Effective chronic care means recognising the importance of mental health | Chris Naylor

Effective chronic care means recognising the importance of mental health | Chris Naylor: As policy-makers and professionals increasingly focus on how integrated care can become a reality in the UK, integration of mental and physical health care must become a key part of the debate. (Blog, 8 Feb 2012) Kings Fund

Lansley reveals funding plan for new NHS

Lansley reveals funding plan for new NHS: Doctors, nurses and other health professionals could control almost £65bn of NHS funding, the Health Secretary said Public Service

King's Fund warns mental health failings cost NHS billions

King's Fund warns mental health failings cost NHS billions: Poor identification and treatment of mental health problems is costing the NHS billions of pounds a year, the King's Fund has warned.

You can find the report here.

Government suffers new health bill defeat in Lords

Government suffers new health bill defeat in Lords: The House of Lords votes 244 to 240 against part of the Government's controversial NHS reforms. The Daily Telegraph

One in five in casualty are wasting staff time - Northamptonshire Evening Telegraph

One in five in casualty are wasting staff time - Northamptonshire Evening Telegraph:

Northamptonshire Evening Telegraph

One in five in casualty are wasting staff time Northamptonshire Evening Telegraph In response, NHS Northamptonshire and Milton Keynes is launching a television campaign aimed at encouraging people to use emergency departments appropriately. The consequence of inappropriate use, the advert says, is that someone could die. and more »

''NHS passes patients around like parcels''

''NHS passes patients around like parcels'': MPs say it's time for fine words to turn into deeds and for health and social care to be integrated once and for all Public Service

Health and social care merge to save £30m

Health and social care merge to save £30m: Creation of the UK's largest integrated health and social care provider will simplify access, says Trust Public Service

DH reveals details of CCG share of NHS funding

DH reveals details of CCG share of NHS funding: The DH has published details of how NHS funding currently managed by PCTs will be split between clinical commissioning groups (CCGs) and the NHS Commissioning Board (NCB).

New apprenticeship guidance launched

New apprenticeship guidance launched: New guidance has been launched which aims to ensure employers ‘get full benefits’ from apprenticeship schemes NHS Employers

Learning disability reports

Learning disability reports:

The CQC has published a further 20 reports from a targeted programme of 150 unannounced inspections of hospitals and care homes that care for people with learning disabilities.

• Reports


• CQC - press release

MPs call for joint commissioning of health and social care - Public Finance

MPs call for joint commissioning of health and social care - Public Finance:

The Guardian

MPs call for joint commissioning of health and social care Public Finance Jo Webber, deputy policy director at the NHS Confederation, also added her support to the calls for better integration. 'The starting point must be to find a long-term solution to social care funding as, without reform, the system is on the brink of ... Health select committee to say government's health reforms have failed to ...The Guardian (blog) Government details structural breakdown of new health funding plansZenopa Health committee recommends joined-up social care commissioningCivil Society Media Yorkshire Post -OnMedica -Huffington Post UK all 249 news articles »

Why the NHS must embrace telehealth on a larger scale

Why the NHS must embrace telehealth on a larger scale:

There is a more efficient and cost-effective way to treat long-term conditions that also benefits the patient

A target of delivering between £15bn and £20bn in efficiency savings over the next four years has been set by the new operating framework for the NHS.

The announcement of the Whole System Demonstrator (WSD) results in early December 2011 highlighted that telehealth provides a unique opportunity to make significant financial savings when implemented for patients suffering with long-term conditions.

The report provides robust evidence in support of changing the way healthcare is delivered and accessed and, in particular, the way that the NHS manages the growing problem of long-term conditions. The government's recent drive to boost private sector funding of infrastructure projects is also a timely catalyst to help deliver telehealth systems in the UK.

Patients who suffer from long-term conditions make up 31% of the population, but approximately 69% of all primary and acute care budgets in England are spent on them. They account for more than half of GP appointments and nearly two-thirds of all outpatient appointments. The 5% of patients who have one or more long-term conditions account for 49% of all inpatient bed days.

One particular long-term condition, chronic obstructive pulmonary disease, is the second most common cause of emergency admissions, the largest cause of hospital readmission and is one of the most costly diseases in terms of hospital care.

So, looking at different ways of delivering care to patients who suffer from these long-term conditions is a key priority for an NHS facing challenging efficiency targets. The delivery of those targets will require the NHS to challenge the current methods of service delivery and the boundaries that are often placed on the provision of acute, community and social care.

Telehealth and telecare have been shown to provide opportunities for delivering care more efficiently. There is national and international evidence that demonstrates the delivery of both cost savings and improved care to patients with long-term conditions. The benefits have primarily been in preventing unplanned hospital admissions and facilitating early discharge.

