Last year was a colourful one for most, littered with flu pandemics, shamed MPs and very little loose change. NHIS reviews the most significant events of the 2009 NHS diary.
Arguably, the NHS in 2009 was conditioned greatly by Lord Darzi’s report, High Quality Care for All, published in June of the previous year; with an acute focus on quality and efficiency still highly apparent. Further, many ideas originally conceived in the report were witness to significant progression. In a year characterised by dramatic shifts in the economy, as well as the political cabinet, this was certainly no easy feat.
The National Health Intelligence Service (NHIS) looks back over a somewhat eventful year, and provides your comprehensive guide to the top goings on in the NHS.
2009 kicked off with the publication of the Health Bill. This permitted direct payments for healthcare to patients for the first time, allowing greater choice and control over the health services to which they are entitled. This was accompanied by the introduction of a personalised care plan for patients with long-term conditions and follows Alan Johnson’s belief that those patients in question should become experts in their own care. The Department of Health also moved a step closer towards the introduction of Personal Health Budgets in England by inviting expressions of interest for a new pilot programme. This invitation was readily accepted, with 68 projects being awarded provisional pilot status by May 2009.
The first National Dementia Strategy was launched. Backed by £150 million over the first two years, this initiative aimed to increase awareness of dementia, ensure early diagnosis and intervention and radically improve the quality of care that the people with the condition receive. Such concern also extended to the role of those who care for patients with debilitating conditions such as dementia. Research announced in February demonstrated that individual budgets can greatly improve carers’ quality of life, when compared with carers using conventional social services.
A package of measures was announced designed to speed up access to new drugs and treatments for NHS patients. The four proposed changes aimed to ensure that more NHS patients receive the life-saving drugs and treatments that they need. This initiative moved on later, in July, when a blueprint on proposals for an ‘Innovation Pass’ was released.
March was also witness to the publication of the Chief Medical Officer’s Annual Report 2008, as well as a renewed vision of the relationship between Practice Based Commissioning and World Class Commissioning. Further, as part of the drive towards a more preventative NHS, it was announced that NHS Health Checks would begin from April for everyone aged between 40 and 74 in England. Hailed as an essential tool in tackling health inequalities across the country, it was also stated that these checks could help to prevent 1600 heart attacks and strokes each year.
As the extent of the economic downturn became ever more apparent, it was announced that a £220 million fund would be made available to encourage innovation within the NHS. This sat alongside the introduction of a range of measures, designed to raise the quality of services and standards. These included the Performance Framework, Patient Recorded Outcome Measures (PROMS) and a new, simpler complaints system. Further to this, two new integrated organisations started work; the National Quality Board and the Care Quality Commission, the latter of which would have a significant impact with the production of its ‘annual health check’ later in the year.
In Northern Ireland, following an announcement in February, the previous four Health and Social Service Boards were replaced by a single Health and Social Care Board as part of the reorganisation to streamline health provision. This move was later echoed by the NHS in Wales, which also adopted a new structure in October.
NICE launched the web-based NHS Evidence, just short of a year after its initial conception in Lord Darzi’s High Quality Care for All Report in June 2008.
The Department of Health joined forces with The NHS Information Centre to publish a list of more than 200 Indicators for Quality Improvement (IQI), designed to measure the quality of care delivered in the NHS, highlight areas for improvement and track the changes they implement. The IQI span the three dimensions of high quality care: patient safety, effectiveness of care and patient experience.
Also in May, the NHS Chief Executive’s Report was published, outlining the achievements of the NHS in 2008/09. These achievements included surpassing targets for efficiency savings and the reduction of MRSA infections, as well as providing extended opening hours at 71% of GP practices and employing an additional 1,195 midwives. All in all, a very positive report.
Amidst the declaration of a swine flu pandemic and the scandal of illegitimate MP expenses, Gordon Brown’s cabinet reshuffle in June named Andy Burnham as the new health secretary.
The Quarter 4 (January-March 2009) performance report was published, and closely echoed much that was revealed in the Chief Executive’s report of the previous month. As well as outlining the beating of numerous targets, it also reported positive patient experiences and effective planning in response to swine flu.
