Proposals to move NHS patients out of hospitals and into hotel-style care facilities are being considered by NHS England.

The move would see patients who do not require 24-hour medical care, such as new mothers or those recovering from a stroke, moved out of secondary care to reduce pressure on services.

A spokesperson for the DH said that “proposals for health hotels” were submitted by Baroness Greengross and ministers have forwarded these to NHS England “so they can review them.”

It’s estimated that round 30,000 patients each year are kept in hospitals despite them being well enough to be discharged.

The ‘hotels’, which are already in place across much of Scandinavia, offer patients more freedom and comfort and would see the NHS save money through the facilities.

Although the proposals may seem radical, certain hospitals already provide facilities for patients who still require care but not hospitalisation. University College London Hospitals (UCLH) provides patients and the elderly with hotel-style rooms where they can still with relatives near to a hospital.

Lady Greengross told The Independent that unused NHS buildings on hospital sites could be converted by hotel companies to provide the service.

“The idea is that if you go into hospital and you don’t need acute care, which a lot of old people particularly don’t, or you've had a difficult pregnancy and you need access to specialist care but you don’t need it most of the time, you are immediately moved out of a hospital to something run by a hotel,” she said.

“It is of course much cheaper than being in a hospital. The family can help because they can go in at any time because you’re in a private room.”

Health Secretary Jeremy Hunt answers the questions you weren’t afraid to ask.

After the clinical waste left by Andrew Lansley, Secretary of State for Health, Jeremy Hunt, is keen to restore public confidence, establish clarity and, generally, galvanise a flagging NHS reform bill. In a Pf exclusive he takes his place on our imitation-leather hot seat, as readers (and writers) don ominous white outfits for a bit of ‘ultra-questioning’.

Since you took over the role as the ‘guardian’ of people’s health in the UK, what has surprised you most about the functionality of the NHS? – Iain Bate (Writer)
I’m very proud to be the Secretary of State for Health, and I know that a lot of people are incredibly passionate about our health service. The NHS is one of our greatest assets; it is admired around the world and has a reputation for excellence, but I want it to be even better.

The coming year will be an important one for the health service and my priorities are to improve care and nursing in the NHS; promote technology to make care more straightforward; and help people to feel in control of their health, supporting them to lead longer, healthier lives.

Given the rapidly expanding role of the private sector in the NHS, how will transparency in contracting be achieved? After all, business to business transactions are confidential. – Joel Lane (Writer)
We have always been clear that, whenever services are procured in the NHS, it should be through a fair and transparent process, judged on the quality of the care. This helps improve healthcare and enables patients to access the best possible services.

The Health and Social Care Act was the first piece of legislation to create rules and regulations around this process, making it more straightforward. It prevents discrimination in favour of private health companies over the NHS, and helps protect patients’ interests.

But it is worth remembering that charities, social enterprises and independent providers have played an important part in providing NHS care for some time. They offer patients more choice about how they are treated by the health service, and every year, a significant number of patients choose to be treated in independent hospitals, ‘on the NHS’.

The NHS is moving into an era whereby it will need to make decommissioning decisions which are unpopular, such as delivering services that patients will have to pay for. How do you aim to integrate this into the wider healthcare bill implementation? – Omar Ali (Pharmacist)
Let me be absolutely clear on this – the NHS will always be free at the point of delivery and no one will be asked to pay for its services. Yes, in the future, services will be provided differently – public health services will be organised by local authorities, for example – but the founding principle of those NHS services being free, for those who need it, will never change.

To some extent, the NHS remains a 1950s animal trying to survive in 2013. What are the challenges when it comes to changing an institution’s post war philosophies and encouraging it to embrace modern practices, without altering the fundamental concept? – John Pinching (Writer)
Of course the NHS has evolved over its 64 year history, and it continues to improve the lives of people up and down the country, but we have to guarantee that the founding principles of the NHS are protected.
I would like to see the NHS using technology more, while continuing to improve care and experiences for patients. That would mean people being able to book their GP appointments online, or those with long-term conditions managing their situation from home, digitally; saving time for both them and their doctor. Technology in the NHS is rapidly developing, and I would urge local doctors and nurses to embrace it.