It also provides a mechanism through which selected patients with long-term conditions can remotely monitor a range of daily vital signs such as blood pressure, oxygen saturation, pulse rate, temperature and weight. This also provides trend data for clinical teams.

Additionally, it has been demonstrated that the act of taking their own readings can provide patients with a greater understanding of their own condition thereby promoting improved self-management and they often highlight a renewed independence from a normal daily life.

Recent Department of Health research highlighted that over 90% of people with long-term conditions say they want to be more active self-carers and over 75% would be confident in being a self-carer if they had support and assistance.

The WSD projects figures show a 20% reduction in emergency admissions and a 14% reduction in elective admissions. Telehealth also leads to significant reductions in the number of A&E visits, increased levels of patient satisfaction and a 45% reduction in mortality.

Even greater benefits can be realised when the NHS works collaboratively with colleagues in adult social care to develop integrated telehealth care pathways.

This kind of integrated approach can deliver reductions in the amount of domiciliary care needed, as well as a 17% reduction in the number of people needing residential or nursing care over a 12-month period. Equally, in groups of frail elderly people who were provided with telecare, there is a reduction in the number of hospital admissions following falls.

While the evidence for telehealth is clear, to date, telehealth procurements have usually been on a small scale. They have not been fully implemented and have not led to substantive changes in the way services are delivered or in the patient experience of those services.

The NHSis currently missing the opportunity for significant financial benefits and improved patient care and urgently needs to look at implementing telehealth on a larger scale.

Ivan McConnell is a telehealthcare expert at PA Consulting Guardian Professional.

The NHS is a professional service ripe for re-engineering | Ali Parsa

The NHS is a professional service ripe for re-engineering | Ali Parsa:

Our healthcare system will only survive if it allows private companies and others to innovate, increase quality and drive down costs

The health and social care bill will be the subject of heated debate at its report stage in the House of Lords today. Yet the real healthcare issue should be less about the NHS landscape in the next three years, and more about the survival of our universal and equitable healthcare system for the next three decades.

The £20bn deficit facing the NHS in the next three years is undoubtedly important, but the elephant in the room is the sustainability of the sector.

In Britain, we spent about £40bn on healthcare in 2000. Around 10 years later, we are spending near to £120bn. Economic value is defined as quality divided by price. We have tripled the denominator of the value equation. Yet it is hard to claim the nominator – defined as clinical results and patient experience in healthcare – has kept pace.

We have been here before in Britain. When any sector has become unsustainable, we have brought down barriers to entry, stopped artificially pumping up the outdated, and allowed new entrants to come up with new solutions and flourish ahead of our global competitors. As a result, we have in our small country of 60 million people some of the world's most successful telecommunication, retail, financial, creative and professional services.

The NHS, too, is a professional service now ripe for re-engineering. By contrast, manufacturing teaches us a salutary lesson. When we protect our old industries with subsidies and inflexible legislation, we risk losing all. British factories are now predominantly foreign-owned.

When innovation is needed in a sector, it is understandable that those involved in the current system feel insecure about their future. Yet neither incumbent organisations nor employees should fear the opening up of their sector to new ideas, because both tend to do better in sectors where Britain stays ahead of the global rejuvenation curve. Just contrast the fate of the British telecommunications industry and its participants with that of the once-mighty British Leyland.

Liberating a sector is simply about giving professionals the liberty to create a new chapter in their profession. In healthcare, the future will be created by people who are delivering the services today. We should therefore spend less energy safeguarding existing structures and institutions and focus more on freeing their participants to create the new.

Of course, with freedom comes responsibility. Concerns over independent companies competing with the public sector often centre on accountability and profit. It is true that some lost their way in recent years in the quest for profit. Profit for an enterprise is like oxygen, food and water for the body: necessary to sustain life, but not the point of life. Just as the entire public sector can not be condemned for the failure at Mid Staffordshire hospital, it is wrong to judge every non-state operator according to the actions of a guilty few. The key here is the accountability of all operators to public scrutiny.

In fact, the search for new solutions in healthcare gives us a great opportunity to create a fairer society. At the moment, two single square miles – the City and Whitehall – control over 90% of our productive assets. This concentration of ownership is unique among developed countries, and has produced unacceptable consequences. For instance, the richest region in Germany is two times more prosperous than the poorest; in France this ratio is four times; in the United States five times; in Britain it is a shameful 10 times.

Healthcare professionals must be empowered to set up their own alternatives. GPs provide a great example of how healthcare professionals can be freed to own and deliver their own services. They set up and own their practices, and sell their services back to the NHS as single-handed practitioners or small partnerships. This model could be expanded to nurses, midwives, hospital consultants and countless others, so that many more professionals could come up with new solutions that they control for their patients.

