Posts Tagged ‘Funding’

Health Bill distracting NHS from making savings

By Mike Broad - 24th January 2012 11:12 am

Service integration to deliver the Nicholson Challenge is more important than NHS reform say MPs on the influential Health Select Committee.

The report on public expenditure, by the cross-party committee, says the reorganisation process in the NHS continues to complicate the push for efficiency gains. NHS chief executive David Nicholson wants £20bn of savings by 2015.

The MPs say that, although the push towards GP commissioning may have facilitated savings in some cases, it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings.

The report expresses concern that trusts are currently making savings through “salami-slicing” existing processes and services instead of rethinking and redesigning the way services are delivered.

The Nicholson Challenge can only be achieved through a wide process of service redesign on both a small and large scale, the report says. These changes should not be deferred until later in the Spending Review period: they must happen early in the process if they are to release the recurring savings that will be vital in meeting the challenge.

Commenting on the report, Sir Richard Thompson, president of the Royal College of Physicians, said: “We agree that meeting the £20bn efficiency savings at the same time as dealing with the increasingly elderly population is a difficult challenge for the NHS. It is crucial that the proposed reforms help services meet this challenge, rather than distract from it. The government has failed to set out clearly how this will be achieved.

“While improving efficiency, the NHS must still at the same time invest in quality. A key priority is to provide consultant delivered care, which would both improve standards and patient experience, and save money. The health reforms must also improve the process for making decisions about service reconfiguration, for this will increase the availability of consultants, and facilitate seven day infrastructure to underpin consistent patient care. Clinicians and local communities should lead those decisions.”

The MPs says that more integration of services is vital. While the separate governance and funding systems make full-scale integration a challenging prospect, health and social care must be seen as two aspects of the same service and planned together for there to be any chance of a high quality and efficient service being provided which meets the needs of the local population within the funding available.

Dr Hamish Meldrum, chairman of BMA council, said: “Better integration of care is key to improving patient care yet many of the implications of the Health and Social Care Bill, including the government’s focus on competition, will make this harder to achieve.”

He described the Bill as a “distraction” and said it “is causing chaos on the ground even before the legislation has been passed. It is perhaps little wonder that those trying to make efficiencies are focussed on short-term issues, such as their job prospects, and making rushed decisions on savings rather than looking to the longer term”.

He added: “There is still time for the government to withdraw the Health and Social Care Bill - a bill which an increasing number of health professionals are opposed to - and work with healthcare professionals and others to agree a more pragmatic way forward.”

The MPs conclude that it is too early fully to assess the types of savings being made in 2011-12, the first year of the QIPP programme. However, the report says: “We are concerned that there appears to be evidence that NHS organisations are according the highest priority to achieving short-term savings which allow them to meet their financial objectives in the current year, apparently at the expense of planning service changes which would allow them to meet their financial and quality objectives in later years.”

Read the full report.

Read a blog on the Health Bill.

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Why the ridiculous deadline on additional funding?

By Bob Bury - 12th January 2012 10:53 am

OK, now listen to this because you couldn’t, as they say, make it up.

You know how much pressure we are under to cut costs and rationalise services in light of the current austerity programme, don’t you? And you will have noticed that your pension contributions are increasing at an eye-watering rate, and that your money is being poured into the black hole of NHS finances rather than salted away to fund future pensions, as has been the (mal)practice of successive governments?

Knowing all that, you will be as delighted as I was to learn that Andrew Lansley is indulging in one of those old end-of-year mindless spending binges that we hoped had become a thing of the past.

As I discovered when I dropped in to work today for one of my twice-weekly locum sessions, and as reported in the Health Service Journal a few days ago, trusts (well, a few of them) have been told that there is a capital sum of £300m available - that’s 6.7% of the total available for the year - and that the DoH is inviting bids against it. The closing date for those bids - which must be for at least £5m? The 12th of January. That’s right - today. Although NHS London sent a letter announcing the bonanza on 23 December, many others have still not been informed about the end of year (?closing down) sale.

A colleague in Leeds first heard about it from a representative of one of the leading manufacturers of radiology equipment, who was asking if we would be directing any of the largesse their way. Well, we could easily spend four or five million on a PET/MR scanner, or a cyclotron for our existing PET/CT scanners, and even justify it to ourselves, but is this any way to allocate scarce resources in the middle of a funding drought?

This is just another example of crass incompetence at the highest level in Whitehall. How can they seriously expect trusts to produce fully-costed business cases for expenditure of this magnitude in a few days? Also, of course, many PCTs and trusts seem to know nothing about it even now, and so any distribution which does occur will be seriously skewed. It’s a recipe for waste on a grand scale in a department of state that has already set records for profligacy with its failed connecting for health programme.

