Are health reforms a cure-all for ailing NHS?:
Changes are afoot in the National Health Services with major alterations in the way the NHS is funded.Evening Telegraph
Friday, 16 March 2012
Minor Injuries and Minor Illnesses unit is relocating
Minor Injuries and Minor Illnesses unit is relocating: NGH's Minor Injuries and Minor Illnesses unit (MIaMI) will be leaving the Highfield Clinical Care Centre when the doors close this Friday (16 March) to reopen on Monday morning (19 March) alongside A&E in the main hospital.
Will the Information Strategy start an information revolution?
Will the Information Strategy start an information revolution?: The Department of Health's Information Strategy is due to be published next month. It's been a long time in development – it's nearly two years since the government consulted on its aim to achieve an 'Information Revolution'. So what should the strategy say if it is to start the revolution? Kings Fund
Cash boost for veterans' mental health services
Cash boost for veterans' mental health services: Health Minister Mike O’Brien has unveiled £2m of new funding to help improve access to mental health services for Armed Forces veterans.
The cash will also help former soldiers obtain access to the best possible NHS services under part of the Department of Health’s ongoing commitment to provide high quality, tailored, health and social care to Armed Forces veterans and those preparing to make the transition ... Healthcare Today
The cash will also help former soldiers obtain access to the best possible NHS services under part of the Department of Health’s ongoing commitment to provide high quality, tailored, health and social care to Armed Forces veterans and those preparing to make the transition ... Healthcare Today
Guidance on providing NHS treatment for asylum seekers and refugees
Guidance on providing NHS treatment for asylum seekers and refugees:
Like other UK residents, people with an outstanding application for refuge in the UK are entitled to use NHS services without charge.
Asylum seekers are often from very different cultures, may not understand the principles behind the UK health system, may not speak English, and may have complex healthcare requirements.
In a judgement issued on 30 March 2009, the Court of Appeal found that failed asylum seekers can not be considered to pass the ordinary residence test, nor can they be considered exempt from charges by virtue of spending one year in the UK. This is now the law. The Court of Appeal also found that trusts have the discretion to withhold treatment pending payment and also the discretion to provide treatment where there is no prospect of paying for it. Trusts should take account of DH guidance when applying this discretion.
Read the document: Failed asylum seekers and ordinary/lawful residence; and when to provide treatment for those who are chargeable.
For questions about access to primary care for overseas visitors please contact your PCT for advice in the first instance. Any questions about access to primary care for overseas visitors which cannot be resolved by the PCT can be sent to foreignnationals@dh.gsi.gov.uk
For any questions specifically relating to eligibility for free NHS hospital treatment for overseas visitors which cannot be resolved by the PCT, the Department provides a helpline number (0113 254 5819). If using this helpline, please note that it is not for questions about general asylum seeker health issues, or questions relating to personal medical services. Alternatively, you can email overseasvisitors@dh.gsi.gov.uk.
Like other UK residents, people with an outstanding application for refuge in the UK are entitled to use NHS services without charge.
Asylum seekers are often from very different cultures, may not understand the principles behind the UK health system, may not speak English, and may have complex healthcare requirements.
Introduction to the National Health Service
This Introduction to the NHS fact sheet explains the role of UK health services, the National Health Service (NHS), to newly-arrived individuals seeking asylum. It covers issues such as the role of GPs, their function as gatekeepers to the health services, how to register and how to access emergency services. It is available in many languages.Entitlement to NHS treatment
The Department of Health appealed a High Court ruling, which found that, in certain circumstances, failed asylum seekers can pass the ordinary residence test that confers an automatic right to free NHS hospital treatment or, alternatively, be exempt from charges for hospital treatment after having spent one year in the UK.In a judgement issued on 30 March 2009, the Court of Appeal found that failed asylum seekers can not be considered to pass the ordinary residence test, nor can they be considered exempt from charges by virtue of spending one year in the UK. This is now the law. The Court of Appeal also found that trusts have the discretion to withhold treatment pending payment and also the discretion to provide treatment where there is no prospect of paying for it. Trusts should take account of DH guidance when applying this discretion.
Read the document: Failed asylum seekers and ordinary/lawful residence; and when to provide treatment for those who are chargeable.