Recently the Government announced that it will cap individual payments for social care at twice the Dilnot-recommended level, i.e. at about £70k rather than £35k. Will NHS funding for the less wealthy be increased, or will their suffering and avoidable death be allowed to escalate? – Susan Ranch (Key Account Manager)
This is incorrect. The Government has not said this and no decision has been made. I want this country to become one of the best places in Europe to grow old and make sure people can live independent and healthier lives into old age. As part of the care reforms, we committed to taking action: ensuring people do not have to sell their homes to pay for care. While we have also agreed that Andrew Dilnot’s model of the cap on care costs is the right basis for any new funding model. Given the current economic situation, we need to look carefully at how we can pay for this. 

You have acknowledged the differences within the UK of cancer survival rates and compared to other European countries. How can the pharmaceutical industry work with the NHS to help address these inequities? – Leigh Saunders (Key Account Manager)
The pharmaceutical industry already plays a vital role in improving the health of people with cancer. I want to improve mortality rates, where the targeting and development of medicines is becoming ever more important. I am sure the pharmaceutical industry will want to build on its work in this area and help improve cancer care.

Are you still encouraging British hospitals to sell their services abroad and, if so, what future plans do you have to support this? – Valerie Nolan (Clinical Nurse Specialist)
The NHS has many valuable assets, including products, technologies and knowledge. It makes absolute sense that the NHS should be able to use those assets to earn money, which it can reinvest back into patient care at home.

Through Healthcare UK – a UK government initiative in collaboration with UK Trade and Investment and the Department of Health – we are working on several very promising commercial opportunities to support those parts of the health service that can earn income abroad. Any investment generated will be put back into the NHS for the benefit of patients. Importantly, no part of the NHS will be forced to do this, and NHS patients will always come first.

At the current time, David Nicholson is praising the NHS for achieving a major reduction in referral rates, Diabetes UK, however, has noted that reducing referral rates has led to an increase in premature deaths and amputations in people with type 1 diabetes. Is this a case of cost saving targets being achieved at the cost of human lives?  – Nick Dawes (Sales Manager)
Patients should always get the care they need from the health service, and rationing services on the basis of cost alone is wrong and compromises that patient care. Decisions on treatments, including suitability for surgery, should be made by clinical experts taking the needs of each individual into account. We have already written to the NHS to set out clearly, that access to services should not be restricted on the basis of cost.

Should there be incentives in place for the private healthcare sector to expand and take on some of the load from the NHS, such as removing income tax on insurance payments? – Barry Rose (Independent Market Consultant)
The most important thing is ensuring everyone has access to the very best NHS care available and that those services are designed and provided to best meet the needs of the people who use them. This is why we are giving doctors, nurses and other health professionals more power to make decisions. They are the ones who know their patients best and will make sure that services meet the needs of their local communities.

Under this Government the NHS is performing well: waiting times are down, mixed sex accommodation has nearly been eliminated, we have the best ever record on hospital infections and access to dentistry has increased.

The NHS needs to involve the general public in making important decisions when managing their care and encourage greater interaction in their health and wellbeing, the NHS Confederation has said.

Mike Farrar, Chief Executive of the Confederation, said the NHS needs to go further to meet statements in its constitution to combat future challenges.

Farrar, writing in an editorial in The Guardian, said “NHS organisations need to do more to involve patients and the public” in how services are run.

The NHS Confed leader referred to the statement in the NHS Constitution that: the NHS belongs to the people.

But he admitted that the “daily reality for patients and the public” is somewhat different – and highlighted poor clinical practice and senior NHS leaders ignoring public opinion when making difficult decisions.

He said: “Take all this into account and you sense the NHS is a ‘public service’ with a long way to go.” Farrar added that the solution must change rapidly if the “NHS is to survive its next decade of challenges.”

Farrar pointed towards greater patient engagement in the future to obtain “faster and more sustainable results.” He said this was “business critical” if the NHS is to provide better standards of care and outcomes “for less money as healthcare demands grow”.

“There is no doubt that healthcare issues are complex,” he said. “But NHS managers and doctors do themselves no favours by their attitude of ‘arms around their work, no peeking’. We have to change.

“There is a huge need for more transparency, honesty and openness about why we need to modernise health services. There is an even bigger need for revealing to the public information about the economics, finances, and costs of health and social care.”

