The Government’s controversial Health and Social Care reforms have left the NHS and doctors across England in distress, Dr Clare Gerada has claimed.

The chair of the Royal College of GPs again voiced concerns about the introduction of the Health Act and the consequences of the reforms for the NHS and healthcare professionals.

Speaking at a conference in Glasgow, Dr Gerada claimed the NHS is experiencing the “mother of all top-down reorganisations” – which were the most “radical” in its 60 year history.

Dr Gerada said that as a result of the reforms the health service and GPs had been left “in distress” after the Act was “rushed through at breakneck speed.”

“We GPs will always make the system work for our patients,” she said. “But we will never compromise the founding values of our NHS. And each of us must continue to play our part in raising concerns wherever we see inequalities and unfairness in our health system.

“We’ll show courage, just as our forefathers did as they rose to the extraordinary challenges posed by post-war austerity and the uncertainties of the new NHS.”

“Yet despite her opposition to the Health Act, Dr Gerada called upon doctors to embrace our future with optimism and confidence.” A statement echoed by the Department of Health.

“Local doctors are the right people to lead the NHS,” said a spokesperson. “They will make this system work and make sure the NHS is locally led. They know what their local health and care issues are and will ensure patients are treated as individuals – with dignity and respect – improving services and the quality of care.”

Sir David Nicholson has predicted “big changes” on the day the NHS Commissioning Board (NHSCB) takes over its new responsibilities.

The NHS Commissioning Board Chief Executive said Monday 1 October 2012 was a “landmark” day in the history of the NHS as the NHSCB takes full control of its budget.

Writing in The Guardian, Sir David outlined how the Board plans to split the health service’s £85m budget.

He explained how around £60m will be allocated to clinical commissioning groups to “plan and pay” for local health needs.

The remaining £25m will then be used by the Board on “community services” and on more “specialist services” for conditions that are more complex and rarer.

Sir David said that patients “won’t notice a difference” immediately as a result of the changes, but was confident “they will start to experience real improvements” soon.

The Board’s CEO outlined how it had recruited experienced healthcare professionals to “key positions” so it can make the correct decisions “made on the best clinical advice.”

However, Nicholson said the “most significant shift” in emphasis is the way “we underpin all that we do” with a single focus on “improving the quality of care for our patients”.

Nicholson added that there are “no better words” to explain the work of the NHSCB than the principles and values set out in the opening paragraph of its constitution. The four short sentences describe how the NHS “belongs to the people”, how the health service aims to support patients “mentally and physically well”, to work at the “limits of science”, and to touch the lives of individuals at “times of basic human need, when care and compassion are what matter most.”

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.”

Health Secretary Andrew Lansley has been replaced by Culture Secretary Jeremy Hunt as part of David Cameron’s cabinet reshuffle.

Mr Lansley has been demoted to the role of Leader of the House after serving as Secretary of State for Health for two controversial years.

Mr Hunt said the new role was the “biggest privilege of his life” and that he was looking forward to starting work within his new department.

Lansley’s controversial reign will be remembered for the introduction of the Health and Social Care Act – which abolished Strategic Health Authorities and Primary Care Trusts in favour of GP-led clinical commissioning.

The move – which was which contested by a host of national organisations representing healthcare professionals – resulted in thousands of NHS workers losing their jobs during an era of austerity within the health service.

Dr Kaliash Chand, who was recently elected as BMA Deputy Chairman, welcomed Mr Lansley’s removal and hoped his replacement would end the marketisation of the NHS.

He commented: “He has done an utterly miserable job. Especially considering he was shadow health secretary for six years. He was unable to explain what he wanted to achieve. He was not a good communicator. In my view he has not been a very good health secretary. He epitomised everything that has gone wrong in the last two years in the NHS.”

Stephen Whitehead, ABPI Chief Executive, “welcomed” Mr Hunt to the new role and thanked the outgoing Andrew Lansley for his efforts over the last two years. “The NHS is highly regarded both here in the UK and around the world and Jeremy Hunt will face a number of challenges in not only safeguarding its short term success, but its long term future.”