Contacts for further information
For questions about general asylum seeker health issues (not GP registration issues or eligibility for healthcare) phone 0113 254 5002.For questions about access to primary care for overseas visitors please contact your PCT for advice in the first instance. Any questions about access to primary care for overseas visitors which cannot be resolved by the PCT can be sent to foreignnationals@dh.gsi.gov.uk
For any questions specifically relating to eligibility for free NHS hospital treatment for overseas visitors which cannot be resolved by the PCT, the Department provides a helpline number (0113 254 5819). If using this helpline, please note that it is not for questions about general asylum seeker health issues, or questions relating to personal medical services. Alternatively, you can email overseasvisitors@dh.gsi.gov.uk.
The week: issue 239
The week: issue 239:
On the agenda this week: discussions over the remaining details for the new NHS Pension Scheme have been published in Proposed Final Agreement, the NHS Atlas of Variation launch new health maps to drive improvement in child health, and plans to raise the profile of school nurses are announced in a new report.
Download ‘the week’: issue 239, 9-15 March 2012 (RTF, 515KB)
Please note:
We apologise if have you not received your email copy of ‘the week’ for the last few weeks. We are experiencing some technical issues which we are urgently trying to resolve.
If you or your colleagues are not receiving your usual email copy of ‘the week’, please email theweek@dh.gsi.gov.uk to let us know.
‘The week’ is always available here from a Thursday evening and you can also find it on Department of Health home page, on the right hand side under ‘Latest bulletins’. Department of Health
On the agenda this week: discussions over the remaining details for the new NHS Pension Scheme have been published in Proposed Final Agreement, the NHS Atlas of Variation launch new health maps to drive improvement in child health, and plans to raise the profile of school nurses are announced in a new report.
Download ‘the week’: issue 239, 9-15 March 2012 (RTF, 515KB)
Please note:
We apologise if have you not received your email copy of ‘the week’ for the last few weeks. We are experiencing some technical issues which we are urgently trying to resolve.
If you or your colleagues are not receiving your usual email copy of ‘the week’, please email theweek@dh.gsi.gov.uk to let us know.
‘The week’ is always available here from a Thursday evening and you can also find it on Department of Health home page, on the right hand side under ‘Latest bulletins’. Department of Health
Update on PiP breast implants
Update on PiP breast implants:
New evidence has emerged that shows that around 7,000 more women in the UK may be victims of the PiP scandal caused by a French breast implant manufacturer, Health Secretary Andrew Lansley announced today.
These women will be eligible for the same NHS care as announced in January.
French authorities had previously advised that only PiP breast implants that were used after 2001 may have been made with unauthorised silicone gel.
Following an investigation by the UK regulator, the Medicines and Healthcare products Regulatory Agency, the French authorities have this week reported that PiP implants made before 2001 may also contain unauthorised silicone gel.
This means an extra 7,000 women, who had PiP implants before 2001, could be affected.
About 1 in 5 breast implants need replacing within 10 years, whatever the make, so it is unlikely that all these 7,000 women still have the same PiP implants.
The independent expert group – led by the NHS Medical Director Professor Sir Bruce Keogh – continues to advise that there is not enough evidence to recommend routine removal of PiP breast implants given that this would mean many women having to have surgery.
However, we have always recommended that if women are concerned they should speak to their surgeon or GP. The NHS will support removal of PIP implants if, after this consultation, the patient still has concerns and with her doctor she decides that it is right to do so. The NHS will replace the implants if the original operation was done by the NHS.
We expect the private sector to do the same for their patients. We believe that private providers have a duty to take steps to provide appropriate after-care to patients they have treated.
If a clinic that implanted PiP implants no longer exists or refuses to care for their patient – where that patient is entitled to NHS services, the NHS will support the removal of PiP implants where clinically necessary.
All women should be offered the same care, whether they had their implants before or after 2001.
Health Secretary Andrew Lansley said:
Further information on PiP breast implants is available on NHS Choices.
The Chief Medical Officer has written again to all GPs to set out what they should do if a private patient with PiP implants asks for their help and to inform them about the change in advice from the French authorities. Department of Health
New evidence has emerged that shows that around 7,000 more women in the UK may be victims of the PiP scandal caused by a French breast implant manufacturer, Health Secretary Andrew Lansley announced today.
These women will be eligible for the same NHS care as announced in January.