Our healthcare system is on an unsustainable trajectory. The solution is fundamental innovation that increases quality and reduces costs. We need charities, mutuals, private companies and public sector organisations all to participate to give us the greatest chance of rejuvinating our NHS for future generations. The country that pioneered the first antibiotic, the first blood transfusion and the first universal health service should still be a place where the brightest minds can create the boldest solutions. The Guardian

No alternative to NHS reforms, say coalition

No alternative to NHS reforms, say coalition:

David Cameron and Nick Clegg admit it could take until election to persuade voters their fears are unfounded

David Cameron and Nick Clegg have agreed they have no alternative but to push ahead with the planned reforms to the NHS, even though they admit they are in "a rubbish place politically" and it could take three years until the general election to persuade voters that fears about the reforms are unfounded.

Cameron endured a mauling over the issue at prime minister's questions , and afterwards one senior minister involved in deciding how to proceed with the bill admitted: "This is a politically rubbish place to be. We can either go back, sideways or forward." Ministers have argued there was no alternative but to plough on.

Liberal Democrats, including Baroness Williams, are in no mood to abandon the bill, even though many health professionals – at one time reconciled to the bill – have now defected.

On the day that health visitors and the Faculty of Public Health joined the long list of those deserting the bill, Labour leader Labour leader Ed Miliband accused Cameron of presiding over a "complete disaster" with the bill.

He said the prime minister had broken a pre-election promise not to have any "top-down re-organisation of the NHS" and told him: "Every day he fights for this bill, every day trust in him on the NHS ebbs away, every day it becomes clearer the NHS is not safe in his hands."

But Cameron said Labour had previously supported NHS reform – and would not match government commitments on NHS spending: "They are not in favour of the money. They are not in favour of the reform. They are just a bunch of opportunists."

He criticised Labour's record on the NHS in Wales – where the party controls the Welsh Assembly – and said the coalition was cutting bureaucracy and ploughing money back into patient care.

He said of Miliband: "This is not a campaign to save the NHS. This is a campaign to try and save his leadership. I make this prediction, the NHS will go on getting better and his prospects will go on getting worse."

Cameron also backed his health secretary Andrew Lansley, saying he would survive a lot longer in office than Miliband.

It is understood that Lansley put in angry performance at cabinet this week defending his reforms, saying they were in line with government public services reform. He has been infuriated by leaks form Downing Street blaming him for mis-selling the reforms.

Although a Downing Street source has suggested Alan Milburn, the former Labour health secretary could be drafted into Lansley's role, Milburn himself dismissed the suggestion.

He criticised Lansley's handling saying: "This bill has ended up as a – to be frank – a patchwork quilt of complexity and compromise and confusion. They will get the measure through in my view, they will probably win the day in parliament, but at a terrible cost. The NHS will not have either the clarity or the direction that is necessary in a period of considerable challenge where it is being asked to make unprecedented efficiency savings."

In a sign that the government will face a tough month as the bill enters the Lords report stage, peers inflicted an early defeat over the issue of social care. By a margin of four votes, peers demanded mental health be made a higher priority. The amendment creates a duty for the health secretary to promote a health service that deals with "mental and physical illness", rather then the original draft of just "illness". The government described issue as largely symbolic.

All but three Lib Dem peers voted with the government, suggesting that on most issues Labour will rely on cross bench support to further amend the bill that has already been heavily altered by government to take on concerns of health professionals.

Meanwhile there was a fresh embarrassment to the reforms after part of a major risk assessment into the bill was published on the internet, suggesting that changes could lead to the financial "failure" of some NHS organisations, worse care for patients, and threats to maternity services, children's safety and public health.

Most worryingly for the coalition the "risk register" for the London NHS suggested that problems with implementing the new system could delay improvements to patients' health – even after a host of proposed "mitigation" measures to ensure a smooth transition.

The document, dated October 2011, was published by NHS London on their website, according to the Labour-supporting blogger Dr Eoin Clarke, who has waged a campaign to get the full national risk register published. At least nine Lib Dem MPs have also signed an early day motion organised by Labour MP and health select committee member Grahame Morris calling on the health secretary to publish the document.

Health officials have pointed out that such a risk assessment would be carried out for any major changes, but added that during the transition there was "more of a risk because of the uncertainty".

In a statement to the Guardian, an NHS London spokesperson said: "It is our job to identify and manage potential risks to deliver safe services for patients. We are duty bound to publish this information quarterly on our website and have done since our formation." These risks cover a wide range of services and issues, including how we manage the transition to 2013 appropriately. The more we plan for and pre-empt issues, the less of a risk they become." The Guardian

Senior Tories begin to get cold feet as health Bill is defeated in Lords

Senior Tories begin to get cold feet as health Bill is defeated in Lords:

David Cameron has been urged to abandon the Government's controversial Health and Social Care Bill by at least one senior Cabinet minister in the face of widespread public hostility. The Independent