The Health and Social Care Bill has returned to the House of Lords with peers urged to back the controversial reforms by a host of directors from NHS Trusts around the country.

A letter published in the Times states the potential income under the new system may result in a higher quality care for patients by commissioning treatments that are currently deemed too expensive.

The letter, signed by 53 NHS medical and clinical trust directors, says there are “sound medical and clinical reasons” for supporting the measures to introduce the option of commissioning services outside of the health service.

But despite the rare backing, Health Secretary Andrew Lansley has again come under attack over his proposals. The Institute of Healthcare Management has today made the unprecedented move to oppose the Bill after associations for doctors, general practitioners, nurses and midwives previously made similar moves.

The letter defends the proposals to allow NHS trusts to earn up to 49% of their income from non-NHS sources. “It will enable us to bring much needed additional resources into our organisations to benefit NHS patients,” the letter reads.

“Examples of these benefits include developing treatment innovations and specialisms – such as complex paediatric treatment, robotic surgery, and employer-funded mental health treatment – and mean that trusts will be able to provide services on the NHS that can no longer be commissioned or are now rationed, including IVF.”

The directors argue that without this amendment being approved by peers the NHS will “lose millions of pounds of potential income and will lose the opportunity to expand and develop our clinical services.”

The Bill was returned to the Lords after the Government was forced to make numerous changes after cross-party opposition to the reforms. Prime Minister David Cameron insists that Andrew Lansley has his “full support”, despite a Downing Street advisor reportedly saying that he “should be taken out and shot”.

“The Prime Minister backs Andrew Lansley and he backs the reforms we are pushing through Parliament in order to deliver a better health service for the future,” a No. 10 spokesperson said.

“As far as we are concerned, the reforms are going to deliver a better NHS, one which will be freer of bureaucracy and have less political interference. It will mean that health care workers can get on with delivering care to patients.

“We have made our position very clear about what the reforms we are legislating for will do to improve the NHS and put the powers and decision-making ability into GPs’ hands.

“Understandably, lots of people have different views on our reforms, we accept that. We are very clear that they will deliver an NHS which is freer of bureaucracy. The fact is that we have to reform the NHS.”

The Government is to introduce 60 new goals that NHS hospitals and doctors are to be judged against in a move it hopes will save thousands of lives a year.

Benchmarks such as preventing unnecessary early deaths and improving the quality of life for people with long-term conditions will replace the target system introduced by Labour to assess the success of the NHS.

In an interview with The Daily Telegraph, Health Secretary Andrew Lansley says the benchmarks will “define what the NHS is setting out to achieve”.

The new system will focus on patients’ experience of the NHS – and not the speed of which they were treated – in an attempt to drive performance levels.

The use of comprehensive data on hospital death rates, the performances of GPs and surgeons and surveys from patients to gauge their satisfaction of the standard of care they received and their speed of recovery will all be analysed to assess whether benchmarks have been met. The views of bereaved relations and children for the first time will also be obtained as part of the Government’s plans.

“This is literally saying to patients ‘if you were in hospital, if you were being looked after by your general practitioner was the service and experience you had good or not?’” said Andrew Lansley. “It’s not like some other kinds of medical model where you kind of treat people and they get better. This is different. This is really where you begin to kind of focus on the experience of care.”

“We’ll be undertaking a consistent national survey of the bereaved relatives of people who received end of life care,” Mr Lansley said. “Asking them, after a suitable passage of time, what was their loved one’s experience of care and how well were they looked after towards the end of life.”

If the new standards are to be achieved, the Health Secretary believes that up to 24,000 early deaths a year could be prevented from cancer and other long-term conditions. Mr Lansley also hopes the new measures will increase access to NHS dentists and see fewer people with long-term conditions treated in hospitals. Patients undergoing routine hip and knee operations will no longer be left in pain or unable to walk, the Health Secretary pledged.

Mr Lansley said that his time as Health Secretary will not have been successful if the new benchmarks do not improve the NHS by the next general election.

“We have to clear the decks and be clear this is what we are focusing on,” he said. “People say in three and a half years’ time, in 2015, at the next election, how will we know whether you’ve succeeded or not? The answer is ‘have the outcomes improved? It will be my failure if we haven’t improved them and the NHS should feel that it has not succeeded, that is what we are setting out to do.

