The NHS maintained or improved performance in 2011/12 against a range of indicators outlined in the NHS Operating Framework, the Secretary of State’s Annual Report says.

The report noted that the “NHS has performed well” over the last twelve months whilst meeting the first stage of its efficiency savings target.

Health Secretary Andrew Lansley said NHS staff across England have “maintained or improved quality while making significant cost savings and preparing for the transition to the new system”.

The annual report has been published a year earlier than required by law. The move was made by the Health Secretary to allow Parliament and the public to see the “direction the NHS is heading”, the Department of Health said.

It found that 212 CCGs are now on their way to being authorised by January next year. Also, as of April this year, there were 144 Foundation Trusts (FT), with 104 trusts remaining in the FT pipeline. Of these, only 18 trusts were not making progress towards gaining FT status and were in discussions with the DH to “develop recovery plans and progress towards sustainable, high-quality services”.

In future, the report will analyse the performance of the NHS against the three outcomes frameworks – NHS, public health and adult social care. As these are still being developed, it focused on “key achievements” during 2011/12.

It found that the QIPP agenda had generated savings of £5.8 billion; more than 12,500 patients had accessed the Cancer Drugs Fund; maximum waiting times for diagnosed and suspected cancer patients were met; and more people with diabetes are now being offered diabetic retinopathy screening than ever before.

Despite the structural reforms to the NHS, cost-cutting measures and the rationing of services, the report included data from a recent MORI poll which found that nearly three-quarters (73%) agreed that England had one of the best national health services – the highest level ever recorded.

Andrew Lansley said that performance data has “undoubtedly been positive”, but there were a number of “significant challenges” facing the health service. “Compared to other countries we continue to lag on performance on some key outcomes including life expectancy for women, cancer survival, and conditions related to obesity,” he said.

To meet “continued pressure” on finances, Lansley said there will need to be “sustained efforts to ensure that every penny of public money is spent as effectively as possible, delivering the best possible outcomes for patients.”

Future annual reports are expected to be published in October to allow Arm’s Length Bodies time to publish their own reports and accounts for the financial year.

The draft mandate for the NHS Commissioning Board (NHSCB) will require the Board to make CCG autonomy and patient choice its major priorities.

While drawing on the NHS Outcomes Framework, the draft mandate avoids setting objectives for specific clinical conditions, saying that CCGs should have the flexibility to identify local clinical priorities.

Clinical senates and clinical networks are identified as “sources of advice” for CCGs, who will be able to decide for themselves and source other advice providers.

The primary task of the NHSCB remains the authorisation of “as many CCGs as are willing and able” by April 2013.

Our NHS Care Objectives: A Draft Mandate to the NHS Commissioning Board outlines 22 objectives for the NHSCB for the two years from April 2013, as well as ‘ambitions’ for the decade following.

Launching the draft document, Health Secretary Andrew Lansley said: “Today we will be laying the foundations of the new, more independent NHS” – meaning an NHS “free from constant political interference” and “tasked with continuously improving the care that patients receive”.

The document confirms the Quality Premium incentive scheme, a bonus payment rewarding CCGs who achieve a surplus on their annual budget. This incentive was heavily criticised by GPs during the ‘listening exercise’.

However, one objective that reflects feedback from GPs is to ensure that NHS commissioning supports the integration of care.

Objectives focused on patient choice include the availability of personal health budgets and the right of patients to choose another provider after waiting 18 weeks for elective treatment.

The final mandate will be published in the autumn.

Spending plans for the NHS between 2011 and 2015 will be the tightest four-year period in the last half a century, financial experts warn.

Researchers from the Institute for Fiscal Studies warn that only a long-term fix in public service budgets or large tax increases will enable a return to the 4% average annual growth the NHS budget had become accustomed to.

The NHS, the report says, should now consider what services remain freely available as it tackles a decade of austerity and unprecedented savings targets.

The report, funded by the Nuffield Trust, found that NHS spending in the UK reached £137.4bn in 2010/11, with this cost in England accounting for a quarter of all public spending.

Authors said that continuing the freeze in NHS spending in England between 2015 and 2017 would mean reducing spending in other areas of public services by an average of 2.3% annually.

The Government increased spending on the NHS in its 2010 Spending Review by 0.1% each year in real terms. But the report found that increasing levels of money spent on healthcare in line with national income between 2015 and 2022 would still leave the NHS budget growing slower than demand for care in an ageing population.

Anita Charlesworth, Chief Economist, Nuffield Trust, said the NHS needs to plan a “medium-term future based on belt-tightening” and be prepared for future years of hardship.

Mike Farrar, NHS Confederation Chief Executive, said the NHS needs to be honest about the necessary action needed to deal with future challenges. “We need to forensically examine what services and treatments provide the best outcomes for patients and local communities, and what the NHS can and cannot afford to provide in the future,” he said.

