Evaluation of integrated care pilots:
The evaluation which commenced in 2009 looked at 16 sites across England who undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services.
The report also provides information on evalution methods, data collection and analysis. NHS Networks
Monday, 26 March 2012
Diabetes issues 'at record high'
Diabetes issues 'at record high': Rates of stroke and kidney failure in people with diabetes have reached record levels in England, according to new analysis by Diabetes UK. BBC News
VIDEO: Dementia to be 'national priority'
VIDEO: Dementia to be 'national priority': Care Services Minister Paul Burstow says working towards an earlier diagnosis for dementia must be a priority, as funding for research is to be more than doubled to £66m by 2015. BBC News
Reducing migrant nurses ''will harm care''
Reducing migrant nurses ''will harm care'': The move could have a ''significant impact'' on the quality of healthcare, the government has admitted Public Service
Industrial action update
Industrial action update from Dean Royles: Our director, Dean Royles, has written to HR directors in the NHS with an update on the decisions being made by the various trade unions, in response to the NHS Pension Scheme reforms. NHS Employers
Identifying and managing tuberculosis (TB) among hard-to-reach groups
Identifying and managing tuberculosis (TB) among hard-to-reach groups:
This guidance sets out how commissioners and providers of TB services and other statutory and voluntary organisations that work with hard-to-reach groups can achieve better outcomes through targeted action to find patients early, and by providing intensive clinical and social support to help them complete TB treatment.
This guidance sets out how commissioners and providers of TB services and other statutory and voluntary organisations that work with hard-to-reach groups can achieve better outcomes through targeted action to find patients early, and by providing intensive clinical and social support to help them complete TB treatment.
Alcohol strategy
Alcohol strategy:
This strategy sets out Government proposals to crack down on binge drinking culture, cut down on alcohol fuelled violence and disorder and slash the number of people drinking to damaging levels. It includes commitments to introduce a minimum unit price for alcohol; consult on a ban on the sale of multi-buy alcohol discounting; introduce stronger powers for local areas to control the density of licensed premises; and pilot innovative sobriety schemes to challenge alcohol-related offending.
This strategy sets out Government proposals to crack down on binge drinking culture, cut down on alcohol fuelled violence and disorder and slash the number of people drinking to damaging levels. It includes commitments to introduce a minimum unit price for alcohol; consult on a ban on the sale of multi-buy alcohol discounting; introduce stronger powers for local areas to control the density of licensed premises; and pilot innovative sobriety schemes to challenge alcohol-related offending.
How GPs are set to make a killing out of NHS reform
How GPs are set to make a killing out of NHS reform:
He is arguably the medical profession's highest-profile cheerleader for the most radical reorganisation of the NHS the UK has seen. And, as one of Britain's most senior GPs, he holds our trust. But Dr Shane Gordon is also one of a number of GPs backing Andrew Lansley's reforms who stand to profit personally. And that, critics claim, is the embodiment of a fundamental flaw in the new Bill which could dangerously erode public trust in the NHS – the potentially volatile mix of money and medicine. The Independent
He is arguably the medical profession's highest-profile cheerleader for the most radical reorganisation of the NHS the UK has seen. And, as one of Britain's most senior GPs, he holds our trust. But Dr Shane Gordon is also one of a number of GPs backing Andrew Lansley's reforms who stand to profit personally. And that, critics claim, is the embodiment of a fundamental flaw in the new Bill which could dangerously erode public trust in the NHS – the potentially volatile mix of money and medicine. The Independent
What the NHS can learn from accountable care organisations
What the NHS can learn from accountable care organisations:
The new health models being used in the US are similar to those coming to Britain: the aim is to cut costs while improving the service, says Mark Zezza
Among all the health reform activities in the United States, the arrival of accountable care organisations is considered one of the more promising for bending the health care cost curve while improving patient outcomes.
