The National Health Action party, which opposes the coalition’s NHS reforms, aims to stand 50 candidates in the next General Election.

Founded by BMA council member Dr Clive Peedell, the NHA is also critical of the market reforms of previous Governments, arguing for a unified and publicly owned NHS.

The NHA is not allied to the Labour Party or to any left organisation: it seeks to defend the NHS in isolation from broader political or economic issues.

Peedell, a consultant oncologist, traces NHS privatisation back to the 1990 NHS and Community Care Act, which separated purchasers from providers.

Speaking to The Guardian, he said: “We are going to see the NHS shrink to a rump service and everyone else forced to pay top-ups in the future.”

According to the NHA’s analysis, key aspects of NHS reform are designed to lead to privatisation: shifting healthcare to the community will make it easier for private providers to enter the NHS market, while personal health budgets will open the door to charges for NHS services.

Peedell does not accept the argument that the NHS was integral to the postwar socialist agenda: he argues that it lasted within a market-driven society for 60 years, but more recently the three major parties have irrationally undermined it.

The NHA aims to target 50 Parliamentary seats held by coalition MPs who supported the Health and Social Care Act.

However, an analysis by Conservative peer Lord Ashcroft predicted that its campaign would keep Labour out of power.

The payment by results (PbR) system for healthcare reimbursement is unfit for meeting the changing needs of society, according to the King’s Fund.

The think tank identified the current tariff as a barrier to the shift of healthcare from hospitals to the community.

A range of payment systems would be needed, the report argued, to encourage local innovation and to balance the priorities of quality, cost and supply.

The report explored the payment systems used in the NHS and other health economies, and examines whether PbR is able to support such long-term objectives as disease prevention and the care of long-term conditions.

Payment by results incentivises hospitals to continue treatment, thereby blocking a shift to preventative and community-based care, the report said.

It concluded that different services require different payment systems: PbR is most appropriate to elective care, but less suited to other services.

In addition, the King’s Fund said, payment systems need to be flexible to assist adaptation at a local level and trade-offs between priorities.

The NHS needs a new reimbursement framework that allows different payment systems for different types of service, the report argued.

Monitor, the foundation trust regulator, commented that it could “recognise many of the areas for improvement identified in the report” and would give it “careful consideration” when developing its pricing strategy.

Health Minister Lord Howe said: “We are working to make sure a payment system supports care being delivered closer to patients’ homes.”

He added: “We are working to expand our best practice tariff programme which supports patient-focused care, encourages innovation and makes better use of resources.”

Mike Farrar, Chief Executive of the NHS Confederation, has said the growing crisis in hospital funding demands major investment in community-based healthcare.

His statement follows an Audit Commission report showing that the number of hospital trusts in deficit increased from 13 in 2010/11 to 31 in 2011/12.

While the report called for tight control of trust finances, Farrar argued that the underlying problem is the over-dependence of the NHS on acute care.

The Audit Commission’s annual report on NHS finances said that while PCT finance was mostly healthy, there had been a dramatic increase in the number of foundation trusts and NHS trusts in debt.

There was “no room for complacency” over hospital trust finances and the need for tight spending controls, the Commission said.

Andy McKeon, its Managing Director of Health, commented: “The Department of Health and other relevant national authorities need to focus their attention on the minority of organisations whose financial position is deteriorating and on their geographical distribution and service standards.”

Farrar, who has long argued for a shift in funding from acute to preventative and long-term care, said: “This is the time for the NHS Commissioning Board to help providers, not with bailouts, but by releasing money to new CCGs so they can work with providers to help put them on a sustainable footing by changing the type and range of services they provide.

“Now is the time for big investment in community and primary care. It is worrying that the number of trusts in deficit has more than doubled in the past year. This situation is likely get worse unless we take radical action.”

Private health providers are set to take a fifth (£20bn) of the NHS market by 2020, according to corporate finance consultant Catalyst.

CCG commissioning and the new ‘any qualified provider’ rules, combined with the shift to community-based care, will greatly increase the opportunities for the private sector, the Catalyst report says.

Catalyst predicts a major increase in M&A activity within private healthcare, with growing interest from overseas investors in NHS assets and businesses from other sectors seeking to enter the market.

Justin Crowther, Catalyst’s Director and co-author of the report, said that NHS commissioners “are increasingly using the skills and capital of the private sector” – for example, “to turn around underperforming hospitals, operate GP surgeries, deliver community services or create centres of excellence in areas such as pathology”.

The report points to the “landmark contracts” recently awarded to Circle, Virgin Care and Serco as a sign of the growing trend.

