NHS struggling to meet ‘Nicholson challenge’

by JoelLane 19. September 2013 15:36

John Appleby web The NHS looks set to fail in its target to save £20bn by 2015, according to a new report.

Research from the King’s Fund found that more than half (56%) of NHS finance directors questioned said there was a ‘high or very high risk’ that the ‘Nicholson challenge’ will not be met.

Only 1 in 10 of the directors questioned estimated the chances of hitting the savings target as 50/50, highlighting the growing demand for services and pressure placed on NHS providers.

Professor John Appleby, Chief Economist at The King’s Fund, said it was now “clear the NHS will struggle” to meet its productivity target resulting in “potentially serious consequences for patient care.”

The latest quarterly monitoring report was conducted in July between NHS trust finance directors and CCG finance leads.

Only a third (34%) of financial directors said the likelihood of success of reaching the savings target in the next two years was 50/50.

When quizzed about this year’s targets, just a third of directors at NHS trusts were optimistic of reaching cost improvement parameters. However, nearly three-quarters (72%) of CCG financial directors were confident of meeting their own individual targets.

For 2013-14, the vast majority of respondents expected their organisation to be in surplus or break even, with 11% expecting to be in deficit. But the news isn’t so good for the next 12 months with 72% questioning the prospects for their local health economy.

“The findings from our survey of finance directors have become significantly more pessimistic over the past 12 months, reflecting the growing pressures on the NHS,” said Professor Appleby.

“The reality for many hospitals is that they face an uncomfortable choice between whether to prioritise the quality of services for patients or allow performance in some areas to slip in order to balance the books.”

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DH finds £500m for struggling A&E units

by JoelLane 8. August 2013 16:03

David Cameron  gives a speech to The Brookings Institution, 1775 Massachusetts Avenue, NW, Washington DC 20036PRESS ASSOCIATION Photo. Picture date:Thursday 29th November , 2007.See PA Story. Photo credit should read: Andrew Parsons/PA Wire The Department of Health has freed £500m from its ‘efficiency savings’ to support struggling A&E units this winter.

The cash will be made available to those units suffering the greatest difficulty in meeting demand, and community services (such as pharmacies) linked to them.

The measure reflects the fact that last winter, failure of A&E units to meet waiting time targets was up by 39% on the previous year.

Prime Minister David Cameron said: “In the longer term what we’ve got to do is get our hospitals working better with GP surgeries, and also get our hospitals working better with social care departments so that the frail elderly are better cared for in the community.”

The £500m will be sourced from money saved by the NHS under the ‘Nicholson challenge’, a fact that led the BMA to comment: “At a time when they are demanding cuts of £20bn across the NHS, this is nothing more than papering over the cracks.

“It is recognition that their austerity programme has hospitals facing ever-increasing demands with diminishing resources.”

Dr Clifford Mann, President of the College of Emergency Medicine, argued that the measure was “a short-term fix” that “does not address the underlying cause – we have a shortage of doctors.”

Non-EU nationals to be charged for NHS services

by JoelLane 3. July 2013 16:29

Jeremy Hunt - Web.2 Patients without EU nationality will be charged for NHS services, according to plans outlined by Health Secretary Jeremy Hunt.

The proposals include adding a £200 health levy to six-month visa costs and charging people who are in the UK for less than six months for GP visits.

The scheme also aims to step up the measures used to reclaim hospital treatment costs from EU patients via insurance.

The BMA and disease control specialists have expressed concern at the public health risks posed by denying free NHS care to many visitors and migrants.

According to Hunt, treating ‘foreigners’ costs the NHS £30m per year, which is a matter of “widespread public concern” (though the total is only 0.6% of the annual ‘Nicholson challenge’).

The National Aids Trust warned that the new measures would “undermine years of work to encourage marginalised at-risk groups to access HIV testing and treatment,” and so risk “accelerating the spread of HIV in the general population”.

Dr Laurence Buckman, Chair of the BMA’s GP Committee, commented: “The BMA would strongly oppose any system where GPs are required to act as UK Border Force agents and enforce immigration checks.”

