News from Nowhere’s roving reporter on STP news, the state of mental health services, a crisis in Children’s palliative care funding and to lighten the mood – medicine as a career.

No better but at least no worse?

The newly published results of the Picker Institute’s 2016 Community Mental Health Survey demonstrates how difficult it is to bring about service improvements in an austere economic climate. Declines in communication, involvement and effective coordination that occurred between 2014 and 2015 have not been reversed, but also have not worsened.

The Care Quality Commission Survey, developed and co-ordinated by Picker, was completed by over 13,000 people, many of whom would have liked greater access to services.  More than half of respondents (53%) felt that they had not always seen NHS mental health services often enough, and over a third (37%) were not given enough time as they might have liked to discuss their needs and treatment.

The best outcomes are achieved through shared decision making between clinicians and service users, but respondents to the survey report significant room for improvement in this area. 10% of people said that they had not been involved in deciding what treatments or therapies to use and a further 34% said they had only been involved “to some extent”. Similar proportions said that their care agreement didn’t fully take their personal circumstances into account. Despite a proclaimed commitment to parity of esteem there have been few improvements in the areas of care that are most important to users.

Services for seriously ill children

Children’s palliative care charity funding is facing a crisis. There are 40,000 children and young people with life-shortening conditions in England and the number is growing. The cost of caring for an increased number of children with complex health conditions is rising, but government funding is declining.

A survey of statutory funding for children’s hospice and palliative care charities in England – conducted by Together for Short Lives and Hospice UK’s – looked at funding by local authority, Clinical Commissioning Groups and NHS England, and reveals a bleak outlook.

Cuts mean that local authorities are now only contributing 1% of the money charities need to provide palliative care to seriously ill children. This is despite the duty that councils have to provide short breaks (respite) to all disabled children and young people.

On average, the overall amount of statutory funding for charities providing children’s palliative care continues on a downward trajectory, falling year on year (22% in 2015/16 compared to 23% in 2014/15 and 27% in 2013/14).
Rising care costs are not matched by statutory funding. The cost of delivering lifeline care and support to seriously ill children in 2015/16 was nearly 10% greater than it was in 2014/15.

There is heavy reliance on the Children’s Hospice Grant: Nearly 60% of children’s hospice services say they would be forced to reduce their services if the NHS England children’s hospice grant was no longer available. And over two thirds would be most likely to cut short breaks – leaving families, without respite care, at breaking point. NHS England is consulting on this grant and evidence from this report suggests it needs to be greatly increased.

Charities delivering palliative care are worried that unless funding arrangements change they will not be able to meet the needs of these children and may have to cut existing services. This compounds the existing inequitable funding for children’s palliative care across the country.

The UK government could follow the example of the Scottish Government, which has recently committed £30 million funding to Children’s Hospice Association Scotland (CHAS) over the next five years. A national inquiry into the state of children’s palliative care funding in England would be a first step to putting this problem right.

Medicine as a career

The Universities and Colleges Admissions Service (UCAS) has just released details of medical school applications for the 2017 entry. Some had expected that applications would decline following the junior doctor conflict.

The number of individual applicants for the 2016 entry was 20,100 and success at gaining a place depended on country of origin. Success rates were 40% for UK applican

ts, 10% for EU applicants and 20% for non-EU applicants.

The 2017 UCAS data are just for applications. The total number of applications has fallen by about 5% – from 20,100 to 19,210. First-time applicants from the UK are almost the same at 12,150 for 2016 compared to 12,090 for 2017, but applicant numbers for 2017 are actually higher than for the 2015 entry. The biggest drop has occured in EU and other non-UK applications, which fell by 16% and 6% respectively. Medicine still seems to be an attractive career choice for UK students but Brexit may have had an impact on applications from other countries.

STP update – the disease spreads?

NHS Sustainability and Transformation Plans will have to deliver billions in cuts BMA analysis has found that NHS sustainability and transformation plans (STPs) will have to deliver £22bn in cuts by 2020/2021 in order to balance health and social care spending across 44 ‘footprint’ areas, raising serious concerns about cuts to services and the impact on patient care.

Officials in each area have been asked by NHS England to predict in their STPs the financial hole they face in their budgets and set out how they can close it. The savings figures were found in papers from 42 of the 44 areas across England.

The BMA believes that sustainability and transformation plans could help develop health policies more suited to local needs and help integrate services across health and social care. However, it has serious concerns about the ways in which some of these plans have been put together and that they will be used as a cover for delivering cuts.

The BMA is calling for:

  • The plans to be published as soon as possible;
  • Genuine public and professional consultation on any proposed changes;
  • All proposals within the plans to be realistic and evidenced based;
  • All STPs to be funded appropriately to ensure they can deliver what has been promised

Improving patient care to be the priority for each and every plan, rather than STP schemes being used to cut back budgets and services. Despite the weasel words “genuine” and “appropriately”, News from Nowhere has yet to see a better plan of action. NHS Sustainability and Transformation Plans will have to deliver billions in cuts BMA analysis has found that NHS sustainability and transformation plans (STP) will have to deliver £22bn in cuts by 2020/2021 in order to balance health and social care spending across 44 ‘footprint’ areas, raising serious concerns about cuts to services and the impact on patient care. Officials in each area have been asked by NHS England to predict in their STP schemes the financial hole they face in their budgets and set out how they can close it. The savings figures were found in papers from 42 of the 44 areas across England.

The BMA believes that sustainability and transformation plans could help develop health policies more suited to local needs and help integrate services across health and social care. However, it has serious concerns about the ways in which some of these plans have been put together and that they will be used as a cover for delivering cuts.

The BMA is calling for:

  • The plans to be published as soon as possible;
  • Genuine public and professional consultation on any proposed changes;
  • All proposals within the plans to be realistic and evidenced based;
  • All STP schemes to be funded appropriately to ensure they can deliver what has been promised;

Improving patient care to be the priority for each and every plan, rather than STP schemes being used to cut back budgets and services.

Despite the weasel words “genuine” and “appropriately”, News from Nowhere has yet to see a better plan of action.