News / News review November 2014
- The NHS focus remained steadily on finance in October from start to finish – from funding pledges made by the political parties at their conferences to the debate about how much the taxpayer must give the service in the period to 2020/21 following the publication of the Five-year forward view. In between, there were many reports on how the NHS could use existing funds more efficiently. The forward view, with its suggested transformational changes and call for annual efficiencies of 2% or more, must be kept in mind when considering these reports.
- In one report, the Royal Pharmaceutical Society claimed greater use of community pharmacists to treat patients with common or minor ailments could save the NHS £1bn a year. While the cost of treating patients with common illnesses such as coughs was £147.09 per patient in A&E, it was £82.34 in general practice. But Community pharmacy management of minor illness said it cost £29.30 per patient in community pharmacies. The study estimated that 3% of
A&E and 5.5% of GP consultations could be managed by community pharmacists, delivering an annual saving of £1.1bn. - A further report, by Frontier Economics for the Department of Health, suggested that unsafe care costs the NHS more than £1bn a year and could be as high as £2.5bn. Savings could be made, though Exploring the costs of unsafe care in the NHS noted there may be costs attached to preventative measures.
- Alongside these suggestions for savings, the Nuffield Trust warned about potential costs. It said the NHS will need an additional 17,000 hospital beds in the next seven years if improvements in community and secondary care are not made. NHS hospitals under pressure: trends in acute activity up to 2022 found that hospital admissions grew by 2 million (16%) over the past seven years. If admissions continue to rise, population change alone would mean an extra 17,000 beds would be needed by 2022. It also found that despite the rise in admissions over the past seven years, the NHS has coped with fewer beds because of the type of admissions – day cases or short stays.
- Hospitals are struggling with the number of admissions, according to latest figures from the Department. The week ending 24 October saw the highest number of emergency admissions from A&E departments since the week of
- 2 January 2014. A&E departments are also under strain, with a 32% increase in attendances between 2003/04 and 2013/14. The Department has provided additional funding to help local health and care economies cope over the winter, but also claimed that NHS111 was helping the service deal with demand.
- Even the best managed NHS organisations will struggle to avoid financial failure because of the prolonged slowdown in funding, the King’s Fund said. The fund warned there would be no quick fixes for hospitals at risk of financial failure. The failure regime has been controversial in the two instances where it has been implemented, while there has been limited success with other methods, such as mergers, management changes and franchising. Its report, Financial failure in the NHS, called for a more nuanced approach, including distinguishing between providers with fundamental problems and those struggling in the difficult financial environment. In a separate report, the fund also called for transitional funding to pilot, evaluate and refine services where hospital consultants spend more time in the community.
- One of the outcomes of the failure regime, the dissolution of Mid Staffordshire NHS Foundation Trust, was confirmed. Its services transferred to the new University Hospitals of North Midlands NHS Trust and Royal Wolverhampton Hospitals NHS Trust on 1 November. Mid Staffs will remain a shell legal entity as criminal cases are concluded.
- No clinical commissioning group will be more than 5% under its target fair share allocation within two years, NHS England chief executive Simon Stevens told the Public Accounts Committee. Giving evidence to the committee’s inquiry on NHS allocations, following the earlier National Audit Office report on the subject, he said that the allocations for 2014/15 and 2015/16 were already set. ‘But clearly, from 2016/17 we definitely want to make much faster progress against target allocations.’
- With attention focused on the Five-year forward view, the breakdown of talks over new contracts for consultants and junior doctors may have slipped under the radar. NHS Employers claimed the British Medical Association had abruptly withdrawn from negotiations, while the doctors’ body said the talks had stalled due to ‘unreasonable demands’ that would undermine patient and doctor safety.
- There was a warning on GP numbers, with the Royal College of General Practitioners claiming nearly 600 GP practices across the UK could be forced to close in the next 12 months. The RCGP said a deepening recruitment and retention crisis had left many practices unable to recruit enough doctors to replace GPs who are due to retire.
- All health boards in Scotland broke even in 2013/14, but several needed additional funding from the Scottish government or had to rely on non-recurring savings, Audit Scotland said. NHS in Scotland 2013/14 said current financial and performance targets should be reviewed as, along with tightening budgets, they were making it difficult to reshape care and move more services into the community by 2020.
- Northern Ireland’s health service will receive an additional £60m following an agreement by the local executive. Recently appointed health minister Jim Wells said the money, together with an additional £20m in the June monitoring round, was welcome, but warned some services would be reviewed. And because of staffing levels, clinicians may advise closure or restricted opening. There was no option but to impose further cuts in areas such as arm’s length bodies, his department and pharmacy spending, he said.
- There will also be an additional £120m over the next two years to improve mental health services in England. NHS England announced the funding alongside new waiting time standards. The standards, which come in from next April, include treatment within two weeks for more than 50% of people experiencing a first episode of psychosis. The moves are part of a five-year plan to put mental health services on the same footing as physical health services.
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In the media The HFMA continued to feature in the national and business press, commenting on stories such as the affordability of mental healthcare, specialised commissioning plans, the better care fund and the relationship between finance and quality. HFMA policy director Paul Briddock was quoted in The Times, responding to its story on new access targets and an extra £120m over two years for mental health. The paper quoted experts who backed the commitment to mental health, but warned the extra funding risked cuts elsewhere. Mr Briddock said it was important to know where the money was coming from. ‘If it’s not more money, it’ll put pressure on the system somewhere else,’ he said. In a letter published in Public Finance, he called for greater realism on what can be delivered by the better care fund (BCF) and the financial impact on providers. He voiced concern that there has been a reported cut in BCF pilot sites, which he said reduced the opportunities to understand the challenges in implementing the BCF, as well as its successes. He called for greater collaboration and the need to get financial and governance arrangements right from the outset. Mr Briddock was quoted in a Health Service Journal story on an NHS England plan to control specialised services spending in 2015/16. He also contributed an article to Health business magazine on the results of the HFMA’s last financial temperature check. |
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The Month in quotes ‘People who present in crisis often wait too long for an assessment and to access treatment. This new approach will help improve crisis care and help reduce the distress that untreated mental illness brings.’ Dr Geraldine Strathdee, NHS England national clinical director for mental health, sets out her hopes for new funding and access times ‘Developing an approach to financial failure that responds to this environment is a significant challenge. A nuanced approach is required based on understanding the whole local health economy and balancing a range of other factors. None of this makes for a speedy or straightforward process, but there are no quick fixes.’ King’s Fund policy director Richard Murray believes the failure regime must be subtler ‘Pharmacists are central to relieving demand on A&E and GPs. Fast, same-day access to community pharmacists will be of huge benefit to patients, doctors, nurses and the bank balance of the NHS.’ ‘My priority is that services must be safe and effective for patients. Unfortunately that may mean that some services will need to be reviewed and, in some cases, opening times may need to be restricted or indeed some services may need to cease based on the views of clinicians on safe staffing levels.’ |
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