NHS England has announced a new national system for the Cancer Drugs Fund designed to end regional variation in ‘fast-track’ access to cancer drugs.

However, according to the charity Macmillan Cancer Support, the new system has halved the number of indications for which drugs are covered by the fund.

The single national list of drugs approved for ‘fast-track’ funding contains 28 drugs to treat 64 cancer indications, compared to the 129 previously covered by the ten SHAs through the Fund.

The Cancer Drugs Fund, which was established in 2010 and will end in March 2014, provides £200m per year for access to drugs not approved as cost-effective by NICE but requested by doctors for individual patients.

NHS England (formerly the NHS Commissioning Board) took over responsibility for management of the Cancer Drugs Fund from 1 April, ending the regional administration that had seen variations in access to cancer drugs.

Sean Duffy, NHS England’s National Clinical Director for Cancer, said: “Having one consistent method for consideration of overall clinical benefit and funding means that all applications will be assessed by the same criteria. Regional variation of the past is clearly not acceptable for patients.”

Any patient who is already receiving funding for a cancer drug, or has been told they will receive funding as part of an agreed treatment plan, will continue to receive that treatment where clinically appropriate.

The single drugs fund list was developed by the National Cancer Action Team together with the regional clinical leads for the ten former SHAs. A national Clinical Reference Group for Chemotherapy, appointed by NHS England, has approved the proposed list.

However, Mike Hobday, Head of Policy and Research at Macmillan Cancer Support, commented: “It is worrying that the reduced list of cancer drugs that can be funded will restrict access to drugs which were previously routinely available. For rarer cancers, this will be particularly acute.”

The new NHS structure came into force on 1 April, with local commissioning now entrusted to clinical commissioning groups (CCGs) that combine business and clinical expertise.

The CCGs are managed by NHS England (formerly the NHS Commissioning Board) and governed by new laws that enforce a ‘level playing field’ for provider competition.

The 152 Primary Care Trusts are now abolished, and all NHS hospital trusts are required to qualify for Foundation Trust status within the next year.

NICE, renamed the National Institute for Health and Care Excellence, will set standards for both health and social care services, promoting integrated care.

The statutory role of CCGs in facilitating competition between providers of NHS services has polarised opinion, with only a third of GPs in a Pulse survey saying they felt empowered by the new system.

According to private health analysts Laing and Buisson, the NHS in England spent 11% more on services from private providers in 2012 than in 2011 – a clear sign that the provider base is already shifting.

Professor David Haslam, the new Chairman of NICE, commented: “It is a time of huge risk. We know in medical care in hospital that the greatest risk is when patients are being handed over from one person to another. It is a risky time for the system, so it is important that the big players work together.”

Mike Farrar (pictured), Chief Executive of the NHS Confederation and a long-time champion of community-based healthcare, warned that trying to improve patient safety while reducing costs would place great pressure on the new NHS.

“We need to recognise the huge challenges facing the health service,” he said. “New structures alone won’t enable us to tackle these challenges, and we should not see them as a silver bullet.”

The NHS Commissioning Board, the ‘quango’ entrusted with managing the new NHS, will be known as NHS England from 12 April 2013.

The new name, according to Chairman Professor Malcolm Grant, is intended to represent a more “public-facing” organisation that represents the NHS as a whole.

Health Secretary Jeremy Hunt has approved the change of name, noting that its only purpose is “ensuring effective communications with the public”.

Grant’s letter to the Health Secretary outlined two “key benefits” of the Board’s new name:

• “To connect more readily with patients and the public” – thus helping to establish its support for “openness and transparency”.

• “To speak for the NHS” – thus underlining its role as the authoritative source on “NHS delivery and performance”.

Grant also highlighted the need for NHS England to maintain “presentational consistency with Government policy” – an important qualification of the ‘autonomy’ of the new NHS.

In his reply, Hunt observed that “the Board will have a critical role in communicating effectively with the media”.

He also noted that the Care Quality Commission (CQC) will have “an increasingly important and powerful role in the system in assessing the quality of providers”, and will work in partnership with NHS England.

The Board is committed to minimising the costs of the rebranding.

Robert Garner has been appointed as interim Managing Director for Surrey and Sussex CSU after its former leader took a new role at the NHS Commissioning Board.

