The focus of NHS investment needs to shift from large acute hospitals to community and home-based services, according to the NHS Confederation.

A new report, Transforming Local Care, argued that “significant” investment in making the community the “default setting” of healthcare is needed to meet the combined pressures of increasing demand and shrinking budgets.

Hospital inpatient services can be reserved for complex surgery and treatment of life-threatening conditions, the report said – but major and visible improvements in community-based care need to take place at the same time.

The NHS Confederation, which represents commissioner and provider organisations, called for long-term condition management to be shifted decisively out of the hospital framework.

It highlighted the proven value of strategies such as home monitoring, mobile diagnostics and medication adjustment in helping to keep people out of hospital.

While these strategies were recommended by Lord Darzi’s NHS review in 2008, the “unprecedented” economic pressures have made them urgent priorities for national adoption, the report argued.

Calling on the NHS Commissioning Board to “facilitate the necessary shift in the financing of care”, the Confederation outlined the need for payment incentives to promote prevention, early intervention and early supported discharge.

Crucially, it added, efficiency savings must be reinvested in community-based services, instead of being claimed by the Treasury (as currently happens).

“It is time we started thinking differently and making sure investment supports innovative service delivery that supports patients’ independence and recovery,” said Jo Webber (pictured), the NHS Confederation’s interim Director of Policy.

“For too long, the default setting when we think about healthcare or support is to think of a hospital. But in reality, acute hospitals are rarely the best place for someone who needs ongoing treatment.”

The end to the ‘postcode lottery’ will have to wait a little longer. Hopes were raised earlier this year when the Department of Health unveiled plans to introduce an ‘innovation scorecard’. The scheme would prevent hospitals blacklisting expensive drugs recommended by NICE. Patients, regardless of their location, would be able to receive the latest treatments without delay.

The DH initially planned to have the scorecard “fully implemented by the Autumn.” But, after discussions with the NHS and the pharmaceutical industry, it now looks likely that the scorecard will not be in place until the end of the year.

Speaking exclusively to Pharmaceutical Field, a DH spokesperson said talks were still ongoing between the health service and pharma to “collect all the data and information needed to ensure the scheme is accurate and effective. It will be launched in the coming months.”

The new scheme is expected to work in three different ways:

1. The innovation scorecard will allow patients and the public to see which NHS organisations have adopted the latest NICE guidance on recommended drugs and treatments.
2. The NHS will no longer have an excuse not to provide patients with NICE recommended products. Treatments recommended by the Institute will now be automatically added on to local formularies, allowing doctors to prescribe more expensive treatments if they wish.
3. A new group will be established to help the NHS overcome any barriers when implementing NICE guidance. The introduction of new medication or treatment may mean big changes in the
   way services are delivered. The group aims to spread best practice across the health service.

The DH added that NHS Trusts receive funding for each new NICE appraisal, so financial issues should not be used as a barrier to the uptake of innovative new treatments.

Speaking when the details were first announced in late August, then Health Minister Paul Burstow said the “new regime” would be a “catalyst for change”. He added that the DH is “determined to eradicate variation” across the uptake of NICE approved drugs. “NHS organisations must make sure the latest NICE approved treatments are available in their area, and if they are not, then they will now be responsible for explaining why not,” he said. “Being transparent with data like this is the hallmark of a 21st century NHS. It is
a fundamental tool to help healthcare professionals improve patient care.”

The introduction of the scorecard has been backed by the ABPI. Stephen Whitehead, ABPI Chief Executive, said it would be a “valuable tool” to support the latest NICE recommendations. “There is still a great deal of variation across the country on which treatments patients are able to access and so I am hopeful the scorecard will help highlight discrepancies which can then be addressed,” he said.

Whitehead called the scorecard a “definite step forward” in ensuring patients receive the latest treatments as quickly as their European counterparts. He said the existing system was bad news for the health of the nation which resulted in a lost opportunity to “drive efficiency savings through the use of medicines”.

The NHS Confederation was equally receptive to the introduction of the scorecard. But former Deputy Chief
Executive David Stout warned its implementation may cause “unnecessary bureaucracy” and stretch NHS finances even further. “It is also important to remember that the NHS is facing an unprecedented financial challenge and organisations must live within their means while providing high quality care,” he said. “The reality is we can only afford to provide new drugs or treatments where they are cost effective and demonstrably add real patient benefits. In a health system with no financial growth, any new costs have to be offset by savings elsewhere.”

Stout added that the introduction of the scorecard will only be a success if the NHS engages with local communities and clinicians to decide what local priorities are.

A majority of NHS finance directors think the ‘Nicholson challenge’ of saving £20bn by 2015 is unlikely to be achievable, according to the King’s Fund.

Most of the respondents were confident of meeting their financial targets for this year, but said the same level of savings and productivity gains would be very difficult to repeat.

Nearly half of the directors believed that local health services would deteriorate over the next three years, while only one-fifth thought they would improve.

