Raiding the piggy banks

The King’s Fund’s report into the progress of the implementation of the Five Year Forward View has hit some raw nerves. Stephen Dalton, Chief Executive of the NHS Confederation, said:

“This report shows long-term plans for improvement are being put on the back burner because of short-term funding issues arising from a health and care system which is stretched to breaking point. We understand the need to ensure services have enough money today but the tactic adopted is to effectively raid resources which were meant to enable change and ensure we develop a 21st century NHS offer. If we are to have a sustainable NHS and care system, the government needs to urgently invest in social care, halt planned cuts to public health, get serious about preventing ill health and kickstart an honest, open public conversation about what needs to change if the next generation is to carry on benefitting from the high quality health care we have today.” We can only agree.

A Conservative critique

A new report on the NHS from UK 2020 a think tank established by Rt Hon Owen Paterson MP to produce a conservative policy platform for the General Election of 2020. Argues that despite improvements since the early 2000s, the NHS is still lagging behind the health systems of most comparable countries on most health outcome measures for which robust data is available.

The report goes on to say that the NHS has relatively low survival rates for the common types of cancer, although it does better on some of the rarer ones. The same claim is made for measures of ‘amenable mortality’, an indicator which captures unnecessary deaths across the healthcare spectrum. Long waiting times are still a problem, even if this one that the UK shares with a number of other countries. The uptake and diffusion of medical innovation is relatively slow. The NHS does guarantee universal access to healthcare, but so do all healthcare systems in the developed world, with the exception of US system. Healthcare spending is lower than in some of the neighbour countries, but this does not indicate superior efficiency. In more sophisticated estimates of health system efficiency, the NHS is, once again, inferior to most other countries.

A further report is promised on what the NHS can learn from other countries. NfN moles are placing their bets on compulsory health insurance being the offering.

Did somebody say market failure?

On October 19th the Health Services Journal reported that private company Ramsay Health Care UK had pulled out of a project with Cambridge University Hospitals Foundation Trust in which it had been appointed to run a 90 bed private hospital as part of a complex including a hotel, conference centre and a medical education centre. The company took the decision to pull out shortly after the EU referendum on 23 June.  This blow to a flagship NHS infrastructure project comes as capital funding for the NHS is in desperately short supply. The Cambridge project has been seen by some as a potential model for new infrastructure development elsewhere.

An anonymous commentator in the HSJ said in response:

“What is it about the Cambridge, rather than Cambridgeshire, system where it has to be the test bed for most new health concepts and then see them fail. The PCT were at the forefront of mergers when it took on Peterborough, the local commissioning group CATCH were the forerunner of the CCG model with the architect as their local MP, the failed Older Peoples tender was the first to attempt outcome based commissioning using capitated budgets and now this. What next?”

Answers in an email to ‘info at HealthMatters dot org dot uk’ please.

Therapy automation

A new study has highlighted the scope of computerised cognitive behavioural therapy (CBT) tools available worldwide and outlined their impact on people with mental health needs.

The study from RAND Europe, commissioned by the education and social service company Ingeus, showed that computerised cognitive behavioural therapy tools, which are online platforms or mobile applications to help tackle common mental health illnesses such as depression, anxiety or insomnia, have grown significantly in the past two years. These tools are available in a number of countries, including Australia, China, Denmark, Ireland, Japan, Norway, Spain, Sweden, the Netherlands, the UK, and the U.S.Cognitive behavioural therapy is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel.

Computerised cognitive behavioural therapy tools aim to address a variety of mental health conditions, with the study finding that these largely had a positive impact on users. It also found that condition-specific tools could reduce the symptoms of other conditions. For example, a tool to help those with insomnia could simultaneously reduce symptoms of depression. Despite the overall positive impact, the study revealed that some groups with mental health needs are less likely to participate in treatment (or trials) of computerised cognitive behavioural therapy tools than others. For example, the average user was a woman in her late 30s with a university degree and in full-time employment. However, computerised cognitive behavioural therapy tools specifically focused on people with depression had a more equal proportion of male and female participants, while those specifically for people with anxiety disorders had somewhat younger and less-well-educated participants. News from Nowhere asks: if these are the characteristics of the users, exactly what is the problem being solved?

To view the report visit Rand Europe.

Sellers’ market in general practice

The problems of accessibility and understaffing in general practice are not unique to Britain. The New Zealand Dominion Post reported on November 2 that up to 25% of people surveyed across the country had been unable to get a routine appointment with their usual medical centre (not their usual doctor, please note) within 24 hours. General practices in New Zealand are struggling to recruit new doctors and half of current GPs seem likely to retire in the next ten years. There is also the same tendency to work part-time as there is in Britain.

During the junior doctors strikes there was talk by some doctors in training of emigration to avoid the overbearing manner of the NHS and to take advantage of the better salaries and easier working conditions of health services in New Zealand and Australia. The New Zealand doctor shortage may well attract some disaffected British doctors, who might also be attracted to the different lifestyle. In a sellers’ market they could set their own terms.

But it is not that simple. The doctor shortages in New Zealand are least in trendy Auckland, the cultural centre of the country, and greatest in rural communities. In the countryside, notes the Dominion Post, doctors face geographical isolation, less peer support, longer working hours (including out of hours work) and encounter a wider range of clinical problems than their urban peers. If British doctors only want the easier jobs they compete with themselves in New Zealand, and the labour market could turn towards the buyer.