The healthmatters blog; commentary, observation and review
Responding to a report published today by the Commonwealth Fund, which judged the NHS as the best, safest and most affordable healthcare system out of 11 countries analysed, BMA council chair, Dr Chaand Nagpaul, said:
“This report provides clear evidence that the NHS is one of the top-performing healthcare systems in the world, and the most cost-effective in this study.
“We need to make sure our NHS is protected, invested in and maintained, especially as a combination of rising patient demand, staff shortages and falling funding is seeing the health service reach breaking point. These pressures may be a factor in why the NHS has scored lower in the report’s comparison of health outcomes. However, the study also shows the UK to be one of the worst funded health systems. It is unfortunate that funding for public health and social care has been drastically cut, with large chunks of funding set aside for “sustainability and transformation” in England being used to plug holes in hospital finances, and with local decision makers being told to find billions of pounds of efficiency savings.
“To ensure we stay at the top, as well as improve health outcomes, the NHS needs an end to the short-termism that has plagued the delivery of health care for too long and the government to agree a long-term, credible plan to deliver the fully funded and supported NHS that staff want and patients deserve.”
- The report can be found here.
Responding to the publication today of NHS Resolution’s Annual report and accounts 2016/17, which shows the cost of clinical negligence claims increasing by 14%, Niall Dickson, chief executive of the NHS Confederation, which represents health service organisations in England, Wales and Northern Ireland, said:
“We cannot go on like this with the NHS spending more and more on litigation. We now have fewer claims but we are paying more to claimant’s lawyers in legal fees – that went up 19% last year to nearly £500 million.
“What is more the decision by the last Lord Chancellor to change the way compensation claims are calculated is about to make the costs even higher.
“The Office for Budget Responsibility has estimated that this decision alone will cost the public sector an extra £1.2bn a year. According to one report, as a result an NHS trust saw the cost of one claim go from under £4 million to more than £9 million.
“It seems madness that we are now paying out sums greater than almost any other country in the world, when we have a universal, government funded system of healthcare.”
The total bill for agency staff within NHS trusts in England decreased by £700m in 2016/17 from £3.64bn to £2.86bn, representing a 20% reduction.
Hourly pay rates across all grades of locum staff in the NHS fell during 2016/17, as rate caps introduced by NHS Improvement (NHSI) and more stringent workforce management began to curb the spiralling cost of temporary staff. Commission rates simultaneously continued to fall.
The biggest reduction in pay rates was seen among Consultants, who make up 40% of all locum spend, as average rates fell by 2.3% to £91.89 an hour.
Despite a reduction in both average rates and the total cost to the NHS, the annual cost remained £3.3m in 2016/17 for the top ten highest earning locums. If these locums’ pay rates were limited to within the price caps, the annual saving would be £888,197, the equivalent of almost 1,500 Core Consultant shifts.
The findings are in the fourth annual ‘Taking the Temperature’ report produced by Liaison, the organisation which provides financial and workforce services to two thirds of the NHS, and benchmarks the last financial year (2016/17) with the previous findings. It is the largest review of NHS spending on medical locums carried out.
The report analyses pay and commission by grade and specialty across 61 trusts and boards that Liaison supports with its workforce services, and compares results by size, type, region and agency.
The trusts and boards researched in the report booked over 6,000 locums for a combined total of more than 2.3 million hours and paid out £160m in pay and commission during the year.
Pay and commission rates have shown significant variation regionally, with a difference of £21.44 per hour between the most and least expensive regions across all grades and specialties. At £50.49 per hour, average pay rates continue to be lowest in London, compared with £69.78 in South Central, which shows the highest rates despite a £3.04 decrease on 2015/16 figures.
Unfilled substantive vacancies were the cause of 86% of hours booked in 2016/17, an increase of 20% over two years. Bookings due to sickness and service pressure have fallen by 2.1% since 2015/16, indicating trusts and boards are introducing better workforce planning practices, but are continuing to suffer from a lack of supply, especially in specialist roles, which was the cause of 51% of escalated rates in 2016/17.