He called for an “impact assessment” to determine how much time and money the scheme would cost.

“We need to ensure that financial considerations are balanced with a doctor’s ethical obligation to meet the needs of patients, irrespective of their immigration status, and that safeguards exist to protect vulnerable individuals,” commented Dr Vivienne Nathanson, Director of BMA Professional Activities.

“Doctors also have an important obligation to protect public health. If parts of the population are not able to access healthcare, this could result in highly transmissible conditions, such as TB, going undetected and spreading more widely across the population.”

NHS must plug holes in social care budget

by JoelLane 27. June 2013 16:28

George Osborne (resized) Chancellor George Osborne has committed the NHS to sharing £3.4bn a year with the heavily cut social care services.

The new ‘joint commissioning’ funding outlined in the Comprehensive Spending Review was described by Health Secretary Jeremy Hunt as a major step towards integrated care.

However, coming together with a 10% cut in local government resource budgets, it will primarily serve to shore up cash-deprived social care services.

The NHS already transfers £1bn of its annual budget to social care, and this will rise to £3.4bn in 2015–16, combining with Government grants to create a £3.8bn ‘joint commissioning’ fund.

In order to access this fund, social services will need to provide seven-day care and work together with CCGs.

Every person cared for under this funding will need to have an ‘accountable clinician’, normally their GP. The new system will serve primarily to improve the continuity of care for vulnerable elderly patients.

Hunt claimed the new fund was “a huge moment in the NHS’s history” that would “restore clinical accountability outside hospitals”.

“In order to access the £3bn pot local councils and CCGs will have to do joint commissioning for vulnerable older people,” he said, implying that direct care provision is not necessarily part of the picture.

The new NHS ‘accountable care’ organisations could be similar to the US private healthcare company Kaiser Permanente, he added.

Plans for integrated care will need to be developed by CCGs and HWBs and signed off by Health Minister Norman Lamb.

Hunt added: “The integration pilots announced by Norman Lamb are going to be very significant. We want to create space for innovation.”

A key aspect of the new system, he suggested, would be “better clinical care of people in residential care homes”.

However, the new integrated care plans apply in a context of cuts on both sides. The NHS continues to face the ‘Nicholson challenge’ of a £5bn absolute (though formally undeclared) cut in its budget each year, while social care will be affected by a 10% cut in local government funding.

Sandie Keene, President of the Association of Directors of Social Services, said: “The benefits gained from closer integration with the services provided by our health colleagues will be rendered less valuable if the intricate relationship with other services is threatened by severe downward pressures on local government as a whole.”

Nicholson slams coalition health record

by JoelLane 10. June 2013 17:25

Sir David Nicholson 2 (resized) Sir David Nicholson has used his last speech to the NHS Confederation to challenge the coalition Government’s health record.

As well as saying he was “incensed” by the Government’s recent attempt to blame A&E problems on GPs, Nicholson pointed out that the worsening economic picture since 2010 has prevented the QIPP agenda from making any difference.

Implicitly criticising the NHS reform policy, which was driven by the Department of Health, he said: “NHS England needs to involve the public in setting out a long-term strategy for the NHS.”

Other criticisms of the Government were implied in his praise for the NHS tribute in the Olympic Games opening ceremony (which Jeremy Hunt had tried to veto) and his statement that the two years following the 2010 election were “wasted” for the NHS.

Nicholson’s speech was reminiscent of his warning in late 2012 that the Government policy of “carpet bombing” the NHS with private providers would lead to “misery and failure”.

Noting the way in which the media (led by Hunt) had run with the idea that GPs were to blame for the overloading of A&E departments, he observed: “There is a sort of wheel that gets spun every so often, and on that wheel this week it is nurses. Let’s have a go at the nursing profession... But I was particularly, I think, incensed about some of the coverage in relation to general practice.”

