The healthmatters blog; commentary, observation and review
Commissioning adult social care services through personal budgets and direct payments is an important way of giving care users more choice and control over their services. When implemented well they improve users’ quality of life. The Department of Health, however, requires a deeper understanding of the best ways to implement personalised commissioning, according to the National Audit Office.
Local authorities spent £6.3 billion on long-term community care in 2014-15. Around 500,000 adults in England received personal budgets in 2014-15, varying between 10% and 100% of users across authorities. The Care Act made personal budgets mandatory for all eligible users from April 2015. Much of the positive evidence for personalising commissioning, however, is old or relates to subgroups of users. The NAO believes there is a strong case for better use of existing surveys and evidence gathering, so the Department and its national partners understand the relationship between the different ways to commission personalised services for users, and improvements in user outcomes. The Department is extending personal budgets in healthcare and has an ambition that between 50,000 and 100,000 people will have a personal health budget by 2020.
The NAO found that some authorities have transformed their care and support processes to ration their resources fairly, share information about a broad range of local services, and monitor and manage spending on personal budgets efficiently, while others are finding personalising commissioning a challenge as they seek to save money, and are constrained in how they can personalise care by the need to reduce overall spending.
There are circumstances under which personalised commissioning can reduce the costs of care. For example, around 120,000 users with direct payments employ personal assistants to provide personal care, which is generally a cheaper option than homecare. The Care Act guidance, however, acknowledges that responding to users’ needs and their desired outcomes can increase the cost of care. The NAO also found that some authorities are struggling to manage and support their local care markets as well as we would expect of a well-functioning public service market.
The Department expects the value-for-money of personalised commissioning to come from improved outcomes for users, not necessarily from savings, which differs from local authorities’ expectations that savings can be made by personalising care. The Department’s monitoring regime does not enable it to fully understand how personal budgets and direct payments improve outcomes. In addition, the Department has not investigated how services can be personalised when money is tight. It is not clear whether local authorities will achieve the spending reductions they have forecast without putting user outcomes at risk.
Amyas Morse, head of the National Audit Office, said today:
“Giving users more choice and control over their care through personal budgets and direct payments can improve their quality of life, but much of the positive evidence for personalised commissioning of adult care services is old.
“The Department now needs to gain a better understanding of the different ways to commission personalised services for users, and how these lead to improvements in user outcomes.”
- 500,000 – approximate number of adults in England whose social care services were paid for through local authority personal budgets in 2014-15
- £6.3bn – spending by local authorities on long-term social care for adults in the community, 2014-15
- 7% – eal-terms reduction in spend on adult social care by local authorities between 2010-11 and 2014-15
|88%||median proportion of users with personal budgets per local authority in 2014-15|
|22%||median proportion of users with direct payments per local authority in 2014-15|
|84%||proportion of local authority directors of adult social services who report that increasing personalisation is a high (43%) or medium (41%) priority area for savings in 2016-17|
|£0||amount that the Department of Health expects to save from personalisation|
|26%||proportion of long-term social care users who said it was difficult to find information about support in 2014-15|
Social care is on its knees, according to recent public satisfaction reports . The Good Care Guide’s latest evaluation of reviews states that home care services are in a ‘dire state’. It cites short visits and ‘missed and late appointments’ by many staff looking after vulnerable older people as the cause for plummeting levels of satisfaction. Social care is a big industry. The UK Home Care Association estimates that nearly 900,000 people received home care in 2013/14 – a number that is set to rise as the number of older people living alone increases. According to the latest Laing and Buisson survey, there are 426,000 elderly and disabled people in residential care (including nursing), approximately 405,000 of whom are aged 65+.
A unique new app may provide the answer to a transformational uplift in quality and efficiency of care. Launched by everyLIFE Technologies, ‘openPASS’ (patent pending) is an app that enables a person’s up-to-date care record to be viewed in real time in their home or remotely. This can be done at any time, via a smart phone or tablet, by all the people involved in their care, including health professionals and their families. This is an important first step in uniting health and social care intelligently, providing up-to-date information on length of care visits, and missed and late appointments.
