New organisations formed as a result of the NHS reforms may cause conflicting policies and bundles of red-tape for the health service, Mike Farrar, NHS Confederation CEO, has warned.

Mr Farrar said the reforms would lead to several new bodies interfering with the day to day operation of the health service and result in a “tsunami of new bureaucracy”.

He added that new organisations will need to “minimise the burdens their policies place” on the NHS in order for it to “stay focused on patient care” and not on “repeatedly providing information in different formats to multiple bodies.”

Writing in an editorial for the Health Service Journal, the NHS Confed chief executive was responding to a survey of NHS chairs and CEOs. The survey found widespread concerns by NHS leaders as a result of the reforms.

Managers warned that widespread structural changes will result in a lack of senior experience and that savings targets are causing serious financial pressures.

Mr Farrar argued that the reforms are not a magic wand to improve performance and that expectations must be realistic. “Performance in many parts of the system will be patchy at first,” he said.

“Those leading the change need to be open-minded and flexible to improve policy and practice as we go. We are losing many experienced leaders.

“We need to ensure that as new ones emerge, taking on these challenges, they are given the support and cover they need to succeed, even if that means tolerating some difficulty along the way.”

The former SHA leader added that for new organisations to be successful they must listen to NHS leaders and focus on “critical overarching concerns that will matter most in the end”.

“It’s essential that national bodies ensure they are driving towards the same goals, not subjecting the NHS to a myriad of conflicting policies,” he said. “Otherwise the NHS will be pulled in different directions and unable to make progress.”

Health Minister Simon Burns insists the reforms remove layers of administration and will actually result in less bureaucracy for the NHS. “Our reforms mean that doctors and nurses will be in charge of the NHS, not managers,” he said. “It makes sense for the people that know their patients best, doctors and nurses, to take responsibility for driving up standards in their local NHS, free from bureaucratic interference.

“Careful work is underway now to ensure that new NHS bodies are prepared, but this is not affecting patient care. Waiting times are low, infection rates are down and patient satisfaction remains high.”

How the NHS Outcomes Framework can help KAMs align value propositions with customer need.

The NHS Outcomes Framework is an important information tool for both the health service and the pharmaceutical industry in the UK. The framework sets out to provide a benchmark for measuring NHS performance against agreed national indicators in areas identified as health priorities. First introduced in 2010, the framework has subsequently been updated annually to reflect patients’ evolving healthcare needs and encourage a stronger focus on tackling known health inequalities. It aims to provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board, and to act as a catalyst for driving quality improvements and outcome measurements throughout the NHS. Crucially, the framework is designed to help NHS organisations understand what a focus on health outcomes means in practical terms – and as such provides a powerful level for the pharmaceutical industry to engage with customers in ways that help them deliver local and national objectives.

Integrated frameworks

The 2012/13 framework follows the passing of the Health & Social Care Act and advocates an increased emphasis on improving the alignment of care sectors, encouraging collaboration and integration between health and social care. The Adult Social Care Outcomes Framework and the Public Health Outcomes Framework – which was published in March 2012 – compliment the Government’s ambitions to improve the integration of services. Collectively, the three frameworks are an attempt to create an “outcome-based health and social care system where success is measured in terms of the actual results achieved for patients, service users and whole populations.” The Government hopes that this approach at a national level will cascade down to local level, where Health & Wellbeing Boards will play a critical role in identifying shared outcomes goals for local populations – and also in understanding the contribution that different commissioners can make individually and collectively in achieving these goals.

The NHS Operating Framework is divided into five domains:

1. Preventing people from dying prematurely.
2. Enhancing quality of life for people with long-term conditions.
3. Helping people to recover from episodes of ill health or following injury.
4. Ensuring that people have a positive experience of care.
5. Treating and caring for people in a safe environment; and protecting them from avoidable harm.
   

Each domain has a series of overarching indicators covering its broad aims. These combine to form:

• One framework defining how the NHS will be accountable for outcomes
• Five domains articulating the responsibilities of the NHS
• Twelve overarching indicators covering the broad aims of each domain
• Twenty-seven improvement areas looking in more detail at key areas within each domain
• Sixty indicators in total, measuring overarching improvement area outcomes.

