News review – November 2019

05 November 2019

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A decision over pension tax reform will be in the in-tray for any incoming government. Potential large tax bills have led many clinicians to turn down extra shifts, promotions or even consider early retirement. Boris Johnson’s government moved to address the issue by proposing new flexibilities, allowing clinicians to vary their contributions to the NHS pension scheme to minimise or avoid pension tax. However, in its response to a consultation on the proposals, the British Medical Association said they were merely a sticking plaster that will not solve the current crisis. The doctors’ trade union said the proposals would provide ‘a much-needed but temporary mitigation’ and that where a doctor has reduced their pension contributions, their employer’s contribution must be recycled back to the doctor as salary. It called for the annual allowance and tapered annual allowance, which dictate how much a doctor could pay in pension tax, to be scrapped – a move that will require legislation.

NHS England has reached an agreement with the manufacturer of three cystic fibrosis drugs to make them available to patients in England. The national commissioning body had been in long discussions with Vertex Pharmaceuticals on the price of Orkambi, Symkevi and Kalydeco. About 5,000 patients in England will benefit and clinicians will be able to prescribe the drugs within a month. The Scottish government reached an agreement with the company last month. The Welsh government and Northern Ireland health department intend to make the drugs available to local patients. The legal agreement with NHS England requires Vertex to make equivalent terms available to the countries’ health services.

VaccinationTargets for the uptake of pre-school vaccinations in England were missed in 2018/19, according to the National Audit Office. A report, Investigation into pre-school vaccinations, said uptake of nearly all pre-school vaccinations had declined since 2012/13. The decrease could not be attributed to a single factor, though the report said there was evidence that the reorganisation of the health system in 2013 led to fragmentation in the way the vaccination programme is delivered.

The pay review body for doctors and dentists must take account of affordability when it makes recommendations for the 2020/21 pay round, according to health and social care secretary Matt Hancock. In a letter to the review body, he added the recommendations should also consider the need for workforce growth and improved productivity – the government will decide on pay awards in the context of planned workforce reform and productivity improvements. The government is not asking for pay recommendations for junior doctors or GP contractors as both of these groups have multi-year pay agreements.


State of CarePatients’ ability to access the right care at the right time is having an increasing effect on the sustainability of health and social care services, the Care Quality Commission (CQC) said. In its annual assessment of health and care in England, the CQC said that lack of access to appropriate care can lead patients to attend emergency departments and other inappropriate settings, or to delay accessing care before eventually needing crisis intervention. This year the State of care report focused on mental healthcare – while the overall quality picture for these services remains stable, the report said that this masks a deterioration in some specialist services. 

The Department of Health and Social Care allocated the £200m in capital funding for new cancer screening equipment, announced last month. Health and social care secretary Matt Hancock said 78 trusts across England would benefit from the funding over the next two years. Efficiency would be increased, with the investment used to replace, refurbish and upgrade CT and MRI scanners, as well as breast screening imaging and assessment equipment.

NHS Wales recorded its worst performance on record for four-hour waits and patients waiting more than 12 hours in emergency departments, according to the Welsh NHS Confederation. While A&E attendances were 7.3% higher than in September 2018, only 75% of patients waited less than four hours this September – 5.3 percentage points lower than a year earlier and the lowest on record. In October, the Welsh government allocated £30m to support frontline care this winter, allowing patients to access care closer to home and to leave hospital when appropriate.

The NHS in England also continued to experience patient access problems. NHS England monthly performance figures showed that delayed transfers of care increased in August compared with 12 months earlier – a 1.4 percentage points increase in delayed days. However, the proportion of delayed days attributable to the NHS fell compared with August 2018 (60.4% in August 2019; 61.7% in August 2018). More patients on referral-to-treatment pathways were waiting longer for care – this August, 85% had been waiting fewer than 18 weeks, but it was 87.3% a year earlier. In both cases the 92% standard was not met.

An NHS manager who was jailed for fraud in 2018 has been ordered to pay back more than £220,000 to Newham Clinical Commissioning Group or face an extra three years in prison. Michael Inije of Ilford – who worked at North East London Commissioning Support Unit – was jailed for three years and nine months last year after pleading guilty to fraud by abuse of position. The CSU prompted a fraud investigation when concerns were raised over an invoice approved by Mr Inije – investigators found a further 24 fraudulent invoices, totalling more than £382,000, from a company where he was the sole director. The NHS Counter Fraud Authority established that Mr Inije had available assets totalling £220,431.48, which must be paid to the CCG to avoid extended time in jail.

A Scottish Parliament committee has highlighted the additional costs of keeping a patient in hospital compared with intermediate or care homes and care at home. A Health and Sport Committee report added that staying in hospital when they are ready to be discharged was bad for patients’ health. Overall, delayed discharges had risen by 6% in Scotland over the last year and it called for an immediate focus on reducing unscheduled care and hospital admissions, while meeting patients’ needs in other parts of the NHS.

From the HFMA

Fraudsters are the only ones who benefit from charities failing to talk about fraud, according to Alan Bryce. In a blog for the HFMA website, the Charity Commission for England and Wales head of development, counter fraud and cyber crime said charities must share information on current and emerging fraud risks. They should also recognise and celebrate good practice in fighting fraud. Though the blog highlights Charity Fraud Awareness Week, which took place in October, its messages remain relevant, including the fact that the public expects charities, including those in the NHS, to play their part in the fight against fraud.

Bill SheildsAlso in October, former NHS finance director and former HFMA chairman Bill Shields delivered the latest instalment of his blog on life as the Bermuda Hospitals Board chief financial officer. He reflects on experiencing a hurricane for the first time, as well as witnessing a new level of care in US academic medical centres. Meanwhile, the Bermuda Hospital Board takes initial steps towards a health system that incentivises value rather than utilisation.

The association also produced several publications, including briefings on NHS recommendations on legislation to further integrate care by implementing the NHS long-term plan; supporting Getting it right first time using patient-level costing; and an update on its Going concerns briefing.


 

Quotes

‘While the proposals in this consultation offer short-term mitigations, they are merely a sticking plaster that fail to address the crux of the problem. Only by scrapping the damaging annual and tapered annual allowance will the government stem the flow of doctors refusing additional work or considering leaving the profession.’

BMA pensions committee chair Paul Youngs says more action is needed on pension tax

‘The committee believes more must be done to communicate that hospitals are not always the best, most suitable option. This will reduce unnecessary calls to the GP, out-of-hours service and A&E, and help reduce costs and pressures on the acute service.’

Lewis Macdonald, convenor of the Scottish Parliament Health and Sport Committee, says hospitals can have a negative impact on patients’ health

Simon Stevens‘The UK has the second highest prevalence of cystic fibrosis of any country in the world, so [this] is an important and long hoped for moment for children and adults living with cystic fibrosis. That also means any drug company wanting to succeed commercially in this field needs to work constructively with the NHS.’

NHS chief executive Simon Stevens celebrates a deal to bring cystic fibrosis drugs to NHS patients in England

Darren Hughes
‘Once again, we’ve seen exceptional demand on NHS services in Wales. It is clear the demand we traditionally experienced over the winter months is now all year round.’

Darren Hughes, director of the Welsh NHS Confederation, says demand is rising and that service transformation is needed