a whole.

NICE Granted Responsibility for Assessing Medicine Values The Government has announced that the National Institute for Health and Clinical Excellence (NICE) is to take on responsibility for assessing the value of medicines when new pricing arrangements are introduced in 2014.

The announcement was included as part of the Government’s official response to the Health Select Committee’s report on the future role of Nice.

The new powers granted to NICE will see it take on an important role in the future of value-based pricing arrangements for branded medicines. The body will be able to build on its current drug evaluation processes through enjoying a broader scope to assess the benefits and costs of new medicines. The aim is to ensure that the price the NHS pays is more closely linked to a medicine’s value to NHS patients and society as a whole.

The announcement comes as NICE’s remit also expands to cover social care, as well as the NHS and public health. This is intended to assist in the development of better integration of services between different health and care organisations.

April 2013

Doctors to Advise NHS on Patient Care NHS England has announced it will seek expert advice on distinct areas of NHS care. The Commission’s Medical Director, Professor Sir Bruce Keogh has revealed the names of 21 National Clinical Directors (NCDs) who will provide advice and research to the national medical directorate on a range of conditions and services.

Sir Bruce revealed the details of new advisers as part of his address to the inaugural Medical Leaders’ Conference, held at the NHS Innovation Expo 2013.

Commenting on the appointments, he said that the “national clinical directors will provide the expert insight, knowledge and research we need in order to understand and address the challenges we face in all different aspects of NHS care”.

Existing national clinical directors will continue to work in their current roles, and remain focused on their current areas. There will be a total of 25 NCD posts altogether with new appointments for Urgent Care, Rural and Remote Care and Services and Offender Health currently taking place.

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CQC Overhaul Inspection Regime The Care Quality Commission is to launch a massive overhaul of its inspection regime with the aim of focusing on those health service providers seen as most in need of closer monitoring.

Under the new regime, to be introduced in April, annual inspections for NHS organisations and the generic approach to health and social care will be abandoned. Instead, inspectors will work under one of three newly created chief inspector posts responsible for hospitals, social care and primary and integrated care.

As a result of the changes, the Commission’s inspection activity will be split into specialist teams reflecting individual areas of expertise. It is also expected that mental health will be spread across all three, depending on setting. In addition, chief inspectors will each be supported by five national teams who will go into the most challenged organisations to conduct inspections characterised as “deep dives”.

Interviewed by the Health Service Journal, the Care Quality Commission’s David Prior said the national teams would focus on the bottom 10 to 20 per cent of hospitals, which will receive “a lot of attention” under the new risk based system.

Change to the Health Service Ombudsman

By contrast he estimated there would be about 20 per cent of hospitals which were “excellent” and will only be inspected once every five years unless their circumstances changed. Meanwhile a further 40 per cent classed as “good” would “probably” not be inspected “more than once every three years”.

Under the new plans, the Ombudsman will adopt a new principal by which it will investigate any complaint once it meets a number of basic tests. This is likely to mean the Ombudsman will be investigating thousands more complaints each year.

The new approach has been devised in response to calls from a number of public organisations for the Ombudsman to share more information about the cases that it examines. The intention is for this to support the drive across public services to use complaints as a means of identifying service failures and delivering improvements, especially in light of the findings of the inquiry into the Mid Staffordshire NHS Trust.

The Parliamentary and Health Service Ombudsman, which is responsible for the consideration of complaints against the National Health Service, has announced that it will be expanding the scope of its investigations.

Going forward the Ombudsman will conduct a consultation about further changes which will be intended to make it easier for people to find and use the Ombudsman’s complaints procedure.

NHS England Launch Health App Library NHS England has announced the launch of a library of NHSreviewed health apps, with the aim of providing a resource for those seeking to better manage their health. The new Library currently contains around 70 apps that have been produced by a variety of organisations and reviewed by the NHS to ensure they are clinically safe.

The Health Apps Library has been announced as one of a number of initiatives that seek to provide easier access to health services through the application of digital technologies. The library will be available at apps.nhs.uk and through the NHS Choices website.

The apps are intended to assist people with tasks such as getting advice on their condition, booking repeat prescriptions, accessing test results, and finding the most appropriate NHS services.