Accountable care organisations are providers that are held accountable for the cost and quality of care for a defined population of patients. The successful ones are expected to manage costs by aligning incentives for hospitals, physicians and other providers to encourage better co-ordination and to promote continuous quality improvement efforts. Those that are able to keep costs below specified amounts can share in the savings, contingent upon meeting performance standards.
The organisational model is still relatively new and untested. In fact, the results for the Medicare physician group practice demonstration, one of the largest such efforts to date, has been mixed at best: only half of the 10 participants have achieved cost-reduction targets by the end of the fifth year.
However, providers and payers remain committed to the concept. Over the next year, the number is expected to grow substantially, as a new Medicare programme designed specifically for accountable care organisations is set to begin in April. Interestingly, the model bears a strong resemblance to the basis of proposed reforms being introduced in the NHS in the United Kingdom – ie, the clinical commissioning groups. These will also be provider-led and be responsible for managing the health of a defined population of patients under a budget.
At the recent Nuffield Trust Summit, I had the chance to meet several NHS delegates and other UK stakeholders. Three key issues were raised, which I have outlined in more detail below.
Flexibility in design
A key feature of the accountable care organisations framework is its inherent flexibility. For example, participating provider organisations can range from integrated delivery systems to loosely affiliated physician groups that may be linked together through a regional health information exchange.
In addition, payment models can range from one-sided approaches that reward providers for reducing costs, but do not hold them at risk of any excess costs, to two-sided approaches, in which providers can achieve even larger rewards, but are held accountable for excess costs.
Since the US programme is voluntary, this flexibility can help encourage broad participation. However, too low a barrier for entry could lead to the enrolment of providers not ready to co-ordinate and manage care effectively, potentially resulting in wasted investments.
Hospital participation
One suggested cost-reduction strategy is to avoid high-cost hospital services. However, those services represent revenue to hospitals, which calls into question the value proposition for a hospital to participate in the new model.
On the other hand, hospitals can be considered logical leaders for the new model organisations. For example, they already have a management structure and are likely to have a data sharing infrastructure in place, as well as the capital available for the upfront investments needed.
In addition, hospitals may be motivated to protect their market share, realising that change may be inevitable as current payment rates are unsustainable and physician groups and competing hospitals may already be getting a head start in reform efforts.
Engaging patients
The new organisational model does not require any insurance benefit design changes. For example, patients assigned to an ACO under the Medicare program would still have access to other Medicare providers. While this helps ensure that patients retain choice, it also makes it harder for ACOs to manage the care of their patients. Ideally, they will retain their patients by providing high-quality care associated with positive patient experiences.
Conclusions
As can be gathered from this sampling of issues, the new model is certainly not a sure fix to the problems in the United States health care system. It represents a sharp change from the current health care environment in which most providers are not well-equipped to co-ordinate care and have little financial incentive to do so because of the predominant fee-for-service payment system which rewards inefficiency by paying more for more care, regardless of the impact on patient health.
Thus, it would likely take years and many modifications from lessons learned, to foster the type of change that can permanently bend the cost curve. Given that similar issues are being faced by the NHS, ideally that process can be accelerated by sharing lessons learned across health systems on both sides of the Atlantic.
Dr Mark Zezza is a senior policy analyst at The Commonwealth Fund in the United States. He presented at the Nuffield Trust's Health Policy Summit 2012. Guardian Professional.
Among all the health reform activities in the United States, the arrival of accountable care organisations is considered one of the more promising for bending the health care cost curve while improving patient outcomes.
Accountable care organisations are providers that are held accountable for the cost and quality of care for a defined population of patients. The successful ones are expected to manage costs by aligning incentives for hospitals, physicians and other providers to encourage better co-ordination and to promote continuous quality improvement efforts. Those that are able to keep costs below specified amounts can share in the savings, contingent upon meeting performance standards.
The organisational model is still relatively new and untested. In fact, the results for the Medicare physician group practice demonstration, one of the largest such efforts to date, has been mixed at best: only half of the 10 participants have achieved cost-reduction targets by the end of the fifth year.
