News / New review - July 2017

04 July 2017

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With the election over and a Conservative government formed under Theresa May, it looks like it’s back to normal for the NHS in England. With the prime minister carrying out only the lightest of reshuffles, Jeremy Hunt (right) kept his place at health. He is one of the longest serving health secretaries, having been appointed in September 2012 – a continuity choice to lead a service that faces a raft of familiar problems over the next few years, Mr Hunt’s reappointment was widely welcomed across NHS think-tanks and pressure groups. Though Philip Dunne and Lord O’Shaughnessy were reappointed minister of state and health lead in the Lords, respectively, two new junior ministers were appointed – Winchester MP Steve Brine and Jackie Doyle-Price, who represents the Thurrock constituency.

Jeremy Hunt

The UK’s exit from the European Union will dominate matters over the next few years and could have a significant impact on the health service. The Nuffield Trust warned that the NHS could face a £500m bill if retired British expats returned to the UK due to their right to healthcare being withdrawn where they are currently living. Care homes and homecare agencies could face a staffing shortage of 70,000 by 2025/26 if migration of unskilled EU workers is halted after the UK leaves, it added.

There was a further warning on staff numbers as the Health Foundation said the number of nurses from other European Union countries registering to practice in the UK has fallen by 96% since last July. The EU referendum took place in June last year. Figures obtained from the Nursing and Midwifery Council show a decline from 1,304 in July 2016 to 344 in September 2016 and just 46 in April this year. The foundation said this suggested a sustainable, long-term approach to workforce planning was needed. Its figures show that, historically, a greater proportion of registrants came from outside the EU, but since 2008/09 most newly registered overseas nurses now come from EU countries. The foundation said that without EU nurses the NHS would find it even more difficult to find the staff needed to provide safe care.

With risks to the NHS evident, a Brexit Health Alliance was launched at the NHS Confederation conference. It aims to be the voice of the UK health sector as the country leaves the EU. The alliance will focus on areas such as healthcare research and UK citizens’ rights to treatment. Members include the NHS Confederation, NHS Providers, the Academy of Medical Royal Colleges and the Association of the British Pharmaceutical Industry.

The NHS is on course to save more than £2m from the first two products bought through a central purchasing programme, according to NHS Improvement. It said the aggregation of national demand for couch rolls and blunt-fill syringes through the NCP (nationally contracted products) programme was on track to make the savings. NHS Improvement had worked closely with NHS Supply Chain to simplify the ordering process, it added. 

NHS Improvement is also targeting cost
reduction in private finance initiative schemes. Chief executive Jim Mackey (right) issued a letter setting out the steps the oversight body was taking to support providers with PFIs. Mr Mackey wants to reduce these costs, which make up a significant proportion of these organisations’ cost base – as well as the overall NHS cost base. He asked trusts with PFIs to take part in a survey to give NHS Improvement a better understanding of how existing contracts are managed and what areas trusts are covering in discussions with PFI suppliers. 

Jim Mackey

Procurement and PFI costs are well-known issues. Another – rising activity and subsequent failure to achieve operational targets – was evident in June. According to NHS England statistics, A&E attendances were 4% higher in April 2017 than in April 2016, while emergency admissions were 2.8% higher. The four-hour A&E waiting target was met for 90.5% of patients, below the 95% standard. Referrals to consultant-led treatment increased 5.2% on the preceding 12-month period and 89.9% of patients had been waiting less than 18 weeks – the standard is 92%. The daily average number of delayed transfers of care beds was 5,905 in April, compared with 5,601 in April 2016.

Figures for Northern Ireland showed similar issues. A&E attendances increased by 4.5% between 2015/16 and 2016/17 and just over 74% of patients attending emergency departments were treated, discharged or admitted within four hours in 2016/17. Over the last five years, attendances have increased by more than 11%, with performance against the four-hour target declining by 4 percentage points.