April 2013

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Government Response to GP Contracts Consultation The Government has published its response to the consultation on the proposed changes to GP contracts. The proposed changes are intended to maintain current levels of investment in general practice, while permitting improvement in the quality of services.

In its response, the Department of Health has rejected calls to combine the new online access and telehealth services, arguing that this would not guarantee access for sufficient patients. The Department has, however, conceded that it is unlikely that remote monitoring will be rolled out for all patients before 2015. They also claim that the “phased implementation” of the two new services will address. potential risks related to security and confidentiality.

NHS England is currently developing the detailed specifications for both new and enhanced services.

GPs Forced to Choose between Money and Patient Safety GP leaders have warned that the DH’s GP contract imposition forces GPs to choose between maintaining funding levels and ensuring patient safety. Few concessions were made to GPs, whilst the Government is pressing ahead with plans to introduce higher Quality and Outcomes (QOF) Framework thresholds as well as new QOF indicators, alongside plans to phase out the Minimum Practice Income Guarantee over seven years from April 2014.

The General Practice Committee (GPC) said that patient care will be compromised as GPs will not be able to meet all these demands.

GPC chair Dr Laurence Buckman criticised ministers for failing to listen to GPs’ concerns, saying, “It is unacceptable that the Government has ignored this weight of opinion and ploughed ahead with so many ill thought out proposals that run the risk of destabilising patient care”.

Ban on Gagging Clauses is ‘Smoke and Mirrors’ Jeremy Hunt has announced that gagging clauses that prevent employees who leave under a compromise agreement from raising concerns about patient safety will be banned. Sir David Nicholson told the House of Commons Public Accounts Committee that the ban would be applied retrospectively, meaning that those subject to existing agreements should now feel confident about raising concerns.

An employment lawyer at Hempsons, Paul Spencer told health sources that, “the announcement is smoke and mirrors. If it’s not explicit in the agreement, staff might interpret that they are being gagged when the reality is that’s not the case. [If they are under that impression] it is probably because they have received inadequate legal advice when signing the agreement”.

Health in Parliament Health Select Committee Publish Report on Health and Care Services Public Expenditure The Health Select Committee has launched a report that says health and social care services need to be “re-imagined” to secure better access to high quality care. The Report warns that care within the health and social care system will break down if quicker progress is not made to develop more integrated health and social care services which focus on the needs of individual patients.

Mr Dorrell said however that this must not lead to less overall funding for care services and that the Government should extend the commitment to protect real-term funding for healthcare to local authority social care services.

The Committee Chair, Stephen Dorrell MP, said that with spending on health and social care services unlikely to increase significantly soon, the only way “to improve present service levels in the NHS will be to focus on a transformation of care through genuine and sustained service integration”.

The Committee called for the responsibility for integrating commissioning of health and care services to be vested in Health and Wellbeing Boards.

April 2013

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DH on Course for Biggest Underspend this Parliament The recent Budget revealed that the Department of Health is on course this year for its biggest annual underspend in the current parliament, with none of the unused budget due to be carried over for future use. The Budget showed the DH is expected to underspend against its 2012/13 expenditure limit by £2.2bn. In 2011/12 DH underspent by £1.4bn, whilst the figure for 2010/11 was £1.8bn. This means the DH’s underspend would be 2 per cent, higher than the 1.5 per cent that the DH says is consistent with “prudent financial management” for a department of its size.

The Budget also reiterated the Government’s previous assurances that the health budget will be ring-fenced in 2015-16 after the current spending review period.

Report on Delivering Efficiency Savings in the NHS The Public Accounts Select Committee has published a report examining the NHS’s progress in delivering its efficiency savings, suggesting that although it has largely met its targets in this area, these have in large part been delivered through freezing wages and rationing treatments. The Committee’s report, Progress in making NHS efficiency savings, cautioned that the NHS’s reliance on employing short term measures mandated by Whitehall to meet its savings targets, would mean that it would be much harder for it to achieve its targets from 2013/14.

The report also warned that the savings data provided by the NHS was not “fully reliable”, with ministers only able to provide evidence for 60% of the reported savings.