Mr Whitehead said that one of the first challenges the new health secretary faces is getting the latest medicines to patients. He added that the pharmaceutical industry will continue to work closely with the DH to “design a pricing system” that provides value for money for taxpayers whilst “ensuring a healthy and productive environment for companies to research and develop the medicines of the future.”  

Mr Hunt, the MP for South West Surrey and the former Secretary of State for Culture, Olympics, Media and Sport, faced widespread criticism earlier this year when he urged David Cameron to support Rupert Murdoch’s bid for BSkyB – a month before he was due to decide whether the bid should be allowed.

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

Renowned NHS foundation trusts in England will be encouraged by the Government to establish new facilities abroad in measures to increase profits.

Proposals by the Department of Health and UK Trade and Investment will see high-profile hospitals such as the Royal Marsden and Great Ormond Street create branches abroad to boost funds.

Profits from the overseas facilities would then be reinvested back into the NHS.

The plans, which are set to come into force later this year, have been criticised by the Patients Association who called them concerning.

“The key and only focus of an NHS hospital should be to provide treatment to patients on the NHS,” said the Association’s Michael Watson. “Any moves which would see commercial ventures, which are naturally going to be important for hospitals because they need to use them to raise revenue, would simply result in the attention of the hospitals being taken away from the core purpose – to treat patients in the UK and instead be focused on these hospitals abroad.”

Under the plans, Healthcare UK will identify trusts wishing to expand into new countries and find clients who wish to use the services. Funding for the ventures would come from the private sector to establish the facilities.

London’s Moorfield Eye Hospital and Great Ormond Street already have facilities in Dubai. But critics have argued that other hospitals are not in a position to provide services overseas, and any profits raised would be minor compared to the £100bn annual running cost of the NHS.

Plans to globalise the NHS were first outlined by Labour back in 2010. However, Jamie Reed, Shadow Health Minister, said the proposals were further measures to commercialise the health service.

He said: “At a time when staff are losing their jobs and waiting times are rising, the Government’s priority should be sorting out the mess it has created in our NHS.

“Under David Cameron we’re seeing a rampant commercialisation of the NHS. He needs to get a grip and start focusing on patients, not profits.”

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 operating framework provides the blueprint for the NHS in England. Pf examines its objectives around quality and reform.

The Operating Framework for the NHS in England 2012/13 is an important document for UK medical sales professionals. It outlines the national priorities, system levers and mechanisms that the NHS in England must focus on to improve patient care. The strategic framework details expectations for the NHS’ ongoing efficiency challenge and the transition to the new commissioning and management system. It sets out the planning, performance and financial requirements for NHS organisations and the basis on which they will be held to account. With QIPP imperatives at the heart of the strategy, proactive pharmaceutical companies that can demonstrate an ability to help NHS customers deliver efficiencies and improve qualities in areas of national priority will be best placed to succeed.

The Framework identifies four key themes for NHS organisations in 2012/13:

1. Putting patients at the centre of decision making in preparing for an outcomes approach to service delivery
2. Completing the final year of transition to the new system
3. Accelerating the delivery of the QIPP challenge
4. Maintaining a strong grip on services and financial performance.

Quality - a focus on outcomes

The Operating Framework says that the NHS’ model of delivery must be overhauled in 2012/13 to become a system driven by quality and outcomes. It identifies the Outcomes Framework as the catalyst for this – with its focus on clinical outcomes and the reduction of health inequalities driving changes in culture, behaviour and service delivery. The Outcomes Framework sets out the improvements against which the NHS
Commissioning Board will be held to account from 2013/14.

These measurements are set out within five domains:

Domain 1: preventing people from dying prematurely.

Domain 2: enhancing quality of life for people with long-term conditions.

Domain 3: helping people recover from episodes of ill health or following injury.

Domain 4: ensuring people have a positive experience of care.

Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm.

The Operating Framework details a range of indicators for each domain, all of which are explored in the NHS Outcomes Framework. These will be supported by NICE quality standards, which provide definitions of what high-quality care should look like for a particular pathway of care. The document also advises NHS organisations to meet the service specific outcomes strategies that have already been published in areas such as mental health, cancer, COPD, asthma and long-term conditions.