In particular, it notes the growing opportunities for private sector providers of primary and secondary care, accelerated by “the removal of barriers” through the new ‘any qualified provider’ rules.

Catalyst also predicts that the shift of healthcare to community settings will open up £2bn of business for the private health sector by 2020, while commissioning support services will create another £1.3bn of opportunities.

In all, it predicts that private health providers will command £20bn of the NHS market – 20% of the whole – by 2020.

The UK needs major investment in community-based healthcare funded though the partial “decommissioning” of acute care, according to the King’s Fund.

The health think tank’s report calls for a major shift towards integrated care, relying on new technologies and flexible “health and social care teams”.

The King’s Fund argues that health providers need to focus on implementation to make sure that ideas proven effective for home-based care are put into practice.

The report Transforming health and social care points out that these ideas have been current since the Darzi review of the NHS, but the current economic challenges have made it urgently necessary for them to become reality.

Echoing comments by NHS Confederation leader Mike Farrar, the authors suggest that “decommissioning outdated models of care” is necessary “to create resources and space for new ones to emerge”.

They use the example of mental health care, where in-patient care was almost entirely phased out in the 1990s, as an example of a radical change in services driven by “a vision of care being delivered in the community”.

In addition, they argue, NHS organisations must be supported to “adopt established best practices” and experiment with new ones; and it must be made easier “for new providers to enter the market”.

Chris Ham (pictured), co-author of the report, said he hoped the new Health Secretary would “show real political leadership” by addressing the “long-term” issues highlighted by the report, and focusing on “services not structures”.

A new scheme developed by Bedfordshire CCG will use £1.5m to drive improvements in primary care, with the aim of reducing secondary care costs.

GP practices will receive a premium of up to £20,000 for achieving targets such as reducing emergency admissions and providing alternatives to outpatient clinics.

The General Practice Quality and Productivity Scheme is part of a drive by the CCG to save £9m by treating less acute conditions in the community and keeping patients out of hospital.

The money saved will be reinvested in GP practices and other community-based services in the region.

The scheme will award points for achievement of a number of indicators, including: providing safe alternatives to hospital outpatient appointments; reducing avoidable emergency admissions; offering patients a choice of providers when referring; and improving measurable patient experience.

The indicators will trigger additional investment in the GP practice of up to £20,000 in 2013.

Dr Paul Hassan (pictured), Chair of BCCG, said: “If we are to deliver more and better care closer to home, there has to be planned investment in primary medical services.

“This scheme will invest in GP practices that think and work innovatively to offer safe, high-quality alternatives to hospital care.

“Reducing our reliance on hospitals for less serious illnesses and injuries will free up hospitals to concentrate on what they do best.”

The financial problems faced by NHS foundation trusts (FTs) will become worse over the next few years, according to Monitor.

The economic regulator’s review of FTs’ annual plans states that far from being a legacy of their NHS trust past, the financial malaise of FTs is set to intensify as their cost-cutting measures reduce their income.

Without positive service redesign, Monitor says, the 20% spending cuts planned by FTs over the next five years will not improve their financial health.

It notes that the financial gap between more and less successful FTs is widening, with the latter including many based at district hospitals, carrying PFI debts or in deprived areas.

“We expect an increasing number of trusts could be placed in significant breach for financial reasons,” said Stephen Hay, Monitor’s Chief Operating Officer.

According to the regulator, FTs “need to be making significant changes in the way services are delivered, including further service reconfiguration and consolidation of suppliers”.

The financial plans of FTs forecast a 1% decline in income overall in the next three years, with no increase in acute care activity (compared with an average annual growth of 4.5% in recent years).

The review predicts that at least 17 FTs will receive a red rating (indicating a serious risk of breaching their authorisation terms) in 2012–13. “We expect there will be more,” it warns.

According to David Stout, Deputy Chief Executive of the NHS Confederation, Monitor’s report shows an urgent need for service redesign towards more integrated and community-based care.

A new specialist unit will give dementia patients in south Essex a halfway house between hospital and home, easing the transfer of care.

The Mountnessing Court healthcare facility in Billericay will be developed into a short-stay dementia treatment unit with 22 beds.

The flagship integrated care facility will bring doctors, nurses and therapists together with social care and mental health professionals, as well as Alzheimer’s Society workers.

A specialised care environment designed for people with dementia, it will provide 24-hour intensive treatment for patients staying up to eight weeks as a bridge between secondary care and independent life at home.

It will also treat patients being treated concurrently for a dementia and another medical problem, and will provide support for family carers of dementia patients.