Clodagh Warde-Robinson has decided to leave the Support Unit in favour of a role with the NHS CB working on the programme to enable the externalisation of CSUs.

Mr Garner said he was “delighted to have the opportunity to lead the Surrey & Sussex CSU” and had already spoken to his predecessor to gain insight into the role.

One of his first tasks will be to meet with CCG accountable officers to explore solutions to deliver the best outcomes for commissioners and ensure sustainable arrangements in the future.

Mr Garner previously served as interim MD at the Norfolk and Waveney CSU.

The NHS CB has completed its authorisation process for the 211 CCGs across England after finalising the fourth and final wave of commissioning groups.

The remaining 48 CCGs in wave four have been authorised by the Board’s assessment experts, meaning all commissioning groups are ready to take on their new responsibilities from 1 April 2013.

Dame Barbara Hakin, NHS Commissioning Board National Director: Commissioning Development, called the completion of the assessment process a “tremendous achievement”.

In total, 43 CCGs were fully authorised after they met all of 199 criteria set by the Commissioning Board. A further 168 groups were authorised with conditions, after issues were raised with certain elements of their development. Fifteen CCGs were also issued legal directions after serious concerns were raised. These CCGs will be given additional support by the NHS CB and by neighbouring CCGs to assist their development.

Commissioning groups in the first three waves of the process which were authorised with conditions will be re-assessed by the NHS CB at the end of March to check on their progress since their initial assessment. CCGs in the final wave will be reviewed in June 2013.

“CCGs are a vital foundation of a new, clinically-led NHS that is focused on delivering improved health outcomes, quality, patient safety, innovation and public participation,” said Dame Barbara Hakin.

“CCGs will have wide-ranging responsibilities with regard to patient safety and will manage very large budgets, so it is vital that they are robust and capable of making important decisions. The NHS Commissioning Board has a duty to ensure CCGs have made arrangements to deliver their responsibilities, and we take that duty very seriously.”

The NHS Commissioning Board has appointed 22 doctors as national clinical directors or ‘Tsars’ to oversee specialist areas of NHS care.

They fall into four broad domains: ‘reducing mortality’, ‘long-term conditions’, ‘acute episodes of care’ and ‘patient experience’.

Two new directorships reflect a concern with recovery from illness and early discharge from hospital: ‘enhanced recovery and acute surgery’ and ‘rehabilitation and recovering in the community’.

Two more new clinical areas are relevant to the needs of the growing elderly population: ‘integration and frail elderly’ and ‘end of life care’.

Sir Bruce Keogh (pictured), the Commissioning Board’s Medical Director, said: “Our national clinical directors will provide the expert insight, knowledge and research we need in order to understand and address the challenges we face in all different aspects of NHS care.”

According to the NHS CB, “A national clinical director’s role is to spearhead change. They work with policy and delivery teams, clinical networks and the NHS management community to achieve joined-up action.”

The four domain directors who will lead the specialist directors are: Mike Richards (reducing mortality), Martin McShane (long-term conditions), Keith Willett (acute episodes of care) and Neil Churchill (patient experience).

There are now 25 specialist directors, with four more still to be appointed, and one post (that of stroke tsar) being shared by two doctors.

Evidence of widespread conflicts of interest among NHS commissioners has prompted calls from the BMA and the Labour Party for tighter regulation.

A BMJ study found that more than a third of GPs on the new CCG boards had a financial interest in private providers of healthcare, either as shareholders or as directors.

The NHS Commissioning Board stated that transparency over potential conflicts of interest would enable CCGs to self-regulate effectively.

Shadow Health Secretary Andy Burnham commented: “There is a real risk that the doctor-patient relationship will be corroded and public trust in the NHS lost.

“At the very least, ministers must bring in new rules to ensure that no GP takes part in any decision in which they could be perceived to have a financial interest.”

The BMA expressed concern that the reputation of GPs was at risk. Laurence Buckman, Chairman of its General Practitioners Committee, said: “In our view, GPs who are directors of, or who have significant financial interests in, companies who might be awarded contracts to provide services should seriously consider their membership of CCG governing bodies. Alternatively, they should consider their position within provider companies.

“We support the principle of greater clinician involvement in commissioning, but it must not come at the expense of the trust of patients.”

