2012 Q1 January-March
Health and Local Government Policy Updates
New Start Date and Funding for Local Healthwatch
Establishment of Local Healthwatches to be delayed until April 2013. (Local Health Watch replaces Local Involvement Networks and will be the local consumer champion for patients, service users and the public).
There is to be £370k for the 75 pathfinders for the final quarter of 2011-12. £3.2m will be available for local authorities to set up Local Healthwatch next year.
Shaping Local HealthWatch – The Actions and Findings of 9 Local Authorities
Advice on appointment of directors of public health
The NHS Future Forum delivered its second report. It includes recommendations on integration (should be defined round the patient, driven by Health and Wellbeing Boards), education and training, information (patients should access to their GP records by the end of this parliament), and NHS’s role in public health (NHS should do more to prevent poor health, make every contact count).
Draft Strategic Guidance on JSNAs and Joint Health and Wellbeing Strategies published for consultation (there will be further consultation on the Strategic Guidance proper at a later stage)
Royal College of Nursing and Royal College of Midwives call for the Health and Social Care Bill to be dropped.
Public Health Outcomes Framework Published
LGA comment on the announcement:
Health Committee publishes review of public expenditure in health and social care. “Service integration to deliver the Nicholson Challenge more important than management change say MPs on Commons Heath Committee.”
Consultation on membership of Healthwatch England (the national body)
Amendments to the Health and Social Care Bill published, including making clear the Secretary of State’s responsibility and accountability for a comprehensive health service
Three key documents on commissioning development published
Royal College of GPs and Chartered Society of Physiotherapy call for the Health and Social Care Bill to be scrapped.
Baseline spending estimates for new NHS and public health commissioning published. These are not the final figures, but it suggests that in 2012-12 the NHS will spend £5.2bn on public health, of which £2.2bn is on future LA responsibility areas. It suggests a total CCG spend of £64.7bn.
No. 10 insists that Andrew Lansley has David Cameron’s full support
Health and Social Care Bill begins its report stage in the House of Lords, with 136 amendments. Government defeat over priority given to mental health.
Pathfinder bulletin for emerging CCGs – February 2012. A newsletter for CCGs which provides brief information on many of the items listed above.
Conservative Home website calls for much of the Health and Social Care Bill to be scrapped.
Government insists public health ringfence must stay – but subscriber only content and can’t find any more of this from elsewhere.
[First update sent up to here]
Lancet paper suggests productivity in NHS has been rising, contrary to previous reports. The paper is by Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine. It doesn’t put a precise figure on the increase, but notes ways in which productivity has increased which aren’t included in previous methodologies.
Available free, but requires registration/log in: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61782-0/fulltext#article_upsell
“Patients are getting excellent or very good care in the NHS but more needs to be done”
From website: “Patients continue to report improvements in aspects of care that matter most to them, and 84 per cent of patients rated their experience as excellent or very good, according to the results of the 2011 Patient Experience Outpatient Survey.”
The Guardian’s take on it is:
NHS patient survey reports rise in postponed appointments
Almost a quarter of outpatients say appointment was postponed at least once, but cleanliness and respect scores improve
The Department of Health has published a series of fact sheets explaining the Health and Social Care Bill.
According to the Guardian, internal risk assessments by four NHS regions suggest the health reforms run a risk of reducing safety and patient care and leading to overspending.
Michael Marmot says cuts to children’s services and regressive taxation risks increasing inequality, with consequent impacts on health.
[Second update up to here]
Dame Fiona Caldicott is to lead a review on how to balance the need to protect individuals’ confidential information while getting the benefits of data sharing, in the health and social care sector. The review is to report to the Secretary of State for Health in the summer.
A useful update giving the current position on establishing CCGs, ‘commissioning support organisations’ (CSOs) and the NHS Commissioning Board.
From the Guardian: “NHS hospitals that compete with each other become more efficient and save money, but making them compete with private healthcare providers leads to “cherry-picking”, leaving them treating older and poorer patients, a new study has found.”
This appears to be the original article:
Draft (non-statutory) advice on what public health advice should be provided to CCGs in the new arrangements.
DH publishes NHS Patient Experience Framework. One page listing the eight features that ought to be monitored.
A guidance note has been published by DH on how health sector regulation should work in the reformed system.
DH published the performance and capability review of the Care Quality Commission.
Cynthia Bower resigns as Chief Executive of the CQC after criticisms of the organisation.
A single operating model is being introduced for support NHS trusts through the application process to become foundation trusts.