French authorities had previously advised that only PiP breast implants that were used after 2001 may have been made with unauthorised silicone gel.
Following an investigation by the UK regulator, the Medicines and Healthcare products Regulatory Agency, the French authorities have this week reported that PiP implants made before 2001 may also contain unauthorised silicone gel.
This means an extra 7,000 women, who had PiP implants before 2001, could be affected.
About 1 in 5 breast implants need replacing within 10 years, whatever the make, so it is unlikely that all these 7,000 women still have the same PiP implants.
The independent expert group – led by the NHS Medical Director Professor Sir Bruce Keogh – continues to advise that there is not enough evidence to recommend routine removal of PiP breast implants given that this would mean many women having to have surgery.
However, we have always recommended that if women are concerned they should speak to their surgeon or GP. The NHS will support removal of PIP implants if, after this consultation, the patient still has concerns and with her doctor she decides that it is right to do so. The NHS will replace the implants if the original operation was done by the NHS.
We expect the private sector to do the same for their patients. We believe that private providers have a duty to take steps to provide appropriate after-care to patients they have treated.
If a clinic that implanted PiP implants no longer exists or refuses to care for their patient – where that patient is entitled to NHS services, the NHS will support the removal of PiP implants where clinically necessary.
All women should be offered the same care, whether they had their implants before or after 2001.
Health Secretary Andrew Lansley said:
“The French regulator has confirmed this week that more women may be affected by the criminal activity of the French breast implant manufacturer PiP. These women are the victims of a fraudulent company and I know this situation is causing a huge amount of anxiety.Professor Dame Sally Davies, the Chief Medical Officer said:
“I want to reassure those affected by the news today that they will be provided with all the help they need from the NHS.
“We are still working to get private clinics to live up to their responsibilities and look after their patients. Our commitment is to ensure support for all women from the NHS if needed; we will continue to press for the same standard of care or redress from private providers.”
“The expert group advises that there is no evidence to suggest that every woman with a PiP implant should have them removed. But we know this is a worrying time for them and want them to be able to see a GP or specialist to get reassurance and have them removed if necessary.The Department of Health is advising women with PiP implants to take three steps to reassure themselves. The steps are to:
“All women who had the implants put in on the NHS will be able to have them removed and replaced by the NHS. We expect private clinics to offer their patients the same care. If they refuse, the NHS will provide advice, a scan and, if necessary, remove the implants. Private patients will not, however, be able to have their implants replaced on the NHS unless this is clinically necessary.
“We will be placing adverts in the weekend papers again to inform all women with PiP implants about the advice from the experts and how they can get help if they are concerned. I have also written to GPs today to remind them that we want them to help women with PiP implants.”
- Find out if they have PiP implants by checking their medical notes. This information can be accessed for free from clinics or through GPs. Most women who had PiP implants on the NHS should already have received a letter – anyone who received an implant between 1997 and 2000 will be contacted in the near future.
- Speak to their GP or surgeon. Women who had PiP implants on the NHS should speak to their specialist or GP and women who had them done privately should speak to their clinic.
- Agree what’s best for you. Women should get advice on whether or not they need a scan then discuss appropriate action with their doctor.
Further information on PiP breast implants is available on NHS Choices.
The Chief Medical Officer has written again to all GPs to set out what they should do if a private patient with PiP implants asks for their help and to inform them about the change in advice from the French authorities. Department of Health
Home care for elderly 'shocking'
Home care for elderly 'shocking': The standards of care provided to the elderly in their home in the UK has been labelled "shocking and disgraceful" by the consumer group Which? BBC News
VIDEO: NHS parking fees criticised
VIDEO: NHS parking fees criticised: More than a quarter of hospital trusts in England increased car parking charges for patients and visitors in the year to last April, figures show. BBC News
MPs criticise DH over 'heartless' failures on neurology care
MPs criticise DH over 'heartless' failures on neurology care: NHS neurological care in England is plagued by poor integration, variable quality of services and a shortage of expertise, MPs have found. GP Online
Many CCGs choosing PCT managers
Many CCGs choosing PCT managers: A significant proportion of clinical commissioning groups (CCGs) are choosing primary care trust staff to fill key leadership roles in their organisation.