The centre will be trialled from this autumn until January 2013. Patients will be drawn from Basildon, Thurrock , Rochford and Castle Point.

Ian Stidston, Director of Primary Care and Partnership Commissioning at NHS South Essex, said the unit would enable people “to have intensive support away from hospital” and that its purpose was to help patients “stay at home and live as independently as possible, for as long as possible”.

The Mountnessing Road facility was previously used as a day-care centre for elderly people with mental illness. It was faced with closure, but instead will be redeveloped as a specialist unit.

Will the new NHS deliver effective community-based healthcare or revert to the old fire-fighting approach? Maxine Vaccine asks whether a cheaper healthcare model is something the NHS can afford.

Healthcare in the community is an idea whose time has come. It’s not new, of course: preventative care and avoidance of hospital admissions were strong themes in the Darzi review. For years, the NHS has been talking about a radical change in the healthcare model: from acute to chronic, from fire-fighting to safer housekeeping.

What the new austerity has done is to impose a financial imperative on the change. The general principle that prevention is cheaper than cure has to be hard-wired into patient pathways that deliver measurable cost savings. That may work readily for a condition such as COPD where the clinical and financial stakes are high – but does it work every time for obesity, for diabetes, for depression? The problem with mixing austerity and community healthcare is that you need to pay up front for primary care, for prevention, for monitoring and control, and the savings appear further down the line. Which is not the way business tends to work.

The Government has taken some positive steps towards integrated care. The decision to allow physiotherapists and podiatrists to prescribe independently may seem a minor step, but it’s unprecedented (not just here, but worldwide) and it bridges the gap between primary and secondary care, giving the outpatient clinic a decisive power of intervention that addresses a key weakness in long-term condition care.

On the other hand, the worrying prevarication over the Dilnot recommendations highlights concern that shifting responsibility for public health to local government is merely a way for the coalition to go on claiming it’s not cutting the NHS budget – when it is, of course, slashing the local government budget to ribbons, and social care is bearing the brunt of that. Our hospitals are increasingly packed with ‘revolving door’ patients who, until recently, would have been cared for by social services: alcoholics, drug addicts, the mentally ill, the disabled, the elderly.

So the wheels are in danger of coming off the Government’s model of community-based care. Even GP-led commissioning – this Government’s flagship health concept – may ultimately be disabled by austerity culture. There’s a growing sense that CCGs exist to cut costs, not to improve care – and GPs don’t have the time or the stomach for that. If the balance between clinical and financial outcomes tilts too far towards the £ side then CCG management will be outsourced, and the circle of private providers and private commissioners will be complete.

But whether it fully works or not, community-based healthcare is what the realities of patient need dictate. Whether you’re looking at mental health, diabetes, obesity, sexual health or the effects of smoking, the message is clear: the NHS needs affordable strategies to keep people well, keep them out of hospital and, where possible, keep them looking after themselves.

Integrated care means not just the integration of health and social care, but that of primary and secondary care, and that of different therapies. Pharmaceutical companies need to see drug interventions as part of a multi-faceted patient pathway in real time. They need to see diagnostic and device companies, physiotherapy and psychotherapy providers, as partners rather than as rivals. In hard times, nothing of value should be wasted.

Making the best of what’s available by combining talents and resources is the future of the NHS. It needs to be the future of the life science industries as well.

Maxine’s views are not necessarily those of Pharmaceutical Field.

The NHS Commissioning Board is planning to fund a new innovation body that can deliver a “system-wide” response to the QIPP challenges facing the NHS.

According to Jim Easton, the Board’s Director of Improvement and Efficiency, the new organisation will commence operation in April 2013.

It will replace the NHS Institute for Innovation and Improvement and the NHS Technology Adoption Centre, as well as the National Cancer Action Team and NHS Diabetes and Kidney Care.

The Board will set priorities for the new body after consulting with providers and commissioners.

The new body will seek to generate practical tools that can be implemented across the NHS, and to help providers and commissioners access existing partnerships such as the Advancing Quality Alliance.

“The Board is trying to set this up as a system resource that responds to the needs of players,” Easton said. It will not be a “top-down change machine”, rather a “system-wide response” to the challenges facing the NHS.

“QIPP is everything,” he argued, echoing Sir David Nicholson’s recent statement that the QIPP agenda would dominate the NHS for “the foreseeable future”.

Easton emphasised the need to shift more care into the community through service redesign, which meant adopting ideas from other sectors and nations.

“This organisation needs to provide hands-on support for great models of care that you can get access to and deploy quickly,” he said.