Each domain in the NHS Outcomes Framework has a strong relevance to pharma, whether through the development of medicines to treat disease in priority areas, or via collaborative service design to move care closer to patients’ homes and reduce hospital admissions. Organisations that are able to show how their innovations can improve a care pathway or be used as part of a redesigned service will enjoy
more positive NHS engagement.

The Operating Framework identifies dementia and care of older people as a key priority, and sets clear goals to integrate health and social care. It also highlights examples of initiatives where NHS organisations have successfully improved services in line with each of the four key elements of QIPP; quality, innovation, productivity and prevention.

Reform - the transition blueprint

The Operating Framework outlines the key milestones for the reorganisation of the NHS. Whilst the headlines are widely known, it is interesting to track current progress against a timetable that was set out many months before the Health & Social Care Act was passed. The Framework notes that by
the end of 2012/13:

“The NHS will have transformed the commissioning landscape into one focused on local clinical decision
making, with the development and authorisation of CCGs, assisted by commissioning support vehicles and overseen by the NHS Commissioning Board. Local authorities will take the lead role in public health, alongside the new Public Health England. Central to the new system will be the establishment of Health & Wellbeing Boards (HWB), who will provide local systems leadership across health, social care and public health. Alongside this, developments will continue to the provider landscape, through the extension of Any Qualified Provider (AQP), progress with the NHS Foundation Trust (FT) pipeline and the establishment of the new NHS Trust Development Authority.”

Key 2012/13 objectives in the transition are as follows:

• PCTs and SHAs will remain statutory organisations until April 2013. They will be held to account on delivering performance and support the development of new organisations for clinical leadership. Clinical Senates and networks will be established
• PCTs will support CCG authorisation and the transition of power before March 2013
• HWBs will be established in shadow format, becoming statutorily operational from April 2013. They will act as the local system leader through JSNA and HWB Strategies
• CCGs must be coterminous with a single HWB ‘as far as possible’
• CCGs must: play an active role in planning and budgeting, develop relationships with local partners
  including social care, deliver their share of the QIPP agenda and identify how to secure commissioning support services in line with their running cost allowance
• Public Health England will become a statutory executive agency from April 2013
• NHS Trusts are expected to achieve FT status by April 2014
• PCT clusters should start to offer patients choice of AQP in at least three services that are local priorities. There should be a presumption of choice for most services from 2013/14.

THE NHS Commissioning Board’s role in NHS reform is still widely debated. Pf looks at how it will direct the NHS of the future.

The new NHS Commissioning Board (CB) is unique in three respects. Firstly, it stands to take on more power than any arm’s length body in NHS history. For up to three years at a time, it will be entrusted by the Government to run the NHS and allocate its entire commissioning budget, without regular scrutiny by Parliament.

Secondly, it stands to hand over more power than any arm’s length body in NHS history. Of its annual £80bn
commissioning budget, £60bn will be delegated to the 212 Clinical Commissioning Groups responsible for commissioning local services. While the CB will commission primary care from the CCGs and ensure that they deliver on the NHS Outcomes Framework objectives, it will allow them to devise their own solutions and choose their own partners.

The powers of the SHAs are being delegated ‘upward’ to the CB, while the powers of the PCTs are being delegated ‘downward’ to the CCGs. The widespread concern about a potential gap in responsibility led Sir David Nicholson to say: “The NHS Commissioning Board could turn into the greatest quango in the sky. So it needs to have clinicians at its heart and the powerhouse for change in the system must be the
clinical commissioning groups.”

Andrew Lansley’s letter to the CB’s Chair, Malcolm Grant, in April about the Board’s strategic objectives stresses that its first responsibility is to make a “shift of power from national and regional organisations to CCGs, Health and Wellbeing Boards, local providers and patients.” The CB will not be a monolith within a static system: it will be a facilitator of future NHS transformation. That dynamic role is the third unique
feature of the CB, and the most important.

TAKING THE REINS

The DH plan Developing the NHS Commissioning Board (July 2011) outlines the intended structure and functions of the Board. It will have two broad national roles: to commission primary care and specialised services, and to ensure that the entire commissioning system is “cohesive, co-ordinated and efficient”.