Which is what people want, according to new online YouGov research, commissioned by everyLIFE Technologies to mark the launch of openPASS. . Fieldwork was undertaken between 11 – 12 February 2016 and a survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18+). 2,083 adults were asked what would help them know a relative is safely cared for at home or in a residential care home:
- 70% said regular updates on their relatives’s care
- 68% said having one person (eg, one care worker) as the recognised point of contact for their relative’s care information
- 65% said having regular medicines reviews to ensure medicines are being taken correctly
- 61% said being able to view their relative’s social care plan and social care record whenever they wanted to
- Only half (50%) said having no time limits on appointments between their relative and carer
They were also asked who they thought should be able to view their relative’s social care record whenever they wish:
- 84% said their GP
- 74% said clinical hospital staff
- 61% said community nurses
- 60% said family members
- 58% said paramedics
Paul Barry, chief executive, everyLIFE Technologies said: “Everyone gets anxious when a family member needs social care, but what’s interesting is that being out of the loop concerns people more than short care visits. Now that most people have smart phones, a simple app like openPASS, which connects to a platform recording their relative’s or patient’s information in real time, means they can now see what’s going on at any time, wherever they are. Missed or late appointments can be noted immediately, giving greater control over a loved one’s care.”
Dr Michael Dixon OBE, a Devon GP, and chair of everyLIFE’s professional advisory group, said: “We talk endlessly about patient-centred care, but the reality is that we are far from delivering it. Records are not joined up, and people receiving care from different professionals find themselves giving the same information over and over again, which can be challenging for many elderly people. I believe openPASS will mark a step change in how we deliver care.
“For me, it’s about transparency and visibility. The ability for families and health professionals to view their relative’s or patient’s care records whenever they want is an obvious step forward to improving quality. It simply makes sense and often it’s the simplest steps that make the greatest difference.”
Professor Rob Darracott, chief executive, Pharmacy Voice, which represents community pharmacy, said: “‘openPASS is a great example of how technology can enhance patient care. Crucially, this technology pays as much attention to data security as it does to data sharing – providing the confidence needed to make this time-saving tool a success. By opening up patient data in a highly secure way, such as making social and summary care records available to community pharmacists, healthcare can be truly joined-up – while reducing red tape for clinicians. The role of openPASS in medicines management could also be crucial. There are many good reasons why older people may have to take a number of medicines concurrently, but it is neither good for them, nor for the wider NHS, if they are taking too many, especially if some are no longer effective, or if they are no longer taken as prescribed. openPASS has huge potential to stay on top of this.”
Paul Barry founded everyLIFE Technologies in 2015 based on his own experience of running a home care provider. “Balancing quality with efficiency was what kept me awake at night. My first challenge was the endless, time consuming paperwork, which took valuable time away from front line care and also meant unacceptable time delays in monitoring care, which is why we first developed a platform to record and monitor information in real time and why more than 200 home care agencies and 10 residential care homes are now actively using the PASSsystem. The second challenge was how to deliver consistent quality of care, and keep people’s families, and the health professionals involved in their care, fully up-to-date. openPASS, is our response to that.”
 Care of Elderly People Market Survey 2013/14, Laing and Buisson, 2014
The head of NHS England will today (Tuesday) announce plans to create ten NHS-supported ‘healthy new towns’ across the country, covering more than 76,000 new homes with potential capacity for approximately 170,000 residents.
Simon Stevens, Chief Executive, will use a speech to the Kings Fund in London to name the sites that form NHS England’s Healthy New Town programme, supported by Public Health England (PHE).The NHS will help shape the way these new sites develop, so as to test creative solutions for the health and care challenges of the 21st century, including obesity, dementia and community cohesion. NHS England is bringing together renowned clinicians, designers and technology experts to reimagine how healthcare can be delivered in these places, to showcase what’s possible by joining up design of the built environment with modern health and care services, and to deploy new models of technology-enabled primary care.
Mr Stevens says: “The much-needed push to kick start affordable housing across England creates a golden opportunity for the NHS to help promote health and keep people independent. As these new neighbourhoods and towns are built, we’ll kick ourselves if in ten years time we look back having missed the opportunity to ‘design out’ the obesogenic environment, and ‘design in’ health and wellbeing. We want children to have have places where they want to play with friends and can safely walk or cycle to school – rather than just exercising their fingers on video games. We want to see neighbourhoods and adaptable home designs that make it easier for older people to continue to live independently wherever possible. And we want new ways of providing new types of digitally-enabled local health services that share physical infrastructure and staff with schools and community groups.”