The King’s Fund surveyed 45 NHS finance directors. Nearly all (42) forecast successful financial performance for their organisations this year, but most (27) said there was a high or very high risk that the NHS would not meet the overall £20bn savings target by 2015.

The two-year freeze on public sector pay was considered a major factor in enabling cost reductions, but it ends in April 2013. “An average increase of 1% in staff pay would add around £400 to £500 million to NHS expenditure,” the King’s Fund noted.

Only 8 of the 45 respondents thought local patient care services would improve in the next few years, while 19 thought they would decline.

The King’s Fund noted that the number of NHS nurses has fallen by 5,500 since March 2010, a loss of 2% of the workforce.

John Appleby, chief economist at the King’s Fund, said finance directors had already implemented easier cost-cutting initiatives such as reducing hospital stay length and number of managers.

Now, he said, it would be more difficult: “You get into a territory where it is not just a case of shaving a little bit off patients’ length of stay and that sort of thing. You are having to think completely differently about how you supply services.”

The £2bn gap in long-term social care funding will have a detrimental effect on NHS services, a new report by the NHS Confederation has predicted.

The report, Papering over the cracks, suggests that a failure to resolve the funding issue will have a severe impact on patients as more people require services.

Jo Webber, NHS Confederation Deputy Director of Policy, said the NHS “cannot keep on picking up the pieces of a broken social care system.”

The NHS Confed has now called for a cross-party political consensus to address the immediate cash surplus and find a long-term funding solution.

If a solution is not found, the Confederation warns that even basic social care services which are currently provided may not be available in the future.

The report advises that the health and social care system must respond to the needs of a population where people are living longer with long-term conditions. It found that more people are accessing NHS services due to cuts in social care, and that funds allocated to transform services have been used to ‘paper over the cracks’ in the social care system.

At a time when the NHS is being asked to find £5bn of efficiency savings, the report adds that it is not sustainable for the health service to continue covering the social care funding gap.

“The NHS and our local authority colleagues need to look at how we can radically redesign care and be more innovative in the way we integrate services for people with care needs,” said Jo Webber.

“We cannot solve this problem on our own. Increased funding is a key part of this solution. Without the involvement of the Treasury, including a clear outline of how we will address long-term social care funding in the next Spending Review, we will see a decline in services and greater pressure building on the NHS.”

The NHS Confederation backed the short term transfer of NHS funds to support local social care services. But it added that a continued policy of “robbing Peter to pay Paul would be very short sighted.”

Acute care services across England are struggling to meet increasing demand and the complexity of patients’ conditions, a new report has said.

The report by The Royal College of Physicians (RCP) found that standards were falling in hospitals due to an increase in emergency admissions, the treatment of elderly patients with a variety of conditions and a reduction in the amount of beds.

Professor Tim Evans, from the RCP, said the evidence was “very distressing” and the Government must make “drastic changes” to improve standards of acute care.

The survey of RCP fellows found that doctors were most concerned about staff shortages, the workload in acute medicine, a lack of continuity of care, and the impact of NHS efficiency savings.

Doctors also raised concerns about how older patients were transferred between wards and that levels of care dropped at night time.

The report suggested that the NHS has been a victim of own success. Contemporary medicines are now allowing people to live longer, but this has resulted in them developing long-term conditions such dementia.

“All hospital patients deserve to receive safe, high-quality sustainable care centred around their needs,” said Professor Evans. “Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population who increasingly present to our hospitals with multiple, complex diseases.”

Solutions to tackle the problems, the report said, include concentrating services in fewer, larger sites that are able to provide excellent standards of care, regardless of the time of admission. The report also advises improving community services to stop patients returning to hospital.

Health minister Dr Dan Poulter said it is “completely wrong” to suggest the NHS is struggling to meet demand and insisted that the “NHS only uses approximately 85% of the beds it has available”.

“It is true that the NHS needs fundamental reform to cope with the challenges of the future,” he said. “To truly provide dignity in care for older people, we need to see even more care out of hospitals. That’s why we are modernising the NHS and putting the people who best understand patient's needs, doctors and nurses, in charge.”

A leading trade unionist has claimed there are just six months left to prevent the NHS from ending as we know it.

The TUC’s John Lister, Director of Health Emergency, insisted efforts to resist the controversial Health and Social Care Act must be increased before it is too late.

Mr Lister said an “urgent clarion call” is needed to “resist the privatisation, cuts, closures and wage reductions”.

He said that the Act aims to “fragment the NHS, marketise it, commercialise it and privatise the services that offer profits, while leaving the rest as an underfunded, understaffed shambles.”

Despite being at the heart of the health reforms, Mr Lister claims that GPs “will be in the hot seat for future cutbacks.” “In reality all of these plans are cash-driven, cynical efforts to meet Lansley’s £20bn target for ‘efficiency savings’,” he said.

The activist has now called for a “firm rejection of the Act” by union members, increased publicity to raise “public alarm” over the proposed reforms and a planned demonstration as a “landmark” to “highlight the lethal threat the coalition poses to the health service.”