Whilst pharma can help the NHS drive improvements in all five domains, it is perhaps in the first three domains where medicines can make their biggest and most obvious contribution. Domain four includes outcomes that relate to the quality of the patient experience. Here, pharma can potentially support the NHS in areas such as redesigning care pathways or joint working arrangements. The final domain includes outcomes that relate to patient safety.

Indicators and coverage

Since the last Outcomes Framework was published, the DH says it has made considerable progress in refining the definitions of indicators. The majority now have been finalised, although work is continuing to develop further indicators to ensure the breadth of NHS activity is covered.

Two new indicators have been identified for 2012/13: improving recovery from stroke and improving children and young people’s experience of healthcare. Both of these are now subject to technical work to ensure they are suitable for inclusion to the Framework. Additionally, work is also being conducted by the DH to identify outcomes for groups or areas which the original framework failed to cover and capture. One such group is people with learning difficulties and another area is the quality of life of people with dementia. Again, these are being considered for more focused inclusion, and have been added as ‘placeholders’ on the 2012/13 framework.

Key aims

The main improvement areas in domain one include reducing premature mortality from the major causes of death such as cardiovascular disease, respiratory disease and liver disease in those aged under 75. Additionally, improvement is sought in one and five year survival rates in colorectal, breast and lung cancer. The domain also outlines metrics for improvement in: premature death in people with serious mental illness, reducing deaths in babies and young children and reducing premature death in people with learning disabilities. Undoubtedly, pharma can help shape new care pathways in these areas.

Domain two focuses on helping patients manage their condition, improve the functional ability in those with long-term illnesses and reducing the time these patients spend in hospital. In particular, a reduction of unplanned hospitalisation for chronic ambulatory care sensitive conditions in adults and unplanned hospitalisation for those under the age of 19 with asthma, diabetes and epilepsy is a key focus.

Domain three highlights the need to reduce emergency admissions for acute conditions that should not usually require hospitalisation and readmissions within 30 days of discharge. Improvement areas focus on continuing the development of Patient Reported Outcomes Measures for hip and knee replacements, groin hernia and varicose veins. The Framework also outlines a requirement to prevent and reduce emergency admissions in children with lower respiratory tract infections and improve recovery from fragility fractures, injuries, trauma and stroke – although these indicators are to be developed.

Domain four – which lists its overarching indicator as patient experience of primary and hospital care – cites eight improvement areas, such as improving people’s experience of outpatient care and improving hospitals’ responsiveness to personal needs.

Finally, the overarching indicators for domain five focus on patient safety incidents reported and safety incidents involving severe harm or death. The framework aims to reduce the incidence of hospital-related venous thromboembolism (VTE), infections such MRSA and C.difficile, category 2,3 and 4 pressure ulcers and incorrect medication errors which cause serious harm to patients. The admission of full-term babies to neonatal care and the incidence of harm to children due to ‘failure to monitor’ are also highlighted.

Moving forward

The DH says the NHS Outcomes Framework will continue to evolve as more indicators are developed. It will be refined on an annual basis to ensure the indicators are fit for purpose. In the meantime, it remains a vital resource for pharmaceutical sales and marketing professionals – enabling them to identify areas of national priority and develop value propositions that align with customer needs.

Spending on healthcare is set to soar over the next 50 years despite NHS efficiency measures, a new report predicts.

The Office of Budget Responsibility’s Fiscal Sustainability Report forecasts increased costs will result in a 5.2% rise in public spending on healthcare – the equivalent of £80bn in today’s terms.

A hike in the proportion of the population aged 65 and over is highlighted in the report, as are additional costs required to cover social care and pensions.

Report authors say the findings should not result in “a bigger tightening” of NHS purse strings but ministers should “think carefully” about long-term consequences resulting from short-term policies.

Health spending will rise from 17% today to 26% in 2061, the report found. As a consequence, the government will need to increase tax rates to generate £17bn in funds or make major spending cuts to reverse levels of debt, the report said.

