News from Nowhere February 1st 2016

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Desperate times:

The Guardian exposed new guidance about shrinking the NHS workforce on January 30th. NHS Hospitals are being told to shed staff to rescue the health service from an acute funding crisis, despite intense concern that reducing staff will hit quality of care, patient safety and staff morale, whilst also increasing waiting times. Monitor and the NHS Trust Development Authority (TDA) have issued the instruction to reduce staffing almost three years after ministers ordered hospitals to do the opposite, following the official report into the Mid Staffs care scandal. The move could lead to hospitals being forced to shed hundreds of staff in a bid to balance their books, with nurses and managers the most vulnerable to being axed.

Here come the bad boys:

The Health Services Journal has revealed that the very same Monitor has sounded out commercial management consultancies about putting up to 25 Hospital Trusts that are struggling financially into ‘turnaround’. The regulator confirmed to HSJ that it was considering “a programme of support” (i.e. cuts) for Trusts but had not decided how many organisations would be affected. If implemented across 25 trusts – about one-sixth of the acute hospital sector – the programme would be one of the biggest single interventions in the day-to-day running of providers since NHS England medical director Sir Bruce Keogh led a review of 14 trusts with persistently high mortality figures in 2013.

It’s not working:

The chief executive of NHS Improvement, Jim Mackey, has criticised the speed with which the “success regime” programme has made progress (HSJ January 29th). The “success regime” was launched by NHS England chief executive Simon Stevens in June last year and three areas were designated to be put through the programme: Devon, parts of Essex and Cumbria. The regime is supposed to address “deep rooted and systemic issues that previous interventions have not tackled across [a] whole health and care economy”. Clearly, it is not as easy as it seemed at the time.

Are you sleeping soundly?

A survey by Intel (NASDAQ: INTC), a world leader in computing innovation, shows that while the UK public understands the link between a good night’s sleep and their wellbeing, a huge percentage struggle to sleep and worry about the impact on their health. Working with a sleep expert and physiotherapist, Intel asked the British public questions about their sleeping habits and awareness of the links to wellbeing, with startling results:

  • Over 1/3 of Brits (38.8%) believe that sleep quality and duration are one of the factors affecting their health, and it’s taking a toll
  • 9 in 10 Brits (94%) think it’s important to factor sleep into health and fitness routine
  • Over 50 % of Brits say that healthy eating (54.6%) and regular exercise (53.8%) are incorporated in their 2016 health regime
  • Only 1/5 of Brits believe that everyone needs eight hours sleep a night (21.6%)

You can find more information on the Reclaim your Sleep survey here.

The great and the good:

Twenty one Presidents of Medical Royal Colleges and Associations have written to both sides in the Junior Doctor dispute to encourage the negotiations and to support those seeking a deal on both sides. Insiders wonder if this would have been necessary if negotiations were not bogged down in detail or troubled by intransigence, possibly on both sides.

Commanding Heights:

In January 2013 the The NHS Commissioning Board announced its intention to reshape England’s largest teaching and specialist hospitals in an attempt to control the “commanding heights” of the health economy. The Commissioning Board then directly commissioned specialist care worth £12bn., amounting to between a third and a half of the income of the country’s largest Hospital trusts. Chief Executive Sir David Nicholson argued that the large teaching, specialist and tertiary trusts had not paid enough attention to their commissioners. This would change, he said. It’s not going well, this struggle for the commanding heights. News in the HSJ (January 25th) has described how NHS England is troubled by the expansion of specialist services, now worth £14bn, and the difficulty in getting their costs under control. Even big commissioners can be avoided, it seems.

The real cost of healthcare fraud:

Fraud is a challenging problem no matter what sector it impacts on. News of its economic effects are clear – worse public services, less financially stable and profitable companies, diminished levels of disposable income for all of us, charities deprived of resources needed for charitable purposes. In every sector of every country, fraud has a pernicious impact. At present we have a fraudulent or corrupt minority who are prepared to divert the funds which are intended to keep us all well. That minority exists in all countries – and even in the UK’s National Health Service (NHS). Every penny lost to fraud and corruption weakens healthcare systems and undermines their capacity to provide essential treatment.

PKF Littlejohn and the Centre for Counter Fraud Studies at University of Portsmouth have published the latest global (and UK) research concerning the extent to which this happens – ‘The Financial Cost of Healthcare Fraud Report 2015’. (

The Report does not simply describe detected fraud or the individual cases which have come to light and been prosecuted. Because there is no crime which has a 100% detection rate, adding together detected fraud significantly underestimates the problem. Nor does the Report rely on survey-based information where those involved are asked for their opinions about the level of fraud. Instead it considers 107 statistically valid and highly accurate loss measurement exercises looking at the total cost of fraud (and error). The data considered covers 17 years and 14 different types of healthcare expenditure in different countries, with a total value of £2.9 trillion.

Across this massive global dataset it shows average losses of 6.2% with 88% of the loss measurement exercises showing losses of greater than 3% of total budget and an increase of almost 11% in this cost since 2007. In the UK’s NHS, the report identifies losses in 6 areas of expenditure and 3 of patient charge income, using the NHS’s own data where it has measured losses or global data where it has not. Total losses for the NHS (for fraud alone) are estimated to be between £3.73 and £5.74bn, depending on the assumptions made – either way an enormous sum which is not being devoted to patient care.

Fraud is a cost which the NHS needs to do more to manage and minimise. The report cites the period between 1998 and 2006 when the NHS did just this – reducing the cost of fraud by up to 60% and delivering £811m of financial benefits to fund better patient care.

It is the view of the authors of the Report that there are 3 first steps for the NHS to take to reduce the cost of fraud:

1) The NHS needs to re-adopt an approach which is focussed on reducing the cost of fraud not just investigating and prosecuting individual examples (although this is important too);

2) It therefore needs to re-commence loss measurement exercises across key expenditure streams. It is only with accurate knowledge about the nature and extent of fraud that proportionate, effective action can be taken to reduce its extent; and

3) It needs to re-create a powerful, well-resourced organisation to lead this work with a remit and authority across all parts of the NHS.

 February 1st 2016  

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