“We need to get people aware, angry, campaigning and reclaiming our NHS before the private sector reclaims the bits they have wanted since 1948 and dumps the rest into permanent crisis,” he said.

Commenting on the appointment of the new Health Secretary Jeremy Hunt, Mr Lister added that Andrew Lansley’s replacement has “all of the neoliberal politics” of his predecessor but “none of his declared attachment to the NHS”.

“He has made none of Lansley’s conciliatory gestures and promises to GPs during the progress of the Bill through Parliament and will no doubt find all of its worst proposals most congenial,” he said.

“His appointment as part of a rightward lurch by Cameron seems likely to result in accelerating the implementation of the Bill, while no doubt briefly diverting the energies of the British Medical Association and others who will feel obliged to give him the benefit of the doubt for a few weeks, wasting a bit more time before recognising the need to crank up the fight.”

Hospitals across England are struggling to deal with real term cuts in funding imposed by the Government as part of its efficiency savings, the NHS’ economic regulator has warned.

Trusts across England are forecasting cuts of more than 8% over the next three years as the Government attempts to meet its target of saving £20bn by 2015.

But following a review of trusts’ three year plans Monitor said that hospitals need to make “significant changes” beyond efficiency savings to remain financially sustainable.

The review found that hospitals may be forced to reduce services in an attempt to meet financial targets – despite being tasked with treating the same amount of patients.

Hospitals across England have started to reduce their cost base by an estimated £7bn to meet Government targets. However, Monitor expects trusts with hospitals built using private finance initiatives and small general hospitals to suffer the most when aiming to cut costs.

Andy Burnham, Labour’s Shadow Health Secretary, accused the Government of making a “major mistake” in imposing harsh savings targets instead of finding cost-savings efficiencies.

“Eyes were taken off the ball just when the NHS needed its full focus on the money and this report suggests the NHS has failed to get ahead of the problem,” he said.

“Senior civil servants complain of how hard they have found it to get the Secretary of State on the seriousness of the financial challenge – a damning indictment of his time in office. This failure to plan is resulting in an increasingly crude approach to reducing costs and panic measures. Ministers are in danger of losing control of NHS finances and urgently need to get a grip.”

The King’s Fund anticipates that the outlook for hospital finances are bleak over the course of the next three years but is unsure how the cuts will affect standards of care. “The question is to what extent that will translate into a cut in quality or in the amount of care hospitals provide,” said Professor John Appleby, Chief Economist at the King’s Fund

A trust struggling to meet the Government’s efficiency savings targets is being forced to do without full time cleaners as hospital bosses continue to cut costs, a new report claims.

Nurses at Mid Yorkshire Hospital Trust are being forced to clean and tidy dirty working environments as it struggles to meet the £20bn Nicholson Challenge and the QIPP agenda.

The report by a former inspector at the Department of Health said the nurses being forced to clean impacts patient care and is something that requires “urgent attention”.

The investigation by Brian Duerden, a former inspector of microbiology and infection control at the DH, found that nurses were mopping and cleaning beds despite not being trained to do so.

The Trust was forced to reduce the hours of professional cleaners earlier this year to just two days per week in measures to control finances. The cash-strapped trust is seeking to save £24m in the next financial year to meet Government targets.

A spokesperson for Mid Yorkshire Hospital Trust insisted the practice of nurses cleaning up wards was not reserved to the hospitals it controls. She said that the need for nurses to clean certain wards was not due to cost-cutting practices but to meet levels of high demand.

NHS Chief Executive Sir David Nicholson recently said the health service had enjoyed a “remarkable year” after it made £5.8bn in savings through the QIPP agenda.

However, those comments were in contrast to Jim Easton from the NHS Commissioning Board who insisted that cuts should not represent QIPP savings.

Many NHS hospitals are failing to maintain stable care teams or continuity of care, according to a survey of the Royal College of Physicians.

Breakdown of care regimes at weekends was identified as a threat to patient safety by a quarter of RCP members.

Other concerns raised by the RCP’s Future Hospital Commission include lack of compassion towards patients and poor aftercare following discharge.

The Commission’s interim proposals this autumn may include focusing resources on smaller number of larger hospitals.

Tim Evans, Academic Vice President of the RCP, reported to the college that many hospitals provide “disjointed” care with breakdowns in activity and in transfer of responsibility.

Increased risk to patients at weekends was highlighted as a major concern, with Evans saying it was better to have slightly suboptimal care on all days than to have serious health inequalities built into the weekly schedule.

The survey showed that 24% of RCP members did not think their hospitals delivered continuity of care; 23% did not think stable care teams were maintained; and 17% did not think aftercare following discharge was adequate.

Major underlying concerns raised by members included ‘efficiency savings’ (52%) and clinical staff shortages (49%).

The Commission has identified five ‘workstreams’ as priority areas: compassion towards patients; design of care settings and processes; staffing and teamwork; data handling; and care planning.

The RCP plans to publish its interim proposals in September and its full report in March 2013.

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.