Thursday, 13 September 2012

Report recommends which specialised services should be commissioned nationally

Report recommends which specialised services should be commissioned nationally:
The services listed in the report will be commissioned by the NHS Commissioning Board from April 2013, rather than by Clinical Commissioning Groups. The list will be agreed by Ministers and the Commissioning Board in the autumn. NHS Networks

Safeguarding children and adults in the future NHS

Safeguarding children and adults in the future NHS:
The NHS Commissioning Board Authority has published interim advice on arrangements to secure children’s and adult safeguarding, which provides additional information, in particular, to emerging clinical commissioning groups.  A covering letter reminds PCTs and SHAs of the vital importance of maintaining appropriate arrangements as the health system goes through transition.
The interim advice, with a covering letter from Jane Cummings and Shaun Gallagher (Acting Director General, Social Care, Local Government and Care Partnerships), is in the Resources for CCGs area under the Safeguarding heading.
NHS chief executives will wish to consider the implications of this interim advice.
NHS Commissioning

National audit of intermediate care report 2012

National audit of intermediate care report 2012:
This audit highlights wide variation in service models being used
nationally with differences evident in the extent of multiagency
integration, the scale of services provided, and how intermediate care
sits within the full range of health and community services, in each
local health economy.
Kings Fund

Personal health budgets for continuing healthcare: the 10 features of an effective process

Personal health budgets for continuing healthcare: the 10 features of an effective process:
This paper is part of a broader programme of work with PCT clusters
in the north west of England to help support them for roll out of
personal health budgets in 2014. It draws on the learning of pilot sites
in the region and nationally to outline the 10 features of an effective
personal health budget process within NHS continuing healthcare.
Kings Fund

NICE issues draft guidance on the development and updating of local formularies for consultation

NICE issues draft guidance on the development and updating of local formularies for consultation:

NICE is developing good practice guidance on the development and updating of local formularies, for use within the NHS in England and Wales.
The Guideline Development Group has reviewed current practice and found that although many organisations have established groups for making formulary decisions, many have identified the need to review their structures as a result of changes to NHS commissioning arrangements. Furthermore they identified a variation in the size and scope of current local formularies, and variation in the processes used by decision-making groups.
The following key components were identified as inherent in the development and updating of local formularies, and are discussed in the draft guidance:
. relationships with other decision making bodies
. formulary scope
. terms of reference
. membership
. resourcing
. accountability and reporting arrangements

NME trusts could get central funding

NME trusts could get central funding: Trusts in the North, Midlands and East of England could receive central funding from the Department of Health for a clinical IT system, even if they choose not to take CSC's Lorenzo. EHI News

Hospitals 'can't cope' with rise in elderly patients

Hospitals 'can't cope' with rise in elderly patients: Hospital wards are "on the brink of collapse" due to ever-increasing numbers of elderly patients and weekend staff shortages that are seriously compromising safety, according to a hard-hitting report by the Royal College of Physicians. Telegraph

How to cut spending and raise patient care standards

How to cut spending and raise patient care standards:
NHS Cost Improvement Programmes can play a part in improving quality, as well as cutting costs, argues Bill Upton
Grant Thornton recently carried out a survey of NHS provider finance directors on their Cost Improvement Programmes (CIPs). Results showed that the average CIP target for NHS trusts in 2011/12 was 5.1%, yet by the end of the year the average saved was 4.8%, 91% of the initial target.
For 2012/13, the average CIP target is the same as the previous year, and 4.9% for 2013/14. These results were supported by a recent study by the King's Fund which produced similar findings.
This clearly puts some context around the challenge facing NHS trusts looking to cut costs. The amount that needs to be saved isn't changing substantially year on year, yet the accumulated savings needed over the next few years are large and challenging.
The situation gets worse when targets are missed, with year on year targets having to increase to make up for those when targets haven't been reached. When asked specifically how they plan to achieve their CIP targets for the next couple of years, nearly nine out of 10 finance directors identify service redesign as playing a major role over the long-term.
Financial directors recognise that while headcount and pay reduction are an important part of reducing costs, they can only be taken so far. Fundamentally redesigning patient pathways (the way that patients receive care), offers a way to make costs savings while also actively improving the whole patient experience.
This kind of service redesign can come in many guises, from combining all outpatient appointments (consultation, X-ray, pathology) into one hospital visit; to looking at how aspects of treatment can be delivered in the community.
These pathways will need to centre on the patient's needs and be delivered in the optimum location, avoiding unnecessary duplication, intervention and tests.
However, this type of fundamental change is clearly much harder to put into practice than other cost saving initiatives. It can be difficult to implement at the best of times, and it takes a substantial amount of time to plan – time which many NHS directors simply don't have as they struggle with the limited resources at their disposal.
Less staff means that management is being forced to do more with less, and has to concentrate on running the service without the freedom to step back and take stock. As a result, although finance directors may have identified how patient pathway redesign could be used to cut costs, they have been unable to create worked-up plans for these redesigns.
It is a significant change and requires more cross-organisational coordination than other money-saving measures, meaning it is often easier to focus on incremental smaller gains.
Changing patient pathways is not something that has to be approached in a vacuum, and financial directors should look at how they can get the whole organisation involved. One aspect of our study looked at how clinical staff view CIPs.
Only 22% of financial directors felt their clinical staff saw CIPs as an opportunity to improve quality while reducing costs. The majority (53%), were neutral, believing the goal of the CIPs is to cut costs without having an impact on quality.
In our discussions around the survey, it is clear that those trusts that have a major focus on continually improving standards appear significantly more successful at delivering on-going financial savings. NHS managers should engage with clinical staff to identify the areas where services can be redesigned in a more efficient manner.
However, when seeking this engagement, it is important to stress the role that CIPs can play a part in improving quality, as well as cutting costs. For example, reducing waste or duplicate appointments improves quality but also saves money.
Ultimately, CIP targets mean NHS management is faced with a task that is going to get progressively more difficult. Once the obvious cuts have been made, reaching the savings targets becomes harder.
Implementing fundamental changes to patient pathways will play a major role in future cost savings, but it is only by embracing this now, working with clinical staff, realising the scale of the task and allocating resources appropriately that trust managers can ensure they can continue to reach their cost-cutting targets over the next couple of years.
Bill Upton is partner and head of healthcare at Grant Thornton UK LLP.
Guardian Professional.