News review - July 2018

03 July 2018 Seamus Ward

Login to access this content

June was a busier-than-usual month for healthcare news, with the build-up to, and then announcement of, the five-year funding deal, together with the report on an independent inquiry into more than 450 deaths at Gosport Memorial Hospital, the NHS Confederation’s annual conference and agreement of a new pay deal for NHS staff in England.

The NHS reaches 70 years this month and the pressure mounted on the government to give it a ‘present’ in the form of a long-term funding settlement. In an open letter to Theresa May, the Health Foundation, Nuffield Trust and King’s Fund said 4% a year was needed to maintain services, invest in key areas such as mental health, cancer care and general practice, and continue transformation. Less than 4% risked a further deterioration in standards of NHS care and delays to capital programmes, including vital repairs. At the NHS Confederation annual conference, its chair Stephen Dorrell said both NHS and social care needed 4% a year.News - Niall Dickson

The conference was held before the funding announcement on 18 June, and chief executive Niall Dickson (pictured) called for urgent investment in new models of care in the community. He said it was ‘shocking’ that primary care spending had fallen in real terms over the past eight years. Since the mid-1990s, the number of hospital doctors had increased by 72%, while GP numbers had fallen by 5%. He insisted he was not attacking the acute sector, but if services outside hospital were not supported, whole systems would fail. The NHS needed performance management arrangements and financial incentives that support system working and encourage investment in new models of care, he added. An Ipsos Mori poll of more than 1,000 people across Britain – commissioned by the confederation – found that 77% supported or strongly supported a 4% rise. Even more – 82% – backed a 3.9% rise for social care.

Regulators should ‘exercise discretion’ when deciding whether to withhold sustainability funding due to financial performance, the confederation said in a report launched at its conference. Sustainability and transformation funding allocated to trusts (now known as the Provider Sustainability Fund) has been based on their achievement of control totals, but the report, System under strain, argued that denying access to these funds only harms patients in areas where need could be greatest.Simon-Stevens

NHS England chief executive Simon Stevens (pictured) and his NHS Improvement counterpart Ian Dalton announced a new plan to free up 4,000 beds in time for winter by reducing long stays in hospital. Working with local authorities, they aim to reduce the number of long-staying patients by a quarter and further reduce delayed transfers of care.

In May, there was an improvement in the performance of A&Es in Wales, despite an increase in attendances. The latest figures show 82% of patients were seen within the four-hour target – 1.9 percentage points higher than in April this year. The 95% target continues to be missed. The number of patients waiting more than eight weeks for diagnostic tests increased – this was driven by the inclusion of additional cardiac tests, according to Statistics for Wales. However, health boards in Wales were warned they will receive their full share of extra waiting list funding only if they meet agreed reductions in their waiting lists. Health secretary Vaughan Gething said health boards had submitted plans to access £30m in funding this financial year. He expected to see significant improvements, as had been achieved over the past two years, when £100m of additional funding was provided to reduce referral to treatment, diagnostic and therapy waiting times.

NHS performance in England continued to be mixed, with, for example, improved waiting times in A&E but more people waiting for elective care as demand rises. Figures released by NHS England showed 90.4% of patients were seen within four hours in A&E in May – up from 88.5% in April and 89.7% in May 2017. Emergency admissions were up 5.6% compared with May 2017. At the end of April 2018, there were four million people on the waiting list for elective care – 6.2% more than a year earlier.

Though many would argue confirmation was not needed, the Royal College of Emergency Medicine said the performance of the NHS emergency care system in winter 2017/18 was one of the worst in the history of the service. A report on winter flows across the UK, said between October and March the average A&E four-hour wait performance was 81.2%, while between January and March it was 79%. This was despite an average of 3,400 operations cancelled each week – a record for the college’s winter flow project, which began in 2015.

MPs called on NHS England to deliver on its forward view commitment to move more care out of hospital and into the community. In a report, Reducing emergency admissions, the Public Accounts Committee said almost 1.5 million people could have avoided an emergency admission in 2016/17 if hospitals, GPs, community services and social care had worked together more effectively. The committee said it was frustrating that progress had been made in reducing the impact of emergency admissions for patients and hospitals, but there had been little progress in reducing the number of avoidable emergency admissions.

Generic drugs with temporary higher prices cost clinical commissioning groups an estimated £315m in 2017/18, according to the National Audit Office. An NAO report said this cost, which is over and above what would have been spent if the usual drug tariff applied, was seven times greater than the equivalent spend in 2016/17. The report, Investigation into NHS spending on generic medicines in primary care, said the cost of some medicines increased tenfold over the year. It was caused by a range of factors, including shortages, increases in manufacturers’ prices and concessionary prices that were set too high by the Department of Health and Social Care. The cost of the latter (estimated at £86m) is expected to be reimbursed through established mechanisms over the coming years.

The NHS in England could improve patient experience and outcomes and deliver efficiencies of up to £16.4m in cranial neurosurgery, according to the Getting it right first time programme. Its report on cranial neurosurgery said the efficiencies could be made through smarter procurement, avoiding unnecessary admissions and using critical care only where clinically required. Specific savings opportunities included admission on day of surgery to reduce length of stay; increasing the number of minimally invasive day surgeries; and reducing the length of stay in critical care to five nights or fewer.

Month in quotes

‘It is shocking that over the past eight years spending on primary care in England has fallen in real terms – indeed from the mid-90s the number of hospital doctors has increased by 72%, whereas in the same period the number of GPs fell by 5%.’

NHS Confederation chief executive Niall Dickson tells his conference that more funding must go into community and primary care …Stephen_Dorrell

… while chair Stephen Dorrell (pictured) calls for greater overall funding for health and care

‘Not 4% for the NHS and a squeeze on local government – or a special fund to ease the pressures on social care. But 4% per annum for the NHS and 4% per annum for social care, year-on-year, between now and 2030.’

‘Health boards will need to meet the targets they set out in order to receive the full funding. I expect to see significant improvements on waiting times as we did in the first two years of this fund.’Vaughan Gething

Wales health secretary Vaughan Gething (pictured) warns health boards they must meet expectations to access additional funding

‘NHS providers have tried to accommodate an ever-larger number of needy patients with an ever-diminishing bed base. The predictable result has been bed occupancy at record levels and thousands of patients stranded on trollies for more than 12 hours.’

Royal College of Emergency Medicine president Taj Hassan on the 2017/18 winter pressures


From the HFMAAlan Milburn

The HFMA published a number of blogs in June, including one with a stark message from former health secretary Alan Milburn (pictured) – the NHS financial system must be reformed if the government is to leverage maximum value from the new investment in healthcare. Writing before the government’s funding announcement, he said this was the conclusion of research into how funding flows could be redesigned – undertaken by PwC in collaboration with the HFMA. Too much money was invested in increasing hospital activity rather than improving outcomes in the community. A survey of finance staff found strong support for changing the current funding flows and creating a single budget for each health, social care and public health economy. More than three-quarters believed outcomes could be improved by giving greater long-term funding certainty.

Sandra Easton, chair of the HFMA Environmental Sustainability Special Interest Group, blogs that finance staff must bring their concerns for green issues into their working lives. Projects can have a positive impact on the environment and the bottom line, so finance has a role to play, she argues.

In his latest blog, former NHS finance director and current chief financial officer at Bermuda Hospitals Board Bill Shields sees an improvement in the deficit position and a break-even budget set for 2018/19. But it’s really only the end of the beginning, and he looks forward to further developments, such as costing and service-line reporting.

See all our other news blogs here or on the HFMA app, which is available from stores and free for full members to download.