“This will be far from pain-free, but decisive action is necessary if we are to maintain high-quality services and stay in the black. If the NHS does not change, it will not be fit for the future. We need swift action before the financial pressures overcome us.”

A spokesman for the Department of Health said it was well aware of the challenges facing the NHS. “Where the NHS can do things better and save money to reinvest in high-quality patient care, it must do so,” he said.

The rationing of NHS services has become a focus of political debate, though all politicians involved have condemned it.

A Shadow Health Minister has called for “an immediate review” of rationing and action on clinically unjustified decisions.

Health Minister Simon Burns has said that CCG leaders may be sacked if they fail to correct cost-driven restrictions on care.

In June, a study published by GP magazine revealed that 91% of PCTs impose limits on referrals for ‘non-urgent’ procedures such as cataract surgery and hip and knee replacements.

Clinicians have argued that these procedures, when delayed, become both more urgent and more costly, while patient wellbeing suffers.

Following a Parliamentary debate on this issue, Health Secretary Andrew Lansley insisted that “blanket plans on treatments” are “unacceptable”.

He argued that the new CCG structure would give GPs more power to resist rationing, because they would no longer be dictated to by PCTs.

Simon Burns told radio listeners that PCT leaders could be dismissed by the DH if they failed to restore clinically necessary services. In future, he added, Monitor could exert the same sanction on CCG leaders.

The DH subsequently clarified that the NHS Commissioning Board, not Monitor, would have that power.

Shadow Health Minister Lord Hunt of King’s Heath (pictured) called online for “an immediate review of rationing in the NHS”, with action to reverse “treatment restrictions” that caused suffering or restricted independence.

The decision whether to make a treatment available should be made at a national level, he argued, rather than locally and “in a random fashion”.

As Chair of Heart of England NHS Foundation Trust, Lord Hunt has stated that ‘efficiency savings’ should not affect the quality of NHS services.

GPs will not be allowed to vote on commissioning locally enhanced services (LES) from their own practices under new guidelines outlined by the NHS Commissioning Board (NHS CB).

An official code of conduct has been published by the Board to avoid conflicts of interest in the health service from 2013 and urges CCGs to use AQP or full tendering for LES to avoid transparency issues.

The NHS CB said the code of conduct will “enable CCGs and member practices to demonstrate that they are acting fairly and transparently”.

The code outlines how LES will form part of CCGs’ baseline allocations from next April – with the exception of public health services.

CCGs will have to commission services using the NHS standard as opposed to the GP contract, the code said, and must provide evidence that proposed services go “beyond the scope” of services provided at practices and that they have fully adhered to new procurement rules.

The code opens up services to private competition. CCGs must decide, it advises – subject to DH proposals – where to “commission community-based services through competitive tender or an AQP approach and where through single tender.”

The document also says that members of Health and Wellbeing Boards or other CCGs could be asked to sit in on primary care commissioning decisions to provide “additional scrutiny”.

As the Department of Health, the NHS and the pharmaceutical industry clash over what is good and bad news, Maxine Vaccine asks whether there can ever be a consensus of the non-fake variety.

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us… – Charles Dickens

Dickens made some bad choices in the romance, wardrobe and facial hair departments, but despite that he was a shrewd commentator on human affairs. His words precisely capture the uncertainties of a time when different stakeholders are trying to spin not just the news, but the world itself, in opposite directions.

This week, the Office of Health Economics predicted a slight increase in the growth of the annual NHS spend on medicines, from 3.5% to 3.7% per year to 2015. This will be driven mainly by an increase in generic prescribing. Expenditure on new branded medicines will rise by just 1.3%, meaning that their place in the NHS will shrink. Stephen Whitehead, Chief Executive of the ABPI, declared himself “deeply concerned” at these figures. Yet they quite obviously represent the impact of the QIPP agenda.

Last week we had Andrew Lansley telling an audience of GPs that that the current fall in referral rates is a positive achievement. His speech came shortly after a National Audit Office report saying that a lack of GP referrals is increasing the death rate among people with diabetes, and shortly before an All-Party Parliamentary Group report saying that a lack of GP referrals is creating a ‘barrier’ between people with dementia and the treatments they need.

The week before, Sir David Nicholson’s annual NHS report celebrated a “modest reduction in activity levels”. That means the NHS is providing less: fewer drugs, fewer procedures, fewer referrals. It’s called rationing. A “modest reduction” in activity levels is unlikely to be good news on a hospital ward or in a GP surgery, unless you’re an accountant.

So what’s good news for those running the NHS is not good news for clinicians, suppliers or patients. The pharma industry will have to adopt a variety of tactical positions between the conflicting priorities of providers and commissioners, tailoring the message to the local customer. As Bob Dylan said, when there’s not a lot of food on the table but people still have forks and knives, they’ve got to cut something.

The first casualty of the austerity wars will be that most pervasive myth of the pharma industry, the win-win. In business, as in politics, there is always one who gains and one who loses.

