Uncovered McKinsey report challenged ‘free at point of delivery’ pledge

A report prepared by consultants McKinsey suggests politicians may need to “challenge the principle that the NHS is free at the point of delivery” in order to fund healthcare.

The report explores a number of options based on abandoning that principle including:

  • Patients paying to attend A&E 
  • Patients paying for access to primary care
  • Patients paying for inpatient stays
  • Enforcing tougher eligibility criteria for treatments, “e.g., hip replacements only for the over 80s, social care packages only for the acutely-ill, asking people who need it to buy their own equipment”
  • Means-testing patients
  • Denying “high-cost end of life treatments such as chemotherapy” and other treatments that are “high cost per Quality-Adjusted Life Year (QALY)” Continue reading

Will commissioners respond to feedback?

A date for your editorial diary in the latest briefing from the NHS Commissioning Board, on one specific pledge being made on health services:

“All NHS patients should have the opportunity to leave feedback, in real time, on any service, by 2015. This will start with roll out of a friends-and-family test to see if patients would recommend a hospital to those to whom they are closest. Clinical commissioners will need to demonstrate they have responded.”

This is a concrete marker to track in holding the new system to account. Worth making a note in your diary!

Scrutinising the new health system? Health and wellbeing boards

There’s a quick guide to health and wellbeing boards on the Department of Health website, explaining how they are intended to guide spending decisions under the new health system, where clinical commissioning groups control £60bn of spending. Some highlights for those interested in the scrutiny role: Continue reading

Hospital blunders investigated by Melanie Hall

Help Me Investigate user Melanie Hall has been using Freedom of Information requests to look at ‘hospital blunders': serious untoward incidents (SUIs) and ‘never events’. She reports:

“Surgeons operating on the wrong side of the body, swabs left inside patients after surgery and the wrong implant being used were among the blunders happening at NHS health services across England last year”

Overall, her investigation reveals at least 6,000 serious untoward incidents (SUIs) and more than 100 ‘never events’.  Continue reading

NHS Commissioning Board livestreams its board meetings

Transparency is supposed to be a key element of the new clinical commissioning NHS system – something we’ll be looking closely at. So it’s encouraging to see that the new NHS Commissioning Board has been livestreaming its board meetings, then putting the whole thing up on its own YouTube channel, too.

A useful source if you’re interested in the governance of health – and you can subscribe to that channel in your RSS reader too.

Useful health links for October 30th to November 19th

Here are the health-related links that have caught our eyes between October 30th and November 19th:

  • BBC News – Consultants warn care hit by poor deals on supplies – For this investigation, Ernst and Young looked at 10 NHS hospital trusts out of 166 – and found the prices paid for the same box of medical forceps ranged from £13 to £23.

    For an identical box of blankets the lowest price was £47, the highest more than £120.

  • CCG constitutions – frequently asked questions – Guidance from law firm Hill Dickinson
  • Jimmy Savile scandal shows mental health inpatient voice is crucial | Society | The Guardian – Is it any wonder, then, that the last CQC survey of psychiatric inpatients in 2009 found that fewer than half of them reported always feeling safe on psychiatric wards? And yet they have abolished the only means by which many patients can express their concerns and hope to be listened to.

    It is only in numbers that the ignored can hope to make an impression. When the first few women began to speak up about Savile's behaviour, his nephew, Roger Foster, was brutally dismissive, describing himself as "disgusted and disappointed" that such claims were being made. With a further 300 people now stepping forward, his tone has changed markedly.

    The charity, Rethink Mental Illness, has launched an e-campaign to persuade the government to reintroduce the mental health inpatient survey. It can be accessed via its website rethink.org, and I would urge you to sign it.

  • Changes to the GP contract for 2013-14 | Department of Health – These proposals have been sent to the British Medical Association for consideration and include:

    new measures to improve care for patients with long term conditions and help prevent unnecessary emergency admissions to hospital
    ensuring that quality rewards for GPs reflect expert advice, from NICE, so that patients receive the very best care in line with the most up to date evidence
    stopping additional rewards for organisational tasks like good record keeping, which should be part of any good health organisation. This money will instead go into rewarding the quality of services that GPs offer patients.
    ensuring that more patients benefit from best practice in areas such as keeping blood pressure low and reducing cholesterol levels, especially those in most need or hardest to reach.

  • HSJ Briefing: general practice services and policy – The DH also last week set out to make significant changes to the quality and outcomes framework. If they are enforced, practices would have to provide a new set of enhanced services, directed by the DH and NHS Commissioning Board, to continue earning the same income. They would also be required to step up performance on QOF measures, many of which are focused on population health and prevention.

    The department has not said what the new enhanced services would be but it is expected they would include:

    A requirement to risk-stratify their population for likelihood of illness and deterioration, and provide support/attention to them
    Improving services for those with chronic conditions and for older people
    Promotion of patients’ self care, including through access to their own records.

Two resources for reporting health

If you’re reporting on health issues here are two useful resources for health journalists:

European Health Journalism (register for free to gain access) includes a range of resources on reporting health policy, healthcare quality and performance, conflicts of interest and health industry economics.

The related Health Reporting Training Project (HeaRT) includes a database of courses, a discussion forum, and resources on medical research, global health, multimedia reporting, statistics, and the politics and business of healthcare, among others. Registration is also free.

Health news roundup for October 5th to October 29th

Here are the health-related links that have caught our eyes between October 5th and October 29th:

  • The Green Benches: Virgin Care represent the greatest conflict of interest in the history of the NHS – The GP Practices in Virgin Care’s network get to keep 50% of the profits they make. The total budgets over a 5 year period that these 21 CCGs are responsible for is £27.5 bn and this places an extraordinary amount of power in the hands of doctors linked to Virgin Care. See a full list of the committees and details below. I include a 5 year figure because many of the contracts they will award will be of that length. The spreadsheet I have created below lists the 21 CCGs on which doctors, who work in Virgin Care medical practices, have been mentioned in the CCG board minutes as connected with that CCG. For substantiation, click on any links you seen in green or writing that appears between brackets. Continue reading

The role of local councils in scrutinising clinical commissioning

A parliamentary written answer from Anna Soubry MP provides some useful information for those interested in the lines of accountability of clinical commissioning groups (CCGs).

In short, this involves consulting with the local authority’s health and wellbeing board, which in turn can report to the NHS Commissioning Board if it is not happy (which can in turn take action). The health and wellbeing board is also accountable itself to the local authority’s scrutiny committee, for which you can find details by adapting this search for your own local council site.

Here’s Anna Soubry’s answer in full: Continue reading