Expressions of interest in the Healthy New Towns programme were invited last summer, and attracted 114 applications from local authorities, housing associations, NHS organisations and housing developers, far exceeding expectations. After a rigorous selection process and presentations from the shortlisted projects, the first ten sites have now been chosen:
- Whitehill and Bordon, Hampshire – 3,350 new homes on a former army barracks. A new
care campus will co-locate ‘care-ready homes’ specially designed to be adaptable to the
needs of people with long term conditions with a nurse-led treatment centre, pharmacy and
integrated care hub.
- Cranbrook, Devon – 8,000 new residential units. Data suggests that Cranbrook has three times the national average of 0-4 year olds and will look at how prevention and healthy
lifestyles can be taught in schools from a young age.
- Darlington – 2,500 residential units across three linked sites in the Eastern Growth Zone. Darlington is developing a ‘virtual care home’ offer where a group of homes with shared facilities are configured to link directly into a digital care hub, avoiding institutionalisation in nursing homes.
- Barking Riverside – 10,800 residential units on London’s largest brownfield site.
- Whyndyke Farm in Fylde, Lancashire – 1,400 residential units.
- Halton Lea, Runcorn – 800 residential units.
- Bicester, Oxon – 393 houses in the Elmsbrook project, part of 1300 new homes planned.
- Northstowe, Cambridgeshire – 10,000 homes on former military land.
- Ebbsfleet Garden City, Kent – up to 15,000 new homes in the first garden city for 100 years.
- Barton Park, Oxford – 885 residential units.
Options to be tested at some of these sites include fast food-free zones near schools, designing safe and appealing green spaces, building dementia-friendly streets and ensuring people can access new GP services using digital technology.
The developments will reflect the needs of their local populations when working up their plans. Design questions being asked include: Why are children happy to walk all day round a theme park but often get bored on every-day journeys? Could adventure areas be designed into streets to encourage walking and play? And for the ageing population, how far away are we from a town where more older people live independently and safely in their own home, backed by better technology and social support? Mr Stevens will point to facts showing that:
- Britain loses over 130 million working days to ill-health each year.
- 19 per cent of children aged 10-11 were obese and a further 14 per cent were overweight in 2014/15.
- The figures for 4-5 year olds were 9 per cent obese and 13 per cent overweight. In other words, the proportion of children who are obese doubles during primary school – from one in ten five year olds, to one in five eleven year olds.
- Today only 21 per cent of children play outdoors, compared to 71 per cent of their
parents when they were children, Design Council figures show.
- A Design Council guide also estimates that a quarter of British adults now walk for less than nine minutes a day.
- Physical inactivity is a direct factor in 1 in 6 deaths, and has an overall economic impact of £7.4 billion.
The Building Research Establishment has published a report on the cost of poor quality housing to the NHS. It estimates that the 3.5m homes in England that have serious hazards such as damp and pests has led to health problems that cost the NHS at least £1.4bn every year.
Professor Kevin Fenton, National Director for Health and Wellbeing at Public Health England said: “Some of the UK’s most pressing health challenges – such as obesity, mental health issues, physical inactivity and the needs of an ageing population – can all be influenced by the quality of our built and natural environment. The considerate design of spaces and places is critical to promote good health.
This innovative programme will inform our thinking and planning of everyday environments to improve health for generations to come. “PHE is proud to have played an active role in the development of the Healthy New Towns programme and we will continue to support the delivery of high quality, healthy environments.”
The 2015 NHS Staff Survey, published on February 23rd 2016 by NHS England and the Picker Institute, is the largest ever collection of feedback about what it is like to work in the NHS in England. With nearly 300,000 responses, the survey provides very reliable evidence both nationally and for 297 participating organisations and shows that:
Overall staff engagement has improved continuously over the last five years. The majority of staff (69%) agreed or strongly agreed that they would be happy with the standard of care their organisation provided if a friend or relative needed treatment. Most staff (80%) agree that they are “able to do [their] job to a standard [they are] personally pleased with”. Many staff feel under pressure: only 31% agree that there are enough staff at their organisations to enable them to do their jobs properly, and 37% reported feeling unwell due to work related stress in the last year. As in previous years, results for ambulance trusts were typically much poorer than for other organisation types
Commenting on the results, Chris Graham, the Picker Institute’s Director of Research & Policy and chief investigator for the survey, said: “The results of the NHS Staff Survey provide unparalleled insight into the experiences of staff working in the NHS in England. Today’s publication shows welcome improvements in some key measures of staff experience, including overall engagement and staff willingness to recommend their organisations. These improvements represent continuation of a general upward trend and are very encouraging.
