6th February 2015

Contents

• King's Fund report criticises "damaging" coalition reforms
• Public Accounts Committee highlights fragility of NHS finances as RCN reveals unprecedented rise in spending on agency nurses
• Latest figures show A&E performance has worsened slightly
• DH publishes consultation outcome as transferral of morbid obesity services from NHS England to CCGs is postponed

King’s Fund report criticises “damaging” coalition reforms

The Health and Social Care Act has been “damaging and distracting” for the NHS, according to a new report from the King’s Fund. The report, a comprehensive assessment of the coalition government’s record on the NHS during this parliament, criticises major reforms for implementing complex organisational changes at a time when the NHS should have instead been focussing on managing unprecedented demand.

While the report does find some positive developments, such as the closer involvement of GPs in commissioning and advances in the integration of care, the authors highlight that the top-down reorganisation of NHS structures has been distracting, that the new systems are complex and confusing, and that the abolition of Strategic Health Authorities has led to a lack of local systems leadership. The research also finds that while the coalition reforms have resulted in greater marketization, any claims that they have led to mass privatisation of services are unfounded.

The paper notes that the second half of the parliament has been devoted to “limiting the damage” of the Health and Social Care Bill and has been characterised by a shift towards a renewed focus on improving care quality and patient safety. It concludes that the next government should continue with this agenda, albeit with less of an emphasis on regulation and more on supporting culture change through supporting staff and improving leadership.

Public Accounts Committee highlights fragility of NHS finances as RCN reveals unprecedented rise in spending on agency nurses

The latest report from the Public Accounts Committee on NHS finances has yet again painted a bleak picture of the financial performance of NHS bodies. The report, on the financial sustainability of the NHS, draws attention to the worsening performance of the NHS, with £2.1bn net surplus achieved by the sector in 2012/13 falling to £722m in 2013/14. The report also finds that the percentage of trusts in deficit has nearly tripled, from 10% in 2012/13 to 26% in 2013/14, and that 80% of FTs that provide acute hospital services were reporting a deficit by the second quarter of 2014/15.

The Committee’s report says that the current system of paying providers for emergency admissions – the marginal tariff – is a hindrance to the viability of NHS organisations. The marginal tariff is a system designed to incentivise keeping patients of hospital, where providers are only paid 30% of the full tariff for emergency admissions and the remainder is incentivised in arrangements to reduce hospital admissions. However, the report states that this arrangement has served to intensify the financial difficulties faced by the acute sector.

The report states that the existing means of achieving efficiency savings in the NHS – such as the continued pay freeze for staff – are unsustainable. Instead it makes a number of recommendations to the government to help ease financial pressures, including making better use of primary and community care services as well as further upfront investment to help support beleaguered NHS trusts.

Also published this week was a report from the Royal College of Nursing which exposed an unprecedented rise in spending on agency nurses. Data from the report shows that the health service will spend an estimated £980m on agency nursing staff by the end of this financial year, amounting to an average of £4.2m per trust.

Latest figures show A&E performance has worsened slightly

An increase in A&E attendances was mirrored by a slight decline in A&E performance as the number of patients seen within the 4 hour target frame decreased on the previous week from 93% to 92.3%, according to the latest data. The target is to have 95% of patients treated within 4 hours. Moreover, the figure for type 1 attendances continues to be markedly below the 95% target at 88.3%.

Meanwhile, the latest statistics show that since the first Monday in November until last Sunday there have 19,668 elective and 972 urgent operations cancelled. Respectively, this is a 40.9% and 30.5% increase in the number of cancellations compared to last year.

DH publishes consultation outcome as transferral of morbid obesity services from NHS England to CCGs is postponed

The Department of Health has published the consultation outcome on proposals to transfer the commissioning responsibility for renal dialysis and morbid obesity surgery services from NHS England to CCGs. This follows the previous announcement that the transferral of obesity services from the specialised commissioning budget to local commissioners would be postponed.

The paper shows that the majority of respondents felt the timescale for the proposals was not feasible. Many CCGs said that NHS England hadn’t provided enough information on the proposals and would need to offer more details before a full consultation process on the logistics could take place.

The transfer has been postponed until April 2016.