Andrew Armitage, Managing Director of Liaison, said:
“It’s been a year of positive change for our clients. We have seen significant signs of progress as the rates introduced in 2015 and agency expenditure ceilings set out in 2016 begin to make a real impact in reducing the cost of temporary staff to the NHS. The lower overall bill, reduced pay rates and a reduction in commission across most staffing grades represent a real breakthrough and emphasise the fact we are seeing significant issues being addressed.
“In addition to the impact of NHSI measures, we are also seeing an increasing appetite for more collaborative working from our clients, to understand their agency spend and share best practice on how to reduce it.
“We know the NHS faces an ongoing battle and there is clearly still work to be done with a supply shortage continuing to force the hand of trusts and boards in regards to some specialist locums, but where there is scope for improvement, progress is being made and we will hopefully see this trend continue in 2017/18.”
Among the report’s key findings:
- Average hourly pay rates decreased most notably for Consultants, by £2.19 per hour.
- Commission, as a percentage of the total pay and commission bill dropped from 11.27% in 2013/14 to 9.77%.
- Some trusts are paying almost three and a half times the £55 wage rate for Consultants in General Medicine, at highest rates of £187 per hour.
- Bookings due to substantive vacancies have increased 20% between 2014/15 and 2016/17.
- Across the top ten highest earning locums, the annual cost to the NHS was £3.3m for the equivalent of 17 Whole Time Equivalents (WTE). If rate caps were enforced for these Consultants, the annual saving to the NHS could be £880,000 a year.
- Overall average pay rates increased in six out of 11 regions, most significantly in the West Midlands where hourly rates increased by £2.89. At £50.49 per hour, average pay rates in London remain the lowest, showing a decrease of £0.76 since 2015/16.
- Overall pay rates paid by South Central trusts remain the highest in the country, despite showing a demonstrable improvement of a £3.04 reduction on 2015/16.
- Commission rates vary by 38% regionally. Overall commission rates decreased the most in London where – at £6.22 per hour – rates are now the lowest in the UK.
Liaison works with NHS trusts and boards to give more control over temporary staff spending, directly addressing each of the key issues faced, including, maximum hourly rates for agency staff, ensuring trusts are only engaging with framework agencies and highlighting maverick buying that can be flagged and challenged.
By encouraging further collaboration between trusts and boards, Liaison helps to keep locums working within the system rather than them relying on costly third parties for staffing requirements. It is estimated that around 60-70% of medical locums are already employed elsewhere within the NHS, meaning such cooperation can have a significant impact in reducing costs.
The data in this ‘Taking the Temperature’ report is derived from Liaison’s direct engagement service, part of its STAFFflow and TempRE offering that comprises a range of services helping trusts and boards control their agency staff spending. Over 20% of all NHS trusts and boards in England and Wales are using Liaison’s services to help them to better manage their temporary staffing costs.
Liaison’s independent support provides NHS trusts and boards with a technology enabled service that offers transparency, guidelines and benchmarking to help them track performance, identify areas of necessary improvement and enable significant movement towards control of agency staffing spend. Prior to Liaison’s contribution, trusts and boards often lacked the power to check, challenge and change rates at the point of booking. The information they receive on their temporary staff usage helps them manage this spend more effectively by building their own bank, negotiating discounts and eradicating invoice errors.
The 2016/17 annual ‘Taking the Temperature’ report can be downloaded here: http://liaison.co.uk/taking-temperature-annual-report-201617.
Intergenerational Mental Health Conference – how a whole-family approach can improve children’s health and wellbeing
Join professionals, academics and families at the 1st Annual UK Maternal Mental Health Alliance Conference this September.
Join practitioners, service users and academics to explore how a whole-family approach can break the intergenerational cycle of mental health problems at the first annual Maternal Mental Health Alliance conference: Intergenerational Mental Health: working with mums and babies in perinatal mental health practice on 13 September 2017 at Imperial College, London.
Special rates available for students and not-for-profits, book your ticket here.