Commenting on the report’s findings the Committee’s Chair Margaret Hodge said there was concern “that other savings are being achieved by rationing patients’ access to certain treatments”. She went on to add that there was a need for the NHS to “fundamentally change” the way it provided healthcare in order to deliver the savings expected of it.

Subsequently the Health Select Committee called for “unnecessarily inflexible” restrictions on NHS spending to be “abolished”, to allow providers to invest their accumulated reserves in reforming services.

The Committee’s report on underspending said “excessive inflexibility around year-end financial control risks reintroducing into the NHS a perverse incentive to spend a budget”. The Committee chair, Stephen Dorrell MP, stressed that it was particularly perverse “at a time when we’re wanting to encourage service integration and changing models of care that we can’t use money that’s already in the system”.

New Regulations Laid in Parliament on Choice and Competition After a considerable level of professional and media backlash, the Government has brought forward new regulations to emphasise their commitment to putting doctors and nurses in charge of local health services, making it clear that they will not be forced to use competition against the best interests of patients. The regulations clarify that there is no requirement to put all contracts out to competitive tender, meaning commissioners can offer contracts to a single provider where only that provider is capable of providing the services needed. They also confirm that local commissioners will be free to commission an integrated service where it is in the interest of patients.

Monitor and NHS England will soon publish guidance to commissioners to help inform their decision making. On the back of very hostile stakeholder reaction, Health Minister Lord Howe said it was “absolutely not the Government’s intention to make all NHS services subject to competitive tendering or to force competition for services”.

Review of NHS Complaints System Launched In the wake of The Francis report examining failings at Mid Staffordshire NHS Foundation Trust, Jeremy Hunt has launched a review aimed at ensuring that all hospitals listen to and act upon the concerns of patients. It will be led by Ann Clwyd MP for Cynon Valley, and Professor Tricia Hart, Chief Executive of South Tees Hospitals NHS Foundation Trust, who was an advisor to Robert Francis during his inquiries into Mid Staffordshire. Ms Clwyd’s husband died in hospital in October, with the MP saying he was treated by hospital staff with “coldness, resentment, indifference, and even contempt”.

The review will engage with patients, carers, managers, staff and other organisations involved in handling patient complaints to hear how Trusts currently act when concerns and issues are raised. Mr Hunt said he looked forward to “their recommendations about how we can introduce a much more rigorous and effective system for handling complaints across the NHS”.

April 2013

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Health Moves and Appointments NHS England Appoints New Director of Patient Experience NHS England has appointed Neil Churchill as Director of Patient Experience. Mr. Churchill arrives from Asthma UK where he is the Chief Executive; he is also a Non-Executive Director in NHS South of England. He brings with him over 25 years of experience in the voluntary sector at organisations including Barnardo’s, Age Concern, and Crisis.

NHS England Appointments Dame Barbara Hakin will take up the role of Chief Operating Officer and Deputy Chief Executive on a temporary basis from the second half of April. Dame Barbara is currently the Board’s National Director for Commissioning Development and was previously chief executive of a strategic health authority and a primary care trust, in addition to having spent over 20 years as a GP. Meanwhile, Rosamond Roughton, the Board’s Director of Commissioning Systems and Strategy is set to become interim National Director for Commissioning Development. Ms. Roughton was previously Director of Strategy at NHS Yorkshire and Humber Strategic Health Authority.

Reports and Publications Care Quality Commission Dignity Report Published The Care Quality Commission has published the findings of a review into the privacy, dignity and nutrition of older people in care. The CQC’s research has suggested that nearly a fifth of those in care are not being treated with the dignity or afforded the respect and privacy they require.

The review also argues that this situation appears to be getting worse.

As part of the research CQC visited 500 care facilities and found that 82% were respecting people's privacy and dignity, compared against 88% in 2011. CQC inspectors also found that call bells were being left unanswered, leaving people without help to get to the toilet and without support for other basic needs.

David Behan, CQC Chief Executive said: ‘We found good care and care that had improved. However, it is disappointing people are still not being given enough privacy when receiving personal care and that they are left alone when they call for help.

The hospitals were assessed against five standards, respecting and involving patients, meeting nutritional needs, safeguarding people against potential abuse, staffing and record-keeping.

