Renowned NHS foundation trusts in England will be encouraged by the Government to establish new facilities abroad in measures to increase profits.

Proposals by the Department of Health and UK Trade and Investment will see high-profile hospitals such as the Royal Marsden and Great Ormond Street create branches abroad to boost funds.

Profits from the overseas facilities would then be reinvested back into the NHS.

The plans, which are set to come into force later this year, have been criticised by the Patients Association who called them concerning.

“The key and only focus of an NHS hospital should be to provide treatment to patients on the NHS,” said the Association’s Michael Watson. “Any moves which would see commercial ventures, which are naturally going to be important for hospitals because they need to use them to raise revenue, would simply result in the attention of the hospitals being taken away from the core purpose – to treat patients in the UK and instead be focused on these hospitals abroad.”

Under the plans, Healthcare UK will identify trusts wishing to expand into new countries and find clients who wish to use the services. Funding for the ventures would come from the private sector to establish the facilities.

London’s Moorfield Eye Hospital and Great Ormond Street already have facilities in Dubai. But critics have argued that other hospitals are not in a position to provide services overseas, and any profits raised would be minor compared to the £100bn annual running cost of the NHS.

Plans to globalise the NHS were first outlined by Labour back in 2010. However, Jamie Reed, Shadow Health Minister, said the proposals were further measures to commercialise the health service.

He said: “At a time when staff are losing their jobs and waiting times are rising, the Government’s priority should be sorting out the mess it has created in our NHS.

“Under David Cameron we’re seeing a rampant commercialisation of the NHS. He needs to get a grip and start focusing on patients, not profits.”

Scarborough and North East Yorkshire Healthcare Trust has officially merged with York Hospitals Foundation Trust after failing to gain foundation trust status.

The Trust has suffered financial difficulties for the past decade and health bosses decided a merger was required with the York trust to maintain high standards.

Patrick Crowley, Chief Executive of York Hospitals Foundation Trusts, says the merger is a “momentous occasion” as no two acute trusts within a 45 mile radius have ever merged together.

It’s reported that the newly-merged trust will be given additional funding towards the basic operational costs of the Scarborough trust – which has around 2,500 staff. The trust also received £8m last year as part of the deal.

“I’m looking forward to welcoming staff from Scarborough trust into our organisation and to hearing their ideas about how we can continue to provide the very best services for our patients,” said Mr Crowley.

He added that “much of the detailed work” will now be conducted to “integrate the two organisations” to generate the best results and services for patients.

A host of NHS trusts received bailouts totalling more than £1 billion in the last six years, a report from the National Audit Office (NAO) has shown.

The Department of Health was forced to issue four struggling foundation trusts and 17 other trusts the money between 2006 and 2012 to pay creditors and staff.

Amyas Morse, Head of the NAO, said that it was clear “parts of the service are under strain.”

Research found that South London Healthcare NHS Trust – which recently became the first to go into administration – needed a total of £356 from the DH to break even over the last six years. It is yet to pay back the money.

Barking, Havering and Redbridge University Hospitals NHS Trust also required £195 by the DH to cover its debts.

Last year, trusts needed £253m from the DH, the report found – a huge increase from the £76m requested between 2010 and 2011.

The NAO now estimates that NHS trusts and foundation trusts will need approximately £300m more in bailouts next year to cover ailing finances – despite a surplus of £2.1bn across the NHS.

Meanwhile, official figures from the Department of Health showed ten NHS hospital trust recorded deficits last year.

Mid Yorkshire Hospitals was £19m in the red, Surrey and Sussex Healthcare ended with a £6m deficit, Mid Essex Hospital Services Trust ended up with £2m debts and Newham University Trust recorded losses of £200,000.

Hospital trusts in the capital struggled to control finances more than any other part of the country with the region finishing £96m in the red overall.

Sir David Nicholson, NHS Chief Executive, said the “demands of an ageing population and increased costs owing to developments in drugs and advancing medical technologies present challenging financial conditions in a constrained economic environment.”

He added that “all parts of the NHS” will need to take “bold, long-term measures” to meet financial challenges.

A host of NHS trusts received bailouts totalling more than £1 billion in the last six years, a report from the National Audit Office (NAO) has shown.

The Department of Health was forced to issue four struggling foundation trusts and 17 other trusts the money between 2006 and 2012 to pay creditors and staff.

Amyas Morse, Head of the NAO, said that it was clear “parts of the service are under strain.”