In particular, managers are being picked to be the CCGs accountable officers, who will be responsible for each CCG’s duties, functions, finance and governance, and chair and chief operating officer roles. Of the 81 CCGs that have identified their preferred ac... Healthcare Today
In particular, managers are being picked to be the CCGs accountable officers, who will be responsible for each CCG’s duties, functions, finance and governance, and chair and chief operating officer roles. Of the 81 CCGs that have identified their preferred ac... Healthcare Today
28% of hospital trusts raise car parking fee - The Independent
28% of hospital trusts raise car parking fee - The Independent:
 Daily Mail | 28% of hospital trusts raise car parking fee The Independent Stockport NHS Foundation Trust and the Royal Marsden cancer hospital in London charged patients 100% more in 2010/11 than 2009/10. They increased prices from 50p an hour on average to £1 an hour. United Lincolnshire Hospitals NHS Trust upped prices ... One in four hospitals increase parking charges - some by up to 200 per centDaily Mail all 111 news articles » |
Bad science should not be used to justify NHS shakeup | Allyson Pollock
Bad science should not be used to justify NHS shakeup | Allyson Pollock:
Arguments from pro-market academics about the benefits of healthcare competition don't stand up to scrutiny
The drip-feed of pro-competition arguments from economists Julian Le Grand and Zack Cooper at the London School of Economics raises serious questions about the independence and academic rigour of research by academics seeking to reassure government of the benefits of market competition in healthcare.
Last July, Cooper and several colleagues released an unpublished paper to coincide with the prime minister's announcement that he was setting up a forum in response to concerns about his health bill. The authors were sufficiently persuasive for David Cameron to declare "Put simply: competition is one way we can make things work better for patients. This isn't ideological theory. A study published by the London School of Economics found hospitals in areas with more choice had lower death rates."
The study in question claimed that competition in the NHS saved lives. The authors claimed that if heart attack mortality rates were used as an indicator of quality, mortality rates fell more quickly and therefore quality improved for patients after competition between hospitals was introduced to the NHS in their area. But if you examine the evidence it is clear that competition had nothing to do with it. The intervention that the authors claimed reduced deaths from heart attacks was patient choice – a proxy for competition. In 2006, patients were given choices of hospitals, including private providers, for some selected treatments, mainly non-emergency surgery. Yet there is no biological mechanism to explain why having a choice of providers for cataract, hip and knee operations could affect the overall survival rate from heart attacks. These are emergencies where patients do not exercise choice over where they are treated and are usually treated in the NHS.
As the government's own cardiac tsar Roger Boyle explains. "Patients can't chose where to have their heart attack or where to be treated. It is bizarre to choose a condition where choice by consumer can have virtually no effect. Patients suffering severe pain in emergencies clouded by strong analgesia don't make choices. It's the ambulance driver who follows the protocol and drives to the nearest heart attack centre."
So among the numerous problems with this study the authors have made the cardinal error of confusing minor statistical associations with causation. Deaths from acute heart attacks are not a measure of the quality of hospital care as a whole, as they claim, but rather a measure of access to and quality of cardiology care. Gwyn Bevan, professor of management science at the London School of Economics, who carried out a review of patient choice and competition in the BMJ commented on the paper's shortcomings. He subsequently went on to say that he was "perplexed" by Andrew Lansley's emphasis on the role of choice and competition because "the evidence is very weak and contested".
"In fact, I would argue that we don't have any strong evidence of that effect. To my mind, the jury is at best still out on whether choice and competition will improve quality of care in the NHS."
Cooper and colleagues were at it again in February, press releasing another as yet unpublished paper, once again coinciding with an important NHS event – Cameron's summit on the NHS bill. This time the authors claimed that length of stay fell more rapidly in NHS hospitals experiencing greater competition, but appeared to be unaware that lengths of stay differ between the four conditions they chose to examine. These were elective hip replacements, knee replacements, hernia repairs and arthroscopies (keyhole examination and sometimes surgery to repair joint damage), for which lengths of hospital stay vary widely. Arthroscopy may be done as an outpatient or day case procedure and therefore may not be recorded in statistics derived from admissions to hospital. Hernia repair usually involves admission as a day case although this varies according to the type of procedure and median lengths of stay range between one or two days. In contrast, for hip and knee replacements the median lengths of postoperative stay are four or five days depending on the procedure.