“We’ve really got to get into the big picture, which is delivering improvements in the results we achieve for patients right across the board. We know that we can do it.”

The Government will also publish current performance data for the first time for each of the benchmarks in an attempt, Ministers hope, will force up standards.

Shadow Health Secretary Andy Burnham said the new measures would not be received well by those working within the NHS. “Doctors and nurses will roll their eyes in sheer disbelief at this news,” he said.

“The Government that promised to scrap NHS targets now loads 60 new targets on an NHS already under severe pressure. It will add red tape and bureaucracy just as the NHS is struggling to cope with the financial challenge and the biggest reorganisation in its history.”

Inconsistent NHS leadership questioned

The NHS has suffered due to inconsistent leadership over a prolonged period, peers in the House of Lords have been told.

Baroness Cumberlege, a Conservative peer, told the House the number of different health secretaries in recent times has led to a lack of trust and confusion by the health service.

Speaking during the committee stage of the Health Bill, Baroness Cumberlege compared the Sir Alex Ferguson’s 25-year reign at Manchester United and asked “what difference it might make to the NHS” had it had a leader for a similar tenure.

Since 1997, there have been seven different health secretaries – six of which under the previous Labour government.

“One of the real problems that we have, and it exists even if it is the same party in power for a length of time, we lack a consistency of leadership, because the Secretaries of State are here one minute and gone the next,” said Baroness Cumberlege.

“I think that contributes to an NHS that gets confused, that gets fed up and is mistrustful of its masters.”

Despite the ongoing criticism of the Health Bill as it passes through the House of Lords, structural changes are still happening at ground level. Dr Thoreya Swage outlines the timescale for changes as PCT clusters switch responsibilities to CCGs.

The momentum of reform of the National Health Service in England continues to gather pace. Following a four month hiatus while the wise and the good of the NHS Future Forum pondered and produced recommendations for the adjustment of the Bill, the DH published further guidance on the developing role of the Primary Care Trust (PCT) clusters.

Although the 151 PCTs have been squeezed into fifty-one PCT clusters in preparation for their demise in April 2013, it seems that they have a vital part to play in the development of the emerging Clinical Commissioning Groups (CCGs).

This guidance or ‘shared operating model for PCT clusters’ has been produced by the mandarins at the DH to ensure that the commissioning landscape is as consistent and smooth as possible in time for the takeover by the CCGs. This is so that the nascent NHS Commissioning Board inherits a robust enough system to take account of further developments and improvements in healthcare in early 2013.

 

A shared model

There are six main functions or ways of working for the shared operating model for the clusters. These have been identified where consistency of approach is considered to be of importance and they are listed as commissioning development, financial and operational issues, ensuring quality, emergency planning, development of providers as Foundation Trusts and communications.

 

CCG development

The most important function is the preparation of CCGs for authorisation as soon as possible following the successful passage of the Health Bill through Parliament. The process of authorisation to become fully fledged commissioners is due to begin in the second half of 2012.

Although this is a year away, CCGs can commence their preparations now using a self diagnostic tool – an interactive computer-based assessment that helps them to determine their capability in six domains and identify their development needs.

The areas covered include:

• A clear clinical focus of the CCG commissioning plans to include tackling health inequalities and improving primary care
• Demonstration of meaningful involvement of patients and the wider community
• A plan for development that is clear and credible which, in particular, delivers the QIPP (quality, innovation, productivity and prevention) agenda
• Capacity and capability of the CCG, i.e. robust constitutional and governance arrangements which enable the CCG to commission care effectively and ensure financial control
• Collaborative arrangements for working with other CCGs, local authorities and the NHS Commissioning Board
• Capacity and capability of the CCG leadership which ensures effective working.

The tool helps the CCGs identify priority development areas which form the basis of the developmental plan paving the way to full authorisation.

To support all this work CCGs will receive £2 per head from the PCT clusters as well as extra management resource to help the groups hone their commissioning skills and capability.

CCGs experiencing difficulty in defining their boundaries will have guidance from PCT clusters on how to resolve this. PCT clusters also have the unenviable task of engaging the reluctant practices that so far have not participated in their local CCG discussions, with the aim of being part of a viable commissioning group by October.

