The NHIS Update

Getting to grips with thinking about the NHS these days isn’t easy. A lot more money is being spent and so much is going right, so why doesn’t it feel better than it does. Why is it so difficult not to harbour an uneasy sense of trouble ahead? Mr. Blair and his advisors must be thinking the same thoughts and unfortunately we can’t help him. For example, in February:

• the new allocations to PCTs were announced
• the remaining section of the Renal Services National Service Framework was published.
• a national review was announced of genito-urinary medicine as part of the process of transforming sexual health services
• a review of cancer treatment said that most people’s experience was improved – although there was still more to do
• Chlamydia screening is to be offered on the high street increasing numbers of people stopped smoking
• a national Strategic Partnership Forum will review the agreement with the voluntary sector
• £41 million more was given to improve learning disability services
• it was announced that hospitals will be rewarded with cash for meeting A&E targets
• councils’ spending on personal social services was up 11%
• statutory regulation was proposed for herbal medicine and acupuncture
• patient waits are still coming down and long waits for cataract services have been eliminated – with the independent sector being given some of the credit
• £1 million is available to buy diagnostic imaging services from the independent sector to cut waiting times even more
• the funding process was tweaked to ensure that the PACS programme did not get diverted.

Not a bad output for just one month! Get the clinicians to give a bit more information and patients would be even happier. Provided, of course, that hospitals were cleaner. MRSA still has a very high profile, but a bird flu pandemic to worry about, with talk of some 50,000 likely to die, could divert attention for a while. Things aren’t yet so good with mental health services, and the flurry of activity in this area continued with a Guidance on mental health services for those in prison, Guidance on mental health services for the deaf and a Review of mental health nursing. The real political problems around the corner are to do with competition between hospitals with the losers going to the wall, conflicts between the NHS and the private sector, and the seemingly endless urge to reform everything so that it is modernised (whatever that means). Polly Toynbee quotes the statistic that although 66% of people say “my local NHS is providing me with good service”, only 48% think that this applies nationally. Could it be that NHS professionals working hard at the coalface provide the local view, while the national view is fashioned by politicians? Roll on the election! The sooner it is history the better.

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“A bird flu pandemic could divert attention for a while . . .” It will be some time yet with much more piloting, before any definite direction emerges to chronic disease management services. In February, an evaluation of the Evercare CDM system said that hospital avoidance was less than was expected, but of course the company could offer seemingly good reasons why this was so. One major problem appears to be the lack of really clear objectives, so that it is difficult to say what success is. The measurement should be some cost effectiveness of patient benefit but we are a long way from getting firm answers. The NatPaCT site at www.natpact.nhs.uk/news/index.php?article_request=1315 offers a range of downloadable presentations from the Supporting People with Long-Term Conditions events held in February, which give a good idea of the present work.

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