News / News review - October 2017

02 October 2017 Seamus Ward

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One that caught the eye was a claim that cyber-chondria – worrying excessively about health and making unnecessary appointments – is a growing problem. Doctors have said the use of the internet to look up symptoms – they call it ‘Dr Google’ – is a big issue, as they spend more of their time reassuring worried patients. Health anxiety could affect one in five outpatients, the research said.

Commons Public Accounts Committee chair Meg Hillier (pictured) published her annual report. Though the report may be more of historic interest – it was to be published in the summer, but was delayed due to the general election and summer recess – it said the Department of Health was among those giving the committee most concern. It was worried about the 2015/16 and 2016/17 Department accounts and described bickering over funding between the government and NHS England as unhelpful. Sustainability and transformation plans were at risk of being seen as a cover for cuts, even when good-quality, modern patient services were being planned. Financial and demographic pressures meant the NHS focus is on finance rather than effectiveness and transformation, it added.Meg_Hillier

The British Medical Association criticised the government for failing to meet in full its pledge to invest in GP services. A BMA report, Investment in general practice in England, said that despite some increases, spending on GP services as a proportion of the overall NHS budget was still lower than it was more than 10 years ago. While 9.6% went to GP services in 2005/06, in 2016/17 it was 7.9%. Investing at 2005/06 levels would increase GP service funding by £2bn, the BMA said, and meeting the widely accepted target of 11% of the overall budget would add £3.7bn.

An Education Policy Institute report on access to children and young people’s mental health services found that, in 2016/17, just over a quarter of children referred to specialist mental health services were not accepted into those services. This amounted to more than 50,000 children. However, there was considerable variation between providers. NHS Providers said mental health funding must reach frontline services for children and young people. It said the funds would ensure the right level of services is provided where they are most needed. 

A&E performance in England held steady in August, according to the latest official figures. NHS England figures showed 90.3% of patients were seen within the four-hour target – the same as in July. Though attendances were down 0.5% on August 2016, a smaller proportion was seen within the standard time in August this year. The 95% standard was last achieved in July 2015. 

New deals with suppliers to provide leading edge treatments could save the service up to £350m by 2021, NHS England chief executive Simon Stevens announced. A new oral drug for hepatitis C could save thousands of lives and more than £50m, he said, while plans to accelerate the uptake of biosimilar drugs could save an estimated £300m by 2021. At the Expo conference in Manchester, he called on health leaders to harness the potential of innovation for the benefit of patients and taxpayers.

At the same conference, health secretary Jeremy Hunt challenged the NHS to ensure patients in England can access seven services via an app by the end of 2018. With the 70th anniversary of the establishment of the NHS coming up next year, he said they should be able to access NHS 111; see their health record; book a GP appointment; order repeat prescriptions; set organ donor preferences; express data sharing preferences; and access support for managing long-term conditions. 

The government must take action to hold down the rising cost of clinical negligence, the National Audit Office said. In Managing the costs of clinical  negligence, the auditors said clinical negligence costs were rising quickly and adding to the financial pressures faced by trusts. While spending on the clinical negligence scheme for trusts had risen from £0.4bn in 2006/07 to £1.6bn in 2016/17, the number of successful claims had more than doubled. The rising cost was due to higher numbers of claims, increasing damages awarded and claimant legal costs. The latter was up from £77m to £487m over the past decade. A cross-government strategy was needed to tackle this.

NHS Improvement said all providers in England will be required to contribute to the cost of the licence for the national purchase price index and benchmarking (PPIB) tool. The oversight body is taking over the contract with the provider of the PPIB tool (AdviseInc) from the Department of Health. In a letter, it said that it would contribute £200,000 to the cost of the licence and associated services. But it also outlined trusts’ contributions to the balance of the cost, which are based on turnover. 

With the Labour Party saying it would examine the scope for bringing private finance initiative schemes into public ownership, an independent thinktank said that, over the past six years, private companies have made £831m in pre-tax profits from PFI schemes in the NHS. The Centre for Health and the Public Interest (CHPI) said that further profits from taxpayer funds could amount to £973m over the five years to 2020/21. Its report, PFI – profiting from infirmaries, made a number of recommendations, including using public sector loans to buy out PFI contracts; taxing PFI profits; and capping the profit a private company can make from an exclusive contract with the NHS.

The Scottish government has launched an initiative to improve the management of elective care and reduce NHS waiting times. Under its Elective Access Collaborative Programme, the government, NHS Scotland and royal colleges will support health boards to improve the configuration of their elective services. The government said the work would build on the £50m allocated earlier this year to reduce waiting times and health board recovery plans for elective services.

The head of the Northern Ireland civil service has issued an update on the local shared services programme, which is considering options for shared services in HR, payroll, finance and IT across the local public sector. A baseline exercise has been completed, though clarification and benchmarking is ongoing.   

September in quotes

‘GP services are effectively facing a £3.7bn funding shortfall because the government has not reached the goal of allocating 11% of NHS investment to general practice. The rate of extra investment has also noticeably slowed in the past year despite government promises of an acceleration in resources directed to frontline patient care.’ 

BMA GP leader Richard Vautrey attacks the government record on GP funding

‘People now go to their GPs with a whole list of things they’ve looked up on the internet, and the poor GP, five minutes into the consultation, has four pages of reading to do. Dr Google is very informative, but he doesn’t put things in the right proportion.’News review - Jeremy Hunt

The internet is causing cyber-chondria, Peter Tyrer, emeritus professor in community psychiatry at Imperial College London, tells the BBC

‘If the NHS is going to be the safest, highest quality healthcare system in the world we need to do technology better. So I am setting seven challenges, which, if we achieve them, will make the NHS a world-beater in the care of people with long-term conditions. I do not underestimate the challenge – but if we do, it will be the best possible 70th birthday present from the NHS to its patients.’

Health secretary Jeremy Hunt (pictured) sets the NHS a cyber challenge

‘This partnership working between government, the NHS and the profession has already achieved some excellent results in unscheduled care – and we are keen to replicate this successful approach.’Shona_Robison

Scottish health secretary Shona Robison (pictured) says the new collaborative programme aims to improve elective access






From the hfma

The HFMA published a range of blogs in September. They include an international perspective on the value of patient-level costing from Alfa D’Amato (pictured), director of activity-based management at New South Wales Health, Australia. Mr D’Amato, a speaker at the HFMA international costing symposium on 4 October, said costing has a lot in common with gold – it is valuable, but difficult to get at, and once retrieved is often locked away with limited access.Alfa Damato

Mr D’Amato’s deputy, Julia Heberle, who is also speaking at the symposium, looked at how internal audit can be a key ally in ensuring costing data is sufficiently accurate to inform decision-making.

HFMA head of policy and research Emma Knowles used a blog to launch the association’s latest biennial finance staff attitudes survey. She said that a lot of the media attention is on frontline staff, but finance and other key support staff face the same pressures and challenges.

Also online, Bill Shields continued his postcards from Bermuda, while Healthcare Finance editor Steve Brown argued that the NHS has to pursue efficiency on multiple fronts if it is to achieve the levels it requires.

The HFMA also published several briefings in September, including a look at the guidance available to the NHS on reforms to off-payroll rules introduced in April, and its latest watching brief on financial reporting.