News review – December 2018

03 December 2018

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While anticipation was building in England in advance of the publication of the NHS long-term plan – with some details emerging (see page 4) – auditors in Scotland and Wales published key reports on the reform and modernisation of local health services.

A report for the auditor general and Accounts Commission in Scotland said NHS boards, integration authorities and councils in Scotland must accelerate and deepen their collaboration to achieve the full benefits of integrated working. The report, Health and social care integration: update on progress, said advances had been made, but success would ultimately rely on long-term integrated financial planning and stable and effective leadership. 

Meanwhile, the Wales Audit Office warned that, without change, local radiology services were unsustainable, even though they are well managed and are meeting waiting time targets. In a report, Radiology services in Wales, the auditors said radiology was under pressure from rising demand, which was increasing by as much as 15% a year. There were recruitment and retention issues in all but one health board, while hospitals were hampered by outdated and insufficient equipment. IT weaknesses limited the efficiency of the service. Despite this, waiting times had improved in the past five years, though some patients waited a long time for their results.

Figures for NHS performance in England showed an increase in activity, including a 0.8% rise in completed elective care in the 12 months to September. However, 86.7% of patients had been waiting fewer than 18 weeks – so the 92% standard was not met. A&E attendances were 3.7% higher in the 12 months to October this year than in the preceding 12 months. In October 2018, 89.1% of patients in A&E were seen within four hours – the figure was 89.9% in October 2017. The British Medical Association said A&Es faced a year-round crisis, with levels of care delivered in summer 2018 worse than in five of the last eight winters.

Emergency departments in Wales also saw a rise in attendances. A greater number of patients in Wales spent more than 12 hours in A&E in October. Official figures show 12-hour waits up 4.1% on September 2018 and 28.9% on October 2017. Performance against the four-hour target also dropped – 80% spent fewer than four hours in A&E in October this year – 0.3 percentage points lower than September 2018 and 3.5 percentage points lower than October 2017.

Pay rises for doctors and dentists next year could be targeted at recruitment and retention. In its remit letter to the Doctors’ and Dentists’ Pay Review Body, the Department of Health and Social Care asked it to recommend, particularly for junior doctors, how pay funding could address recruitment and retention pressures.

NR_Stephen Hammond MP landscapeFormer transport minister Stephen Hammond (pictured) has been appointed minister of state in the Department of Health and Social Care. He will lead on finance, procurement and operational performance; pay; the NHS England mandate; and transformation and provider policy. His appointment was made after Stephen Barclay moved to become Brexit secretary.

An overhaul of cancer screening services is likely after NHS England launched a review as part of its drive to detect cancers earlier. Professor Sir Mike Richards will lead the review, which will examine the latest innovations, including the potential for artificial intelligence; the integration of cancer research; and how to encourage more eligible people to be screened.

The government must ‘make the case’ for national tax rises to make adult social care sustainable, according to council leaders. Publishing its response to its own green paper on social care, the Local Government Association said the rises could be in either income tax or national insurance or both. It said over the years, governments had taken a piecemeal approach to social care funding. At the same time, efforts to resolve the funding issue had failed.

Prevention is likely to be a central plank of the NHS long-term plan in England, but Scotland has been warned it lacks public health policies that will prevent ill health. A report from the Scottish Parliament Health and Sport Committee, Preventative action and public health, said the health service focused too much on treating existing problems rather than preventing them happening. The report points to examples of good practice – Highland Health Board had significantly reduced hospital admissions due to falls by training staff in care homes, leisure centres and town halls on falls prevention.

Hospital mortality rates in Scotland were more than 11% lower in the period of April to June 2018 compared with January to March 2014. According to new figures, no hospital had a significantly higher standardised mortality ratio (HSMR) in the latter period than the national average. Of the 29 hospitals reported, 13 saw a fall in HSMR of more than 10% compared with the January to March 2014 figures.

Shrewsbury and Telford NHS Trust has been placed in special measures following a recommendation from the Care Quality Commission. NHS Improvement said the trust had been working through its issues, but new support would include additional funding, extra capacity to support the planned improvement programme and strengthened oversight. NHS Improvement added that the trust faced governance, workforce, urgent and maternity care and whistleblowing issues.

NHS England said wearable glucose monitors will become more freely available for people with type 1 diabetes. Prescribing of the device is not uniform, with an estimated 3%-5% of eligible patients having access. If the guidelines are followed, this should rise to at least 20%, NHS England said. The device – which is the size of a £2 coin and worn on the arm – means that patients no longer have to prick their fingers to test their blood glucose. Instead, the device relays their results to a smartphone or e-reader.

The month in quotes

‘This review provides the opportunity to look at recent advances in technology and innovative approaches to selecting people for screening, ensuring the NHS screening programme can go from strength to strength.’

Professor Sir Mike Richards says the cancer screening programme must match the ambitions of the long-term plan



‘Radiology is a vitally important part of our NHS, helping to diagnose, monitor and treat disease and injuries. But it’s a service under strain and while it may be coping at the moment, this is unlikely to continue in the longer term.’

Wales auditor general Adrian Crompton warns that issues with radiology services must be tackled


‘It is imperative that focus is prioritised on preventing people becoming ill with diseases we know are avoidable. By doing this we can also start reducing health inequality and while the health service can’t fix everything, it must play its role in tackling this fundamental issue.’

Scottish Parliament health committee convener Lewis Macdonald



From the HFMA

The HFMA produced several blogs in November. These included a blog from NHS Future-Focused Finance diversity lead Edward John on targeting full equality and a finance function that embraces and celebrates diversity.

HFMA Northern Ireland Branch chair Owen Harkin said local challenges mirror those in the rest of the UK, but there are key differences local finance managers must deal with. These include improving the already integrated health and social care system and transforming care.

HFMA policy and technical manager Debbie Paterson urged estates and finance staff to work more closely.