Research found that South London Healthcare NHS Trust – which recently became the first to go into administration – needed a total of £356 from the DH to break even over the last six years. It is yet to pay back the money.

Barking, Havering and Redbridge University Hospitals NHS Trust also required £195 by the DH to cover its debts.

Last year, trusts needed £253m from the DH, the report found – a huge increase from the £76m requested between 2010 and 2011.

The NAO now estimates that NHS trusts and foundation trusts will need approximately £300m more in bailouts next year to cover ailing finances – despite a surplus of £2.1bn across the NHS.

Meanwhile, official figures from the Department of Health showed ten NHS hospital trust recorded deficits last year.

Mid Yorkshire Hospitals was £19m in the red, Surrey and Sussex Healthcare ended with a £6m deficit, Mid Essex Hospital Services Trust ended up with £2m debts and Newham University Trust recorded losses of £200,000.

Hospital trusts in the capital struggled to control finances more than any other part of the country with the region finishing £96m in the red overall.

Sir David Nicholson, NHS Chief Executive, said the “demands of an ageing population and increased costs owing to developments in drugs and advancing medical technologies present challenging financial conditions in a constrained economic environment.”

He added that “all parts of the NHS” will need to take “bold, long-term measures” to meet financial challenges.

The NHS operating framework provides the blueprint for the NHS in England. Pf examines its objectives around quality and reform.

The Operating Framework for the NHS in England 2012/13 is an important document for UK medical sales professionals. It outlines the national priorities, system levers and mechanisms that the NHS in England must focus on to improve patient care. The strategic framework details expectations for the NHS’ ongoing efficiency challenge and the transition to the new commissioning and management system. It sets out the planning, performance and financial requirements for NHS organisations and the basis on which they will be held to account. With QIPP imperatives at the heart of the strategy, proactive pharmaceutical companies that can demonstrate an ability to help NHS customers deliver efficiencies and improve qualities in areas of national priority will be best placed to succeed.

The Framework identifies four key themes for NHS organisations in 2012/13:

1. Putting patients at the centre of decision making in preparing for an outcomes approach to service delivery
2. Completing the final year of transition to the new system
3. Accelerating the delivery of the QIPP challenge
4. Maintaining a strong grip on services and financial performance.

Quality - a focus on outcomes

The Operating Framework says that the NHS’ model of delivery must be overhauled in 2012/13 to become a system driven by quality and outcomes. It identifies the Outcomes Framework as the catalyst for this – with its focus on clinical outcomes and the reduction of health inequalities driving changes in culture, behaviour and service delivery. The Outcomes Framework sets out the improvements against which the NHS
Commissioning Board will be held to account from 2013/14.

These measurements are set out within five domains:

Domain 1: preventing people from dying prematurely.

Domain 2: enhancing quality of life for people with long-term conditions.

Domain 3: helping people recover from episodes of ill health or following injury.

Domain 4: ensuring people have a positive experience of care.

Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm.

The Operating Framework details a range of indicators for each domain, all of which are explored in the NHS Outcomes Framework. These will be supported by NICE quality standards, which provide definitions of what high-quality care should look like for a particular pathway of care. The document also advises NHS organisations to meet the service specific outcomes strategies that have already been published in areas such as mental health, cancer, COPD, asthma and long-term conditions.

Each domain in the NHS Outcomes Framework has a strong relevance to pharma, whether through the development of medicines to treat disease in priority areas, or via collaborative service design to move care closer to patients’ homes and reduce hospital admissions. Organisations that are able to show how their innovations can improve a care pathway or be used as part of a redesigned service will enjoy
more positive NHS engagement.

The Operating Framework identifies dementia and care of older people as a key priority, and sets clear goals to integrate health and social care. It also highlights examples of initiatives where NHS organisations have successfully improved services in line with each of the four key elements of QIPP; quality, innovation, productivity and prevention.

Reform - the transition blueprint

The Operating Framework outlines the key milestones for the reorganisation of the NHS. Whilst the headlines are widely known, it is interesting to track current progress against a timetable that was set out many months before the Health & Social Care Act was passed. The Framework notes that by
the end of 2012/13:

“The NHS will have transformed the commissioning landscape into one focused on local clinical decision
making, with the development and authorisation of CCGs, assisted by commissioning support vehicles and overseen by the NHS Commissioning Board. Local authorities will take the lead role in public health, alongside the new Public Health England. Central to the new system will be the establishment of Health & Wellbeing Boards (HWB), who will provide local systems leadership across health, social care and public health. Alongside this, developments will continue to the provider landscape, through the extension of Any Qualified Provider (AQP), progress with the NHS Foundation Trust (FT) pipeline and the establishment of the new NHS Trust Development Authority.”