ICM Poll on Private Sector Involvement in the NHS A new ICM Poll has found that a majority of the UK public are open to greater private sector involvement in the provision of NHS services. The poll, commissioned by the think tank Civitas, found that 83% of voters are unconcerned with who provides services as long as they remain free to all at the point of need. In addition, only a minority of those questioned in the poll thought that the NHS provided better care than systems in France and Germany.

Civitas also called on ministers to “forge ahead with radical reform of the NHS in the wake of the MidStaffordshire hospitals scandal and break down the virtual state monopoly on the provision of healthcare.”

Commenting on the poll, Civitas argued that its findings demonstrated that “despite the rhetoric of union leaders, NHS professionals and many politicians, the public at large have no objection to more diversity among the suppliers of state healthcare.”

April 2013

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Nuffield Trust Recommends Ofsted-Style Hospital Ratings A Department of Health commissioned study by the Nuffield Trust has suggested that performance ratings should be introduced for hospitals, general practices, care homes and other social care providers. The study argues that the way in which healthcare provision is currently evaluated remains “confusing” and that a need exists for a simpler rating system, akin to that used by Ofsted to rank the performance of schools.

The Trust’s report asserted that patients in England lacked a comprehensive system for accessing quality data on hospitals, care homes and GPs. At the same time, it acknowledged that quality indicators open to the public, such as the NHS Choices website, did exist but argued that these were not sufficiently comprehensive. The report concluded that the “big gap” in available data meant that patients were forced to rely on the advice of GPs or family and friends.

In its recommendations, the report argues that new performance metrics would be of particular assistance in gauging the performance of care homes and could also be of benefit to general practices, although it went on to suggest that their application would be less well suited to hospitals due to their size and the wide range of services they provided. The Department has yet to prepare a response to the Trust’s study but has expressed a desire to “get any rating system right” while arguing that the “principle that people should get clear information about quality of services has to be the right one.”

The British Medical Association was more cautious in its response, arguing that, although it was “important that patients have access to meaningful information about the quality of services” there were “always going to be problems constructing indicators that measure quality in any meaningful way, and do not result in a target-driven culture.”

2020Health Publishes Digitisation Report The 2020Health think tank has published a report in conjunction with the US Veteran Health Administration and NHS. The report, “Making connections – A transatlantic exchange to support the adoption of digital health between the US VHA and England’s NHS”, explores the potential for digitisation to assist the NHS in tackling the challenges posed by the UK’s ageing population.

Examining the performance of the VHA, the report finds that the US healthcare provider consistently provides a better quality of care than other health systems in the US and that this has largely been achieved through the introduction of new technologies. The report also highlights the importance of changes to “the underlying culture, leadership, processes and training” that it claims are necessary in order to maximize the impact of digitisation.

It recommends that in order for the NHS to achieve its ambition of a “paperless” service by 2018, there is a need for it’s senior leadership to be committed to care ‘at a distance’ and also to ensuring that digital health becomes the default delivery channel for services. It also suggests that digital health should be embedded in the curricula of doctors, nurses and allied health professionals, and relevant local authority staff.

Kings Fund Publish Guidance for Health and Wellbeing Boards As part of its latest set of guidance for the new Health and Wellbeing Boards, the Kings Fund has published a short report outlining the way in which the boards should look to work more closely with the voluntary sector.

The report highlights the importance of Health and Wellbeing Boards drawing on the vast skills and experience available via the voluntary sector, and notes that the grant making powers of Clinical Commissioning Groups and local authorities provide a useful means of facilitating meaningful engagement. The potential for local development and support agencies to provide assistance to policy-makers and commissioners in engaging with these audiences is also identified in the report and is likely to be an area we see expand.

April 2013

About Us This Health Monitor has been produced by Edelman’s UK Health Public Affairs and Market Access Team. A specialist team of political consultants, skilled in health policy, political advocacy, stakeholder relations, regulatory affairs and reputation management. Working as part of a global award winning integrated communications agency, Edelman’s Health Public Affairs and Market Access Team is uniquely positioned to offer clients access to innovative, full-spectrum communication strategies, which draw on the very best experience of our resident Health, Consumer PR, Corporate, Medical Education and Digital Health Teams – spanning disciplines and geographical locations where necessary.

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