As one of the PCT directors interviewed by the HSJ put it: “Get your bids in by 6 January for schemes that must be over £5m, preferably spent by end of March?…We haven’t seen this kind of thing in about 10 years. The ‘use it or lose it’ at short notice mentality went away for a long time. Seems it’s back.” Back indeed, and with a vengeance.

If you wonder how Lansley will explain this lunatic behaviour, wonder no longer. A DoH spokesperson said: “Thanks to good management of central capital budgets, we have identified capital funding which could be made available to the NHS. We are now in discussions with the NHS to see how it could best be spent“. So there you have it - contrary to what you had been thinking, this is an example of good management. As, presumably, was Liverpool’s purchase of Andy Carroll for £35m and £80K a week (and at least he has put the ball in the back of the opponent’s net on four occasions, whereas Lansley only seems capable of scoring own goals).

It’s difficult to know if the delayed and ‘hole-in-the-corner’ way in which the information concerning this fund was released is a deliberate attempt to keep bids against it to a minimum, or just another example of administrative incompetence. However, the fact that one half of the DoH apparently didn’t know what the other half was doing would tend to favour cock-up over conspiracy - in the early afternoon of 5 January the DoH spokesman denied that any such fund existed; later that same day they confirmed that Lansley had indeed authorised the release of the cash. Presumably at some point he will blame Nick Clegg.

What a bunch of wasters (no - literally).

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Spanish doctors bear the brunt of funding crisis

By Mónica Lalanda - 13th December 2011 11:39 pm

I wish we could talk about something else but if you live in Spain, the intense economic crisis takes over any other issues. Things are not looking good over here. Our National Health Service which has traditionally been considered quite decent is struggling to stay above water. Widespread cuts are becoming a fact.

There is a general feeling of gloom; cuts in health kill people. It is incredibly frustrating that politicians don’t seem to see further than their own desks and comfy chairs. Closing down entire wards, cutting theatre lists down, growing debts with the pharma industry, closing Accident and Emergency facilities, and cutting down in clinics might be starting to pay off but not in the expected way. Only a few weeks down the line and there are already victims, human losses and great suffering.

This is scary stuff – not just for patients but also for the staff. Out of all the possible ways to decrease expense cutting doctors’ salaries and wages has taken priority. Cataluña is taking the lead on this ugly business and their junior doctors are the main victims. It is now said that many Residents are facing the next Christmas with half the salary they had a few months ago, this could mean little more than 1000€/month.

The starting point isn’t the best since Spain was already running a good health service on the cheap, mostly by paying peanuts to its staff; it is well recognised that Spanish doctors are amongst the worst paid in the old Europe. GPs are even worse off earning a salary that’s about a third of their British colleagues.

Even worse than low salaries is the lack of good working conditions and job security. A large proportion of doctors have short term contracts.

It has been incredibly frustrating to hear all the politicians gaining kudos for what they like to call “one of the best health systems in the world” during our recent election campaign. Apparently our system is good value for money but they all miss the point of why it’s such a great deal - our medical pockets.

The government might pay doctors peanuts, but let me assure they don’t get monkeys in return. I’ve worked in Spain for three years now and the health system might have some serious problems but the doctors are every bit as good as their British counterparts. I guess one of the beauties of being doctor is that money is not the only payment you get, patient recognition and the sense of doing something good is rewarding. There is no other way to explain certain successes of our national medicine; for example only this week 94 organ transplants were carried out in just 72 hours, an amazing record and well ahead most European countries.

The crisis might be coming down on doctors but sadly there is little reaction, minimal response; doctors in this country have been disrespected for decades and they just soak it up. When you feel mistreated and overworked, you have little energy left for anything else and of course since the mortgage needs paying, and you want to be chosen for the next available locum, you don’t want to be seen as a trouble maker.

Unless we regain some pride in what we do and stand up together for our rights and the rights of our patients, we’ll continue to have our toes stepped on. So here is an addition for your vocabulary if you are learning Spanish: medico cabreado.

We look forward to the new government, only time will tell if they are capable of turning around this mess. Fingers crossed.

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Stop wasting NHS money on worrying about money

By Caroline Whymark - 28th November 2011 10:57 am

So back to the original question: how can the ever spiralling costs of delivering a high quality NHS free-at-the-point-of-use be met? In true political speak, I think if we were to address some tough questions and make some unpopular decisions (and actually follow them through) there would be no need for budgetary panic.

