Bring accountable care out of shadows 15 December 2017 The war over the future of the NHS is being fought on multiple fronts. Campaigners, the Labour party, the government, NHS England and even Stephen Hawking are locked in combat over the structure, funding, transparency, accountability and legality of the current wave of reforms, along with the never-ending fight about privatisation – real or imagined. The famous physicist has joined campaigners in a high court bid to block the introduction of accountable care organisations to oversee local services without primary legislation, arguing they could lead to privatisation, rationing and charging. Meanwhile, the shadow health secretary, Jon Ashworth, has tabled a Commons early day motion after the government announced plans to amend regulations to support the operation of accountable care organisations. Ashworth argues that they are a profound change to the NHS that should be debated in parliament. Accountable care – a term imported from the US, where it plays a key role in Obamacare – can take many forms, but it typically involves an alliance of providers with a fixed budget collaborating to manage the health needs of their local population. NHS England wants to see sustainability and transformation partnerships (STPs) evolving into accountable care systems in which integrated care supports good physical and mental health. Read the full article at the Guardian Healthcare Network __________________________________________________ Patients and staff pay negligence price 1 December 2017 This week I met a man about to launch a legal action for negligence against the hospital where his wife and son almost died during childbirth. Two years later, she is still recovering and waiting for answers as to what went wrong. Exhausted by months of obstruction and denial, they believe going to court is the only way they will get an admission that mistakes were made. They don’t want money, just an apology and assurance that no one else will have to suffer as they did. This entirely avoidable melodrama is being played out across the NHS. Friday’s report by the public accounts committee into the cost of clinical negligence in hospital trusts reveals that the bill has quadrupled in 10 years to £1.6bn and is expected to double again by 2021. That would mean more than £3bn wasted on negligence costs in a single year, amounting to roughly 4% of trusts’ income. The rising costs are driven by two factors. As well as increasing damages for a small and stable number of “high value”, mostly maternity-related claims – which account for 83% of the damages awarded – there is a growth in the number and cost of “low value” claims. Read the full article at the Guardian Healthcare Network __________________________________________________ GPs need to lead health tech revolution 21 November 2017 The launch of the GP at Hand app-based primary care service in London has been met with accusations that it is damaging the NHS. The service is being run by a practice in Fulham, but people across central London are able to move their GP registration there. It offers video consultations 24/7 and face to face appointments at five clinics so far. It uses technology provided by Babylon Health, which bills itself as “the world’s first AI- driven healthcare service”. GP at Hand has been accused of trying to make an easy profit by avoiding the patients who create the most work, threatening the viability of other practices. There have also been concerns that app-based GP services could pull lots of healthy people into the primary care system at the expense of those who really need it. The recent annual conference of England’s local medical committees opposed the rollout of online consulting until there was “clear evidence” of the benefit to patients. The biggest problem with the service is the long list of people who are discouraged from signing on. The website says it may be “less appropriate” for 10 categories of patients, which can reasonably be summarised as people who are, or are likely to be, sick or pregnant. Read the full article at the Guardian Healthcare Network __________________________________________________ How to put citizens at the heart of NHS 3 November 2017 With ever-growing pressures from funding, staff shortages, demand and targets, is it possible to bring joy back to the healthcare workforce and put patients at the centre of their care? A group of healthcare leaders think it is. Frustrated by the difficulties of getting back to what really matters in healthcare but convinced there was a way forward, two dozen people from health and social care got together as the Industry Coalition Group to get some fresh thinking into discussions around NHS reform. Healthcare at Home put some funding in and brought the group together; Mike Bell, chair of Croydon health services NHS trust, led the discussions, and the result was the 2,000 Days Project, launched at the King’s Fund and Cambridge Health Network this week. In the spirit of full disclosure, I should add that I wrote the report. The 2,000 days refers to the first and last 1,000 days of our lives. Maternity and infancy profoundly affect our life chances and lifetime consumption of healthcare. Giving every child a strong start is morally right, economic common sense and good for the NHS. The last 1,000 days crystallise the issues of choice and empowerment; how care can maximise the quality of life, rather than simply its length, and how to get the most value from healthcare resources. Read the full article at the Guardian Healthcare Network __________________________________________________ Blows fly over children’s mental health 20 October 2017 The mauling of NHS England chief executive Simon Stevens by children’s commissioner Anne Longfield over mental health services is a rare example of brutal disputes between officials breaking out in public. The children’s commissioner for England, a post created in 2004, exists to stand up for the rights of children, particularly on issues affecting the most vulnerable. It is certainly not part of the remit to make the NHS, or any other part of the state, feel comfortable about what they do for children. Longfield’s bust-up with Stevens began when she sent a briefing to MPs ahead of World Mental Health Day on 10 October. The brief is a coruscating critique of children’s mental health provision, describing it as bleak and shocking, particularly in comparison with adult mental health care. The thrust of her argument was that help only reaches around a fifth of children with a mental health condition, while a failure to intervene early means scarce resources are being drained away on expensive in-patient care which benefits few children. A failure to prioritise children’s mental health means most local areas are failing to meet NHS standards for improving services or providing crisis support. Read the full article at the Guardian Healthcare Network __________________________________________________ NHS is getting desperate as winter nears 6 October 2017 As the NHS careers towards winter, signs of desperation can be seen across the country. Since the summer, at least six hospital trusts and two ambulance services have been dealing with allegations of bullying. Two chief executives have been forced out for failing to hit the A&E target. More might follow. Local government is getting another beating over the growing problems around moving older people out of hospital after treatment. The Health Service Journal says the Department of Health is threatening to direct how social care funding is used at councils with the worst records for delaying transfers of care. The bed days lost each month to delayed transfers hover close to 200,000. Most are caused by the NHS, although social care’s total has been growing faster. Hospitals have entire wards of people trying to get home. Lest any chief executives might have forgotten that A&E is a priority, recently appointed chief inspector of hospitals, Prof Ted Baker, has sent everyone a handy guide on what they should be doing. It is important to “know whether each patient has a serious problem”, apparently. More helpfully, Baker also stresses the importance of empathetic leadership and managing staff wellbeing. But does that mean a consultant in A&E who breaches the four-hour wait target after sending exhausted staff home will be supported, or will their chief executive be put in front of the next NHS Improvement firing squad? Read the full article at the Guardian Healthcare Network __________________________________________________