LATEST ARTICLES
Bring accountable care out of shadows
15 December 2017
The war over the future of the NHS is being fought on multiple fronts.
Campaigners, the Labour party, the government, NHS England and even
Stephen Hawking are locked in combat over the structure, funding,
transparency, accountability and legality of the current wave of reforms, along
with the never-ending fight about privatisation – real or imagined.
The famous physicist has joined campaigners in a high court bid to block the
introduction of accountable care organisations to oversee local services
without primary legislation, arguing they could lead to privatisation, rationing
and charging.
Meanwhile, the shadow health secretary, Jon Ashworth, has tabled a
Commons early day motion after the government announced plans to amend
regulations to support the operation of accountable care organisations.
Ashworth argues that they are a profound change to the NHS that should be
debated in parliament.
Accountable care – a term imported from the US, where it plays a key role in
Obamacare – can take many forms, but it typically involves an alliance of
providers with a fixed budget collaborating to manage the health needs of
their local population. NHS England wants to see sustainability and
transformation partnerships (STPs) evolving into accountable care systems in
which integrated care supports good physical and mental health.
Read the full article at the Guardian Healthcare Network
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Patients and staff pay negligence price
1 December 2017
This week I met a man about to launch a legal action for negligence against
the hospital where his wife and son almost died during childbirth. Two years
later, she is still recovering and waiting for answers as to what went wrong.
Exhausted by months of obstruction and denial, they believe going to court is
the only way they will get an admission that mistakes were made. They don’t
want money, just an apology and assurance that no one else will have to
suffer as they did.
This entirely avoidable melodrama is being played out across the NHS.
Friday’s report by the public accounts committee into the cost of clinical
negligence in hospital trusts reveals that the bill has quadrupled in 10 years
to £1.6bn and is expected to double again by 2021.
That would mean more than £3bn wasted on negligence costs in a single
year, amounting to roughly 4% of trusts’ income.
The rising costs are driven by two factors. As well as increasing damages for
a small and stable number of “high value”, mostly maternity-related claims –
which account for 83% of the damages awarded – there is a growth in the
number and cost of “low value” claims.
Read the full article at the Guardian Healthcare Network
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GPs need to lead health tech revolution
21 November 2017
The launch of the GP at Hand app-based primary care service in London has
been met with accusations that it is damaging the NHS.
The service is being run by a practice in Fulham, but people across central
London are able to move their GP registration there. It offers video
consultations 24/7 and face to face appointments at five clinics so far. It uses
technology provided by Babylon Health, which bills itself as “the world’s first
AI-driven healthcare service”.
GP at Hand has been accused of trying to make an easy profit by avoiding
the patients who create the most work, threatening the viability of other
practices. There have also been concerns that app-based GP services could
pull lots of healthy people into the primary care system at the expense of
those who really need it.
The recent annual conference of England’s local medical committees
opposed the rollout of online consulting until there was “clear evidence” of the
benefit to patients.
The biggest problem with the service is the long list of people who are
discouraged from signing on. The website says it may be “less appropriate”
for 10 categories of patients, which can reasonably be summarised as people
who are, or are likely to be, sick or pregnant.
Read the full article at the Guardian Healthcare Network
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How to put citizens at the heart of NHS
3 November 2017
With ever-growing pressures from funding, staff shortages, demand and
targets, is it possible to bring joy back to the healthcare workforce and put
patients at the centre of their care? A group of healthcare leaders think it is.
Frustrated by the difficulties of getting back to what really matters in
healthcare but convinced there was a way forward, two dozen people from
health and social care got together as the Industry Coalition Group to get
some fresh thinking into discussions around NHS reform. Healthcare at
Home put some funding in and brought the group together; Mike Bell, chair of
Croydon health services NHS trust, led the discussions, and the result was
the 2,000 Days Project, launched at the King’s Fund and Cambridge Health
Network this week. In the spirit of full disclosure, I should add that I wrote the
report.
The 2,000 days refers to the first and last 1,000 days of our lives. Maternity
and infancy profoundly affect our life chances and lifetime consumption of
healthcare. Giving every child a strong start is morally right, economic
common sense and good for the NHS.
The last 1,000 days crystallise the issues of choice and empowerment; how
care can maximise the quality of life, rather than simply its length, and how to
get the most value from healthcare resources.
Read the full article at the Guardian Healthcare Network
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Blows fly over children’s mental health
20 October 2017
The mauling of NHS England chief executive Simon Stevens by children’s
commissioner Anne Longfield over mental health services is a rare example
of brutal disputes between officials breaking out in public.
The children’s commissioner for England, a post created in 2004, exists to
stand up for the rights of children, particularly on issues affecting the most
vulnerable.
It is certainly not part of the remit to make the NHS, or any other part of the
state, feel comfortable about what they do for children.
Longfield’s bust-up with Stevens began when she sent a briefing to MPs
ahead of World Mental Health Day on 10 October. The brief is a coruscating
critique of children’s mental health provision, describing it as bleak and
shocking, particularly in comparison with adult mental health care.
The thrust of her argument was that help only reaches around a fifth of
children with a mental health condition, while a failure to intervene early
means scarce resources are being drained away on expensive in-patient care
which benefits few children. A failure to prioritise children’s mental health
means most local areas are failing to meet NHS standards for improving
services or providing crisis support.
Read the full article at the Guardian Healthcare Network
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NHS is getting desperate as winter nears
6 October 2017
As the NHS careers towards winter, signs of desperation can be seen across
the country.
Since the summer, at least six hospital trusts and two ambulance services
have been dealing with allegations of bullying. Two chief executives have
been forced out for failing to hit the A&E target. More might follow.
Local government is getting another beating over the growing problems
around moving older people out of hospital after treatment. The Health
Service Journal says the Department of Health is threatening to direct how
social care funding is used at councils with the worst records for delaying
transfers of care.
The bed days lost each month to delayed transfers hover close to 200,000.
Most are caused by the NHS, although social care’s total has been growing
faster. Hospitals have entire wards of people trying to get home.
Lest any chief executives might have forgotten that A&E is a priority, recently
appointed chief inspector of hospitals, Prof Ted Baker, has sent everyone a
handy guide on what they should be doing. It is important to “know whether
each patient has a serious problem”, apparently.
More helpfully, Baker also stresses the importance of empathetic leadership
and managing staff wellbeing. But does that mean a consultant in A&E who
breaches the four-hour wait target after sending exhausted staff home will be
supported, or will their chief executive be put in front of the next NHS
Improvement firing squad?
Read the full article at the Guardian Healthcare Network
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October to December 2017
Public Policy Media
Richard Vize