The conference will highlight ground-breaking academic research, showcase innovative practice, and tell the stories of perinatal mental health service users across the UK, including:
- the relationship between maternal mental health and parent-infant relationships
- trauma-focused care and taking an intergenerational perspective
- using evidence-based psychological approaches in your practice – such as videofeedback and mentalisation
- working holistically with families experiencing domestic abuse
- assessing psychosocial risk and resilience in complex cases
Speakers include international experts:
- Susie Orbach, author, journalist and psychotherapist
- Mark Hanson, Director of the Institute of Developmental Sciences and British Heart Foundation Professor of Cardiovascular Science at the University of Southampton.
- Shiela Redfern, Consultant Clinical Psychologist and Head of Clinical Services, Anna Freud National Centre for Children and Families
- Louise Howard, Head of Women’s Mental Health, King’s College London & Consultant Perinatal Psychiatrist
- Claudia Buss, Professor of Medical Psychology, Charité University Medicine Berlin
- Carmine Pariante, Professor of Biological Psychiatry, King’s College London & Consultant Perinatal Psychiatrist
If you have practice or project to share, we’d love to hear from you. Submit a poster on your service, project or new idea here.
Is there something that inspires you? Nominate a project or service for one of the first ever perinatal mental health awards here. Deadline: 31 July 2017.
Responding to King’s Fund analysis which has found central government cuts have forced councils to reduce planned spending on public health services by £85 million, Niall Dickson, chief executive of the NHS Confederation, which represents health service organisations in England, Wales and Northern Ireland, said:
“The government’s whole approach to reforming health care has been based on the promise of a radical upgrade in prevention and public health, yet all we have seen is cut after cut in this budget. It is self defeating to reduce public health spending while looking to transform care.
“Our members report direct cuts to front-line services, including the treatment of substance misuse, smoking cessation and sexual health. Further gaps in out-of-hospital and social care funding intensifies the pressures on health services.”
A new report suggests that a more strategic role for ‘traditional’ community hospitals might be timely within the NHS in England.
According to research by RAND Europe, the European Observatory on Health Systems and Policies, and Bournemouth University, community hospitals could play a more active role in meeting the challenges facing the NHS, in particular in larger hospitals. This includes easing pressures on A&E and servicing people with long-term conditions. Currently 15 million people in England have a long-term condition, which takes up 50 per cent of GP visits, 70 per cent of the days patients spend in hospitals and 70 per cent of the overall NHS budget.
The study, funded by the National Institute for Health Research (NIHR), is against the background of an increased focus on shifting services closer to people’s homes and delivering more integrated care locally. However, there is no defined role for community hospitals in the English health service, with many largely responding to the needs of larger hospitals. At present, there are around 300 community hospitals in England, 219 of which have beds. A number of community hospitals have faced closure during the past ten years, and some still face uncertain futures.
The study highlights a number of lessons for NHS England on how to incorporate community hospitals into the English health system based on comparable models in five other countries – Norway, Finland, Italy, Australia and Scotland.
The report notes that community hospitals are able to provide a wide range of services, covering the entire spectrum of care provision, from preventative and primary care, through to inpatient and outpatient medical and surgical care. It highlights evidence of improved patient experience and satisfaction associated with community hospitals, while staff valued key aspects of the service, including its ease of access and sense of ‘homeliness.’
However, the often remote location of community hospitals means it can be difficult to attract and retain staff, and maintain a diverse employee skill-set. Infrastructure and IT can also be a challenge, particularly where community hospitals are seeking to deliver integrated care. In addition, the cost-effectiveness of community hospitals is not clear, and the current evidence base remains limited.
The full report is available here: https://www.journalslibrary.nihr.ac.uk/hsdr/hsdr05190/#/abstract
“The social care shortfall is edging ever closer to a full blown crisis” – Nick Sanderson, CEO of Audley Retirement comments on Care Quality Commission report
Nick Sanderson, CEO, Audley Retirement Villages said:
“The social care shortfall is edging ever closer to a full blown crisis and we now find ourselves in a situation where underfunding is at such a critical point, the quality of care itself is falling. More than ever people are having to watch their loved ones experience an appalling quality of care; just further evidence that existing care practices are both undesirable and deeply flawed.
“There may be no ‘one answer’ on how we deal with the creaking care system, but we do know that high quality housing options with flexible care available is a model that works. No matter what their age or care needs, people clearly prefer to be at home as they age, rather than in a nursing or care home. If there were more options which allowed older people to continue to live in their own homes, but bring in support where needed, it would go a long way to improving quality of life. It’s certainly no quick fix, but we need to stop wringing our hands and ignoring the benefits that high quality retirement property delivers.”