Nicholson also acknowledged the futility of the ‘Nicholson challenge’, saying: “We talked about QIPP a few years ago thinking there will be no growth for a few years. There was an assumption that things were going to turn around in a few years – well they haven’t, so we need to make a long-term plan. NHS England needs to involve the public in setting out a long-term strategy for the NHS.”

The NHS reforms had wasted time and resources that should have been invested in transforming services, he said: “During the 2010 general election period, political parties went around the country making promises of no change. What happened when we got a new government was we wasted those two years where you can really make change happen. We didn’t talk about the really important changes that are required for the NHS.”

Decline of the NHS is ‘very worrying’, Farrar says

by JoelLane 4. June 2013 14:07

Mike Farrar A survey by the NHS Confederation shows that 70% of the heads of NHS organisations believe access to care is deteriorating.

Only 7% said significant progress was being made in integrated care, and two-thirds said the lack of progress meant that services were “unsustainable”.

Mike Farrar, NHS Confederation Chief Executive and a champion of integrated care, said the survey results were “very worrying”.

The NHS Confederation, the membership body for NHS commissioners and providers, supported the NHS reforms but has since expressed concern at the impact of austerity policies.

Financial pressure, with the ‘Nicholson challenge’ now known to be an absolute cut in NHS spending, was flagged by 60% of NHS leaders as a “serious” problem and by 83% as one that would worsen in the coming year.

Half of the respondents said waiting times and access to care had deteriorated in the past year, while 70% said they would do so in the next 12 months.

“In the short term the NHS is holding it together,” said Mike Farrar, “But the sticking plasters on the creaking parts of the system will only last so long. We are already seeing the pressures on our A&Es bubbling over.

“Effective long-term change will require NHS leaders, with the support of the public and politicians, to take up the gauntlet and see through some radical changes to the way we deliver care,” he concluded.

Nicholson to quit

by JoelLane 21. May 2013 16:03

Sir David Nicholson 2 (resized) Sir David Nicholson will retire from his role as Chief Executive of NHS England, and from the NHS altogether, in March 2014.

The announcement of his retirement will relieve the pressure on him to resign following the Francis report, which implicated him in the Mid Staffordshire tragedy.

It also means that he will not have to deal with growing anger over revelations that the ‘Nicholson challenge’ of cutting £5bn from the NHS budget each year means an absolute cut in the NHS budget.

A former Communist Party member, Nicholson has been a strong supporter of current Conservative health policy: he began implementing the Health and Social Care Act prior to its approval by Parliament.

However, last autumn he warned that “carpet bombing” the NHS with private sector providers would lead to “misery and failure”. NHS reform needed to support clinical decision-making, he argued.

The Francis report into the unnecessary deaths at Stafford Hospital between 2005 and 2009 found that Nicholson, as head of the region’s SHA, had not acted on warnings about the hospital’s high death rate.

While the Francis report blamed inadequate staffing levels and bad management for the tragedy, Nicholson pinned the blame on the Labour Government’s infection control and waiting time targets.

Nicholson has worked in the NHS for 35 years, and was NHS Chief Executive for almost seven years. In April this year he became Chief Executive of NHS England, a role effectively continuous with his previous one.

In a letter to Professor Malcolm Grant, Chair of NHS England, Nicholson declared his continued support for the NHS reform process: “I still passionately believe in what NHS England intends to do. My hope is that by being clear about my intentions now [I] will give the organisation the opportunity to attract candidates of the very highest calibre so they can appoint someone who will be able to see this essential work through to its completion.”

Nicholson’s retirement will quieten the controversy over his role in the NHS reforms of this and the last government, and allow recognition of his lifelong commitment to the NHS.

Gap between health and social care widens

by JoelLane 14. May 2013 16:25

old-woman-hospital-bed Delayed transfers of care from the NHS to social services are becoming more prevalent, according to Government figures highlighted by Age UK.

NHS and local government leaders have declared a ‘pledge’ to close the gap between the NHS and social care by 2018.

However, the ‘pioneer projects’ declared will take place against a background of ongoing cuts in the social care and NHS budgets.

The Department of Health, NHS England, the Local Government Association and the umbrella bodies for directors of social care have launched a joint programme to stop patients falling into the gap between NHS and social care.