NHS publish statistics showing rise in obesity
Analysis from The Guardian:
Royal College of Paediatricians calls for Health and Social Care Bill to be scrapped.
BMJ (British Medical Journal) report says the NHS already works remarkably well compared to other countries, and doesn’t need radical reform, just continual improvement. Guardian article:
[Update sent round up to here]
27 February 2012
King’s Fund publish a directory of Health and Wellbeing Boards
Government responds to the House of Commons Health Committee report on public expenditure
“Social Value to become a key part of public service contracts”
In essence, when procuring a service, a public body (including local government and health) must consider “how what is proposed to be procured might improve the economic, social and environmental well-being of the relevant area”
ONS. Analysis of experimental subjective well-being data from the Annual Population Survey, April to September 2011
Transforming Public Health, Issue 6, February 2012
Report of the Commission on Improving Dignity in Care.
From NHS Confederation website: “The care of older people needs fundamental change so that hospitals and care homes stamp out undignified care and ensure all patients and residents are treated with dignity and respect.
That is the message from the Commission on improving dignity in care for older people, an independent body set up by the NHS Confederation, Age UK and the Local Government Association (LGA).
The Commission today publishes a draft report for consultation that recommends “fundamental changes to culture, leadership, management, staff development, clinical practice and service delivery”.
The Queen’s Speech is to be on 9th May
Local Healthwatch, the policy explained
Government amendments to the Health and Social Care Bill published
The Daily Telegraph reports that “The Public Health for the NHS network – made up of former Presidents of the Faculty of Public Health and more than fifty Directors of Public Health” has “said public health commissioning should remain within the health service.” (Couldn’t find the report itself online)
An economic case for patient and public involvement in commissioning.
A briefing on the economic case of public and patient engagement based on 14 case studies. It is accompanied by a decision support tool to help estimate the costs and benefits of engagement.
Health and Social Care Bill likely to become law within weeks as the government wins a series of House of Lords votes:
but shadow minister hopes publication of the government’s risk assessment of the bill, opposition by a further two Royal Colleges and opposition at the Lib Dem conference will still delay it.
The Department of Health is seeking views on children’s health and outcomes, particularly in relation to acute illness, mental health, disabilities and long term conditions and public health.
More than half of care home residents are being denied basic care according to the CQC.
The LGA’s Health and Wellbeing Board offer:
The week: 2 – 8 March 2012, for NHS and social care leaders
“An innovative new £5m payment by results’ scheme to help London’s persistent rough sleepers off the streets and into secure homes has been launched by Housing Minister Grant Shapps and London Mayor Boris Johnson. This new incentive fund, known as a Social Impact Bond, will be administered by the Greater London Authority.”
Evaluation of the Youth Justice and Diversion pilot scheme. Evaluation of a pilot scheme, commissioned in 2007, for improvement in health provision in the justice system. The young people were screened, supported and where possible diverted away from the youth justice system. The schemes were in Lewisham, Halton and Warrington, Peterborough, Kensington and Chelsea, South Tees and Wolverhampton.
Ministers lose their appeal to keep the risk assessment of the NHS reforms secret. There is still a further stage of appeal they could make, though.
Royal College of Surgeons is critical of the NHS reforms, but does not call for the bill to be scrapped.
On the basis of information gathered through freedom of information requests, campaigning group False Economy claim that the reforms are taking GPs away from looking after patients to deal with setting up CCGs.
More on the data:
“The NHS Atlas of Variation in Healthcare for Children and Young People maps out the variation in healthcare for 25 different child health issues across England.”
‘The Week’ Issue 239
100 NHS Voices. The Guardian interviews 100 people who work in or with the NHS about the health reforms:
Virgin and Serco are amongst firms bidding to run children’s services in Devon.
The consumer group Which has found examples of ‘disgraceful’ healthcare for the elderly.
Over 60% of Clinical Commissioning Groups are to be led by former PCT staff
69% of respondents to a Royal College of Physicians survey would like the Health and Social Care Bill dropped, with only 6% ‘accepting’ the bill.
[Update sent out up to here]
ADASS questions government targets for personal budgets.
“The pace of further growth of personal budgets has been thrown into doubt after social care directors questioned the “practicality and wisdom” of the target that all eligible users of services in England should have a budget by April next year.”
“NHS trusts seek 111 non-emergency services supplier in £60m deal”. That’s not one hundred and eleven suppliers, but suppliers of the telephone number 111, for non-emergency services! I thought it was worth including this as a reminder (or news) that the 111 number is to be rolled out nationally by March 2013.