So, if providers switched to doing more arthroscopies and hernia repairs and fewer hip and knee replacements they will appear to have shortened their pre-operative and post-operative length of stay to less than a day. Length of stay should also take account of other factors such as whether patients are fit for discharge, especially if they live alone, and the need to avoid readmissions due to complications or premature discharge. So if hospitals switch to operating on patients who are well and healthy or to easier procedures they will also appear to have shortened their length of stay.
Equally, the authors did not look at how clinical coding changed following the introduction of the "payment by results" tariff in 2006, which was modelled on the payment system used in the US. Gaming, upcoding and diagnostic drift are widely recognised in research in the US where providers seek to improve and increase their payments through fraudulent billing and accounting by claiming for work that hasn't been done, or for making out that patients were sicker and more complicated and expensive than they are.
Even without fraud, in the NHS arthroscopy which may previously have been coded as an outpatient activity or not at all (ie it would not have been counted as an admission) may now be recorded separately as a daycase inpatient procedure. Similarly, patients undergoing simple surgical hip replacements might be billed as more complex.
These changes in coding distort measures of productivity so that providers appear to be more efficient as they appear to do both more cases and more complex operations and procedures in the time period.
Le Grand and Cooper call themselves "empiricists" and all those that disagree with them "intuitivists". Yet unlike scientists, they do not appear to have carried out real life observational work in general practice or on the wards, nor have they thought through how financial incentives can change the data. Neither do they appear to have tested their theories with experiments, or adapted their models to see if they are also compatible with different explanations from the many that could be derived from historical data. While their data dredging has generated weak statistical associations, they have made the cardinal error of assuming these associations were causal. Bad science makes bad policy, bad policy leads to careless talk and careless talk costs lives.
Alison Macfarlane and Ian Greener also contributed to this article The Guardian
The drip-feed of pro-competition arguments from economists Julian Le Grand and Zack Cooper at the London School of Economics raises serious questions about the independence and academic rigour of research by academics seeking to reassure government of the benefits of market competition in healthcare.
Last July, Cooper and several colleagues released an unpublished paper to coincide with the prime minister's announcement that he was setting up a forum in response to concerns about his health bill. The authors were sufficiently persuasive for David Cameron to declare "Put simply: competition is one way we can make things work better for patients. This isn't ideological theory. A study published by the London School of Economics found hospitals in areas with more choice had lower death rates."
The study in question claimed that competition in the NHS saved lives. The authors claimed that if heart attack mortality rates were used as an indicator of quality, mortality rates fell more quickly and therefore quality improved for patients after competition between hospitals was introduced to the NHS in their area. But if you examine the evidence it is clear that competition had nothing to do with it. The intervention that the authors claimed reduced deaths from heart attacks was patient choice – a proxy for competition. In 2006, patients were given choices of hospitals, including private providers, for some selected treatments, mainly non-emergency surgery. Yet there is no biological mechanism to explain why having a choice of providers for cataract, hip and knee operations could affect the overall survival rate from heart attacks. These are emergencies where patients do not exercise choice over where they are treated and are usually treated in the NHS.
As the government's own cardiac tsar Roger Boyle explains. "Patients can't chose where to have their heart attack or where to be treated. It is bizarre to choose a condition where choice by consumer can have virtually no effect. Patients suffering severe pain in emergencies clouded by strong analgesia don't make choices. It's the ambulance driver who follows the protocol and drives to the nearest heart attack centre."
So among the numerous problems with this study the authors have made the cardinal error of confusing minor statistical associations with causation. Deaths from acute heart attacks are not a measure of the quality of hospital care as a whole, as they claim, but rather a measure of access to and quality of cardiology care. Gwyn Bevan, professor of management science at the London School of Economics, who carried out a review of patient choice and competition in the BMJ commented on the paper's shortcomings. He subsequently went on to say that he was "perplexed" by Andrew Lansley's emphasis on the role of choice and competition because "the evidence is very weak and contested".
"In fact, I would argue that we don't have any strong evidence of that effect. To my mind, the jury is at best still out on whether choice and competition will improve quality of care in the NHS."
