NHS faces a crisis of beds and money 11 December 2015 As the peak weeks for “winter pressures” in the NHS edge closer, the health care system is facing a second crisis – an imminent clampdown on overspent trusts. In a careful dissection of the evidence of why winter routinely causes serious problems, the Nuffield Trust tries to explain why an extra £250m over winter two years ago, and a huge £700m last year, failed to deal with the issue. It stresses that the problems in winter are not caused by more people turning up at A&E – in fact, fewer attend in cold weather – but admission rates are relatively high and, among other factors, there is a growth in people with breathing problems who need to spend longer in hospital. But the underlying cause is that bed occupancy is too high – often above 90% – so systems soon topple over as more patients are admitted. Nuffield estimates that it would take another 14,000 beds to get occupancy down to the widely-accepted safe level of 85% and hit the four-hour A&E wait target. The alternative is to focus on that very small proportion of patients – less than 4% – who account for more than a third of the time in NHS beds. Read the full article on the Guardian Healthcare Network __________________________________________________ NHS leadership needs swift treatment 4 December 2015 There are too few NHS staff willing to take on the toughest leadership roles, and too few of those that do survive. Successive reviews have exposed the failures in NHS leadership development, but progress in addressing them is a long way from matching the scale of the problem. The review of NHS leadership by former Marks & Spencer executive chairman Lord Rose, published in June, pinpointed one of the central difficulties facing the health service – the organisation is committed to a vast range of changes but does not have sufficient management and leadership capability to deliver them. The Rose review was followed within weeks by Ed Smith’s review of centrally-funded leadership and improvement work. Smith, who has been appointed chairman of NHS Improvement, praised the quality of NHS Leadership Academy programmes, but his assessment of leadership work across the system was coruscating. He concluded the current approach is “remote, fragmented and unclear” and “difficult to access and navigate”. Work intended to support clinical leadership came in for particular criticism, not least the fact that few people understood the improvement roles of clinical senates, strategic clinical networks and academic health science networks. Read the full article on the Guardian Healthcare Network __________________________________________________ Osborne offers NHS relief but no cure 27 November 2015 The chancellor’s promise of more cash for the NHS masks substantial cuts outside the core funding, while the increase fails to keep pace with rising demand. The spending review might mitigate some of the worst extremes of the immediate crisis, but it will not secure long-term sustainability or changes to the way care is delivered. As Anita Charlesworth, chief economist at the Health Foundation, pointed out, substantial areas of critical spending have been stripped out of the definition of the NHS and the wider health system will suffer a real-terms cut of more than 20% by 2020-21. This includes junior doctor training, health visiting, health education, sexual health and vaccinations. On top of this public health is being hit hard, with a 4% cut every year in real terms. The government is also going to consult on whether public health spending should be fully funded by business rates. Government grant to councils will be more than halved by 2020, although the Treasury claims this will be covered by increased revenue from council tax and business rates. Allowing councils that provide social care to impose a 2% levy on council tax to help pay for it will provide some relief, but it is far from a solution. Read the full article on the Guardian Healthcare Network __________________________________________________ Hunt shares responsibility for NHS crisis 6 November 2015 Jeremy Hunt’s confrontation with junior doctors over seven-day working adds to a growing list of problems beginning to engulf the health secretary. Will he still be at the department’s Richmond House headquarters at the end of this parliament? It is just over three years since Hunt replaced Andrew Lansley. It quickly became clear why David Cameron was so determined to keep Hunt in government despite the controversy surrounding his handling of News Corporation’s bid for BSkyBwhile he was culture secretary. Immediately burying any mention of the toxic health reforms, he shrewdly repositioned the role of health secretary from representing the NHS to government, to representing the interests of patients to the NHS. His relentless focus on the Mid Staffordshire scandal allowed him to be seen as the champion of patients and safety, while ensuring media attention was locked on to a failure he could convincingly portray as the fault of the Labour government. But his insistence on “safe staffing levels” for nursing has propelled hospitals down the route of employing agency staff they cannot afford to fill newly-created posts. Balancing the risks between going into deficit or being accused of unsafe staffing, hospital managers have invariably decided to spend the money, which is why the deficit for hospitals in the current year is heading towards £2bn. Read the full article on the Guardian Healthcare Network __________________________________________________ Time to scrap the four hour A&E target? 