However, providers and payers remain committed to the concept. Over the next year, the number is expected to grow substantially, as a new Medicare programme designed specifically for accountable care organisations is set to begin in April. Interestingly, the model bears a strong resemblance to the basis of proposed reforms being introduced in the NHS in the United Kingdom – ie, the clinical commissioning groups. These will also be provider-led and be responsible for managing the health of a defined population of patients under a budget.
At the recent Nuffield Trust Summit, I had the chance to meet several NHS delegates and other UK stakeholders. Three key issues were raised, which I have outlined in more detail below.
Flexibility in design
A key feature of the accountable care organisations framework is its inherent flexibility. For example, participating provider organisations can range from integrated delivery systems to loosely affiliated physician groups that may be linked together through a regional health information exchange.
In addition, payment models can range from one-sided approaches that reward providers for reducing costs, but do not hold them at risk of any excess costs, to two-sided approaches, in which providers can achieve even larger rewards, but are held accountable for excess costs.
Since the US programme is voluntary, this flexibility can help encourage broad participation. However, too low a barrier for entry could lead to the enrolment of providers not ready to co-ordinate and manage care effectively, potentially resulting in wasted investments.
Hospital participation
One suggested cost-reduction strategy is to avoid high-cost hospital services. However, those services represent revenue to hospitals, which calls into question the value proposition for a hospital to participate in the new model.
On the other hand, hospitals can be considered logical leaders for the new model organisations. For example, they already have a management structure and are likely to have a data sharing infrastructure in place, as well as the capital available for the upfront investments needed.
In addition, hospitals may be motivated to protect their market share, realising that change may be inevitable as current payment rates are unsustainable and physician groups and competing hospitals may already be getting a head start in reform efforts.
Engaging patients
The new organisational model does not require any insurance benefit design changes. For example, patients assigned to an ACO under the Medicare program would still have access to other Medicare providers. While this helps ensure that patients retain choice, it also makes it harder for ACOs to manage the care of their patients. Ideally, they will retain their patients by providing high-quality care associated with positive patient experiences.
Conclusions
As can be gathered from this sampling of issues, the new model is certainly not a sure fix to the problems in the United States health care system. It represents a sharp change from the current health care environment in which most providers are not well-equipped to co-ordinate care and have little financial incentive to do so because of the predominant fee-for-service payment system which rewards inefficiency by paying more for more care, regardless of the impact on patient health.
Thus, it would likely take years and many modifications from lessons learned, to foster the type of change that can permanently bend the cost curve. Given that similar issues are being faced by the NHS, ideally that process can be accelerated by sharing lessons learned across health systems on both sides of the Atlantic.
Dr Mark Zezza is a senior policy analyst at The Commonwealth Fund in the United States. He presented at the Nuffield Trust's Health Policy Summit 2012. Guardian Professional.
NHS shakeup spells 'unprecedented chaos', warns Lancet editor
NHS shakeup spells 'unprecedented chaos', warns Lancet editor:
Dr Richard Horton predicts patients will die as a result of health and social care bill's focus on competition over quality
The NHS will be thrown into chaos by the government's shakeup and patients will die as a result, the editor of a medical journal has written.
Dr Richard Horton, the editor of the Lancet, called for a concerted campaign to overturn the health and social care bill which finally completed its parliamentary passage this week.
Horton also complained about a "failure" of leadership by professional medical bodies which did not prevent the coalition proceeding with its plans.
"We are about to see a phase of unprecedented chaos in our health services," he wrote on the Red Pepper website.
"Those of us who opposed the bill should not gloat as this confusion takes hold.
"People will die thanks to the government's decision to focus on competition rather than quality in healthcare.
"The coming disaster puts even greater responsibility on us to overturn this destructive legislation."
Horton accused Labour of being "slow to respond" to the government's "assault" on the NHS and said an inquest was needed into "the abysmal failure of medical 'leadership'.
"Early and united opposition would have seen off the Bill long ago. Instead our leaders, in trade unions and professional bodies, saw 'opportunities' and decided they could work with it on our behalf.