Cooper and colleagues were at it again in February, press releasing another as yet unpublished paper, once again coinciding with an important NHS event – Cameron's summit on the NHS bill. This time the authors claimed that length of stay fell more rapidly in NHS hospitals experiencing greater competition, but appeared to be unaware that lengths of stay differ between the four conditions they chose to examine. These were elective hip replacements, knee replacements, hernia repairs and arthroscopies (keyhole examination and sometimes surgery to repair joint damage), for which lengths of hospital stay vary widely. Arthroscopy may be done as an outpatient or day case procedure and therefore may not be recorded in statistics derived from admissions to hospital. Hernia repair usually involves admission as a day case although this varies according to the type of procedure and median lengths of stay range between one or two days. In contrast, for hip and knee replacements the median lengths of postoperative stay are four or five days depending on the procedure.
So, if providers switched to doing more arthroscopies and hernia repairs and fewer hip and knee replacements they will appear to have shortened their pre-operative and post-operative length of stay to less than a day. Length of stay should also take account of other factors such as whether patients are fit for discharge, especially if they live alone, and the need to avoid readmissions due to complications or premature discharge. So if hospitals switch to operating on patients who are well and healthy or to easier procedures they will also appear to have shortened their length of stay.
Equally, the authors did not look at how clinical coding changed following the introduction of the "payment by results" tariff in 2006, which was modelled on the payment system used in the US. Gaming, upcoding and diagnostic drift are widely recognised in research in the US where providers seek to improve and increase their payments through fraudulent billing and accounting by claiming for work that hasn't been done, or for making out that patients were sicker and more complicated and expensive than they are.
Even without fraud, in the NHS arthroscopy which may previously have been coded as an outpatient activity or not at all (ie it would not have been counted as an admission) may now be recorded separately as a daycase inpatient procedure. Similarly, patients undergoing simple surgical hip replacements might be billed as more complex.
These changes in coding distort measures of productivity so that providers appear to be more efficient as they appear to do both more cases and more complex operations and procedures in the time period.
Le Grand and Cooper call themselves "empiricists" and all those that disagree with them "intuitivists". Yet unlike scientists, they do not appear to have carried out real life observational work in general practice or on the wards, nor have they thought through how financial incentives can change the data. Neither do they appear to have tested their theories with experiments, or adapted their models to see if they are also compatible with different explanations from the many that could be derived from historical data. While their data dredging has generated weak statistical associations, they have made the cardinal error of assuming these associations were causal. Bad science makes bad policy, bad policy leads to careless talk and careless talk costs lives.
Alison Macfarlane and Ian Greener also contributed to this article The Guardian
100 NHS voices
100 NHS voices:
Even professionals find the health and social care bill confusing. Below, as an introduction to this special series of interviews, Denis Campbell, the Guardian's health correspondent, explains what will happen if it goes through
• Explore what 100 people who work in or with the NHS think of the reforms in our interactive
• Tell us how concerned you are about the reforms and what the NHS means to you
• Primary care trusts (PCTs), which currently commission and fund patients' treatment, will be replaced by clinical commissioning groups (CCGs) – local groups of doctors, who are mainly GPs. They will gradually be handed responsibility for £60bn of NHS funds. They, rather than PCT managers, will be the ones who decide what care is right for patients, advise them where to go to get the best treatment and pay the bills. But many GPs are worried that this dramatic extension of their power could also damage their relationship of trust with patients because they will become responsible for rationing care, which will generate inevitable tensions.
• The new NHS Commissioning Board will manage the CCGs and try to drive up quality of care. It is meant to be handed much of ministers' day-to-day control of the NHS, to reduce political involvement. Critics fear, though, that the board's regional offices will be very similar to the strategic health authorities (SHAs) that will disappear next year. Andrew Lansley, the health secretary, has said he intends to streamline the NHS but the new system will contain many thousands of new bodies.
• Public health – tackling problems such as obesity, smoking and alcohol abuse – will transfer from the NHS to local councils. They will have a specific remit to narrow widening health inequalities between rich and poor.
• Any hospital which is not already a semi-independent foundation trust will have to become one, ideally by 2014. They will compete for treatment contracts from CCGs. Health policy experts predict that CCGs could over time force the closure of units, or even entire hospitals, if they do not rate the care given there.
The "cap" on how much hospitals can earn from private patients will rise from as little as 1.5% to 49%, prompting fears of a two-tier service in which NHS patients have to wait longer than those who pay.
• Competition will be extended, and non-NHS groups – charities and private healthcare firms – will be able to bid for increasing amounts of work currently done by NHS staff.
