News Review - October 2018

02 October 2018

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It’s not often this monthly review can begin with a positive story for the health service, but it seems a High Court ruling could save the NHS millions of pounds a year. The court refused a bid to stop 12 clinical commissioning groups in the North of England prescribing Avastin for patients with the common eye condition wet age-related macular degeneration (AMD). The National Institute for Health and Care Excellence has concluded that Avastin is just as safe and clinically effective as the alternatives. The CCGs – based in the North East and North Cumbria – said the drug is about 30 times cheaper than the most expensive alternative and they will save a total of £13.5m a year as a result of the ruling.

New English health and social care secretary Matt Hancock gave his first major speech in September and focused on the power of IT to improve health and the effectiveness of every pound spent. Speaking at NHS Expo 2018, he said poor IT is wasting resources and giving patients sub-optimal care. NHS IT was ‘clunky, clunky, clunky’, with some workstations needing two monitors – not because the service was at the cutting edge but because two unintegrated systems were running side by side. He gave a commitment to sorting out NHS and social care IT systems as an immediate priority.

WinterAs summer turns to autumn, health services across the UK turn their thoughts to the coming winter and the lessons that can be learned from last winter. According to an NHS Improvement report on the 2017/18 winter period, A&Es in England saw 290,000 more attendances than the previous winter. In a review of last winter, the oversight body added that 100,000 more people were admitted to hospital as an emergency. Mitigating steps were taken, including greater capacity and streaming patients into lower acuity settings where appropriate – for example, on arrival at A&E, streaming into primary care was in place across 98.5% of the service; this is now 100%. Winter funding was welcome, but arrived in November, making it difficult for trusts to plan the most cost-effective staffing models.

Taking heed of complaints over the late announcement of extra winter funding last year, in September the Department of Health and Social Care announced that NHS trusts in England will receive a share of £145m to improve emergency services ahead of the winter period. The funding will be spent on 81 schemes to upgrade wards, redevelop A&E departments, improve same-day emergency care, create an additional 900 beds and improve bed management systems.

Winter funding in Scotland was also announced. NHS health boards will receive a further £10m to help them cope with winter pressures, the Scottish government said. The funding will enable boards to plan earlier to increase weekend discharge rates; allow for better staff planning over the festive holidays; and provide more focus on community pharmacies.

Waiting time targets across the UK continue to be missed. In Wales, 80% of patients waited fewer than four hours in August, missing the 95% target. This was 1.4 percentage points lower than July this year and 4.7 percentage points lower than in August 2017. Attendances were 2.4% higher than a year before. In scheduled care, 89% had been waiting fewer than 26 weeks – the target is 95%.

More patients are on the elective surgery waiting list in England and more are waiting longer than the 18-week threshold, according to the latest figures from NHS England. At the end of July 4.1 million people were on the referral to treatment list – an increase of 7% compared with a year earlier. Of those waiting, 87.8% had been waiting fewer than 18 weeks – missing the 92% target. In July 2017 the figure was 89.9%. In August 89.7% of patients were seen within four hours in A&E, compared with 90.3% in August 2017 – over the year there was a 3.2% growth in attendance, while there was a 5.2% increase in the number of patients admitted to hospital as an emergency.

BMA ReportOne way of reducing the demand for services in the long term is to promote better health and the British Medical Association called on the health service to prioritise investment in ill health prevention and tackling the causes of preventable long-term conditions. The doctors’ representative body said as much as 40% of demand on the NHS could be cut by investing in services to reduce smoking and alcohol consumption and improving physical activity and diet. Preventable ill heath accounts for an estimated 50% of GP appointments, 64% of outpatient appointments and 70% of inpatient bed days, a BMA paper said. Ill-health prevention could help secure the financial sustainability of the NHS, it added.

NHS Improvement has published a guide for trusts on opportunities to secure revenue and capital through the local authority planning process. Funds can be available through section 106 agreements and the Community Infrastructure Levy when new housing places additional pressures on local health services. NHS Improvement advised trusts to work closely with their local planning authority and council members to secure the funding; gain affordable housing for their staff; get planning consent for healthcare projects; and identify surplus land and buildings for sale and development.

The Health Foundation voiced concern as it revealed that a quarter of nursing students drop out of their degrees before graduation. With an estimated 40,000 nursing vacancies in England, it said, the issue of nursing student attrition had never been more pressing. Its research with the Nursing Standard found that of the 16,500 students due to complete their three-year degree in 2017, about 4,000 left their courses or suspended their studies (24%). A Nursing Standard study from 2006 found a similar attrition rate, suggesting attempts to address the issue had failed, the foundation said.

NHS Improvement said trusts can make further temporary staff savings. Calling for a ‘bank first’ approach, it said the NHS could free up £480m to reinvest into services and improve patient care. Trusts should fill temporary vacancies with workers from a staff bank instead of using expensive staffing agencies. It added that agencies should be used only as a last resort, and has set all English trusts a target of reducing agency costs by 17% in the current year. The NHS has already cut agency spending by £1.2bn, or a third, since caps were introduced in 2015. And in 2017/18 spending on bank staff was higher than on agency staff for the first time in several years. A toolkit developed by St Helens and Knowsley Teaching Hospitals NHS Trust to grow its own bank has been shared on the NHS Improvement website.

This month in quotes

 

‘The sooner all NHS trusts implement a policy to offer Avastin as an option for the treatment of wet AMD, the sooner we can start to redirect that money into other resources and equipment, so we can make improvements to care that have life-changing benefits for patients.’

South Tyneside CCG chief officer David Hambleton calls on the NHS to make the most of the High Court ruling on Avastin

‘While the attrition rate has remained fairly constant over the last decade, its impact is becoming more severe, bearing in mind the overall shortage of nurses, vacancies in nursing posts and rising demand pressures.’

Ben Gershlick, senior economics analyst at the Health Foundation, says the NHS must retain its student nurses
Matt Hancock‘Now is the moment to put the failures of the past behind us and set our sights on the NHS being the most cutting-edge system in the world for use of technology to improve our health, make our lives easier and make money go further, harnessing the amazing explosion of innovation that the connection of billions of minds through digital technology has brought.’

English health and care secretary Matt Hancock sets his sights on improving health service IT

‘It’s important that we are well prepared and that’s why we are allocating funding earlier than ever before. This investment will ensure boards can put appropriate plans in place – particularly to make sure people are discharged in a timely way when it’s safe to do so, and that the right staff are in place throughout the system.’

Scottish health secretary Jeane Freeman says health boards should prepare for winter

FROM THE HFMA

When introducing value-based healthcare, providers will have to think again about their relationships with patients, professionals and commissioners, according to Yolima Cossio Gil, the clinical data and innovation lead at Barcelona’s Vall d’Hebron University Hospital. In a blog for the HFMA website, she says innovation in management is also needed. Value-based healthcare shifts the focus to the health outcomes of individuals, emphasising what matters to them in a financially sustainable manner.

In another blog, Nigel Davies (pictured), head of accountancy services at the CharityNigel Davies Commission, says charities can still improve their
annual reports and accounts. Recent commission research has shown a modest improvement in the quality of charity public benefit reporting, but too many are falling short of expectations for this key tool in communicating with the public.

HFMA policy and research manager Lisa Robertson outlines the benefits of a new tool developed by the association to give access to all relevant NHS corporate governance documents

from a single source. Keeping track of all the governance requirements is a challenge, she explains in a blog, but the HFMA NHS corporate governance map will prove helpful in this task. It has three sections – the strategic framework, enabling good governance and specific areas for assurance.

  • www.hfma.org.com/news/blogs