The report also forecast an improvement in the efficiency of the NHS. Spending will rise from 6.8% of gross domestic product (GDP) in 2016-17 to 9.1% over the next half century. The report bases this on NHS productivity increasing by 2.2% annually. However, if healthcare productivity grows less quickly at 0.8%, as certain experts predict, spending levels may increase to around 16.5% and see a steep rise in public sector debt.

The NHS will evolve into one of the best health services in the world after the Government’s controversial structural reforms, Health Secretary Andrew Lansley has claimed.

Mr Lansley made the claim after the first Secretary of State’s Annual Report revealed waiting times are the lowest levels on record, MRSA outbreaks have fallen by a quarter and savings totalled £5.8bn.

Speaking in the House of Commons the Health Secretary said the health service was beginning a “new chapter” in its 64-year history.

He said performance results meant the NHS was entering a “new era based on openness and transparency, focused on what matters most to patients, on health outcomes, on care quality, on safety and on positive experience of care.”

“For the first time Parliament, patients and the public will know exactly how the NHS is performing, locally, nationally and by way of international comparison – a new era where patients are more in control, where clinicians lead services and where outcomes are amongst the best in the world,” said Mr Lansley.

However, Shadow Health Secretary Andy Burnham was unimpressed with Mr Lansley’s predictions and accused him of needlessly reorganising the NHS. He said: “Just when the NHS needed stability to focus all of its energy on the money, what did you do? You pulled the rug from underneath it with a reorganisation that no one wanted and this Prime Minister promised would never happen.”

The Labour MP told the Health Secretary he had wasted “not just one but two lost years” as he “obsessed on structures and inflicted an ideological experiment on the NHS”. Mr Burnham also claimed the NHS reforms had “led to a loss of financial grip at local level in the NHS”.

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.

Lib Dem deputy leader Simon Hughes has said that Andrew Lansley should “move on” from his role as Health Secretary “in the second half” of the coalition Government’s term of office.

Hughes’ comment follows reports that three Conservative ministers have privately criticised his handling of the NHS reforms.

In addition, a health service expert writing in The Lancet has challenged Lansley’s case for reform – saying that far from declining under the previous government, NHS performance significantly improved.

The current political storm follows the call of the Royal College of General Practitioners for the withdrawal of the Health and Social Care Bill, which Lansley has claimed will “empower” GPs.

Speaking on BBC1’s Andrew Marr Show, Hughes (pictured) said the Health Bill would be improved by amendments currently being tabled by the House of Lords, but was “not the Bill we would have wanted”.

Regarding the Health Secretary, he said: “My political judgment is that in the second half of the parliament it would be better [for him] to move on.”

While the British Medical Association and the Royal College of Nursing had already declared their opposition to the Health Bill, the intervention of the Royal College of General Practitioners was a serious blow to the Government.

Criticisms of the Bill relate largely to the role of competition and the prospects of fragmentation and private sector control.

Shadow Health Secretary Andy Burnham commented: “We’ve argued all along that the Government made a catastrophic mistake when it combined the biggest financial challenge in the history of the NHS with the biggest ever reorganisation.”

However, Culture Secretary Jeremy Hunt told the BBC that history would vindicate Lansley as “the architect of the modern NHS”.

The Government’s position was also challenged by Nick Black, Professor of Health Services Research at the London School of Hygiene and Tropical Medicine, whose Lancet paper said Lansley’s claims that NHS productivity had fallen by 15% in the last decade were “a myth”.

According to Black, the productivity measures used by the ONS failed to take account of data on quality improvements, including reductions in mortality rates for specialist procedures: 2.4% per year in adult critical care, 3.3% in dialysis and 4.9% in coronary artery bypass surgery.

The previous government’s waiting time targets – which Lansley had dismissed as “politically motivated” – had reduced the number of operations cancelled for non-clinical reasons by over 10% per year, Black said.

Notably, the last British Social Attitudes Survey found that 70% of respondents were ‘satisfied’ with the NHS, compared with 34% (the lowest figure ever) in 1997.

Black argued that “to justify the reforms to the NHS that the Conservative Party wanted to introduce, the claim of declining NHS productivity was necessary” – but in reality, “rather than declining, the productivity of the NHS has probably improved over the past decade.”