Health bill battle escalates

This week has seen clinical commissioning groups (CCG’s) take different sides as the battle over the Health and Social Care Bill escalates. Some 70 CCG leaders have backed Health Secretary Andrew Lansley and have written to The Times to say that dropping the bill would be a ‘disaster’.

The letter’s author Dr Paul Bowen, chair of Eastern Cheshire CCG, said he believed there was ‘a silent majority’ whose voices were not being heard. However, the views of CCG leaders appear at odds with those of many GPs. Tower Hamlets CCG and City and Hackney CCG have written to the PM, calling for the bill to be scrapped. They claim it has aroused deep anger among doctors. The GP committee of the BMA has expressed fears that CCGs will be dominated by profit-driven private firms which will undermine the traditional doctor-patient relationship.

An e-petition calling for a Commons debate on dropping the bill has been rejected by the House of Commons. This is despite the fact that the petition, set up by GP Dr Kailash Chand, was the largest ever on the government’s special website and attracted 162,000 supporters.

In further developments the The Royal College of Surgeons, the most notable college to back the bill, has announced that it is reconsidering its position. The Royal College of Obstetricians is also to hold an extraordinary meeting to consider its own stance.
Andrew Lansley himself has attempted to address concerns that the bill would turn the NHS into a ‘market free-for-all’. In an interview with the BBC he pulled back from his 2005 statement that ‘the first guiding principle is to maximise competition’. Mr Lansley now says he regards competition to be ‘a means to an end – not an end in itself’.

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NHS must innovate – and government has to come clean on rationing

Speakers at the Nuffield Trust’s fourth health policy summit called on the NHS to look to the developing world for inspiration on doing more for less. This week’s event focuses on searching for the world’s best examples of innovation.

Among the speakers will be Dr Devy Shetty, chairman of Narayana Hrudayalaya Hospital in Bangalore, India, which Onmedica describes as ‘revolutionary’ for providing good-quality, low-cost, high-volume heart surgery to people without health insurance. The Nuffield Trust says that countries with some of the lowest GDPs are proving best at finding cheaper ways to deliver good care.

Writing for the think tank’s website Geoff Mulgan, chief executive of NESTA (National Endowment for Science Technology and the Arts), lists several areas where he thinks change is vital. These include:

  • More use of ubiquitous, cheap technologies rather than costly and often over-engineered telecare and telemedicine.
  • Raising productivity by learning from business making better use of the internet, call centres and intensive customer relationship management.
  • Creating wider online support networks of healthcare professionals, family and friends to support older and isolated patients.
  • Improve end of life care by moving away from costly hospital interventions to allow more people to have their wish to die at home.

The trust has also published a report (see podcast and summary) which calls for the government to be clear and open about what services are provided by the NHS and which must be paid for. It recommends:

  • Establishing principles to shape how public money is spent in the NHS.
  • A national list of the treatments that public money should not be spent on.
  • Transparent decision-making by clinical commissioning groups.

Bleak outlook on hospital finances

NHS hospitals face rapidly escalating financial troubles according to a string of revelations. Among the most serious is HSJ’s (subscription required) report that Peterborough and Stamford Hospitals Foundation Trust, which has a £220m turnover, expects a loss this year of £56m. The trust has announced 300 job cuts and is having to rely on more than £47m of temporary assistance to pull it through.

Overall some two thirds of NHS hospital trusts have fallen behind (subscription required) on their savings plans in the first half of 2011-12. DH figures, released after a long Freedom of Information Act battle, show that 68% of the 72 non-foundation acute trusts missed savings targets for the first six months of its £20bn efficiency drive. Tory Commons health committee chair Stephen Dorrell fears that money intended for community services will be hijacked to plug gaps.

On a more positive note, the new £650m Royal London Hospital, Whitechapel, has opened its doors to patients. The 17-storey building replaces a series of older facilities, some dating back to the 18th century. The hospital will house more than 3,000 staff and patients and has 110 wards plus 26 operating theatres.

Older patients face daily humiliation

A major report has concluded that older patients face humiliation and degrading treatment on a daily basis. The Telegraph reports that a commission of senior NHS managers, charities and council leaders is demanding a drive for care with dignity.

More than 40 organisations were involved in the report, which says a fundamental shift is needed in the training of medical and care staff. It also says that disciplinary action should be taken against staff who patronise older people. A key recommendation is that compassion should be at the heart of care, with universities and colleges rejecting applicants who lack ‘basic warmth’.

Royal College of Nursing Chief Executive & General Secretary Dr Peter Carter said the Commission on Dignity in Care for Older People was right to focus on the leadership role of the ward sister or charge nurse, and the need to empower them to ensure the highest possible standards of patient care.

Royal College of Physicians clinical vice-president, Dr Linda Patterson, welcomed the publication of Delivering Dignity, and said: ‘In addition, the RCP recommends that hospitals provide adequate staffing with sufficient time to care for patients, including those with complex needs like dementia, and better continuity of care in acute settings and across providers, with clear accountability’.

News in brief

  • Serious incident report failings condemned: Scottish Information Commissioner Kevin Dunion has criticised NHS Ayrshire and Arran for the worst failings in records, management he has ever seen. The Scottish Government has launched an investigation after accusations that the health board withheld reports on 50 serious incidents including 20 deaths.
  • Child mental health cash: The NHS will invest £22m in England’s child mental health services to deliver more counselling and talking therapies. Some 10% of 5-16 year olds experience a mental health problem and it is hoped that early intervention will reduce problems in later life.
  • Breast cancer trials: Small scale trials have shown promising results for the use of trastuzumab (Herceptin) and bevacizumab (Avastin) in primary non-metastatic HER2-positive inflammatory breast cancer, an aggressive form of breast cancer with a poorer prognosis. Follow up work is planned.
  • Blood test: With donor supplies a major issue, EHI says NHS Blood and Transplant is trialling US software to give hospitals in England and Wales more information about their clinical use of blood.

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The DH has published a new patient experience framework. Jocelyn Cornwell of the King’s Fund welcomes the development and says it draws on 20 years of the fund’s research into what matters to patients. It will, she hopes, bring a clearer understanding of the way ahead. But success takes more than a document.

‘The key to making improvements in service quality though, is to win over clinical staff, especially doctors, and encourage clinical leadership on patient experience. We believe that measures of patient experience must be aligned with clinical level data on process and outcomes; must be rigorously based on evidence (a no brainer), must be simple and must be embedded in the new quality standards from NICE.’

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