4th June 2015
Contents
- MPs and Peers condemn lack of professional regulation recommended by the College to protect patients
- Tackling the deficit and improving patient care go hand in hand, says Jeremy Hunt
- Simon Stevens sets out his plans for tackling NHS finances and redesigning care
- Two of three 18-week referral to treatment targets abolished
- Staff stress needs to be tackled in order to meet £22bn efficiency target and implement seven-day care, says the Nuffield Trust
- Burnham becomes first Labour leadership candidate to secure enough MPs’ support
MPs and Peers condemn lack of professional regulation recommended by the College to protect patients
MPs and Peers have highlighted the College’s concern that new powers to protect individuals undergoing cosmetic surgery were not included in the Queen’s Speech.
Ann Clwyd MP indicated that the RCS ‘ that the Government chose not to introduce legislation to reform the regulation of health professionals’. She noted that at present the law allows any doctor, including non-surgeons, to perform cosmetic surgery without undertaking additional training or qualifications, and that the RCS had therefore called for the General Medical Council to be given a new power to tell the public and employers which surgeons are qualified to undertake cosmetic surgery.
Ms Clwyd described the case of a GP performing cosmetic surgery, saying that ‘many people face exploitation by private sector clinics and even cowboy surgeons’. This story, and the College’s call for action, was subsequently covered in the Mirror and the Daily Mail.
In addition, Shadow Health Secretary Andy Burnham criticised the absence of the legislation from the Queen’s speech. Burnham said the legislation was a ‘significant omission’ from the speech, stressing that it ‘would have enabled the regulators to get on with the job of protecting and safeguarding the public from poor care’.
Similarly Lord Hunt of Kings Heath highlighted that the RCS ‘has warned that one consequence will be that doctors will continue to perform cosmetic surgery without the necessary additional training or qualifications’, and Baroness Walmsley said regulations on the qualifications of healthcare professionals would improve patient safety. Lord Colwyn drew attention to the importance of professional regulation for dentists, noting that ‘oral health is conspicuously absent’ from political discussions on health issues.
Tackling the deficit and improving patient care go hand in hand, says Jeremy Hunt
At the NHS Confederation annual conference, Health Secretary Jeremy Hunt set out his plans for tackling the NHS’ financial challenges, and how to improve transparency and quality in the health service.
He commended the ‘lean philosophy’ which advocates the idea that elimination of waste and improving patient care are not two parallel processes, they go hand in hand. Using examples, he made the case that ‘the path to lower costs is the same as the path to safer care’. After acknowledging that finding £22bn in efficiency savings would not be easy, he put forward some means of achieving this, including: limiting agency spend; improving procurement and rostering processes; sharing best practice. The latter aim will be facilitated by the implementation of hospital chains, the first four of which will be selected by September.
Hunt said he wants the Mid Staffordshire scandal to be a moment of change where we resolve to be the safest health care system anywhere in the world. Transparency is a key means to improving quality, he affirmed, and he argued that we need a much more consistent approach, where all data, including safety statistics, are published monthly on the same day. In addition NHS England will be working with the King’s Fund to identify and develop transparent metrics that look at the provision of healthcare nationally, in order to find a way of holding CCGs accountable. The Government plans to establish safer care, higher quality, and lower costs, by being patient-centred and patient-driven, said Hunt. Data indicating the quality of different services will then be published online, allowing for comparison against other trusts, and used to facilitate an intervention regime for underperforming trusts.
On prevention, Hunt indicated that the Government will publish a national childhood obesity strategy before the end of 2015.
Simon Stevens sets out his plans for tackling NHS finances and redesigning care
Simon Stevens, Chief Executive of NHS England, also spoke at the NHS Confederation Conference, on the next five years for the NHS.
Stevens set out four key areas the NHS needs to focus on. Firstly, the NHS needs to be put on a financially sustainable footing. Since it is unlikely to receive further funding this year, realistic and balanced funding plans will be required, he said. These plans will involve tackling the excessively high use of agency staff, and intervention through a ‘success regime’ in three struggling areas: North Cumbria, Essex, and North, East and West Devon. This regime establishes central support from NHS England to help a local area become financially and/or clinically sustainable.