 

Separating commissioning functions

All through the last quarter of this year a very detailed exercise is being carried out by PCT clusters to identify and segregate the service areas that CCGs and the NHS Commissioning Board will be responsible for. Although CCGs will be commissioning acute, mental health, community and ambulance care there are other services that PCTs currently commission which will need to be transferred to the Board.

Services such as GP and other primary care contractor groups – primary dental care, pharmacy and optical services – secondary dental care, prison, specialised and military health services are set to go under the umbrella of the NHS Commissioning Board. Even though the contracts for GP services are held by another body, the CCGs are expected to have an input into primary care development and improvement.

 

Quality assurance

A vital component of the commissioning process is ensuring the quality of healthcare. Practices may have been involved to a greater or lesser degree in various quality assurance processes in the past. However, CCGs are required to take on board these responsibilities seriously.

There is a whole raft of procedures and measures including delivery of better health outcomes for patients, meeting the Care Quality Commission (CQC) requirements for safety and quality of services, standard contracts, the NHS Operating Framework, professional guidance and other relevant requirements that CCGs need to get to grips with.

This could potentially be a vulnerable time for the development of the CCGs if attention wanders and serious patient safety incidents are not acted on promptly. Clinical governance processes must therefore be extra secure.

 

Budgets and responsibilities

Over the next year or so there will be a period of dual functioning and handover as the CCGs mature and the PCT clusters delegate more and more responsibilities until April 2013. The handing over of the baton has started now with PCT clusters having identified a “clear percentage of budgets” to CCG pioneers or pathfinders in August and plans for future delegation of budgets set by October.

Sandwiched in between will be the agreement on which mental health and community services will be subject to ‘Any Qualified Provider’ (AQP). This policy is set to be implemented from April next year when GPs can refer to providers of certain services eligible for AQP from a list of approved organisations, including the private sector, drawn up by the DH.

A review of commissioning support required by CCGs has already been undertaken in July with clear arrangements agreed by the end of the year.

In March next year, CCGs will be required to enable the development of the local health and wellbeing boards supported by their PCT clusters – health and wellbeing boards being the mechanism for joint health and social care planning and commissioning locally.

Meanwhile, individual PCTs will continue to carry out their statutory functions through the clusters until their abolition in April 2013. The statutory functions include contract monitoring, ensuring that providers meet their QIPP obligations and other statutory requirements, for example, safeguarding children and vulnerable adults.

The big challenge for CCGs will begin when they will be required to lead the next planning round for 2012/13. This begins in the latter part of this year and is a function previously undertaken by the PCTs.

This will involve doing a needs analysis, identifying local inequalities, understanding demand and activity for local services, negotiating and setting priorities with partners and developing the local strategic vision. Handover of commissioning functions will continue with CCGs being an active participant in the subsequent contract negotiations and agreement.

 

The outside world

It is apparent that despite the pause for reflection on the proposed changes in the NHS earlier this year, the momentum for restructuring and dissolving healthcare organisations continues. The picture remains a little confusing however, as CCGs are in varying stages of development and maturity and it is not clear that all will be truly viable by the tight deadline set for October.

What is clear is that that work of commissioning and delivering healthcare has to go on and now is a good time to find out who the key movers are within the CCGs.

It is at this point in time when the developmental needs of CCGs will be uppermost and it is here that pharma can provide some input. Skills and knowledge in leadership development and highlighting therapeutic areas where evidence-based care really works are two such possibilities.

CCGs will be keen to smooth patient pathways across primary and secondary care and nowhere is this more pertinent than in prescribing effectively. Delegated prescribing budgets are now very real for CCGs and they will be keen to ensure value for money and improvements in care for their patients. This provides a good opportunity for pharma companies to demonstrate the effectiveness of their drugs in specific disease areas.

On the commissioning front, by December of this year, CCGs and PCT clusters will have had to agree what commissioning support they need to carry out this function. Given the requirement to reduce costs, commissioning skills and expertise may actually be thin on the ground within CCGs.

Bearing in mind that effective commissioning will be judged by outcomes achieved as outlined in the NHS Outcomes Framework, pharma is well placed to demonstrate how their products can meet the requirements of domain 1: preventing premature deaths, domain 2: enhancing the quality of life of people with long-term conditions and domain 3: aiding the recovery of people who have an acute illness or injury.