Despite the positive messages about staff engagement, the survey also shows evidence that staff across the NHS are struggling with the pressures facing them. Too many staff complain about inadequate resources, staffing shortages, and the deleterious impact of their work on their own health and wellbeing. Furthermore, results show considerable variation across and within different types of organisation.
We call on all employers to closely review their results and take action to ensure staff are supported and listened to. After all, staff wellbeing is not only important in and of itself, but it is also an essential driver of productivity and patient experience: staff experience cannot and must not be ignored.”
The HSJ highlighted some further points:
The results of the 2015 poll, carried out from September to December, show working extra hours has reached a peak. Almost three quarters of NHS staff, 73 per cent, said they work extra hours, up from its lowest level of 64 per cent in 2011.
The percentage of staff seeing potentially harmful errors, near misses or incidents in the last month was at its lowest level for five years at 29 per cent compared with 33 per cent in 2011.
A quarter of staff reported experiencing harassment, bullying or abuse from colleagues in the last 12 months, an increase of 1 per cent from 2014. However, the survey also revealed significant under-reporting, with the number of staff reporting the most recent incident of bullying dropping by 3 per cent to 38 per cent.
Danny Mortimer, Chief Executive of the NHS Employers organisation, added:
“The annual survey reflects the commitment of NHS staff to deliver excellent patient care amidst immense pressure and challenges facing the health service. I am pleased to see progress in areas such as staff engagement and confidence in raising concerns. The survey also highlights however, areas where more action must be taken, such as work pressure on staff and poor behaviour, including bullying.
“The variation in staff experience across the NHS remains a real concern for employers, and Boards will want to do more to address this. NHS Employers will continue to support NHS organisations with a range of resources and by sharing practical examples of good practice including those related to the physical and mental wellbeing of staff, as well as staff engagement and diversity.”
· Public funding allocated to medical research because it is likely to be profitable, not because it will be beneficial for patients
· UK’s leading doctors call for immediate inquiry into safety of medicines
· Britain faces “epidemic of misinformed doctors and misinformed patients”, senior NHS cardiologist warns
Leading NHS cardiologist, Dr Aseem Malhotra, has today highlighted a complete healthcare “system failure” that is resulting in the unnecessary deaths of tens of thousands of people globally every year.
Writing for MailOnline, Dr Malhotra says that biased research funding, biased reporting in medical journals and commercial conflicts of interest are contributing to an “epidemic of misinformed doctors and misinformed patients in the UK and beyond.”
He claims public funding is often allocated to medical research because it is likely to be profitable, not because it will be beneficial for patients.
Leading doctors have today supported Dr Malhotra’s claims and have called on Parliament’s Public Accounts Committee to conduct an independent inquiry into the safety of medicines.
The calls for greater transparency in the prescription of medicines come from the immediate past president of the Royal College of Physicians, Sir Richard Thompson, the Chair of the BMA General Practitioners committee Dr Chaand Nagpaul, the President of the Faculty of Public Health, Professor John Ashton, the Chairman of the British Association of Physicians of Indian origin, Consultant Psychiatrist Dr JS Bamrah and the editor in chief of JAMA Internal Medicine and Professor of Cardiology Rita Redberg.
Citing recent studies, Dr Malhotra says that prescription drugs are the third most common cause of death after heart disease and cancer, with side effects of antidepressants and dementia drugs responsible for more than half a million deaths per year in the United States and Europe.
The elderly are particularly vulnerable to polypharmacy, with one in three hospital admissions in the over 75s a result of an adverse drug reaction.
In addition to a “more medicine is better” culture exacerbated by financial incentives to prescribe more drugs and carry out more operations, Dr Malhotra reveals a more sinister side that is corrupting the information that is being given to doctors and patients when medical decisions are made.
Citing recent examples from Australia and the UK he writes:
“Medical journals and the media can be manipulated to serve not only as marketing vehicles for the industry but be unwittingly complicit in silencing those who call for greater transparency and more independent scrutiny of scientific data.”