NHS England and others will be consulting with healthcare leaders, patient groups, and so on to establish a plan for how to make the required £22bn in efficiency savings.
Secondly, Stevens highlighted the importance of care redesign, with the aim of triple integration, between primary and secondary care; mental and physical health; health and social care. He noted that trials of integration of care in these ways are now well under way at vanguard sites. NHS England also welcomes expressions of interest from organisations interested to become vanguard sites for a new care model for urgent and emergency care.
Reflecting the aim of the Five Year Forward View to get serious about prevention, Stevens emphasised the need for a national conversation on the issue, including with industry. He showed particular concern about the lack of progress in tackling obesity.
Lastly he encouraged people to come together both nationally and locally to work together to improve the NHS.
Two of three 18-week referral to treatment targets abolished
The Government and NHS England have announced they are abolishing the ‘admitted’ and ‘non-admitted’ 18-week GP referral to treatment targets, but retaining the 92% 18-week incomplete target.
Waiting times have been measured in three different ways:
- 90% completed admitted patients: This measures waiting times for those patients who have been admitted as an inpatient or day case admission.
- 95% completed non-admitted patients: This measures waiting times for reasons other than an inpatient or day case admission.
- 92% incomplete pathways: This measures patients who are still awaiting treatments and was introduced in 2012 to incentivise hospitals to treat patients who have been waiting the longest.
Why could this be a good thing for surgical patients?
- Abolishing the admitted 18-week target is a particularly positive step. Under this target patients are recorded when they have treatment, so it can discourage hospitals from treating someone who had already missed the 18-week target because this would count negatively against their target. All the time the patient is not treated, the long wait isn’t recorded.
- The incomplete target measures everyone who hasn’t yet received treatment. This means that there is no penalty for treating someone who has waited longer than 18 weeks.
- The change will therefore have the biggest effect for those waiting longer than 18 weeks as there are now no disincentives to treating them. When the admitted and incomplete targets have been previously suspended, more long waiters were treated.
- The change might help to reduce the overall size of the waiting list in the short-term by reducing the number of long-waiters and removing the incentive to treat short-waiters to help meet the admitted target. In the long-term, waiting list length will be affected by demand and the NHS’ capacity.
- Providing waiting lists do not become too long (see below), the new rules should help surgeons to prioritise treating those that need to be treated more urgently. This has been the College’s primary concern in the past.
- Going from three targets to one target will be much more straightforward for trusts and surgeons to manage and analyse. There will not be competing incentives.
What is the remaining problem?
- Under the remaining target, if a Trust builds up a large waiting list and is close to the 92% target then there is an incentive to treat long-waiters to remove them from the incomplete list. If the list is large and the Trust is struggling for capacity, doctors could be under pressure to treat long waiters at the expense of patients who have been waiting for a shorter amount of time but might need to be treated more quickly.
Staff stress needs to be tackled in order to meet £22bn efficiency target and implement seven-day care, says the Nuffield Trust
The Nuffield Trust has released a report arguing that the NHS will not be able to meet the £22bn efficiency savings target, nor implement seven-day care, unless the health service ‘reconnects with staff and develops their skills’ and tackles stress, disengagement and burnout.
The Trust’s report suggests that the Government prioritises: transforming and funding care outside of hospital; introducing the additional £8bn NHS funding steadily rather than closer to 2020; not placing too much focus on A&E targets at the expense of other goals.
Burnham becomes first Labour leadership candidate to secure enough MPs’ support
As the Labour leadership battle ensues, Shadow Health Secretary Andy Burnham has become the first contender to gain backing from enough MPs to be able to run for the leadership. He has secured the support of 38 MPs, surpassing the required 35, while other contenders Yvette Cooper, Liz Kendall and Mary Creagh have secured the backing of only 31, 21 and 6 MPs respectively.