From the end of this summer, a number of ‘pioneer projects’ will seek to address the problem – including ways to pool budgets, speed up discharge from hospital and streamline patient assessments.

Age UK has published Government figures showing that on average, patients in hospital are waiting 30 days for a care home place, while patients at home are waiting 27 days for a care package.

In both cases, these figures show a 13% increase relative to three years ago – a reflection of the deep cuts in social care budgets.

Social care commissioners have been warned of further cuts this year, while the ‘Nicholson challenge’ – an absolute cut of £5bn per year in the NHS budget – is now planned to continue indefinitely.

Michelle Mitchell of Age UK commented: “Waiting in hospital needlessly not only wastes NHS resources, but can also undermine an older person’s recovery and be profoundly upsetting for them and their families.”

NHS launches support plan for emergency care

by JoelLane 10. May 2013 16:14

Outside-AE The NHS has launched a plan to support its overloaded A&E services, with the formation of ‘urgent care boards’ able to invest in emergency care.

NHS England will work with the NHS Trust Development Authority and Monitor to address the problem of increasing A&E waiting times.

One priority is for hospitals to bring forward their planning for next winter to ensure that seasonal urgent care needs are under control.

The growing pressure on A&E services is due to increasing demand – four million more people in England are using these services than in 2004 – combined with the budget cuts of the ‘Nicholson challenge’.

Health Secretary Jeremy Hunt angered the BMA by blaming the increased A&E attendance figures on lack of GP access, but it is beyond doubt that many people use A&E to bypass primary care and referral barriers.

The NHS support plan therefore aims not only to help maintain A&E capacity, but to relieve the pressure on emergency care through GP and outpatient care.

At the same time, the increasing number of people attending A&E who require urgent hospital care points to a need to improve not just access to care, but the quality of care outside hospital.

While 90% of patients in A&E are seen within four hours, the average waiting time is increasing. The support plan notes: “Long waiting times in A&E not only deliver poor quality in terms of patient experience, they also compromise patient safety and reduce clinical effectiveness.”

The urgent care boards will bring together healthcare leaders from across the local NHS. By the end of May, these boards will ensure that local recovery and improvement plans are in place for each A&E department.

NHS England will ensure that extra money is made available: the urgent care boards will oversee the use of the fees paid for emergency admissions, and ensure that expenditure achieves specific improvements.

Professor Keith Willett, NHS England’s National Director for Acute Episodes of Care, commented: “When pressure builds across the health and social care system, the symptoms are usually found in the A&E department.”

‘Nicholson challenge’ to become permanent

by JoelLane 17. April 2013 17:35

Sir David Nicholson (resized) The NHS cost-cutting policy known as the ‘Nicholson challenge’ will be extended indefinitely beyond 2015, according to NHS England.

The Government does not expect any improvement in the economy beyond 2015, so has put in place plans to extend the QIPP agenda on a long-term basis.

The statement by NHS England’s Policy Director, Bill McCarthy, refutes Government claims that the NHS budget is ‘ring-fenced’.

However, McCarthy emphasised that the incremental cost-cutting measures that have so far been used to achieve QIPP savings will not be either adequate to the challenge or possible to keep repeating.

Instead, NHS England – through its Local Area Teams – would look at “ambitious and radical” service changes.

The LATs will need to ensure that the decisions of individual CCGs do not conflict with this national service redesign agenda, he said – further qualifying the supposed ‘autonomy’ of CCGs.

Instead of closely monitoring QIPP savings at the local level, as the DH had done before, NHS England will rate the savings plan of each CCG as ‘red’, ‘amber’ or ‘green’ based on whether it can be and is being realised.

NHS England recently published a business plan indicating that it was drawing up a framework for “major service reconfiguration”.

Malcolm Grant, Chairman of NHS England, stated recently that the next government would consider the option of charging for NHS services.

The combined statements by Grant and McCarthy suggest that a radical reduction in the availability of free NHS services is planned beyond 2005.


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