News / News review October 2014
For health and social care at least, the main event of the month was billed as the Barker Commission report. And it didn’t disappoint. While its conclusion – that health and social care services should have a single, ring-fenced budget with a single local commissioner – was trailed in its interim report, it marked a seismic change.
In its final report, the independent commission, chaired by Dame Kate Barker, called for a new settlement to provide a simpler pathway through the maze of health and social care entitlements. Social care should be free for those whose needs are defined as critical, with free or reduced charges offered to other patients as the economy picks up. It called for an increase in the combined health and social care spend to between 11% and 12% of GDP by 2025. The report, A new settlement for health and social care, backed a number of changes to benefits to help fund its proposals. These included reducing prescription charges but lowering the number of exempt prescriptions; limiting free TV licences and winter fuel payments; and requiring those working past state pension age to pay national insurance at 6%. New recipients of NHS continuing healthcare should pay for the cost of their accommodation to bring them in line with those receiving residential social care. And, to raise funds as the more generous elements of the settlement were phased in, national insurance should increase by 1% for the over-40s and by the same amount for those earning more than £42,000 a year. ?
Integration is very much the direction of travel for health and social care and bids to pilot a new integrated commissioning model were invited in September. NHS England, the Local Government Association, Think Local Act Personal and the Association of Directors of Adult Social Services published a joint prospectus inviting expressions of interest in integrated personal commissioning (IPC).
They said IPC would bring health and social care spending together at the level of the individual. The closing date for IPC applications is 7 November. They must be made jointly by at least one clinical commissioning group, local authority, and voluntary sector partner. ?
Monitor announced it is to send a team to Tameside Hospital NHS Trust to help build an integrated care organisation (ICO). This is the first time the NHS will try to form an ICO at a foundation trust. Monitor said the trust is clinically and financially unsustainable in its current form and local commissioners, clinicians and other stakeholders have agreed that services would be improved if the trust also offered public health, wellbeing and social care services. ?
Early in the month the media led with calls by home secretary Theresa May (right) to integrate the three emergency services. In a speech to the Reform think-tank, she said emergency ambulance, fire and police services should be integrated to deliver further savings. Few details were available – the idea was addressed in a few lines of a much wider speech on policing – but it was reported that the next Conservative government would examine the sharing of command centres and the merger of back office functions. ?
As often happens in the autumn, pay moves onto the agenda as evidence is laid before the pay review bodies. But this year’s pay season could be marked by industrial action after ?Unison members working in the NHS in England voted to take action in their dispute over pay. The union announced that in a ballot, 68% of members who voted said they would be willing to take part in strike action, while 88% said they would join action short of striking. The dispute is over the government decision not to implement the pay review body’s recommendation of a 1% rise for all agenda for change staff this year. ?The union announced five days of action, starting with a strike on 13 October for four hours from 7am to 11am. Other health unions are balloting members on industrial action.
The government has asked the NHS pay review body, which covers agenda for change staff, not to make a recommendation on pay for 2015/16 as the current year’s settlement will be repeated. Health minister Dan Poulter (below) asked the review body to focus on ensuring the pay system can deliver financially sustainable seven-day services in England. He urged it to make observations on the elements of agenda to change that prevented or facilitated financially sustainable seven-day services. The observations should focus on affordable out-of-hours working arrangements and any transitional arrangements needed, he added.
In a letter to the Senior Salaries Review Body, Dr Poulter said the government would not ask the body to make recommendations on very senior managers’ (VSM) pay for 2015/16. However, it is reviewing the VSM pay framework and hoped to have emerging findings available by the beginning of this month. Dr Poulter asked the review body to examine and comment on these findings.
NHS Employers has appointed Danny Mortimer its new chief executive. Mr Mortimer will join the organisation later this year from Nottingham University Hospitals NHS Trust, where he is director of workforce and strategy. ?
Chancellor George Osborne has announced he will make his annual autumn statement on 3 December. The Treasury said the latest forecasts from the Office for Budgetary Responsibility will be published alongside the statement. ?
Patients with metastatic pancreatic cancer in Wales will be the first in the UK to have access to Abraxane. Health and social services minister Mark Drakeford said the decision to make the drug available was recommended by the All Wales Medicines Strategy Group, which appraises medicines for use in the Welsh NHS.
The Nuffield Trust is to form the New Cavendish Group for small and medium-sized hospitals developing innovative approaches to their business and operating models. Founding members include the chief executives of Yeovil District Hospital, Dartford and Gravesham NHS Trust and Airedale NHS Foundation Trust.
In our last issue, we incorrectly said the 2013/14 accounts for Betsi Cadwaladr University Health Board had been qualified. We apologise for this and any confusion it may have caused.
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In the media The HFMA made regular appearances in the media last month, commenting on the latest figures on the NHS financial position in England and the association’s involvement in the 2015 challenge manifesto. HFMA policy and technical director Paul Briddock was quoted widely in stories on the year-to-date and forecast deficits in foundation and NHS trusts. He told daily papers including The Telegraph and The Times, as well as the HSJ, that the NHS could not afford to carry on providing services in the same way. While the figures were no surprise, given what HFMA members had told the association, the cumulative effect of year-on-year real-terms budget cuts, increased demand and the cost of quality improvements meant providers would struggle. ‘An honest and open debate is required with action on what the NHS can and cannot afford to provide,’ he said. The HFMA and 20 other organisations signed up to the 2015 challenge manifesto – priorities for the next government, including long-term funding settlements and a non-recurrent transitional fund of at least £2bn for two years. The manifesto received lots of coverage. On its launch, Mr Briddock was quoted in HSJ online saying the aim was to highlight the challenges facing the NHS and social care and the need for open debate between the public and politicians. |
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The month in quotes ‘Our system is not fit to provide the kind of care we need and want. We propose radical change, greater than any since 1948, that would bring immense benefit to people who fall into the cracks between means-tested social care and a free NHS’ Kate Barker, King’s Fund ‘Changes in medicine have led to a significant centralisation of services, but it’s becoming clear that there is potential for smaller hospitals to reinvent themselves to adapt to the particular circumstances of their own populations. Much of the really exciting innovation is already happening at a very local level – from bringing family doctors into hospitals, to using telemedicine to support prisons and nursing homes’ Nuffield Trust chief executive Nigel Edwards explains why it has formed a new group for small and medium hospitals ‘‘We know health workers don’t take strike action lightly or often. The last action over pay was 32 years ago. But we also know a demoralised and demotivated workforce isn’t good for patients’ ‘Tameside Hospital is facing serious challenges with providing acceptable levels of care to patients and with its finances. This is an innovative approach and the team will work with patients, staff and other interested parties to work out how to protect and improve patient services in the long term’ Frances Shattock, Monitor regional director, on the plan to develop an integrated care organisation at Tameside Hospital NHS FT |
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