"When they were finally persuaded to see the dangers, their policy changed to seeking 'significant amendments', despite the fact that the government showed no sign of conceding any."
The bitter 14-month parliamentary battle over the coalition's NHS changes finally came to an end this week after the government comfortably fended off a desperate 11th-hour attempt by Labour to delay the legislation.
MPs then approved the last amendments – leaving the way clear for royal assent to be granted before parliament starts its Easter recess next week.
The NHS shakeup has threatened to drive a wedge between the coalition partners ever since it was announced by the Tory health secretary, Andrew Lansley.
It is intended to give GPs greater control over NHS budgets, reduce bureaucracy and increase patient choice.
But furious opposition from professional bodies and Lib Dem activists led the prime minister, David Cameron, and the deputy prime minister, Nick Clegg, to take the highly unusual step of "pausing" the legislation last year.
Despite accepting more than a thousand amendments – including limits on competition and private-sector involvement – the government has failed to win over many health workers. The Guardian
The NHS will be thrown into chaos by the government's shakeup and patients will die as a result, the editor of a medical journal has written.
Dr Richard Horton, the editor of the Lancet, called for a concerted campaign to overturn the health and social care bill which finally completed its parliamentary passage this week.
Horton also complained about a "failure" of leadership by professional medical bodies which did not prevent the coalition proceeding with its plans.
"We are about to see a phase of unprecedented chaos in our health services," he wrote on the Red Pepper website.
"Those of us who opposed the bill should not gloat as this confusion takes hold.
"People will die thanks to the government's decision to focus on competition rather than quality in healthcare.
"The coming disaster puts even greater responsibility on us to overturn this destructive legislation."
Horton accused Labour of being "slow to respond" to the government's "assault" on the NHS and said an inquest was needed into "the abysmal failure of medical 'leadership'.
"Early and united opposition would have seen off the Bill long ago. Instead our leaders, in trade unions and professional bodies, saw 'opportunities' and decided they could work with it on our behalf.
"When they were finally persuaded to see the dangers, their policy changed to seeking 'significant amendments', despite the fact that the government showed no sign of conceding any."
The bitter 14-month parliamentary battle over the coalition's NHS changes finally came to an end this week after the government comfortably fended off a desperate 11th-hour attempt by Labour to delay the legislation.
MPs then approved the last amendments – leaving the way clear for royal assent to be granted before parliament starts its Easter recess next week.
The NHS shakeup has threatened to drive a wedge between the coalition partners ever since it was announced by the Tory health secretary, Andrew Lansley.
It is intended to give GPs greater control over NHS budgets, reduce bureaucracy and increase patient choice.
But furious opposition from professional bodies and Lib Dem activists led the prime minister, David Cameron, and the deputy prime minister, Nick Clegg, to take the highly unusual step of "pausing" the legislation last year.
Despite accepting more than a thousand amendments – including limits on competition and private-sector involvement – the government has failed to win over many health workers. The Guardian
Britain is failing to care for older people with cancer | Ciarán Devane
Britain is failing to care for older people with cancer | Ciarán Devane:
Older people diagnosed with cancer are being under treated because of their age. This is discrimination and must stop
For some, age is just a number. But for older cancer patients it can be a very serious barrier to the best – and most appropriate – treatment. While cancer mortality rates are improving significantly for people under 75, the rate is much slower in the older population. In fact cancer mortality is actually getting worse for people aged 85 and over – as a result, there are about 14,000 avoidable cancer deaths in patients over 75 in the UK each year.
There is mounting evidence to show that older people are being under treated. They are less likely to receive surgery, radiotherapy and chemotherapy than young people and Macmillan Cancer Support is concerned that treatment decisions are too often based on age, not on a patient's overall fitness. A recent Department of Health study for instance found that age was a significant factor in determining treatment recommendations. People are being looked at just as a number, rather than an individual. We would not allow people to be refused treatment for a life-threatening disease just based on their gender. Or their race. Why should age be your one determining factor?