“Better integrated care could save the NHS millions”. “Physiotherapists, dietitians, podiatrists, speech and language therapists and other Allied Health Professionals can have a dramatic impact on care for people with diabetes, cancer, musculoskeletal problems and stroke survivors.”
The AHP (Allied Health Professional) QIPP Toolkits are at:
Health and Social Care Bill clears its final hurdles in the House of Commons.
Useful briefing on the implications of the budget for local government from LGIU:
LGA budget response:
Local government hit hard by cuts.
The Week, Issue 240
Includes a link to a general guidance document on improvement (seems to be built round lean / process mapping type approaches). Actually came out in December, but still potentially useful.
Also includes an item on NHS Staff Survey 2011 (a 10 page summary is available here).
More on the staff survey here:
DH press release on the staff survey:
Report on evaluation of integrated care pilots
“The evaluation which commenced in 2009 looked at 16 sites across England who undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services.
The report also provides information on evaluation methods, data collection and analysis.”
News story on the report: “Increased levels of integration within the NHS have improved care processes, created more satisfied staff and reduced the use of hospitals …”
“NHS reforms fuel rise of high street health clinics” (See also Better integrated care could save the NHS millions, on 19th)
Working with service users to improve services. From the website:
“Guide for commissioners on how NHS staff and service users can work together to improve services.
Earlier this week Panos London and Naz Project London (NPL) launched the findings of a three year collaborative pilot study, Beyond Consultation. The project supported African service users and NHS staff to work together to improve sexual health and HIV services in London.”
Biggest fall in NHS staff in a decade
[Update sent out up to here]
Pathfinder bulletin for emerging Clinical Commissioning Groups (CCGs) – March 2012. Includes the news that draft guidance on authorisation of CCGs is to be published on 3 April. Authorisation of CCGs is to be in four waves: July, September, October and November 2012. Guidance has also been issued on service level agreements (SLAs) between CCGs and Commissioning Support Services (CSSs).
NHS reforms ‘will kill patients’, warns editor of ‘The Lancet’. [I don’t normally include general expressions of opinion like this, but the source and starkness make it stand out]
(Not sure of date)
Kings Fund, Health and Wellbeing Board bulletin, March
Slides from LGA ‘Reducing Health Inequalities’ conference now available. [Not strictly health policy, but probably of interest].
The Health and Social Care Bill receives Royal Assent to become the Health and Social Care Act.
The Act is here: http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted
Risk register on NHS Reforms leaked
“Report reveals stark dangers in opening up NHS services.” A Guardian report says: “A controversial example of private companies being allowed to provide NHS services has resulted in patients in pain being denied treatment, forced to go private and enduring “extended suffering”.
Those are the findings of an internal NHS report into how patients fared when physiotherapy services in Rushcliffe, Nottinghamshire were opened up to “any willing provider””
“Two reports published today by The King’s Fund highlight how frail older people are being exposed to unacceptable standards of care and moved around from pillar to post in hospital because of a lack of continuity of care.”
The Department of Health has launched a consultation on the public health workforce, ‘towards a workforce strategy for the public health system’ on the challenges and opportunities, wider workforce and local community issues. The consultation is open until 29 June.
New National Planning Policy Framework launched. [Health policy? Well, in influencing the homes people have, how they are active and how they relate to each other, yes, potentially very important for health.]
Data from 20 of the 30 NHS Outcomes Framework indicators is published:
Janet Atherton elected President of Association of Directors of Public Health. [From twitter – can’t see reference to it on web]
Transforming Public Health Bulletin – March (Issue 7), from Department of Health.
Includes a link to the LGA resource: “From transition to transformation in public health. A resource to assist the transfer of public health to local authorities.”
“GPs’ shares in private firms raise alarm”. Research from the pressure group ‘False Economy’ says that in 22 of 50 fledgling CCGs, at least half the doctors had financial interests in private health firms.
‘The Month’, special issue 52, March. A bulletin of news and comment for the NHS leadership community. (27 pages).
‘The Week’, issue 241
A report by the Public Accounts Committee strongly criticises the CQC (Care Quality Commission)
Revised Outcomes Framework for Adult Social Care is published.
Essex health trusts, the county council and a local university have created a new health company to help deliver more integrated health and social care in Essex.
Sharing and developing understanding to promote equality, wellbeing, co-operation, freedom and sustainability