NHS Prescription Charges Stop Patients Receiving Life-Changing Medication
The National Rheumatoid Arthritis Society (NRAS) today releases four shocking statistics to highlight how the cost of an NHS prescription in England is impacting on the lives, health and wellbeing of people living with Rheumatoid Arthritis (RA), following a report released by the Prescription Charges Coalition.
1. Nearly a third (31%) of people with RA who have been issued a prescription from their GP have not collected it due to the cost. This means one in three people with RA do not take their medicine as prescribed.
2. Three quarters of those surveyed are not aware of the NHS Low Income Scheme (76%) and therefore many people are paying for their medication when they are entitled to free prescriptions.
3. Half of the people surveyed with RA do not have a Prescription Prepayment Certificate – because they feel it is not worth obtaining one, or it will be too expensive for a fluctuating condition.
4. Over half (55%) of people that missed medications due to the cost, claim that by not taking some of their medication, it has a direct and noticeably negative impact on their health.
Ailsa Bosworth, CEO at NRAS commented: “RA is a debilitating, frightening and potentially life-limiting condition. The fact that so many people living with this disease are failing to get the help their GPs prescribe in terms of medication is a travesty. Everyone, regardless of their medical condition, should receive the medication they need to manage their health and improve their daily life.”
People with RA, their families, friends and colleagues can contact the NRAS helpline for advice on any of the above issues – free-phone 0800 298 7650 or email firstname.lastname@example.org.
Healthcare innovators are being invited to submit their ideas for a prestigious annual competition recognising innovation and excellence in healthcare.
Now in its 14th year, the Bright Ideas in Health Awards encourage, celebrate and reward the outstanding innovation and excellence emerging from front line NHS staff and SMEs in the North East and North Cumbria.
Highlighting the NHS staff and healthcare SMEs working to improve patient care throughout the region, this year’s hopeful healthcare pioneers are being encouraged to submit their inventions and innovative ideas as the contest opens for entries.
Dr Nicola Wesley, Director of Innovation at the Academic Health Science Network for the North East and North Cumbria (AHSN NENC), said: “Over the past 14 years the Bright Ideas in Health Awards have grown to become one of the most highly sought after accolades in the region’s healthcare sector.
“The awards showcase the outstanding examples of practice and innovation achievements of frontline staff and budding entrepreneurs that help to improve patient care, like no other event.
“For winners, the recognition gives a huge boost to their teams and organisations. It enhances their projects, raises morale and can help to secure backing and finance.”
The event is organised by RTC North in partnership with the Academic Health Science Network for the North East and North Cumbria (AHSN) and the NIHR Clinical Research Network North East and North Cumbria.
This year there are seven categories: Innovative Technology or Device, Service Improvement, Patient Safety and Quality Improvement, Outstanding Industry Collaboration with the NHS, Primary and Community Care, Research Delivery Impact, sponsored by NIHR Clinical Research Network North East and North Cumbria and Most Innovative NHS Education Provider, sponsored by Health Education England North East.
The winners of each category will receive a cash prize to help progress their ideas as well as specialist support from organisers RTC North, the AHSN NENC and the Clinical Research Network NENC.
Last year’s ceremony saw success for a range of pioneering ideas including an improved IVF egg collection procedure to save both clinician and embryologist time and a fixation device for use in ophthalmic imaging.
One of the winners of the Patient and Public Involvement Award was a project aimed at empowering GP practice patients to become ‘Practice Champions’.
Sheinaz Stansfield, Practice Manager at Oxford Terrace and Rawling Road Medical Group in Gateshead, was part of the team from NHS Newcastle Gateshead Clinical Commissioning Group that led the ‘Practice Champions’ project, which won the Patient and Public Involvement – Making Research Better award.
The team developed 39 patients as ‘Practice Champions’ who have been trained to support the GP practice, other patients and the broader community, with the aim of taking a population health and wellbeing approach to the provision of GP services.