Macmillan's own research highlights examples when patients have been told their age is the reason for them not receiving treatment. I have heard from a 67-year-old man who was told, when offered treatment options, that if he were 70 or over, it would be unlikely his doctor would offer surgery. There was no assessment of his health or fitness levels – his age was the only thing the doctor took into account.
Similarly, I know of a lady who wasn't encouraged to have chemotherapy purely because she was "60, not 30". People are still running marathons aged 60 and beyond – should they not be given the best chance against a fatal disease?
This situation isn't unique to the UK. But countries such as France and the US have been tackling this issue for more than a decade. We're only just waking up to it.
Older people can often tolerate and benefit from the same treatments as younger patients, but in many cases they simply aren't offered it. Cancer treatments can have unpleasant side-effects at any age. Yet there is a reason for this – it is killing off the cancer inside their bodies. We can't make assumptions about how well someone will cope with a particular treatment just because of their age. Is it because we assume that because someone is 70, 80 or 90, they're not going to live much longer? One 70-year-old may have another 10 years of good quality life ahead of them, another just a few years. This is why we need to treat older people as individuals.
The problem is, the current method of assessing older people for treatment is simply not right. Treating patients where there is no long-term gain is just as undesirable. What we need are fuller assessments of older patients to ensure they get the most appropriate treatment for their cancer.
Admittedly, there are other things affecting older people that can contribute to poor survival rates among this age group – by the time people are in their 80s, for instance, they can be suffering from several conditions. Yet co-existing health problems are often not understood by cancer specialists and are not effectively managed. On some occasions, people could be made well enough for treatment but aren't.
A side-effect of a drug for a different condition is sometimes seen as a reason to deny an older patient chemotherapy. But just a simple conversation between a patient and a specialist would have avoided the mistake.
Another obstacle older people face is that they are not represented enough on clinical trials. Clinicians, therefore, just don't know what impact a treatment will have – whether it will save or risk the patient's life. We want older cancer patients to be better represented on these trials.
Sometimes it's not that older patients are denied treatment – often they reject it, thinking it's not possible. They may have a spouse to care for at home or not be able to get to the hospital on their own. These things can be easily solved but elderly patients often don't know they can ask for practical support.
This issue has been brushed under the carpet for long enough. Our population is aging and, as the number of people diagnosed with cancer is creeping up, it is vital we ensure everyone gets the correct treatment.
The last decade has seen dramatic improvements in cancer treatment and services, but we must not ignore the fact that older people with cancer are not being treated fairly. They still have the worst chance of beating this disease. It simply isn't fair and is an act of discrimination that would not be allowed in any other sector of society.
This is why Macmillan has launched its Age Old Excuse campaign – someone needs to bring these issues to light. The NHS and social care providers must wake up to the specific issues older people face and ensure treatment decisions are based on their overall health – not their date of birth. The Guardian
For some, age is just a number. But for older cancer patients it can be a very serious barrier to the best – and most appropriate – treatment. While cancer mortality rates are improving significantly for people under 75, the rate is much slower in the older population. In fact cancer mortality is actually getting worse for people aged 85 and over – as a result, there are about 14,000 avoidable cancer deaths in patients over 75 in the UK each year.
There is mounting evidence to show that older people are being under treated. They are less likely to receive surgery, radiotherapy and chemotherapy than young people and Macmillan Cancer Support is concerned that treatment decisions are too often based on age, not on a patient's overall fitness. A recent Department of Health study for instance found that age was a significant factor in determining treatment recommendations. People are being looked at just as a number, rather than an individual. We would not allow people to be refused treatment for a life-threatening disease just based on their gender. Or their race. Why should age be your one determining factor?
Macmillan's own research highlights examples when patients have been told their age is the reason for them not receiving treatment. I have heard from a 67-year-old man who was told, when offered treatment options, that if he were 70 or over, it would be unlikely his doctor would offer surgery. There was no assessment of his health or fitness levels – his age was the only thing the doctor took into account.
