18th December 2015
- NHS England sets aside £2.14bn ‘sustainability and transformation fund’
- NHS mandate: Government demands progress in 'transformation areas'
- Trusts with fewer staff have higher emergency general surgery mortality
- London agrees devolved powers for health
- Data Protection Regulation agreement supports research
- Morbid obesity surgery commissioning to be transferred to CCGs
- Independent review of mortality of people with learning disabilities commissioned
- Dame Una O’Brien to leave DH in 2016
NHS England sets aside £2.14bn ‘sustainability and transformation fund’
NHS England has announced it is establishing a Sustainability and Transformation Fund of £2.14bn for 2016/17. Of this, £1.8bn will be deployed on ‘sustainability’ to stabilise NHS operational performance, and £340m for ‘transformation’ to continue the Vanguard programme and invest in other key Five Year Forward View areas. The Fund will grow to £2.9bn in 2017/18, rising to £3.4bn in 2020/21. Local areas will be able to bid for the funding through local ‘sustainability and transformation plans’ to be developed by July 2016
NHS England will also use the Government’s increases to NHS spending to award disproportionately higher funding to general practice and primary medical care.
Commenting on the comprehensive spending review at the NHS England board meeting this week NHS England Chief Executive Simon Stevens also said that social care and public health funding was ‘unfinished business’.
Earlier in the week the National Audit Office also released a report on the performance of acute hospital trusts, revealing that the financial position of NHS trusts and Foundation Trusts (FTs) has been ‘severe and worse than expected’. Despite measures being taken by the Government to limit trusts’ spending, such as a cap on staffing agency spending, the NAO warns that it could be too late for these measures to impact on the 2015/16 financial position.
The NAO reports that despite the additional NHS funding announced by the Government in November, it is not clear that there is a coherent plan to improve trusts’ finances. NHS commissioners and trusts have developed a deficit of £471 million from a surplus of £722 million in 2013/14.
NHS mandate: Government demands progress in 'transformation areas'
The Government has published its mandate for the NHS for the next year, which sets out priorities for the NHS during this parliament.
This includes plans to designate areas of the country as 'transformation areas', which will focus on particular services, such as extended primary care access, seven day urgent and emergency services, and other new models of care. Under the mandate NHS England will also have to begin publishing new CCG assessment ratings.
The Government also announced that they are adding a specific objective to the mandate to implement the recommendations of the urgent and emergency care review following a recommendation made by the College.
Trusts with fewer staff have higher emergency general surgery mortality
A study in the British Journal of Anaesthesia has found that the lowest mortality rates for emergency general surgical patients are at Trusts with higher levels of staff, including general surgeons and nurses, more operating theatres, and more critical care beds. There were also higher mortality rates for patients admitted to hospital at weekends. The study looked at 156 NHS Trusts, covering 300,000 emergency admissions for emergency colorectal laparotomy, peptic ulcer surgery, appendicectomy, hernia repair and pancreatitis. Mortality rates at different Trusts ranged from 1.6% to 8.0%.
Commenting on the study, Miss Clare Marx, President of the Royal College of Surgeons, said, “While many hospitals provide high-quality emergency surgery it is wholly unacceptable that death rates vary so significantly for the sickest patients across the country.
NHS England sets aside £2.14bn ‘sustainability and transformation fund’ NHS mandate: Government demands progress in 'transformation areas' Trusts with fewer staff have higher emergency general surgery mortality London agrees devolved powers for health Data Protection Regulation agreement supports research Morbid obesity surgery commissioning to be transferred to CCGs Independent review of mortality of people with learning disabilities commissioned Dame Una O’Brien to leave DH in 2016.
There is still a current and urgent need to review how emergency care is provided in the NHS, including staffing arrangements. We cannot expect every single hospital to provide all emergency services. We believe emergency surgery should increasingly be provided in networks of hospitals so patients can be directed to where they will get the best possible treatment for their condition.
“The data in this study is now up to a decade old and a number of hospitals have boosted staffing levels, particularly nurse staffing, in the wake of the deaths at Mid-Staffordshire NHS Foundation Trust. The authors have stressed that they cannot prove the cause of variations in death rates.” The President’s quote was used by the Daily Mail and tens of local papers.
London agrees devolved powers for health
This week the Chancellor and Health Secretary announced a health and social care devolution agreement with all London local authorities and CCGs and the Greater London Authority (GLA), so-called ‘London Partners’, along with the establishment of five pilots. The deal outlines plans for the existing London Health Board, chaired by the Mayor, to provide political leadership and oversight of the strategy for devolved services, and for a new London Health and Social Care Devolution Programme Board to be set up in January 2016 to provide strategic and operational oversight.
London’s five pilots will each focus on a particular area of devolved health and social care, including integration of primary and secondary care, health and social care budgets, and physical and mental health services. The devolution agreement also includes consideration of the use of NHS estates in London and of increasing incentives for trusts to make better use of property in the capital.
Data Protection Regulation agreement supports research
This week a compromise text on the revised EU Data Protection Regulation has been informally agreed by the European Parliament, Council and Commission. The Regulation is being revised to protect individuals’ personal data, but this has led to concern that the revised regulation would impinge on the use of data for research.
Fortunately for research, the agreed text includes arrangements to facilitate the use of personal data in research. The Regulation will allow for researchers to use individuals’ health data for research purposes that are in the public interest, as long as safeguards (such as the use of pseudonyms for individuals or ensuring their anonymity) are in place where possible.
Votes to formalise the agreement will take place in the European Parliament and Council of Ministers in 2016, and the new Regulation is expected to come into force in 2018.
Morbid obesity surgery commissioning to be transferred to CCGs
Responsibility for the commissioning of morbid obesity surgery will be transferred from NHS England to individual clinical commissioning groups (CCGs) from 1 April 2016. This decision was made following a consultation by the previous Coalition Government, which originally proposed that the changes come into force in April 2015, but responses advised against this earlier date. NHS England will lead on the contracting for services for 2016/17. The NHS England Clinical Reference Group for Severe and Complex Obesity will publish a draft template for CCGs on access to obesity surgery pathways and follow-up treatment in January 2016.
Independent review of mortality of people with learning disabilities commissioned
Health Secretary Jeremy Hunt has announced that NHS England has commissioned an independent review of the mortality rates of people with learning disabilities. He has also committed to publishing the number of avoidable deaths, broken down by NHS Trust, next year. The announcement was made following a report on Southern Health NHS Foundation Trust, which found that only 272 of 722 unexpected deaths at the Trust had been investigated.
Dame Una O’Brien to leave DH in 2016
Permanent Secretary to the Department of Health (DH), Dame Una O’Brien, will step down from her role in April next year, after five years in post. She had previously served as Director General of Policy and Strategy, and Director of Provider Reform Policy at the Department.