The NHS Confederation addressed the increasingly worrying financial situation and published Dealing with the downturn: the greatest ever leadership challenge for the NHS? This document embraced the fact that the NHS is facing its most severe contraction in finance – with an £8-10 billion real terms cut likely in the three years from 2011 – and announced that the NHS will not survive the impending spending squeeze unchanged.
In reaction to this realisation and to encourage an increase in the pace of change, the Department of Health announced that it is considering creating a ‘premier league’ of some 10-15 PCTs with enhanced freedoms and powers.
At the end of the month, Lord Darzi published a report examining the progress that has been made in the 12 months since High Quality Care for All was published. This latest report – High Quality Care for All: Our Journey So Far – found that there had been a real progress in all areas of quality, with patients already seeing the difference.
A matter of weeks after publishing his latest report, Lord Darzi resigned as health minister to devote more time to his clinical and research roles. He remains a government adviser.
Following the measures initiated in March, the Government, with NICE, introduced an ‘Innovation Pass’; a three-year initiative for selected medicines which will allow patients with the greatest need earlier access to the drugs. This has since become the subject of further discussion with the launch of a consultation in November.
The devolved countries focused on all things heart-related in July; with the publication of the Cardiac Disease National Service Framework for Wales and a Service Framework for Cardiovascular Health and Wellbeing in Northern Ireland. Scotland meanwhile, published the Better Heart Disease and Stroke Care Action Plan, which is committed to revising the CHD and Stroke Strategy of 2004.
As expected, August was a relatively quiet month. However, it was at this point – and in a rather low-key manner – that the Department of Health initiated a strategic approach to supporting Quality, Innovation, Productivity and Prevention on the NHS. This approach was rebranded in November as The Quality and Productivity Challenge and identified eight emerging priorities for the Department of Health to consider in the new financial context.
An introductory guide to the national programme of integrated care pilots was published. Originally announced in April, these pilots are designed to look beyond the traditional health and social care boundaries. The published guide summarised the work that each of the pilots will be doing as they implement and test their models of integrated care.
The Health Bill 2009 began its passage through Parliament and, following a consultation on Pharmacy in England, contains proposals that reflect a need to improve the provision of pharmaceutical services in the NHS. Further to this, an advisory group on the NHS Pharmaceutical Services Regulations was set up, drawn from leading interested parties, to consider and advise the Department of Health.
The health service in Wales was subject to an organisation restructure at the start of this month. Seven revised Local Health Boards were established and represented a greatly condensed version of the previous structure.
In England, the Care Quality Commission (established in April) published the performance ratings for all 392 trusts; including both PCOs and hospitals. This ‘annual health check’ alluded to some of the targets previously praised in the Chief Executive’s report in May, as well as announcing an increase in the number of people being screened for Chlamydia. Overall, the NHS was seen to be performing well on quality, as well as improving its financial management significantly. However, the CQC’s report also raised concerns about the 20 trusts identified as ‘weak’ on quality; launching a field day for the press.
Andy Burnham’s assertion that the best way to achieve reform was to improve existing services sparked debate over the role of competition in the NHS. With ‘good enough’ rather than ‘excellence’ placed in the frame, question marks were raised over the role of World Class Commissioning.
A joint report by the NHS Alliance and think-tank the Nuffield Trust suggested that Practice Based Commissioning had become unfit for purpose. It proposed that ‘local clinical partnerships’ (LCPs), multi-specialty groups of clinicians, should take responsibility for designing health with population-based budgets covering at least 100,000 people.
The NHS Scotland Chief Executive published his Annual Report for 2008/9. This outlined the progress made on the Scottish Government’s action plan for health – Better Health, Better Care – and assessed NHS Scotland’s performance against a range of ministerial objectives, targets and measures. Overall, the Chief Executive claims that the country’s NHS is continuing to improve, giving people faster access to a wider range of treatment.
The strategy, NHS 2010-2015: from good to great. Preventative, people-centred, productive, is published by the Department of Health to explain the need to accelerate the pace of the NHS reform to make the system more productive and to hasten improvements in quality of care. Measures here include a new payment system, linking hospital payments to patient satisfaction and greater patient choice.
Following this, the Department of Health also published the Operating Framework for 2010-11: for the NHS in England, which set out their priorities for the new year to enable them to start their planning processes. For the third consecutive year, these priorities have remained the same and provide important stability; particularly in a year that is set to be rocked with financial instability.
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