The next few months will be busy while the NHS sorts itself out structurally. Once the picture begins to clear, pharma will need to engage with the new clinically skilled commissioners who now have the financial responsibility for making decisions about healthcare.

Dr Thoreya Swage was formerly an NHS clinician and a senior manager in various NHS organisations covering acute and primary care. She has expertise in commissioning health services and is currently working for a number of NHS organisations, including DH agencies, to develop a more commercial approach to the commissioning of healthcare.

New funding for medical technology research by companies, clinicians and academics aims to promote innovative approaches to the prevention, diagnosis and treatment of diseases in the NHS.

The National Institute for Health Research (NIHR) Invention for Innovation (i4i) programme has allocated up to £13m for research projects, and has launched a call for proposals.

The NIHR i4i programme funds projects through prototype and commercial development until a technology is ready for clinical testing, bringing together academic or clinical researchers and technical experts from industry.

The programme has been updated in two ways:

• Research projects in Wales, as well as in England, are now eligible for i4i.
• Instead of being divided between early- and late-stage product development awards, applications will all be submitted through a single route.

As well as looking for technologies that will benefit NHS patients, the NIHR i4i programme supports collaboration between researchers in industry, the NHS and the academic field. Each approved proposal will bring together researchers from at least two of these sectors.

NIHR particularly welcomes proposals from SMEs and from teams that have previously succeeded in developing and commercialising new technologies.

Martin Hunt, NIHR i4i Programme Director, said: “In the present economic climate, it is becoming increasingly difficult for medtech companies to secure funding for new, innovative technologies. The NIHR i4i programme provides a valuable funding opportunity for the medtech sector.”

This year’s i4i funding covers a “much broader” range of projects than last year’s, he noted. “The amount of funding awarded is determined by the nature and scale of the proposed research activity and we are considering projects seeking larger funding amounts than before.”

Outline research proposals must be submitted by 5pm on Wednesday 7 December 2011. Further details are available at www.i4i.nihr.ac.uk.

The ABPI has backed proposals from the MHRA to repeal part of the Medicines Act which allows pharmacists to trade overseas without the need for a wholesalers licence.

Pharmacists can currently sell medicines intended for UK patients at an inflated rate to customers abroad and could potentially lead to a shortage for patients and the NHS.

Stephen Whitehead, CEO of the ABPI, says the current practice is “not acceptable” and the repeal of the legislation “is a good first step” for patients and the health service.

The proposal is expected to be approved and implemented in 2012.

The new legislation would mean that pharmacies will only be permitted to trade when there is a necessary public health need, when small quantities are required, the order is infrequent and deals are non-profit.

The UK has some of the lowest medicine prices in Europe. This has resulted, the ABPI says, in “flowing out of the UK” and having a direct effect on supplies.

“The ABPI welcomes the MHRA proposal to end the trading of medicines by pharmacies that do not have a wholesale dealers licence, except in exceptional circumstances to meet a public health need,” said Mr Whitehead.

“To fully address this challenge it is now essential that pharmacies who serve NHS patients directly need to separate wholesaling activities from pharmacy dispensing activities.

“The ABPI looks forward to taking an active role in solving the on-going challenges.”

Several Liberal Democrat peers are supporting a number of amendments to the Health Bill focused on the regulation of competition within the NHS.

Several senior Lib Dem peers support the amendments and could force the Government to change aspects of the controversial legislation following concerns the Bill could still extend the application of European competition law to the NHS.

Lord Clement-Jones, a former Lords health spokesman who backs the changes, says the amendments would “balance the competitive powers and the integrating duties”.

More than a dozen amendments have been tabled by Lib Dem peers. They include the constraint of Monitor’s action against anti-competitive behaviour, that private income generated by Foundation Trusts would be used solely for the benefits of NHS patients, and that public interest be considered when the Office of Fair Trading is consider mergers.

Speaking to the HSJ, Lord Clement-Jones said he and his colleagues aimed to “make sure we didn’t fall into having a health service covered by European competition law” and that “we don’t have competition red in tooth and claw across the health service”.

The consideration of the Bill at the committee stage in the House of Lords is set to continue until the New Year.