In relation to cholesterol lowering statin drugs he calls for a full reassessment of all the statin studies.
“Physicians should be aware that present claims about the efficacy and safety of statins is not evidence based,” he writes, demanding that the Clinical Trials Service Unit at Oxford University release the raw data for independent scrutiny.
Dr Malhotra gives recent examples of where the National Institute of Clinical Excellence (NICE) and the drug regulator (the MHRA) have failed to manage lack of transparency and conflicts of interest over the prescription of several drugs including Tamiflu, Statins and stroke drug Alteplase.
Gaming the system, manipulation of data and prolific scientific fraud is contributing to the unnecessary deaths of tens of thousands of people and the suffering of millions costing billions to our national economies every year.
“Without full transparency and accountability no doctor can provide what we slogged through medical school and devote our heart and souls to: providing the best quality care for our patients.
“For the sake of our future health and the sustainability of the NHS it’s time for real collective action against ‘too much medicine’ starting with the Public Accounts Committee launching a full independent inquiry into the efficacy and safety of medicines.
“The underlying scandal that may ensue is likely to dwarf that of Mid Staffs. Medical science has taken a turn towards darkness. Sunlight will be its only disinfectant.”
Sir Richard Thompson, immediate past president of the Royal College of Physicians, commented:
“Dr. Malhotra again draws the attention of doctors and the public to the too often weak and sometimes murky basis on which the efficacy and use of drugs, particularly in the elderly, are judged. There needs to be closer scrutiny of the evidence underpinning drugs, and devices, and then better promotion of the evidence, together with more education of the public, doctors and medical students in how to assess the value of prescribing drugs to different groups of patients.
“The time has come for a full and open public inquiry into the way evidence of the efficacy of drugs is obtained and revealed. There is real danger that some current drug treatments are much less effective than had previously been thought.”
Professor John Ashton, President of the Faculty of Public Health, said:
‘Public health relies on a comprehensive, accurate and cost effective evidence base to ensure we make decisions based on the best available research that improve and protect people’s health, as well as prioritise care in the best way for patients. A public inquiry could be a useful tool in ensuring that research is published in a transparent and independent way.”
Dr J S Bamrah, Chairman of the British Association of Physicians of Indian origin, commented:
“There has been an alarming increase in prescriptions in the modern world which cannot be simply explained in terms of increasing disease. The context of this in regards to the dangers of over-prescribing cannot be overstated. As Dr Aseem Malhotra rightly points out, there are a number of areas where there are incentives and conflicts that doctors and researchers have either been complicit or complacent, or plainly they have failed to declare their conflicts of interest. In some cases this will have led others to believe in their authoritative assertions.
“In my own field of psychiatry there are been much abuse and overuse of a number of drugs, and this pattern is destined to repeat unless someone like Dr Malhotra stands up to the establishment. His expose deserves a high level independent inquiry by the government as otherwise patients will continue to rely on medications they need not have been prescribed by trusted doctors.”
Rita Redberg, Professor of Cardiology at the University of California, San Francisco and editor of JAMA Internal Medicine, said:
“As a practicing cardiologist for 30 years as well as a journal editor for seven years, I know how important it is to have reliable high quality data in peer-reviewed medical journals. It is crucial for clinicians to be able to trust what they read. We need this trust and transparency to be able to accurately advise our patients on risks and benefits of medical treatments.
“In addition, all conflicts should be disclosed, such as relationships with industry and any other potential biases. Clinical trial registration before trial initiation on publicly available sites such as clinical trials.gov and publishing of all results is essential, even if results are negative or show harms of a treatment. We need to know that we have full access to all relevant information. Our current system needs more work and efforts towards achieving these goals.”
HIV charities from Liverpool (Sahir Trust) to Leicestershire (LASS) to London have come together with health professional bodies, British Association for Sexual Health and HIV (BASHH), and British HIV Association to launch a new national campaign opposing cuts to HIV services across the country -‘Support people with HIV: Stop the cuts’.
Increasing numbers of local authorities are pulling funding from HIV support services.
The campaign has written to Secretary of State for Health, Rt Hon Jeremy Hunt. calling for a meeting to discuss the impact of these cuts, demand effective commissioning, adequate funding, and access to support services for all people living with HIV.