Sheinaz said: “Winning a Bright Ideas in Health Award for the Practice Champions initiative has been a fantastic accolade for our team. The prize money has helped to fund a full year’s group work and events allowing us to build on the programme, improving services for our practice population.
“Going forward new relationships with patients and communities will have to be developed to address future challenges. The work within our practice at Oxford Terrace Medical Group has gone beyond this to enable patients and communities to work in a ‘liminal space’ understanding both perspectives to work collaboratively to address health inequalities and focus on a patient centered approach to wellbeing.”
Julia Newton, Medical Director of the AHSN NENC, said: “The awards are not only an accolade in their own right but play a key role in making the region’s healthcare industry the great success it is today.
“With the support of our sponsors, we are honoured to once again be able to celebrate the achievements of hardworking people who focus their time and efforts on striving to improve care for their patients.
“I’d encourage anyone with a great idea – whether it’s a groundbreaking piece of technology or a better way of delivering a service – to enter the competition. You could be crowned one of our winners.”
This year’s Awards ceremony, which is sponsored by Health Education England-North East, Sintons, Archer IP, University of Teesside and NHS Newcastle Gateshead CCG, South Tees Hospitals NHS Foundation Trust, City Hospitals Sunderland NHS Foundation Trust and supported by the Emerging Electronics Manufacturing Centre, CPI, will take place at the Hilton Hotel Newcastle Gateshead on Wednesday November 15th.
The closing date for entries is Monday September 11th, 2017. To submit entries, visit:
- Workers in excellent health are more aware of the need to plan financially for retirement
- Only 35% of people in the UK take their health seriously by establishing good habits
- Only 40% consider their long-term health when making lifestyle choices
A global study looking at people’s outlook for retirement revealed that a successful and enjoyable retirement requires a focus on both good financial habits and a healthy lifestyle. The research carried out in countries spanning Europe, the Americas, Asia and Australia, highlights that achieving retirement aspirations requires more than saving, investing and planning, it also depends on staying in good health. Workers around the world share aspirations for an active retirement but relatively few are taking steps to safeguard their health or prepare financially. One of the key findings globally is that there is an alarming disconnect between people’s good intentions and their actions, according to recent research from Aegon.
Many people believe that they are in excellent or good health today, but are they taking sufficient action to help ensure they can stay healthy as they age? When it comes to older age, 82% of people in the UK say they have some concerns about their future health, but there’s a real gulf between their concerns and current behaviours, with surprisingly few taking adequate steps to safeguard their health:
- Only 35% of people currently take their health seriously by carrying out regular self-checks or having routine medical check-ups
- Only two fifths (40%) consider their long-term health when making lifestyle choices, for example, trying to avoid stress
- Alarmingly 46% don’t exercise regularly and 44% expose themselves to harmful behaviours like drinking too much or smoking
Retirement has become an active stage of life, which people associate with staying socially connected, participating in their local community and for a growing number, keeping working. Maintaining good health is an essential pillar for each of these activities.
In the UK, the majority (75%) of people associate positive words with retirement. The most widely held retirement aspirations are, travelling (55%), followed closely by spending time with friends and family (52%) and pursuing new hobbies (41%). A noteworthy 28% of people in the UK mention a desire to work in some capacity in retirement.
The survey also reveals that workers who are in excellent or good health have a more positive financial outlook about their future retirement compared with those in fair or poor health. Those in excellent health (46%) are over three times more likely to be confident of achieving a financially comfortable retirement than those in fair health (13%).
Steven Cameron, Pensions Director at Aegon said:
“Finding ways to develop good savings habits and to maintain a healthy lifestyle from an early age are key factors for a successful retirement. Those who adopt multiple healthy activities are also more likely to be financially prepared for retirement than those who don’t.
“Retirement planning has traditionally focused very heavily on finances, without sufficient consideration of health. A successful retirement requires maintaining good health and being financially secure. However, many people are failing to prepare in ways that can increase their likelihood of success.
“Health has the potential to have major impacts on people’s retirement plans. For example when taking the decision about when to stop working and enter retirement the timing is often dictated by health factors. And while we all aspire to a long and healthy retirement, this may involve saving more to make the most of these years.”