Wednesday, 3 April 2013

No show patients 'cost hospitals £42m'

No show patients 'cost hospitals £42m': Patients failing to make hospital appointments are costing the eastern region NHS £42m a year, it emerges. BBC News

'Postcode lottery' for GP IT

'Postcode lottery' for GP IT: GPs are at risk of a "postcode lottery" of IT support that will affect practice performance and ultimately patient care, a negotiator for the BMA's GP Committee warns. EHI News

Indian drug ruling hailed by health campaigners

Indian drug ruling hailed by health campaigners:
Generic version of cancer drug Glivec will be available at a tenth of the cost of the original


NHS reforms jeopardise future of primary health estate

NHS reforms jeopardise future of primary health estate:
Experts suggest the government may have launched NHS Property Services with an intention to sell it off in future
NHS reforms will result in less local flexibility to manage NHS surplus property, competition between centralised bodies managing NHS estates and concern by private sector investors that future primary care building projects will become more expensive.
The government's controversial decision to abolish primary care trusts – which came into effect from 1 April – has led to concerns among funders over the strength of the new organisations with which they will be contracting.
In 2011, the government created NHS Property Services as a limited company, run by chief executive Simon Holden, to take over the management of the bulk of the primary care estate. In previous reorganisations, NHS property has been passed on to the new local NHS organisations. But much of it is now being transferred to this new, central organisation.
Meanwhile, an existing government agency, Community Health Partnerships (CHP), where Sue O'Connell is chief executive, will take the PCT stakes in NHS Lift companies. These are private sector-led public/private partnerships building new primary facilities.
Banks and investors have raised concerns that these two organisations will have a lower credit rating than the old PCTs, which were backed by central government and were therefore seen as "investment grade".
"As schemes are being developed for head tenants that are limited companies without the benefit of a UK government covenant, it may be harder for developers to get 25-year money for their schemes," said Matthew Newing, a partner at law firm Speechly Bircham, who is working on such deals.
There are also concerns over how NHS Property Services and CHP will work together. "There is a general feeling that we don't need both," said one private sector expert. "These are two UK government-owned companies that are competing in the same space."
Some experts suggest the government may have launched NHS Property Services with an intention to sell it off, along with the estate it manages, at some point in the future. Guardian Healthcare Network

Annulling competition rules is the most important NHS battleground

Annulling competition rules is the most important NHS battleground:
The government may have hoped new health service regulations on competition could be quietly ushered in, but healthcare professionals and more than 250,000 patients have called for their withdrawal
Never has a statutory instrument created such a furore as SI 2013(257) on NHS procurement – the regulations that effectively put the entire NHS up for tender. These obscure orders give effect to ministerial decisions and simply come into force within 40 days unless revoked (in either House) by "negative procedure" – an almost unheard of occurrence. This is the route the government has chosen to flesh out the NHS and Social Care Act, but if it was hoping to slip unnoticed through this legislative back door it has had a rude shock.
Spurred on by a 250,000 signature petition organised by the formidable 38 Degrees, politicians and professional groups have awoken to what is happening. Calls for withdrawal of the regulations have come from the BMA, RCGPs, RCN and the UK Faculty of Public Health – even the conservative Academy of Royal Colleges has joined in, as has the normally loyal NHS Alliance. The obscure Lords scrutiny committee has reeled under the weight of an unprecedented 2000-plus representations, and the crucial "prayer" for annulment will be laid by Labour in the Lords on 24 April.
Taking refuge in claims of "poor drafting" and "inadvertently created confusion", the coalition hastily redrafted the offending regulations. In this new version, assurances are given that CCGs will be free to determine their own procurement decisions, and the option of "integrated care" is belatedly rediscovered. The competition enforcing body, Monitor, is portrayed as an avuncular alternative to the judicial process, and everything being proposed is said to be there to simply ensure "patient interest".
There are many reasons why this simply won't wash:
• The regulations still give primacy to the "sole provider" exemption: the only relevant ground upon which CCGs can decline to go out to tender is where the service is only capable of being delivered by one provider – an impossibly high bar.
• UK and EU competition law trumps whatever is in the regulations: even if a commissioner decides (conceivably with Monitor's consent) that the sole provider test has been met to ensure "patient interes"' an aggrieved provider can still take, or threaten to take, judicial action.
• The concept of "patient interes"' is undefined in the regulations: the task of determining what it is will be left to Monitor whose working assumption is that the main determinant of such benefit is choice of provider enforced via competition law.
• The regulations stipulate that any tenders above £1,000 should be advertised, creating very substantial transaction costs that will have to be diverted from patient care.
• Competitive markets constitute the default setting of the system even though the evidence base for this is, at best, flimsy: the "burden of proof" lies on other approaches to demonstrate (against unclear criteria) why and how an alternative model could be preferable.
Not only do the regulations, even as amended, effectively articulate the role of competition in the NHS, they also invest it for the first time with a statutory basis. Previous procurement rules (which bear some similarity to the new regulations) have been seen as "guidance" - a voluntary code of principles. Regulation is different to guidance – it is in effect mandatory. Moreover the legal focus now will now be upon the subject of a proposed contract, not the broader strategic needs of a locality or the potential impact of salami-slicing the portfolio of an existing public sector provider. Nobody is any longer "running the system".
In the meantime, the traditional public sector structure of the NHS is also being chipped away at from other directions. While the procurement regulations concentrate upon healthcare commissioners, the Competition Commission is spreading its tentacles into NHS providers. For example, we now have the bizarre situation in Bournemouth and Poole whereby two NHS providers contemplating a merger to improve local services are being told they cannot communicate with each other.
More along these lines will follow from the Commission and from the Office of Fair Trading – an unprecedented intrusion into the NHS. In this they will be aided and abetted by Monitor which has just published its "fair playing field" review. In this it proposes a whole host of ways to open up the NHS to the private sector, such as underwriting access to NHS pension rights and longer term contracts which will be difficult to review or rescind. Commissioning support units and GPs themselves are identified as being next in line for scrutiny and exposure to market forces.
1 April has been identified as the day the NHS changed forever. There is truth in this, but in a sense the really important date is 24 April, for this will be when the ideological changes are planned to be approved. Annulling SI 2013(257) is currently the most important NHS battleground. Guardian

