What will Devo Manc mean for the NHS? 22 March 2016 A huge experiment is about to begin in Greater Manchester. On 1 April, power to manage the £6bn (€7.7bn; $8.7bn) budget for health and social care in the metropolitan county will be devolved, and an ambitious plan will be put in motion to change every aspect of the health and care system in the next five years. Foundation trusts will have surrendered their autonomy in the interests of planning hospital care across the city region; GPs will no longer be independent businesses but part of locality focused hubs (see box) providing a wide range health and social care outside hospitals; and a projected £2bn hole in finances will have been filled. Taking Charge, the blueprint for change published in December by the Greater Manchester Combined Authority and the NHS in Manchester, said that GPs will become leaders of local care organisations (LCOs) running primary, community, social, and mental healthcare services, as well as some acute services, as part of a determined plan to move the centre of gravity away from hospitals. In a few years’ time GP services “will be fairly unrecognisable,” says Tracey Vell, chair of the Association of Greater Manchester Local Medical Committees. The plans have “largely landed well [with GPs] because we’re seeing the crisis coming in some areas of general practice; everyone’s worried,” she says. Read the full article in the BMJ ____________________________________________________________________ There’s little hope of avoiding NHS crash 18 March 2016 TThe public accounts committee’s verdict on hospital finances could hardly be more damning. Its report on the financial performance of acute hospital trusts concluded that they are deteriorating “at a severe and rapid pace”. In case anyone was in any doubt, it says this trend is not sustainable. The deficit could pass £2.5bn by the end of the financial year. Accountancy games may get the final figure down to £1.8bn, but that will do nothing to address the underlying problem. Its criticism of NHS England and Monitor was severe, accusing them of setting unrealistic efficiency targets that have caused long-term damage to trusts’ finances. NHS England has conceded the point, and the efficiency targets have been cut from 4% to 2% for the coming year. But even this target is shaky, with many trusts flying blind because their data is so poor. The MPs were dismissive of attempts to get the money under control, pointing out that until the NHS sorts out its workforce planning it will not solve the problem of spending on agency staff, and said there is not yet a convincing plan for closing the £22bn efficiency gap and avoiding a black hole in NHS finances. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ What do NHS inquiries really achieve? 4 March 2016 The claim by the chair of the Morecambe Bay inquiry (pdf) that the NHS risks “another avoidable disaster” by failing to implement the recommendations in his report highlights the dangers of using inquiries to drive service improvements. According to Nursing Times, Dr Bill Kirkup claimed that almost a year after the inquiry into failures in maternity care at Furness general hospital that contributed to the deaths of at least 11 babies and one mother, there has been progress on only 10 of the 26 national recommendations the report made. Kirkup was particularly concerned that his calls for the introduction of investigations by professional regulators, national reviews into isolated rural services and a review of the NHS complaints system have yet to be fully implemented. Public inquiries are the weapon of choice for ministers faced with a public outcry over scandals and avoidable loss of life. From the Piper Alpha oil rig to the Clapham train crash and the poor care at Bristol Royal infirmary and Mid Staffordshire foundation trust, inquiries are epoch defining, cathartic moments in industries and public services. Smaller scale inquiries, such as the recent investigation into Southern health foundation trust’s care of patients with learning disabilities, pepper the NHS landscape. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Mental health needs more than money 20 February 2016 The impression is being created of unstoppable momentum towards expansion and improvement of mental health services. Reports, cash and pledges of action are piling up. But it is hard to identify what will change and from where the money will come. Meanwhile, the problems that give rise to mental illnesses are growing. Hitting hyperbolic heights this week, NHS England promised “the biggest transformation of mental health care across the NHS in a generation”. In the wake of the report (pdf) by the Mental Health Taskforce, led by Mind chief executive Paul Farmer, NHS England pledged to help millions more people and invest more than £1bn a year by 2020–21. The commitment of NHS England and the government to giving mental health the focus it deserves is not in doubt. What is problematic is their ability to deliver on the promises being made. Announcing telephone number-sized quantities of cash to “transform” the NHS is now routine, but the shine soon fades as the realities of tight funding kick in. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Long-term patients need joined up NHS 5 February 2016 Transforming the care of long-term conditions is the key to ensuring the financial sustainability of the NHS. But although there is wide agreement on what needs to change, progress towards achieving it is painfully slow. The seven innovation test beds unveiled by NHS England chief Transforming the care of long-term conditions is the key to ensuring executive Simon Stevens at the World Economic Forum in Davos last month are the latest attempt to build some momentum behind change. The programme is focused on long-term conditions and mental health, and is a collaboration between the NHS and some big private sector names including Verily (formerly Google Life Sciences), IBM and Philips. The idea is to use a mix of technology, data, monitoring and training. Examples include diabetes patients in the west of England having remote monitoring and coaching technology to help them manage their condition better, while in Rochdale, patients who are at high risk of becoming critically ill will be supported with telecare monitoring in their homes. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ A&E is overwhelmed despite the staff 22 January 2016 Accident and emergency services are the national symbol of the NHS. While people may have complaints and grumbles about treatment elsewhere in the health service, it is an article of faith that when you have an emergency you will see the NHS at its best. More than this, it exemplifies the principle of free at the point of need. Extraordinary human and technical resources can be mobilised in minutes to save your life, irrespective of your wealth and status, or the cost to the state. But increasingly A&E is also coming to symbolise a health service struggling to cope, with multiplying pressures and no sign of a long-term solution. Between 2003-04 and 2014-15, according to King’s Fund analysis, annual A&E attendances jumped from around 16 million to more than 22 million. For most of this time, the majority of the increase went to walk-in centres and minor injuries units. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Is it time for a debate on an NHS tax? 8 January 2016 The call this week by three former health ministers for a cross- party commission on the future of the NHS and social care is a sign of the growing desperation among the care services’ most passionate supporters that they are sinking into a crisis from which it will be difficult to escape. The proposal was made in parliament by Liberal Democrat former health minister Norman Lamb, and supported by Labour’s Alan Milburn and Conservative Stephen Dorrell – now chair of the NHS Confederation. It shows that there is convergence between the main political parties in terms of diagnosing the problems, but important ideological differences remain in the prescribed solutions. Could a consensus be emerging by the time of the next general election? Although the chances of such an all-party approach at the current time are vanishingly small, it was attempted as recently as 2010, just before that year’s election. Lamb was one of the driving forces behind it. Then the brutal realities of electoral politics took over, and it soon collapsed in acrimony. Read the full article on the Guardian Healthcare Network