Maxine’s views are not necessarily those of Pharmaceutical Field.

APODI’S Jan Cox examines the importance of focusing on individuals’ strengths and talents when recruiting.

Over the past decade, Gallup has surveyed more than 10 million people worldwide on the topic of employee engagement, and only one-third “strongly agree” with the following statement: “At work, I have the opportunity to do what I do best every day.” A natural conclusion is that in an average organisation, approximately two-thirds of employees do not believe they are maximising the talents they have.

The repercussions of such a massive waste of talent – for the economy, for individual organisations, and to the quality of life of every one of those employees – is mind blowing. When attempting to explain to our clients the impact that such a scenario has on performance, we suggest that they explore this by changing the roles of a small number of employees to maximise their talents. The results are usually dramatic. We then ask the organisation to consider these outcomes if they were to be extrapolated across the whole company.

Implications for recruitment

The implications of such findings for recruitment, development and promotion strategies are significant. At Apodi, we have built a recruitment model that incorporates four key attributes that we test when recruiting every individual. These are: strengths/talent, competencies, cultural fit and mental toughness. Most companies traditionally recruit on competencies (i.e. what people can do) rather than on strengths/talent (what they are really good at, have a passion for and are usually inherent within an individual). The problem with recruiting based solely on competencies is that organisations risk hiring people that can do something, but may have no real inclination to do it. They may lack passion or excitement, display little energy for their work and therefore underperform. This results in disengaged employees who are unlikely to stay with a company for long.

Conversely, those companies that have adopted a strengths/talent-based approach to recruiting are showing dramatic results. Banks in the US are seeing significant increases in sales revenue from representatives recruited based on strengths. Financial services companies in the UK are reporting ‘improvements in quality and lower staff turnover’, and Starbucks have established a clear link between recruiting for strengths/talent and customer satisfaction.

The benefits can be summarised as follows:

Talent , competencies and strengths

The link between talent, competencies and strengths is simple: talent + competencies (knowledge/skill) = strengths. Talent can be defined as those capabilities that individuals naturally exhibit based on experiences and knowledge usually gained in early life, or those that an individual seems to be ‘born with’.

Talent can obviously be displayed in diverse circumstances, however, wherever it is utilised, it gives individuals energy and enthusiasm. Knowledge and skills are those things that are learned, studied and practiced. When combined with innate talent, skills and knowledge can be converted into real strengths. It is these strengths which drive performance. It is because of this causal link that leading recruitment organisations recommend that clients assess talent and competencies separately and as part of a strength-based assessment process.

How to assess for strengths

A strengths-based selection process has many similarities with that used for assessing for competencies. There are, however, some fundamental aspects which must clearly focus on the strengths of an individual. Assessing for strengths can be summarised as follows:

a) Strength-based role profile

A company can develop the profile by reviewing organisational structure and business strategy, developing performance criteria for the role in question, and studying the best performers in the role to identify the strengths that are contributing to success.

To help identify and define the strengths it is seeking, organisations can turn to experts in this field for guidance. For example, Tom Rath in his book Strength Finder identifies 34 particular strengths that may be important in different roles in commercial organisations. For instance, a company looking to recruit sales representatives may identify the following strengths as being the key to success in the role:

• Achiever/results focus – real focus on results, targets,completing tasks, meeting deadlines
• Empathy – identifying with customers and seeing what is important from their perspective
• Resilience –dealing with rejection and setbacks easily and moving forward positively
• Self confidence – strong self belief in own abilities
• Initiative – working independently and taking important decisions quickly to make things happen
• Communication – bringing propositions to life through effective communication.

b) Strength-based profiling tool

An appropriate profiling tool should be used to assess the key strengths of each individual applicant and how well they fit the selection criteria. The report generated can then be used as part of the strength-based interview.

c) Strength-based interviews and assessment centres

Fundamentally, interviews and assessment centres need to be focused on how individuals have previously
used their strengths to achieve success in their business and personal lives. In addition, they should also explore whether:

• The aspirations each individual has for the future
  are consistent with the strengths they display
• The individual will be able to apply the strengths
  they have to the specific challenges the company
  faces and the challenges of the role.

d) Review and measurement process

Recruitment decisions are among the most important that management can make and yet recruitment is one of the most ‘under’ managed processes in corporate life. It is rarely subject to stringent review and measurement, and consequently many ineffective and unsuccessful recruitment processes remain in place. Those more enlightened companies considering strength-based recruitment should ensure that new processes are reviewed and measured systematically and regularly. This will drive a system of continuous improvement and encourage buy-in from senior management and the organisation as a whole.

Conclusion

A reliance on purely competency-based processes for recruitment decisions is almost certain to ensure suboptimal recruitment decisions and, ultimately, sub-optimal performance. However, world-class recruitment processes are a strategic imperative for a company’s future success. Not only has the strengths/talent model been shown to add value to recruitment decisions, it can be a catalyst for performance improvement across any organisation.