HIV services in both Berkshire and Oxfordshire, run by Thames Valley Support and Terrence Higgins Trust respectively, have been cut by over £100,000 between them. In Berkshire this equates to a loss of a third of funding, and will directly affect 300 people living with HIV in both Slough and Bracknell.
In David Cameron’s back yard, Oxfordshire County Council has cut Terrence Higgins Trust’s £50,000 funding, which is forcing the closure of its local centre. The reality is that there are will be no HIV Prevention and Support service in the whole county after April 2016, with almost 500 people left with no alternative support service.
In Portsmouth the HIV support service, provided by Positive Action, has been cut by approximately £26,000 by Portsmouth City Council. Its Hampshire service has been granted an interim support payment of £30,000, less than half of the amount it historically received.
In Bexley and Bromley, equality and diversity charity, METRO is facing cuts to HIV support services of over £80,000.
Public Heath England’s national HIV figures show that in 2014 alone over 6,000 people were diagnosed with HIV, while People Living with HIV Stigma Index UK– found that stigma had prevented 15 per cent of people surveyed from accessing their GP in the last year, and 66 per cent had avoided dental care.
14 per cent had received negative comments from healthcare workers. Despite the obvious roles specialist HIV support services play in combatting this they are being reduced to almost ineffective levels, or cut completely, in a short term cash save measure.
Alex Sparrowhawk, Membership and Involvement Officer Terrence Higgins Trust said:
“As a person living with HIV, I can prove to Jeremy Hunt that HIV support services are vital to dealing with your diagnosis and managing this health condition. The national campaign is about sounding the alarm to policy makers, councils, and the public – these essential services are under serious threat and we need your help.
“At a time when rates of HIV are increasing, stigma is as apparent as ever, we are seeing the start of a disturbing trend of local authorities across the country scrapping HIV services.
Yusef Azad, Director of Strategy National Aids Trust:
“HIV remains a stigmatised and misunderstood condition. It’s not the same as other health issues where people can rely of support and sympathy from friends and colleagues.
“HIV support services can be the only place where people are open about their status, the only places they can find advice and support, the only place they can talk to other people with HIV.
“They are an essential component of the long-term care of people with HIV. To remove them would leave a lot of vulnerable people stranded.”
Dr Greg Ussher, METRO Charity CEO, said:
“People living with HIV can be some of the most vulnerable members of our communities.
“Proposed cuts of up to 100 per cent to HIV support services will decimate vital provision for people that cannot speak out against their local authority’s plans for fear of the stigma publicly disclosing their HIV status might bring.”
The Treasury last year announced it was cutting public health budgets in-year by £200 million with reductions in the funding for public health set to continue this year. The feasibility of the Chancellor’s plan to allow local authorities to income generate to fund social care services will be tested in poorer areas of the country – those areas that also see the highest rates of HIV.
‘Support people with HIV: Stop the cuts’ is also appealing to members of the public to take an e-action to show their support – write to their local council leader and ask what the council is doing to support local people living with HIV.
New case study highlights need to rebalance prevention vs. treatment strategies
A new case study entitled Confronting Obesity in the UK: The need for greater coherence has been published today by the Economist Intelligence Unit (EIU), with experts calling for a coherent strategy to tackle obesity1.
The study explores the UK’s approach to obesity management and interviews experts, highlighting that the fragmentation of the NHS’s obesity treatment may be negatively impacting patients1. Today’s disjointed system is associated with a lack of investment in treatment services1. According to the study, over 94% of the UK’s obesity management budget is spent on prevention strategies1, leaving just 6% of the budget to treat the majority of the population who are already overweight or obese1. The case study reveals that the continued structural reform of the UK healthcare system has led to confusion over accountability, creating huge differences in access to treatment1. Nearly half of the obesity services across the UK do not have access to higher levels of treatment1.
“The UK has excellent evidence based guidelines from National Institute of Health and Care Excellence detailing strategies for the prevention and management of obesity in children and adults. We now need to ensure that these are implemented” said Professor Rachel Batterham, Head of the UCLH Bariatric Centre for Weight Management and Metabolic Surgery and the UCL Centre for Obesity Research. “We know that for some patients, especially those with type 2 diabetes, that bariatric surgery leads to unrivalled health benefits and cost-saving for the NHS. Unfortunately, less than 1% of the patients who could benefit from this surgery currently receive surgery. This represents a major missed opportunity in terms of improving health and economic savings”.
