30th January 2015

Contents

• Providers reject 2015/16 tariff proposals
• Government supports credentialing and protection of surgeons' titles in response to draft Bill
• Public satisfaction with the NHS at second highest figure ever recorded
• Labour lays out 10 year health vision as UKIP pledges extra £3bn per year for the NHS
• Welsh Audit Office highlights poorly performing waiting times
• Waiting time figures improve but target still missed

Providers reject 2015/16 tariff proposals

Monitor, the sector regulator for health services and the body responsible for setting the National Tariff, has announced that 75.1% of all NHS providers (by share of supply) have lodged formal objections to the proposed tariff for 2015/16. The objections breach the 51% threshold that means Monitor must call in the Competitions and Markets Authority to settle the dispute or revise its plans.

This is the first time NHS providers have vetoed the proposed tariff since new pricing rules were introduced by the Health and Social Care Act 2012. Monitor chief executive David Bennett, speaking to the HSJ, revealed that the reasons for providers’ opposition fell under a number of categories, including plans to cap payment for specialist services activity at 50% of normal rates and the imposition of a 3.8% real terms cut to aggregate prices as an “efficiency target”. Hospitals contend this is unsustainable.

Mr Bennett also claimed that hospitals also felt that the individual prices for certain services, such as bariatric surgery, had been set too low.

A new tariff will not now be agreed by the end of this financial year. This means prices for the current year will be rolled into 2015/16 and stay in place until a resolution can be found.

Government supports credentialing and protection of surgeons’ titles in response to draft Bill

The Government has published its response to a draft Bill from the Law Commission on the regulation of health and social care professionals.

The Law Commission had been tasked by the Department of Health to review the regulation of healthcare professionals and propose a draft Bill to reform the regulatory landscape, which the regulators claim to be outmoded and unwieldy. The proposals were published earlier this year and, while no Bill was forthcoming in the Queen’s Speech, the Government has continued to stress that it is committed to introducing legislation at the earliest opportunity.

This response is the first time the Government has commented on the detail of the draft Bill. They have accepted a large majority of the Law Commission’s proposals in full, including agreeing that the regulatory bodies should have powers to annotate their registers with additional qualifications and specialisms. Furthermore, they also agree that the GMC should be able to hold separate registers – as subsets of the main register – for General Practitioners and specialist medical practitioners.

On protected titles, the Government has agreed with the Law Commission that protected titles and functions are fundamental to the overall regulatory framework and should be included in any future legislation. They also indicated their willingness to cooperate with stakeholders to determine how to take forward statutory provisions on protected titles.

Despite the Government indicating a willingness to take forward the plans they said a commitment to legislating could only be done “when parliamentary time allows”.

The College supports the proposed legislation as it would allow for a number of beneficial outcomes, including facilitating the ability of the GMC and GDC to annotate their register with specialisms (therefore allowing for cosmetic surgery to be listed as a credential on surgeons’ entries) as well as protecting the title “surgeon” in legislation.

Public satisfaction with the NHS at second highest figure ever recorded

Public satisfaction with the way the NHS is run is at its second highest level since records began in 1983, according to new research carried out by the National Centre for Social Research and published by the King’s Fund.

The data, which surveys public opinion as opposed to that of patients alone, shows that satisfaction is up five points from last year, and is now at 65%. The highest rating ever was 70%, recorded in 2010. The figures also show that dissatisfaction levels for this year have fallen to an all-time low of 15%.

The survey, which was conducted between August and September 2014, also examined satisfaction with a number of specific NHS services:

• Satisfaction with GP services remains high but has fallen to its joint lowest figure ever recorded at 71%
• Satisfaction with dental services remains lower than other NHS services and has gone down 3 points from last year to 54%.
• Public views on accident and emergency have improved in the last year, up from 53% to 58%

The finding that satisfaction overall has risen significantly despite widespread media coverage of financial pressures and difficulties with A&E and waiting times may seem counterintuitive. However, the Kings Fund speculates that this may indicate the public rallying behind the service to show their support for the NHS in a difficult time. Consequently, they conclude that while satisfaction has improved, this does not indicate an improvement in the actual performance of the NHS, nor does it reflect an actual improvement in patient satisfaction.

Labour lays out 10 year health vision as UKIP pledges extra £3bn per year for the NHS

This week saw the official launch of Labour’s 10 year plan for health and social care. Shadow health secretary Andy Burnham set out his party’s vision that care provision should be shaped to meet a person’s “whole care needs” and said he wanted to “reset the NHS” to become a National Health and Care Service”.

Mr Burnham stressed that while a Labour Government would not impose a top-down reconfiguration some “change cannot wait” and they would still expect health and social care to merge within 10 years. More immediate change would include abolishing the Health and Social Care Act, which he said would be repealed in the first year of a Labour Government.

For CCGs, Labours plans would mean a heavily reduced role in which NICE would assume their responsibility for deciding which treatments and services are provided. Mr Burnham also confirmed that a Labour Government would move away from the national tariff system, which he said rewards episodic treatment, towards a “year of care” model in which budgets cover a person’s health and social care needs over the course of a year. This would be rolled out initially for those groups most likely to be hospitalised.

On competition, Mr Burnham said that Labour would legislate to opt the NHS out of EU procurement law to allow NHS to become the preferred provider. The shadow secretary said that he had been assured by the European Commission that this would be acceptable under EY law.

Also this week, UKIP leader Nigel Farage announced that his party would commit an extra £3bn per year in NHS funding if they were in power. Mr Farage also announced that they would cut £2bn from the NHS bill by ensuring migrants and tourists have valid health insurance as a condition of entry to the United Kingdom

Mr Farage made the comments on the Andrew Marr show. A video of the exchange can be viewed here.

Welsh Audit Office highlights poorly performing waiting times

This week, the Wales Audit Office published a report into NHS Waiting Times in Wales. The report highlights that “waiting time targets (in Wales) have not been met since September 2010 with performance getting worse in recent years” and that the current approach “does not deliver sustainably low waiting times”. The report also finds that “performance against the Welsh Government’s targets has deteriorated significantly, and whilst there are some differences in the way waiting-times performance is measured, Scotland and England are doing better against more stringent targets.”

The report concludes that “emerging plans have potential to improve the position if they are implemented effectively” and that NHS Wales will need to act, particularly regarding the Welsh Government’s proposals around prudent healthcare, to challenge and improve the overall system of planned care. The report also highlights the increased use of day surgery, problems with theatre efficiency and variation in length of length of stay of both elective and emergency patients in Wales.

The College gave evidence to the Wales Audit Office as part of their research.

Waiting times figures improve but target still missed

Waiting times figures published today show that A&E performance recovered slightly again for the third week running, with 93% of patients seen within 4 hours of attending an A&E. However, the national target – for 95% of patients to be seen within that timeframe – continues to be missed. When considering type 1 attendances only however, the proportion seen within the target time falls to 89.4%.

Meanwhile, new statistics show that since the first Monday in November until last Sunday, there have been 18,108 elective and 892 urgent operations cancelled. Respectively, this is a 41.4% and 30.8% increase in the number of cancellations compared to last year.