"Any qualified provider" will see nine NHS services, including treatment of neck and back pain, opened up to competition from next month, with other areas to follow later.
• Campaigners fear a "rush to the bottom" on quality of care as new providers of services put in unrealistically low bids to win contracts, leaving patients dissatisfied. Ministers deny they want to privatise the NHS but health leaders fear growing privatisation is inevitable.
• Explore what 100 people who work in or with the NHS think of the reforms in our interactive
• Tell us how concerned you are about the reforms and what the NHS means to you
• Primary care trusts (PCTs), which currently commission and fund patients' treatment, will be replaced by clinical commissioning groups (CCGs) – local groups of doctors, who are mainly GPs. They will gradually be handed responsibility for £60bn of NHS funds. They, rather than PCT managers, will be the ones who decide what care is right for patients, advise them where to go to get the best treatment and pay the bills. But many GPs are worried that this dramatic extension of their power could also damage their relationship of trust with patients because they will become responsible for rationing care, which will generate inevitable tensions.
• The new NHS Commissioning Board will manage the CCGs and try to drive up quality of care. It is meant to be handed much of ministers' day-to-day control of the NHS, to reduce political involvement. Critics fear, though, that the board's regional offices will be very similar to the strategic health authorities (SHAs) that will disappear next year. Andrew Lansley, the health secretary, has said he intends to streamline the NHS but the new system will contain many thousands of new bodies.
• Public health – tackling problems such as obesity, smoking and alcohol abuse – will transfer from the NHS to local councils. They will have a specific remit to narrow widening health inequalities between rich and poor.
• Any hospital which is not already a semi-independent foundation trust will have to become one, ideally by 2014. They will compete for treatment contracts from CCGs. Health policy experts predict that CCGs could over time force the closure of units, or even entire hospitals, if they do not rate the care given there.
The "cap" on how much hospitals can earn from private patients will rise from as little as 1.5% to 49%, prompting fears of a two-tier service in which NHS patients have to wait longer than those who pay.
• Competition will be extended, and non-NHS groups – charities and private healthcare firms – will be able to bid for increasing amounts of work currently done by NHS staff.
"Any qualified provider" will see nine NHS services, including treatment of neck and back pain, opened up to competition from next month, with other areas to follow later.
• Campaigners fear a "rush to the bottom" on quality of care as new providers of services put in unrealistically low bids to win contracts, leaving patients dissatisfied. Ministers deny they want to privatise the NHS but health leaders fear growing privatisation is inevitable.
Health chief warns: age of safe medicine is ending
Health chief warns: age of safe medicine is ending:
The world is entering an era where injuries as common as a child's scratched knee could kill, where patients entering hospital gamble with their lives and where routine operations such as a hip replacement become too dangerous to carry out, the head of the World Health Organisation (WHO) has warned. The Independent
The world is entering an era where injuries as common as a child's scratched knee could kill, where patients entering hospital gamble with their lives and where routine operations such as a hip replacement become too dangerous to carry out, the head of the World Health Organisation (WHO) has warned. The Independent
Loneliness is 'deadly for the elderly'
Loneliness is 'deadly for the elderly':
Loneliness is as big a killer as smoking, obesity and alcohol, campaigners warned as they held the first major summit on loneliness yesterday.The Independent
Loneliness is as big a killer as smoking, obesity and alcohol, campaigners warned as they held the first major summit on loneliness yesterday.The Independent
Now 7,000 more women drawn into toxic breast implant scandal
Now 7,000 more women drawn into toxic breast implant scandal:
Up to 7,000 more women than previously thought may have been fitted with potentially defective PIP breast implants in the UK, the Department of Health announced yesterday. The Independent
Up to 7,000 more women than previously thought may have been fitted with potentially defective PIP breast implants in the UK, the Department of Health announced yesterday. The Independent
Preparing Primary Care for the Future—Perspectives from the Netherlands, England, and USA
Preparing Primary Care for the Future—Perspectives from the Netherlands, England, and USA: This study, coauthored by 2008–09 Commonwealth Fund Harkness Fellow Hubertus Vrijhoef, sought to understand how the Netherlands, England, and the United States—nations with different ways of organizing and financing care—are responding to these shared challenges.
The Commonwealth Fund
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