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20th February 2015

Contents

Monitor board papers highlight worsening financial position of Foundation Trusts

Over half (53%) of Foundation Trusts (FTs) were in deficit at the end of last year, according to a report to Monitor’s Board published today. In total 78 FTs reported a combined deficit of £321m, five times more than planned.

The report also outlines the growing pressures on hospitals. Analysis by the regulator finds that FTs had 2.7m A&E attendances between October and December a figure that is 8% higher than the corresponding period last year. These trusts also saw a 7% increase in the number of non-emergency cases treated.

Meanwhile, A&E performance in England declined this week as emergency departments handled the highest number of attendances since Christmas. 91.6% of patients were seen within the 4 hour target (dropping to 87.1% for type 1 departments), representing a decline in performance on the previous week and the lowest proportion of patients seen within the 95% target frame in 5 weeks.

New report finds commissioners to be “muddling through” rationing decisions as RCS hosts joint debate with the Nuffield Trust

Commissioners and policymakers have been “muddling through” the process of deciding which treatments to ration on the NHS, according to a new policy briefing from the Nuffield Trust. The think tank says that growing financial pressures have exposed a lack of legitimacy in the way decisions are made over which services commissioners provide. The paper argues that while rationing is inevitable, there should be greater transparency in the way these decisions are made, and clearer guidance for commissioners in describing what acceptable variation in care looks like.

Alongside the briefing the Nuffield Trust has published the results of a survey of 100 health and social care leaders. The poll assesses their views on rationing in the NHS. The results include the finding that seven in ten (68%) respondents feel that people should get the same package of NHS services no matter where they live. However, more than half (52%) think treatments and services should be tailored locally.

The reports were published as the RCS and Nuffield Trust conducted a joint debate on the issue, hosted at the College. Speakers included Ben Page, chief executive of Ipsos Mori, who outlined the public’s attitude towards rationing. A panel debate followed, with oncologist Dr Karol Sikora, Labour Peer and former health minister Lord Warner, Nuffield Trust Chief Executive Nigel Edwards and David Jenner, a GP and Board member from NEW Devon CCG, discussing the issue.

The event was recorded and can be viewed here.

UK Government’s publish statement on Shape of Training

The UK Shape of Training Steering Group (STSG) – a group convened by the four UK Governments to consider the recommendations of the Shape of Training report – has published a statement, endorsing a number of specific proposals.

In particular, the group has endorsed a more evolutionary approach to exploring how medical training might be adapted to meet future needs. This includes requiring that any significant changes be introduced in a measured and incremental manner so as to minimise disruption. The STSG has further recommended the creation of workgroups, with suitable stakeholder representation, to take forward the proposals of the report.

Going forward the STSG will undertake further work to better understand how medical training can become more balanced so as to develop the generalist skills of the workforce. This will involve work conducted by the Academy of Medical Royal Colleges to scope out the extent to which the medical Colleges can develop their curricula in this way.

NICE thresholds damaging care, says new research from York University

A new study has claimed that the threshold used by NICE in assessing the cost-effectiveness of new drugs is too high, leading to deficits of care elsewhere in the system from too much money being spent on less cost-effective treatments.

The research, conduct by the University of York’s Health Economics team, found that NICE uses a threshold of £30,000 per Quality Adjusted Life Year (QALY), arguing that this threshold is too high. The authors argue that the level should be closer to £13,000 as the money saved could be better spent in other, more cost effective, services which would actually lead to a net increase of QALYs across the system.

The paper states that the high threshold used by NICE could be doing more harm than good to patients across the system. The authors are particularly critical of the Cancer Drugs Fund, caliming that the level of investment in the fund has resulted in a total loss of 21,645 QALYs to the NHS in 2014/15.

NHS England and Monitor set out new tariff options for providers

The chief executives of NHS England and Monitor have written to the providers of NHS funded care outlining the two national tariff (pricing) options available to them for 2015/16. This follows the unprecedented objection by providers to the previous proposals set out earlier this month. As a reminder, most surgical services are covered by the national tariff.

The first option is simply that of a rollover (a Default Tariff Rollover (DTR)), which would see providers paid at the rate set out in the 2014/15 tariff.

However, the new option is for an enhanced tariff for 2015/16 that NHS England and Monitor say is worth £500m more to providers. This is achieved by increasing the marginal tariff for emergency admissions from 30% to 70% and by increasing the marginal cost for specialised services from 50% to 70%. In addition, the gross tariff deflater is decreased from 3.8% to 3.5%. The College has previously called for the 30% marginal tariff for emergency admissions – where providers only receive 30% reimbursement for admissions above a baseline level - to be dropped.

Providers have until 4th March to decide whether to choose the enhanced tariff or remain on the default rollover.

Significant reform required to realise ambition of Five Year Forward View, according to King’s Fund

Realising the vision laid out in NHS England’s Five Year Forward View will require significant changes to the way in which health services are commissioned, paid for and regulated, according to a new paper from the King’s Fund.

The think tank warns that without fundamental changes to policy the plan’s ambitions, which have been widely lauded in the health sector, will fail to be delivered. For example, the paper emphasises the need to establish structures that would enable commissioners to learn from examples of best practice as the NHS explores new ways of commissioning care. In addition, the authors state that national bodies such as NHS England and Monitor should review their rules on procurement and tendering to remove any barriers to the development of new care models.

The paper highlights how these bodies have a major role to play in supporting the delivery of the Five Year Forward View, for example through the creation of transformation funds to help support NHS organisations.  Additionally, to help stimulate innovation, the regulators should avoid the “wrong kind” of regulation, especially as the NHS explores ways of implementing new organisational models.

The full report can be read here.

Government proposes new penalties if false information is provided by a hospital

The Department of Health (DH) has released a report on the outcome of the consultation on provision of misleading information by healthcare providers. This consultation was launched in 2014 in response to the Mid Staffordshire Public inquiry recommendation that it should be made a criminal offence for a care provider or individual (funded by the public purse) to provide false or misleading information (FOMI). Under the proposed regulations, a person or care provider found guilty of FOMI would be liable to an unlimited fine and/or imprisonment.

The consensus response to the consultation was to welcome DH’s approach, but many asked for guidance on how the offence should operate. In response DH has published guidance for providers. The final FOMI regulations will soon be laid before Parliament, and if no amendments are required, they are expected to come into force in early 2015.

FDS to give evidence to Health Select Committee on children’s oral health

Professor Nigel Hunt, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons, and Mr Stephen Fayle, a consultant paediatric dentist and FDS board member, will appear before the Health Select Committee on Tuesday (24th February) to give evidence at an inquiry on Children’s Oral Health.

This follows the publication of a report from FDS examining the issue last month.

The session can be watched live at this link.

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