Some of the extra money given to Northern Ireland under the government deal with the DUP will be spent on reducing local waiting times and, in England, the Department of Health said some hospitals will receive more funding to help them prepare for the winter. Health secretary Jeremy Hunt awarded almost £21m to 27 hospitals to ensure A&E departments are ready for winter – earlier, in April, 70 hospitals shared a £56m pot. The funding was announced in this year’s Budget to promote triage on arrival and introduce GP practices in emergency departments.

Former health secretary and NHS .Stephen Dorrell
Confederation chairman Stephen Dorrell (pictured) called for a review of long-term demand for health and care. At the NHS Confederation annual conference in Liverpool in June, Mr Dorrell said the review should also examine the resource implications of long-term demand. He added that it was time to build on the work of sustainability and transformation partnerships and local authorities to deliver more joined-up services

There will be a new deadline for submitting A&E performance statistics. From August, the statistics will be published a month earlier than at present. NHS Improvement said the 10 August statistics publication will include data for July as well as June, while performance statistics published in September will cover August. The latest NHS Improvement provider bulletin said that, to meet this new timetable, the deadline for submission will move to the second working day of each month rather than the 22nd. 

The Scottish government unveiled new health and social care standards, which are due to be implemented in April next year. It said the standards focused on improving patients’ experience of care and are based on five outcomes. These cover the quality of care and support, patient involvement in decision-making and the quality of the care environment.

Quotes

‘The drop in EU nurses registering to work
in the UK could not be more stark – just 46 registered to work in the UK in April. Without EU nurses it will be even harder for the NHS and other employers to find the staff they need to provide safe patient care.’

Anita Charlesworth, Health Foundation director of research and economics, says staffing is one of the chief Brexit issues facing the NHSAnita Charlesworth

‘Every one of us at some point in our lives will use, or know someone who uses a health or social care service. That’s why these standards are so important – to ensure everyone in Scotland receives the care and support that is right for them.’

Scotland health secretary Shona Robison unveils new NHS and care standards

‘‘[The hung Parliament] does not change the need to undertake a thorough review of long-term demand patterns in health and care – and the associated resource implications. I well understand the pressures ministers face, particularly in a difficult parliamentary situation. I have the t-shirt. But real life will not wait; we all know demand pressures in the system are building.’
NHS Confederation chairman Stephen Dorrell calls for a review of drivers of demand and the cost implications

‘This vital investment will help hospitals change the way they assess and see patients so people are given the most appropriate medical care as quickly as possible.’

Health secretary Jeremy Hunt allocates winter preparation funds


From the hfma

The UK and the US must choose a revolutionary path that leads to greater value in healthcare, according to Jason Helgerson, New York State Health Department Medicaid director. In a blog on the HFMA website, Mr Helgerson, who is due to speak at the HFMA CEO forum in September, argues that a system based on rewarding value has patients at its centre. But providers must also be given flexibility to redesign systems to better meet patient need.

Bill Shields

In the first of a series of blogs on the HFMA
website,former association chairman Bill Shields (right) describes his first weeks working in Bermuda. Mr Shields moved there in April, after 30 years in NHS finance, becoming the chief financial officer of the territory’s hospitals board. He talks about the differences in funding, provider reimbursement and some similarities with the UK.

The HFMA has surveyed members in providers and commissioners on investment in mental health services in 2017/18 and 2018/19. In a blog on the HFMA website, technical editor Sarah Bence says the survey shows national policy is encouraging debate and transparency around funding, but the financial challenge of meeting the investment standards is tough. We need to look beyond the investment standards, focusing on outcomes rather than money put in, she adds.

• See our news blogs.

Other HFMA publications in June include: 

  • Accounting for joint working arrangements 2017
  • Capital collaborations between the NHS and local authorities
  • Integrated reporting in the context of the Wellbeing of Future Generations Act (Wales) 2015
  • The importance of strong financial governance
To view these publications click here.