According to an NHS Commissioning Board spokesman, “it is vital that everyone working for a CCG or serving on its governing body declares any interests they have. This allows the CCG to put arrangements in place to ensure that those individuals are not involved in any decisions that would give rise to a conflict.”

Dame Barbara Hakin has been appointed as interim Chief Operating Officer and Deputy Chief Executive of the NHS Commissioning Board.

She will leave her current role as National Director for Commissioning Development to take the temporary roles in mid-April.

Rosamond Roughton, the current Director of Commissioning Systems and Strategy, will fulfil the commissioning development role.

The NHS CB has been searching for a new chief executive since Ian Dalton CBE announced he was ended his long career in the health service to join BT Global Services as President of Global Health.

Dame Barbara has played a pivotal role in the authorisation process of the new commissioning system, helping clinical commissioning groups and commissioning support units in their development.

In her new position – which includes the leadership of the Board’s Operations Directorate – she will be responsible for direct commissioning of certain services, including primary care.

The focus of NHS investment needs to shift from large acute hospitals to community and home-based services, according to the NHS Confederation.

A new report, Transforming Local Care, argued that “significant” investment in making the community the “default setting” of healthcare is needed to meet the combined pressures of increasing demand and shrinking budgets.

Hospital inpatient services can be reserved for complex surgery and treatment of life-threatening conditions, the report said – but major and visible improvements in community-based care need to take place at the same time.

The NHS Confederation, which represents commissioner and provider organisations, called for long-term condition management to be shifted decisively out of the hospital framework.

It highlighted the proven value of strategies such as home monitoring, mobile diagnostics and medication adjustment in helping to keep people out of hospital.

While these strategies were recommended by Lord Darzi’s NHS review in 2008, the “unprecedented” economic pressures have made them urgent priorities for national adoption, the report argued.

Calling on the NHS Commissioning Board to “facilitate the necessary shift in the financing of care”, the Confederation outlined the need for payment incentives to promote prevention, early intervention and early supported discharge.

Crucially, it added, efficiency savings must be reinvested in community-based services, instead of being claimed by the Treasury (as currently happens).

“It is time we started thinking differently and making sure investment supports innovative service delivery that supports patients’ independence and recovery,” said Jo Webber (pictured), the NHS Confederation’s interim Director of Policy.

“For too long, the default setting when we think about healthcare or support is to think of a hospital. But in reality, acute hospitals are rarely the best place for someone who needs ongoing treatment.”

Health Secretary Jeremy Hunt has published strategy documents on tackling premature mortality and cardiovascular disease (CVD).

The DH strategy on premature mortality calls for improvements in the prevention, diagnosis and treatment of cancer, heart disease, stroke, respiratory disorders and liver disease.

The CVD strategy emphasises treating CVD as a single family of diseases with integrated NHS treatment, and making wider use of NHS Health Checks.

Hunt pointed to a current report in the Lancet, according to which the level of premature deaths in the UK has fallen in the last decade but remains higher than in most of Europe.

He claimed that the measures outlined in the two strategy documents could save 30,000 lives by 2020.

Key actions outlined in the CVD strategy include:

• Providing integrated and co-ordinated care by treating CVD as a single family of diseases, and ending the pattern of ‘silo consulting’.

• Using NHS Health Checks to improve the prevention and management of CVD with targeted advice and support.

• Ending the postcode variation in treatment of CVD.

• Better detection and management of CVD risk factors such as atrial fibrillation.

Peter Hollins, Chief Executive of the British Heart Foundation, commented: “We welcome the Outcomes Strategy. It has all the ingredients to tackle the threat posed by cardiovascular diseases, which remain the major public health challenge of our time. We are particularly pleased to see the emphasis on an integrated approach to patients with multiple conditions.”

The strategy document on avoiding premature mortality argued that over half of premature deaths (under the age of 75) could be prevented through more effective public health.

It highlighted the need to address the increasing prevalence of multiple morbidities, where individuals suffer from two or more major conditions.

Alongside action on risk factors and lifestyles, the strategy called on the NHS Commissioning Board to facilitate early diagnosis and “access to the right treatment”, with consistency of outcomes between hospitals.

The document did not explain how, with hospitals that meet clinical targets but overspend facing closure, the emphasis on treatment quality would be funded.