Obesity is a rising concern in the UK with 62% of the population now overweight or obese2. Yet, according to the study, the shortage of obesity services is negatively impacting patients; as people with severe obesity are forced to wait longer to be assessed, have their associated medical problems treated and receive weight-loss advice1. The study states that better access to the UK’s tiered obesity management programme could help the country to treat those patients for whom preventative measures are too late or ineffective1.
Obesity is a major public health concern across Europe and the UK is no exception. Due to its association with serious chronic diseases such as type 2 diabetes, cardiovascular disease and some cancers3, obesity places a huge burden on both the UK’s health and economy. The study highlights that the one quarter of the population that is obese cost the NHS £6bn–8bn alone in 20154. By 2025 the NHS cost of all weight related disease is predicted to reach £21.5 billion per year4, over 20% of the current NHS budget.
The study, which was commissioned by the Johnson and Johnson subsidiary, Ethicon, follows the release of an EIU report entitled, Confronting Obesity in Europe: Taking action to change the default setting. The report highlights the need for European policymakers to address the impending health crisis and stresses that national approaches to obesity need to take into account two distinct populations: those of a healthy weight and those who are obese5.
“The study suggests that a more holistic and cost effective strategy is needed to tackle obesity, and we believe that bariatric surgery could play an important role here” said Silvia De Dominicis, Vice President of Ethicon EMEA. “At Ethicon, we pride ourselves on value-based healthcare and we’re committed to supporting patients in the UK. We hope that this case study helps to open up an urgently needed discussion with policymakers and shape the future of the obesity strategies. It’s time to act.”
A full copy of the EIU case study, is available here:
23rd February, 2016:
The financial situation of the NHS is getting worse. The latest quarterly monitoring report from the King’s Fund shows that NHS trusts are forecasting an end-of-year net deficit of around £2.3 billion. The estimate, based on survey responses from 83 trusts, comes as NHS national bodies are imposing stringent financial controls in an effort to reduce the deficit to £1.8 billion by the end of the financial year. There is a risk that the Department of Health will breach parliamentary protocol by overspending its budget.
Key findings from this quarter’s survey include:
- More than two thirds of trusts (67 per cent) and 9 out of 10 (89 per cent) acute hospitals are forecasting a deficit at the end of 2015/16
- More than half of trusts (53 per cent) are concerned that they will not be able to meet nationally-imposed caps on their agency staff spending, while a fifth (22 per cent) say the caps may impact on their ability to recruit the staff they need to provide safe care
- Nearly two-thirds (64 per cent) of trusts are reliant on extra financial support from the Department of Health or drawing down their reserves
- More than half of trust finance directors (53 per cent) are concerned about meeting productivity targets – the highest level of concern at this time of year since our survey began
- CCGs are in a better financial position, although nearly one-fifth (18 per cent) are forecasting a deficit and nearly a third (29 per cent) are concerned about meeting their productivity targets.
Responding to the King’s Fund quarterly report, Paul Healy, Senior Policy Advisor on Economics and Regulation, NHS Confederation said: “NHS leaders know the status quo isn’t sustainable and are working hard to join up across the health and care system, so as to be more efficient, deliver better value and offer a more individual service for the public. This survey shows up many of the challenges facing the service at this particular point in time and highlights a broader signal from leaders on the need to overcome these through a process of transformation”.
“A new approach to value needs to be stitched into the fabric of the health and care system, which moves away from a technical focus on reducing the costs of current services to a coordinated attempt to get more out of resources within a defined budget. What this means in practical terms is less reliance on cutting the prices paid to hospitals, which has impacted on the bottom line of providers, and more emphasis on transformation across the system through new models of care and effective commissioning”.
“While this is an enormous challenge, it is achievable if national bodies keep working to support strong local leadership and enable them to build on the significant savings delivered in the last five years to ensure the NHS is sustainable and continues to deliver good value for taxpayer funding.”
In January Monitor and the NHS Trust Development Authority issued a financial “control total” to every trust in England for 2016-17, which they had to accept to secure their share of the £1.8bn “sustainability and transformation fund”. This fund was promised as immediate cash flow by after Simon Stevens’ put pressure on the government. According to the HSJ two-thirds accepted the deal in their draft plans for the coming financial year, many only with conditions attached.