1. Rationing:

Not by postcode or by local practice variations dependent on the prevailing wind direction, but by doing the big things first and then assessing what you are going to spend the left over money on. There is a well known adage about fitting stones in a jar - if the big ones don’t go in first they will never fit. The smaller stones always slot in around them in the little left over spaces. Surgery is like stones. Spend money on all the small frivolities and the budget will fall short for the big essentials. Use the budget with this in mind. Do the emergencies, the cancer, the trauma and forget about questionable cosmetic procedures treating self-esteem issues unless you have money to burn in March.

2. Stop robbing Peter to pay Paul:

Time-wise and budget-wise this repeatedly occurs. Let’s say healthcare costs X amount. Whether time and money is spent in pre-assessment clinics, ward bed days, or increasing day surgery capacity, the work required still costs X regardless of whether it is done by a doctor, a nurse or any number of advanced and extended roles. We often simply redistribute where the time is spent and which budget the money comes from. Stop wasting time, effort and more money trying to find more cost efficient ways of doing things. Savings in one area generally mean increased expenditure and reduced time available in another and false economies prevail.

3. Stop measuring things we already know and/or cannot change:

There must come a point when measuring any variable that the process becomes more costly than any potential savings that could be made from removing inefficiencies. Further, when measuring a load of variables (read theatre start time, end time, in between time) which finds we are actually pretty efficient, the actual process of the measuring is a cost which generates no reciprocal saving. Why keep doing it over and over again? Some systems by their very nature are slow. A trauma list finally deciding on clinical priority at 0830, after taking into account overnight admissions, will not start at 0845. This is not inefficient.

It is a fact of this type of work. Priorities change, theatre readiness of a patient changes. Long gone are the days of the instant orthopaedic patient (read ‘add water when ready to operate’). Measuring the ‘delays’ on this type of list goes no way to reducing them. They are not delays, they are the inherent time required in the system to follow due procedure and carry out repetitive safety checks. Measuring them will not change this.

4. Accept clinical risk is the nature of the beast:

Things don’t always go well and this may be no-one’s fault. Accept that complaints and litigation are more prevalent throughout society and not just in medicine. Stop investigating, escalating, referring and reviewing practice in the light of a complaint. Endless meetings and paperwork result from tiers of investigative staff tasked with determining what went wrong when often nothing did. Medicine is a risky business with no guarantees. Sometimes the outcome is not good. Accept that or get out of healthcare.

5. Staffing:

Approximately 80% of the total budget is spent on staffing. Approximately 50% of these are non clinical. Does 50% of Apple’s staff have nothing to do with producing an i-gadget? I think not. Many managers have necessary roles and do the stuff that someone has to do. But their numbers seem to be escalating and at the end of the day the NHS is in the business of delivering healthcare to patients and that should be the main focus of the organisation.

A high quality service free-at-the-point-of-use, encompassing modern medicine as it evolves is expensive. It would be easier to meet this cost if we stopped wasting money on wondering where the money goes.

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NHS Operating Framework set to apply the pinch

By Mike Broad - 25th November 2011 6:40 pm

Sometimes as a health journalist you know when you’re opening with a line that is likely to switch off most, if not all, of your readers.

Well, here goes: the NHS operating framework for next year has been published.

Just hang in there a second, there are a couple of salient points to make.

Firstly, as the NHS Confederation says, this marks the point where we move from debate over the QIPP challenge and new legislative framework to implementation.

The BMA might have started tub thumping at the eleventh hour, but it’s too little too late.

It sets out a tough environment for acute hospitals, with the price for their services cut by at least another 1.5% and it demands that commissioners strictly enforce financial penalties.

It’s no easier in primary care with dozens of fledgling clinical commissioning groups (CCGs) looking like they’ll have to merge after the framework gave commissioners a paltry management allowance of £25 a head. They’re also going to have to be ‘coterminous with a single local Health and Wellbeing Board’. So, for some it’s back to something like the scale of a PCT, which last year was thought to be too cumbersome…

What does this all mean? The government is accelerating its £20bn savings programme, and each and every one of us will feel the pinch over the next year.

Have a good weekend (sorry).

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NHS trusts told to sell-off land to home developers

Daily Mail - 22nd July 2011 1:39 pm

NHS managers are being told to find land they can sell off to raise money for frontline services.

Deputy NHS chief executive David Flory has asked trusts to earmark surplus land that could be used to build affordable homes.

According to the department, almost eight per cent of NHS space is under-used, which could be worth £2.5 billion over the next five years, the equivalent of 50,000 nurses.

Health minister Simon Burns said: “If we want to modernise the NHS and make it more efficient, then we need to be proactive and identify land that is no longer used or needed.