Similarly, I know of a lady who wasn't encouraged to have chemotherapy purely because she was "60, not 30". People are still running marathons aged 60 and beyond – should they not be given the best chance against a fatal disease?
This situation isn't unique to the UK. But countries such as France and the US have been tackling this issue for more than a decade. We're only just waking up to it.
Older people can often tolerate and benefit from the same treatments as younger patients, but in many cases they simply aren't offered it. Cancer treatments can have unpleasant side-effects at any age. Yet there is a reason for this – it is killing off the cancer inside their bodies. We can't make assumptions about how well someone will cope with a particular treatment just because of their age. Is it because we assume that because someone is 70, 80 or 90, they're not going to live much longer? One 70-year-old may have another 10 years of good quality life ahead of them, another just a few years. This is why we need to treat older people as individuals.
The problem is, the current method of assessing older people for treatment is simply not right. Treating patients where there is no long-term gain is just as undesirable. What we need are fuller assessments of older patients to ensure they get the most appropriate treatment for their cancer.
Admittedly, there are other things affecting older people that can contribute to poor survival rates among this age group – by the time people are in their 80s, for instance, they can be suffering from several conditions. Yet co-existing health problems are often not understood by cancer specialists and are not effectively managed. On some occasions, people could be made well enough for treatment but aren't.
A side-effect of a drug for a different condition is sometimes seen as a reason to deny an older patient chemotherapy. But just a simple conversation between a patient and a specialist would have avoided the mistake.
Another obstacle older people face is that they are not represented enough on clinical trials. Clinicians, therefore, just don't know what impact a treatment will have – whether it will save or risk the patient's life. We want older cancer patients to be better represented on these trials.
Sometimes it's not that older patients are denied treatment – often they reject it, thinking it's not possible. They may have a spouse to care for at home or not be able to get to the hospital on their own. These things can be easily solved but elderly patients often don't know they can ask for practical support.
This issue has been brushed under the carpet for long enough. Our population is aging and, as the number of people diagnosed with cancer is creeping up, it is vital we ensure everyone gets the correct treatment.
The last decade has seen dramatic improvements in cancer treatment and services, but we must not ignore the fact that older people with cancer are not being treated fairly. They still have the worst chance of beating this disease. It simply isn't fair and is an act of discrimination that would not be allowed in any other sector of society.
This is why Macmillan has launched its Age Old Excuse campaign – someone needs to bring these issues to light. The NHS and social care providers must wake up to the specific issues older people face and ensure treatment decisions are based on their overall health – not their date of birth. The Guardian
Agencies make millions from £120-an-hour doctors
Agencies make millions from £120-an-hour doctors: Dozens of medical "temping agencies" are making millions of pounds in commission providing part-time doctors for the NHS.
The Daily Telegraph
The Daily Telegraph
Nationwide dementia screening to tackle 'crisis' among elderly
Nationwide dementia screening to tackle 'crisis' among elderly: The first nationwide NHS screening programme to identify dementia patients earlier is to be launched to battle Britain's "crisis" among the elderly.
The Daily Telegraph
The Daily Telegraph
Funding doubled in effort to defeat dementia crisis
Funding doubled in effort to defeat dementia crisis:
Funding for dementia research will be more than doubled by 2015 to tackle "one of the greatest challenges of our time" and make Britain a world leader in the field, David Cameron will announce today. The Independent
Funding for dementia research will be more than doubled by 2015 to tackle "one of the greatest challenges of our time" and make Britain a world leader in the field, David Cameron will announce today. The Independent
More than 9,000 TB cases reported in 2011
More than 9,000 TB cases reported in 2011: Provisional figures released today by the Health Protection Agency (HPA) show there were 9,042 new cases of tuberculosis (TB) in the UK in 2011. Compared to provisional numbers reported in 2010 (8,587), this is a five per cent increase. Health Protection Agency
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