A common reason for not accepting the target was that the control totals were based on trusts’ financial positions at the end of October, so trusts which had experienced deterioration after October had not seen this reflected in their offer. Another was that one-off income had not been discounted, so trusts that received large amounts of non-recurrent funding in 2015-16 effectively had a tougher target next year.
One anonymous respondent to the HSJ story said: “some Trusts have accepted figures they stand absolutely no chance of achieving, solely because of the perceived consequences of not accepting. This is against a backdrop of declining financial performance (suggesting almost all of them are going the wrong way in reality, declining target attainment, rapidly rising mortality (causal effect not yet established) and the single biggest decline in public satisfaction. On top of that, the collapse in primary care, summer of junior discontent and the consultant contract ‘negotiations’ still to come…”
Satisfaction with the NHS has increased, with 65% saying they are satisfied, up from 60% in 2013. This increase in satisfaction was greatest – no less than 11 percentage points – among Labour supporters.
Satisfaction with A&E services has also increased, from 53% to 58%. On the other hand, satisfaction with GP services has declined from 77% in 2010 to 71% in 2014, though this is still the most popular of the NHS services.
A funding crisis?
The public believe, almost universally (92%), that the NHS is facing a funding problem. But how should this problem be addressed?
A majority (58%) say they would not be happy for the government to curb spending in other areas to maintain the current NHS service. Support for increasing taxes to spend more on health, education and social benefits still remains relatively low (37%). Only around a quarter back charging for services such as a GP appointment or hospital meals.
Alternatives to universal NHS care?
Most people are opposed to the idea of a system only for those on lower incomes, while only a minority would prefer to be treated by a private service.
Nearly 7 in 10 (68%) oppose the idea that the NHS should be available only to those on lower incomes. However, 45% think that the NHS will not still be a free universal service in ten years’ time. More (39%) say they would prefer to be treated by a NHS service than a private one (16%) though 43% have no preference.
This is an important set of results for the health and care sector and shows that the public continues to value the NHS very highly. Public perception on NHS funding, staffing and wait times are however driving lower satisfaction. What the public and health service now needs is a strong clear narrative from politicians of all parties on the future of the NHS.
The most important set of results are those on social care. We have said consistently that the NHS and social care system cannot be seen in isolation from each other. A further fall in satisfaction of 5 percentage points to just 26 per cent is deeply concerning. This reflects the pressure social care services are facing and these must be addressed if we are to sustain effective care for vulnerable people. Current resourcing levels in social care will, we believe, be insufficient in the short term to make this a reality.
Rob Webster, Chief Executive, NHS Confederation
Health systems in the United Kingdom have, for many years, made the quality of care a highly visible priority, internationally pioneering many tools and policies to assure and improve the quality of care. A key challenge, however, is to understand why, despite being a global leader in quality monitoring and improvement, the United Kingdom does not consistently demonstrate strong performance on international benchmarks of quality.
This report reviews the quality of health care in the England, Scotland, Wales and Northern Ireland, seeking to highlight best practices, and provides a series of targeted assessments and recommendations for further quality gains in health care. To secure continued quality gains, the four health systems will need to balance top-down approaches to quality management and bottom-up approaches to quality improvement; publish more quality and outcomes data disaggregated by country; and, establish a forum where the key officials and clinical leaders from the four health systems responsible for quality of care can meet on a regular basis to learn from each other’s innovations.
This report rightly acknowledges that our members across the UK have a clear and consistent commitment to improving the quality of care for patients. While all four nations share this common goal, the different systems in each country have been designed to best suit the needs and challenges of their own populations.
The OECD’s investigations have confirmed that it is not possible to look across the health systems in Northern Ireland, Wales, England and Scotland and identify one system to be better than another.
Instead what comes out strongly for England in particular is how our members need support from central government and regulators to drive up standards across the health service but that this must be balanced with empowering local leaders, and staff to drive and lead change for the benefit of patients.
Our members should be enabled to make radical change driven by the needs of local people. By delivering proactive, joined up care closer to people’s homes, we can help people to stay well, and allow hospitals to focus on treating the people that need to be there.”
Dr Johnny Marshall, Director of Policy, NHS Confederation