Key 2012/13 objectives in the transition are as follows:

• PCTs and SHAs will remain statutory organisations until April 2013. They will be held to account on delivering performance and support the development of new organisations for clinical leadership. Clinical Senates and networks will be established
• PCTs will support CCG authorisation and the transition of power before March 2013
• HWBs will be established in shadow format, becoming statutorily operational from April 2013. They will act as the local system leader through JSNA and HWB Strategies
• CCGs must be coterminous with a single HWB ‘as far as possible’
• CCGs must: play an active role in planning and budgeting, develop relationships with local partners
  including social care, deliver their share of the QIPP agenda and identify how to secure commissioning support services in line with their running cost allowance
• Public Health England will become a statutory executive agency from April 2013
• NHS Trusts are expected to achieve FT status by April 2014
• PCT clusters should start to offer patients choice of AQP in at least three services that are local priorities. There should be a presumption of choice for most services from 2013/14.

NICE has appointed a new external assessment centre to support its Medical Technologies Evaluation Programme.

The new assessment centre, developed by Newcastle upon Tyne Hospitals NHS Foundation Trust Medical Physics Department in partnership with York Health Economics Consortium, will provide independent assessment of the clinical and health economic evidence for medical technologies.

It will also develop and facilitate independent research to assist suppliers when NICE guidance recommends that further research should be carried out on a medical device or diagnostic.

The new assessment centres were selected for their knowledge and expertise in the evaluation of medical technologies.

To date, one more external assessment centre, CEDAR – part of Cardiff and Vale University Local Health Board – has been commissioned.

Professor Carole Longson, Director of the Centre for Health Technology Evaluation at NICE, said: “We’re delighted to welcome the new joint external assessment centre based at Newcastle and York. Their input to the production of NICE medical technology guidance will be essential, providing independent assessment of the evidence available for devices going through the NICE evaluation process.

“Where the relevant NICE advisory committee identifies that a technology has considerable potential but insufficient evidence to support widespread adoption across the NHS, it may make recommendations for further research. In such cases, the external assessment centre will play a key role in facilitating the development of further relevant evidence.

“We look forward to working with the centre, and benefitting from their combined technical and economics expertise in supporting the development of robust guidance for the NHS.”

Established by NICE in 2009, the Medical Technologies Evaluation Programme is focused specifically on innovative medical technologies. Seven NICE medical technology guidance documents have been published to date.

Boehringer Ingelheim and Eli Lilly have launched Trajenta (linagliptin), a single dose, once-daily tablet for adults with type II diabetes mellitus (T2DM) in the UK.

Trajenta has been shown to deliver significant HbA1c reductions compared to placebo and was generally well tolerated in clinical trials involving more than 4,000 patients.

Professor Anthony Barnett, Consultant Physician and Emeritus Professor of Medicine, Heart of England NHS Foundation Trust and University of Birmingham, says its release is “an important advance in the management” of diabetes.

The drug is licensed for adults with T2MD as a monotherapy in patients inadequately controlled by diet and exercise alone, and for whom metformin is inappropriate due to intolerance, or contraindicated due to renal impairment.

It is also licensed in combination with metformin when diet and exercise plus metformin alone do not provide adequate glycaemic control; and in combination with a sulphonylurea and metformin when diet and exercise plus dual therapy with these medicinal products do not provide adequate glycaemic control.

In clinical trials, a mean HbA1c reduction from baseline of 0.7% was sustained over 102 weeks as add on to metformin and a sulphonylurea in patients using Trajenta.

Around a third of people with diabetes are affected by chronic kidney disease. The convenient tablet is the only dipeptidyl peptidase-4 (DDP-4) inhibitor which is primarily excreted via the bile, and the first in this class licensed for use in T2DM, irrespective of degree of renal impairment.

“Linagliptin offers the benefits of the DPP-4 inhibitor class with good tolerability, weight neutrality and low risk of hypoglycaemia and the additional advantage of health professionals being able to prescribe without dose adjustment irrespective of the patient's renal function,” added Professor Anthony Barnett. “Renal impairment is common in people with type 2 diabetes so this latter point is extremely important.”