26 October 2015 One month before the comprehensive spending review, data from the King’s Fund have revealed the shocking impact of social care cuts on NHS hospitals. The financial distress in trusts can no longer be allowed to crush every other funding demand across the care system. The King’s Fund’s latest quarterly monitoring report shows nearly 90% of acute trust finance directors surveyed say social care cuts are affecting the performance of local health services. Around 64% of trusts – and 88% of acute trusts – predict they will end the financial year in deficit, and not a single trust finance director is “very confident” of being able to balance the books in 2016-17. When it came to clinical performance, delayed transfers – the strongest indicator of the impact of social care cuts – were up by a fifth on a year ago, and there is little confidence in delivering promised cuts to emergency admissions on the back of the Better Care Fund. There is no sign of the rise in A&E attendances slackening off; according to NHS England there were more than 5.7m A&E admissions in the three months to June; seven years ago it was under 5 million. Read the full article on the Guardian Healthcare Network __________________________________________________ Community services need their voice 9 October 2015 Community services should be at the centre of debate about the future of the NHS. Patient focused, cost-effective and at the forefront of prevention and early intervention, they are crucial to making the health service sustainable in the face of rising demand. Health secretary Jeremy Hunt even described transforming care outside hospitals as his “biggest priority”. But community services are being held back by the relentless focus on hospitals and their own failure to make themselves heard. There is a huge spectrum of community services, from children’s care to re-ablement, mental health support, falls prevention, podiatry, speech and language therapy, wound care, continence, dementia care and palliative care. It includes community nurses, therapists, pharmacists, and sometimes social workers. Most of it takes place in people’s homes. The NHS Confederation says there are more than 100m community health contacts with patients every year. This compares with around 85m hospital outpatients appointments and 340m contacts with GPs. Read the full article on the Guardian Healthcare Network __________________________________________________ New regulator faces an impossible task 9 October 2015 Jim Mackey is an outstanding choice as first chief executive of the new provider regulator, NHS Improvement. The problem is that, in the face of a deficit of £930m in just three months this financial year, he has been given an impossible task. Mackey’s work as chief executive of Northumbria healthcare foundation trust embodies key areas where the NHS needs to succeed. The trust is demonstrably patient focused, it has an impressive level of integration with social services, it is making good progress on working more closely with primary care, and it found a novel solution to its PFI problems – getting help from Northumberland county council, which could access low interest rates. Mackey has also been working on a provider-led “accountable care organisation” to manage population health and is an enthusiast for hospital chains. But an impressive leader and a beguiling new name to replace Monitor and theNHS Trust Development Authority are scant comfort in the face of the growing and apparently uncontrollable deficit. It is far from clear that yet another reorganisation of the central bodies is going to deliver the scale and speed of change required to avoid a complete loss of financial control. Read the full article on the Guardian Healthcare Network __________________________________________________ Addenbrooke’s falls into a CQC trap 2 October 2015 The Care Quality Commission’s (CQC) decision to condemn Cambridge University Hospitals NHS Foundation Trust as inadequate forced out its physician chief executive and opened up serious questions about the inspection process. The chief executive, Keith McNeil—a former sniper in the Australian special forces who became a transplant pioneer at Papworth—quit shortly before the commission published its inspection report last month and the regulator Monitor put the trust into special measures. With a deficit running at around £1.2m (€1.6m; $1.8m) a week, staff shortages, major difficulties getting patients in and out of the hospital, and disruption caused by the implementation of its new electronic health record system, the inspectors must have expected to find serious problems. Yet overall the outcomes at Cambridge—better known by the name of its largest hospital, Addenbrooke’s—are impressive by national and international standards; its mortality rates are low and its safety record is strong. Read the full article at the BMJ __________________________________________________