30th October 2015
- Hunt announces ratings scheme to measure CCG performance
- Government announces consultation on Mandate to NHS England
- CQC publishes cost savings report
- Accelerated Access Review publishes interim report
- MPs debate proposed junior doctors' contract
- Government agrees devolution of health in a deal for the North East
- House of Commons votes in favour of English votes for English laws
Hunt announces ratings scheme to measure CCG performance
At the Health Service Journal (HSJ) annual lecture, Jeremy Hunt announced a new ‘Ofsted style’ ratings system for CCGs, that will be introduced by June 2016. NHS England will publish overall ratings – designated as outstanding, good, requires improvement, and inadequate – for all CCGs, as well as individual service ratings for cancer, mental health, dementia, diabetes, maternity, and learning difficulties. Service-specific judgements will be decided by expert committees, and Mr Hunt announced that Dr Harpal Kumar, Chief Executive of Cancer Research UK, will lead the cancer committee, and Paul Farmer, Chief Executive of Mind, will head the mental health committee.
This announcement formed part of a speech on the Health Secretary’s ‘intelligent transparency’ agenda, which focuses on the use of new and existing technologies to give patients increased power and responsibility over their health and treatment. Other measures outlined by Mr Hunt included the drive for a paperless NHS, with GP practices on course to being fully digitised by 2018, stopping referrals from hospitals back to GPs when patients miss an appointment, and will incorporate principles from the Academy of Royal Medical Colleges report on accountability outside hospitals, as well as the principle of a named responsible clinician, in future planning guidance. He also emphasised increasing patient choice, saying that NHS England will continue to explore ways of increasing choice in maternity services, end of life care, and that NHS England will publish plans by the end of the year for rolling out personal health budgets.
Government announces consultation on Mandate to NHS England
Health Minister Lord Prior announced the Government’s consultation on their Mandate to NHS England to 2020. The Mandate includes plans to better integrate out-of-hospital care to ensure ease of access, enable routine GP appointments at evenings and weekends, and provide multi-year budgets for CCGs to aid their financial planning.
In the RCS Priorities for a New Government briefing from July, the College set out a number of recommendations for the Government’s first mandate to NHS England, including prioritising urgent and emergency care, identifying new surgical procedures, and ensuring older people have sufficient access to surgery. The consultation closes on 23rd November, and the RCS will submit a response. The final Mandate will be published following the outcome of the Government’s spending review in late November.
CQC publishes cost savings report
The CQC has published a strategy and business plan for 2016-21, which focuses on reforming regulation in the context of the Government asking the regulator to seek savings of up to 25-40% of its budget ahead of the spending review in November.
The plan sets out reforms in four areas:
- Risk-based registration – including reducing the frequency of inspections for high performing organisations
- Smarter monitoring and insight from data – increasing analysis of short and long-term trends on providers’ performance, developing data that predicts risks, and better using feedback from service users
- Greater focus on co-regulating with providers – increasing the level of self-assessment by providers, using this information to target inspection activity
- More responsive and tailored inspections – spending more time assessing quality in service areas and clinical pathways, rather than place-based regulation
The CQC is consulting on the plan until 22nd November, and the result of the Government spending review will be announced on 25th November.
Accelerated Access Review publishes interim report
Firstly, patient input needs to be increased throughout the innovation pathway, in order to direct innovation towards outcomes that matter most to patients. This will require earlier, more systematic opportunities for innovators to hear from patients, and earlier opportunities for patients to take part in trials.
A more systematic, transparent horizon-scanning process is needed to identify innovative products. There needs to be earlier engagement with companies to evaluate and license their products, reimburse investment, and conditionally approve new products in order to introduce them into the system early. The review will consider how NICE can evaluate a more flexible, streamlined system for evaluating products.
The review recommends a national ‘Innovation Partnership’ to manage the innovation pathway through links to a network of local Innovation Exchanges, and give advice to small innovators on how to get a product to market. Partners would include NIHR, MHRA, NICE, NHS England and NHS Improvement. The system also needs to better incentivise adoption of new products by hospitals. This may involve funding through Academic Health Science Networks (AHSNs), which coordinate innovation.
The RCS submitted a response to the AAR, in which it highlighted findings from its reports From Theory to Theatre and From Innovation to Adoption. Key points included the importance of a horizon-scanning process to identify promising new techniques, the involvement of strategic clinical networks to advise on the adoption of innovative procedures, and the importance of patient awareness of new techniques.
The review is now in its second stage of engagement and is testing and refining these interim report propositions. The final report will be published by April 2016.
MPs debate proposed junior doctors’ contract
The House of Commons held a debate on the proposed new junior doctors’ contract this week following a motion by the Labour party. Responding in the debate, Health Secretary, Jeremy Hunt, cited academic studies demonstrating a weekend effect on mortality rates in hospitals, and said that the Government was implementing a package to increase consultant and junior doctor cover at weekends.
Mr Hunt said that under the proposals for the new junior doctors’ contract, basic pay would be increased, and pay for overtime and weekend work would be reduced to incentivise better rostering in hospitals. Labour’s motion in the House of Commons had called for the Health Secretary to guarantee that no junior doctor would get a pay cut, to withdraw the threat of contract imposition, and for the BMA Junior Doctors’ Committee to return to negotiations.
Following the debate, the Health Secretary wrote to the Chair of the BMA Junior Doctors’ Committee, Dr Johann Malawana, with an assurance that no junior doctor would lose pay under the new contract, and invited the BMA to restart negotiations. The BMA responded to the letter saying that it ‘could be a step in the right direction’ for the new contract, but continued to insist that the Health Secretary withdraws the threat of imposing the contract on junior doctors.
Government agrees devolution of health in a deal for the North East
The Government has agreed to a devolution deal with the North East region, which includes control over health and social care. The agreement provides for the establishment of a Commission for Health and Social Care Integration, which will be jointly run by the North East Combined Authority and the NHS, and led by a national senior national figure. The Commission will establish the scope and basis for health and social care integration, as well as deeper collaboration and devolution to improve outcomes and reduce health inequalities, and will report by summer 2016. Following the Commission’s findings, the Government and Combined Authority will also assess which regulatory powers should be transferred locally around promoting public health by addressing obesity, smoking and substance misuse.
The agreement follows the Government’s invitation for bids to devolve powers to local and combined authorities, announced in the Budget in July. A number of authorities have produced bids with powers for health and social care, including London, the Leeds City Region, the Liverpool City Region, the West Midlands, and the Heart of the South West, made up of Devon and Somerset. As has been widely reported, deals for Greater Manchester, ‘DevoManc’, and Cornwall have already been agreed.
House of Commons votes in favour of English votes for English laws
MPs have voted to approve, by 312 votes to 270, introducing English votes for English laws, known as EVEL, which would effectively exclude Scottish MPs from deciding legislation relating only to England, or to England and Wales. The Government has proposed the change in the context of devolving further powers to the Scottish Parliament following the independence referendum last year.
The current proposals outline the creation of a new stage in the legislative process, where a Bill that is considered to relate only to England, or England and Wales, only relevant MPs, within a Grand Committee, will be able to consent or veto the legislation. This would take place after committee and report stage, and will act as the final vote following amendments.