Using £20bn of its annual budget, the CB will commission GP services and specialist health areas, including dentistry, maternity, community pharmacy and ophthalmic services. The Board will not govern the CCGs in a traditional way: it will “support” them and “hold them to account” while allowing them “freedom to innovate.” This support includes authorisation, an outcomes framework, guidance tools such as model pathways, and a means of intervening when CCGs are in difficulty.

The CB will host clinical networks to advise on specific areas of care and multi-disciplinary clinical senates to support CCG decision-making. Another key role of the CB is to lead the NHS Outcomes Framework by supporting local clinical improvement, providing “more services outside hospital settings”, improving acute care and the management of long-term conditions, and ensuring that CCGs implement NICE and other national standards.

In addition, the Board will lead patient-centred care by overseeing “the extension of patient choice and the expansion of information available to patients” and promoting both integrated care and innovative self-care.

Finally, it will develop a “medium-term strategy for the NHS” that will combine with the local priorities identified by the Health and Wellbeing Boards to provide a basis for local commissioning plans.

LEADER OF THE PACK

According to the 2011 outline, the CB will work in “partnership” with many other organisations: patient groups, healthcare professionals, healthcare providers, local government, industry and national organisations such as NICE.

The Board’s relationship with suppliers will “support its strategic approach to innovation and development” – in other words, it will play a part in the dynamic evolution of services and provider relationships.

The CB will be organised nationally around the five domains of the NHS Outcomes Framework, with a national lead for each domain. It will also divide its local teams into four ‘commissioning sectors’ reflecting the four existing SHA clusters, each with a sector lead.

The Board will take over functions performed by 8,000 people. It plans to reduce that number to 4,000 – a reflection of its ‘light touch’ approach.

RIDING THE WHIRLWIND

According to Lansley’s letter to Grant, the CB has a responsibility to “contribute to” improved health for “the whole population”, improved care and outcomes “for all patients”, and improved efficiency. Within this context, the Board Authority’s strategic objectives include “transferring power to local organisations” and “establishing the commissioning landscape”. The new NHS will then develop under its own steam, with the clinical networks and senates providing “leadership and insight rather than oversight and compliance”. The authorised CCGs will have the “assumed liberty” to design local services independently.

In addition, Lansley says, the CB will have a “vital leadership role” in enabling the personalisation of care by improving patient choice. This includes the use of personal health budgets. At the provider level, the CB will play a “crucial part” in developing a “level playing field” for competition.

In short, the role of the NHS Commissioning Board is to facilitate the evolution of a rapidly changing healthcare system. These changes will come not from the Board or the DH, but from the decisions of CCGs and their commercial partners.

The Government’s controversial NHS reforms have resulted in public satisfaction levels on the way the NHS is run fall by 12% in the last year, a new survey has shown.

The British Social Attitudes Survey showed how public satisfaction fell from 70% in 2010 to 58% in 2011 after the reforms came under increased scrutiny by the media and public.

John Appleby, Chief Economist at The King’s Fund – who sponsored the survey’s health questions – said he was shocked how quickly satisfaction levels had reduced.

The study questioned more than 1,000 people between July and November last year. It found that satisfaction with individual services also fell by 4% for GPs, 5% for inpatient services, 6% for outpatient services and 7% for A&E services.

Although the survey found the NHS to be performing well in other areas, The King’s Fund said the levels of satisfaction had been influenced by the Government’s reforms, publicised funding pressures and ministerial rhetoric.

“It is not surprising this has happened when the NHS is facing a well-publicised spending squeeze,” said Mr Appleby. “Nevertheless, it is something of a shock that it has fallen so significantly. This will be a concern to the Government, given it appears to be closely linked with the debate on its NHS reforms.”

Mike Farrar, NHS Confederation Chief Executive, said it was “really important” politicians and NHS leaders are “engaging the public in the major debate about the NHS” to improve satisfaction levels.

“The NHS has got to respond to massive financial pressure and the changing nature of health and social care in a way that takes patients and the public with us,” he said. “It will be much harder to make the changes to services necessary if public perception and confidence deteriorates.”

Public satisfaction with the NHS had risen steadily over the previous decade before the most recent findings – the biggest fall in a year since the survey began in 1983.