Perpetual failures of financial incentives 14 March 2019 The King’s Fund wants to kill off the long-held belief in government and the NHS leadership in England that it is possible to devise a system of payments, incentives and contracts which will take us to the nirvana of a perpetually self-improving health service. After 30 years of failure the NHS is embarking on yet another attempt to devise the perfect payment regime. In its report Payments and contracting for integrated care, with the punchier subtitle “the false promise of the self-improving health system”, the King’s Fund highlights the absurdity of clinging to this shibboleth despite decades of evidence that it won’t work. The NHS has set prices for around 3000 services, ranging from £63 for the simplest A&E attendance to £40,550 for complex cranial operations. Alongside this clinical shopping list is a Heath Robinson construction of uplifts, carve-outs, caps, bundles, blocks, baselines, risk transfers, gain sharing, loss sharing, penalties and incentives designed to drive behaviours around everything from adopting new technologies to how a hospital is cleaned. This system fails to achieve its objectives and inhibits clinicians from improving care quality. It encourages treatment in hospitals rather than prevention in the community and, as the report says, there is scant evidence that incentive schemes such as Commissioning for Quality and Innovation (CQUIN) have delivered substantial improvements in quality or efficiency. Read the full article at the BMJ __________________________________________________________________ Children live in a hostile environment 1 March 2019 Children in England are facing their own hostile environment, with government policy undermining their right to a fair start in life and support for families systematically dismantled since 2010. First 1,000 days of life, published this week by the Commons health and social care committee, exposes the extent of the damage – and the impact it has had. The MPs’ report lays bare the desperate need for coordinated support for infants and their families. Under New Labour, resources were poured in to supporting children’s early years. Benefits were increased, children’s services were expanded, child poverty was targeted, the Healthy Child Programme was introduced and Sure Start centres were established across the country. But since the economic crash in 2008 and change of government in 2010, public spending on children has fallen and child poverty has increased, as evidence from the children’s commissioner for England and the Institute for Fiscal Studies shows. According to the Sutton Trust, somewhere in the region of 1,000 Sure Start centres have closed – more than a quarter of the total. The Institute for Health Visiting told MPs that 65% of families are not formally seeing a health visitor after their baby is aged eight weeks. Read the full article at Guardian Society __________________________________________________________________ NHS and council tensions are on the rise 15 February 2019 Who should run local health and care services, especially public health services, is becoming an increasingly tense battleground between the NHS and local government, with serious potential consequences. The NHS long-term plan, unveiled in January, aims to deliver the “triple integration” of primary and hospital care, physical and mental health services and health with social care. From councils’ point of view, this is a unique opportunity to fix one of the big flaws in the way the NHS was set up in 1948, with a centralised service telling local services what to do, rather than focusing on the needs of local communities. With NHS community and mental health services – especially mental health care for children and adolescents – set to be the big winners in the scramble for funding for at least the next five years, local NHS services and councils have a chance to focus on tackling the root causes of physical and mental illness in their area. The NHS plan wisely avoids setting out precisely how this local collaboration should happen, putting the onus on local leaders to find ways to work together. Some are struggling. Read the full article at Guardian Society __________________________________________________________________ The health impact of a bankrupt council 5 February 2019 As the NHS in England begins implementing its plan for spending its additional £20bn over the next 10 years, a growing number of local authorities facing financial crisis are slashing adult social care budgets. The long term impact on health services will be profound, affecting everything from hospital discharge to falls prevention and rehabilitation. According to the Association of Directors of Adult Social Services, councils in England are taking out £700m from their adult spending this financial year, 4.7% of that budget. East Sussex County Council is planning to strip its services back to a “core offer,” which includes reducing services for vulnerable children and adults. Worcestershire County Council is looking to shed around 200 staff—which will have a serious impact on child and adult social care which accounts for almost 70% of its budget.4 Other councils facing serious financial pressures include Cornwall, Lincolnshire, Somerset, Surrey, and Torbay. Northamptonshire County Council—whose problems have been exacerbated by mismanagement—is in the deepest trouble. Last autumn, it adopted a financial stabilisation plan: targets include saving £700,000 by reducing long term care placements from hospital and £1.8m from “new ways of delivering care and independence.” Read the full article at the BMJ __________________________________________________________________ Austerity-battered cities need champion 1 February 2019 This week’s report spelling out the calamitous impact of austerity on our major cities shows that much of the current debate over public policy is looking in the wrong place for answers. Thanks to Northamptonshire county council blowing up its own finances, Surrey using its muscle within the Conservative party to highlight the damage being done by cuts, and areas such as Somerset facing serious difficulties, an impression has been created that English shires are suffering the most pain under austerity. Meanwhile, political debate on which parts of England need the most support has focused on left-behind towns such as Hartlepool, Grimsby and Barnsley, which have relatively low educational attainment and registered their anger at the lack of opportunity by voting strongly to leave the EU. But the Centre for Cities’ analysis, and its fascinating study published last year on which areas voted for Brexit and why, rams home the point that cities as well as towns need support in building their economic firepower. Cities are the unrivalled engines of the economy, but have been clobbered the hardest by austerity. Read the full article at Guardian Society __________________________________________________________________ Patients and staff hold key to NHS Plan 11 January 2019 The newly-unveiled NHS long-term plan reveals an extraordinary breadth of ambition for improving healthcare over the coming decade. While it includes exciting developments in cutting-edge technology, such as gene therapy and artificial intelligence, the greatest improvements in care and outcomes will come not from scientific breakthroughs but from people: by harnessing the power and talents of patients and NHS staff. To stand a chance of the plan succeeding, the health service needs to ensure clinicians have the power and responsibility to make change happen and do far more to exploit the largely untapped resource of patients themselves. One of the plan’s key goals is to reduce unjustified variations in performance, including significant differences in stillbirth and newborn baby death rates. This can succeed only if frontline staff are gien the skills, resources and encouragement to improve quality. Clinicians have to believe they are leading this locally, rather than simply being a cog in a national blueprint. That needs to be central to the workforce strategy, the plan for tackling thousands of NHS vacancies, when it is finally published. Read the full article at Guardian Society __________________________________________________________________