NHS failed to meet four-hour A&E targets for past two months

NHS failed to meet four-hour A&E targets for past two months:
Government figures show casualty departments falling short of goal of dealing with 95% of patients within timeframe
The NHS has failed for the last two months to meet its target of dealing with 95% of A&E patients within four hours, according to official figures that underline the growing pressures on hospitals.
The NHS has missed the target in each of the last nine weeks, with 93.3% of patients being admitted, transferred or discharged within four hours in the most recent week for which data are available – ending on 24 March.
The Department of Health data emerged just after the East of England ambulance service took the unprecedented step of erecting a "major incident tent" in which to treat patients outside the Norfolk and Norwich hospital, to relieve pressure on its A&E unit over the Easter weekend.
The four-hour target covers three types of A&E units: those based at major hospitals, those at specialist hospitals, such as Moorfields eye hospital in London, and minor injury units or urgent care centres.
Major hospitals are under the most intense pressure. Labour highlighted DoH data showing that as a whole hospitals offering consultant-led A&E care, so-called type 1 A&E departments, which treat more than 60% of all emergency patients, have not met the target for 26 consecutive weeks.
In the week ending 24 March, for example, 27,273 of the total of 272,505 patients who sought A&E help – some 10% – were not admitted, transferred or discharged within four hours. Type 1 departments have not met the 95% target since mid-September 2012, the figures confirm.
The last Labour government brought in the target in 2002 to end the scandal of patients sometimes waiting many hours to be seen in casualty. They ordered that 98% of patients had to be dealt with in that time but the coalition, which opposes targets it says are not clinically justified, watered that down in 2010 to 95%.
About 14 million patients a year are seen in major A&E units, about 600,000 in specialist units and almost 7 million a year in minor injury units and urgent care centres.
The DoH accused Labour of making misleading claims by focusing on just type 1 units. In fact 96% of patients have been dealt with within the required four hours at all three types of A&E centres since April 2012, the DoH said. A&E centres are seeing 1 million more patients than two years ago and are coping well, it added.
Prof John Appleby, chief economist at the King's Fund health thinktank, said: "Looking at all types of A&E department, the NHS has missed its four-hour target for the last nine weeks, which is slightly worse than previous winters.
"That's a reflection of the time of year, with norovirus more of a problem than it was last year, financial pressures on hospitals meaning some can't get patients out quickly enough to take someone else in and also what some hospital finance directors say is inadequate social care planning in their area."
Dr Peter Carter, chief executive of the Royal College of Nursing, said emergency care was under strain. "These figures are yet more proof of a system running at capacity, and patients are suffering as a result. Our members are regularly telling us that pressure on the system is rising while staffing levels fall, and as a result any increase in demand results in unacceptable waits for patients who are already going through a difficult time." Guardian

Dementia patients 'need relationships'

Dementia patients 'need relationships':
People with dementia should be involved in decisions about their care and must be helped to maintain relationships and to participate in their communities, according to official guidance published today. Independent