“Any money raised from surplus land will be used to benefit patients. We are increasing investment in the NHS by £12.5 billion, but faced with an ageing population and rising costs of treatments, the NHS needs to be smarter with its resources.”

The announcement comes after the government said in June it wanted to release enough public land to build up to 100,000 new homes by 2015.

The NHS is one of the largest owners of public-sector land.

Read more in the Daily Mail.

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Hospitals will struggle to maintain quality care

By Mike Broad - 8:31 am

Many hospitals will struggle to deliver productivity improvements essential to maintaining quality and avoid significant cuts to services, a monitoring report on NHS performance says.

The majority of finance directors from NHS providers questioned for the King’s Fund quarterly report reveals that their trusts face productivity targets for 2011/12 of 6% or more - above the level required across the NHS as a whole to deliver the £20 billion in efficiency savings needed by 2015.

Twenty seven of the 29 FDs who responded said their trust has a productivity target of 4% or more, with 13 of these having targets of 6% or more - all of them from provider organisations.

Around half the panel are uncertain of meeting their targets, while eight of the 13 panellists with targets of 6% or more are uncertain of meeting them.

The majority are confident that measures taken to meet their targets will not harm clinical quality, although around a quarter are uncertain or concerned about this. Nearly half the panel are pessimistic about the financial prospects for their local health economy.

The report concludes that providers are facing higher targets than commissioners, perhaps indicating that the government sees them as better placed to deliver the improvements needed, given the upheaval faced by commissioners as a result of the health reforms. The findings also highlight concern about the prospects for NHS finances as the spending squeeze begins to bite, with three panellists expecting their trust to be in deficit at the end of the financial year.

The report also says that the six months to March 2011 saw an almost threefold increase in the number of compulsory redundancies, with more than 1,200 NHS staff made redundant.

Professor John Appleby, chief economist at the King’s Fund, said: “The government is looking to NHS providers to deliver the lion’s share of productivity improvements, with many facing very tough cost improvement targets as a result. Based on the feedback we received, there must be significant doubt about whether many of these targets will be met.

“While waiting times remain low in historical terms, the rise against key target measures since this time last year shows how difficult it will be for the NHS to meet the Prime Minister’s pledge to keep waiting times low as the spending squeeze begins to bite.”

Read the full report.

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Spending more on the NHS could be affordable

BBC Health - 13th July 2011 9:20 am

Spending more on the NHS is not necessarily unaffordable - despite the claims of ministers, a leading health expert says.

A major part of the justification for the overhaul of the NHS was that spending would spiral out of control.

But Professor John Appleby, of the King’s Fund, said even a doubling of the budget over 20 years was possible. Writing for the British Medical Journal website, he said it was about whether the NHS was prioritised even more.

Ministers have spent the past few months arguing that the ageing population, rising cost of drugs and factors like obesity mean spending demands would outstrip what was affordable in the coming years.

Last month, Health Secretary Andrew Lansley suggested on current trends £230bn would need to be spent on health by 2030 compared to the £103bn which is spent now. He said that figure was one that the country “simply could not afford”.

But Prof Appleby, the chief economist at the think-tank, questioned that. He said taking into account the expected growth in the economy a budget of £230bn would require the health budget to rise at about 4% a year above inflation - only a little more than it has got on average since 1948.

Read more on BBC Health.

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Waiting times in the NHS rise, report reveals

By Mike Broad - 20th April 2011 6:51 pm

Waiting times for hospital treatment have reached their highest level for three years as the funding squeeze begins to bite, a study reveals.

The report shows that, in February, nearly 15% of hospital inpatients waited over 18 weeks for treatment - the highest level since April 2008.

Furthermore, the proportion of patients waiting more than four hours in A&E rose sharply at the end of 2010, reaching its highest level since 2004/05.

The report - the first of a quarterly update by the King’s Fund - provides a snapshot of the NHS by combining analysis of key performance data with the views of a panel of NHS finance directors.

Most of the finance directors surveyed are already warning that they are unlikely to meet productivity targets in 2011/12.

The panel outlined a range of plans for making services more efficient, such as workforce changes, redesigning services and reducing lengths of stay in hospital. But nearly half identified ward closures and cuts in services among the main ways of meeting productivity targets in their area.

With the NHS needing to find £20bn in productivity improvements by 2015, many of the panel of 26 finance directors surveyed stressed the difficulty of continuing to manage demand for services, meet targets and maintain quality with the financial squeeze.

While most were confident they had met their productivity targets for 2010/11, over two-thirds said they may not meet their targets for 2011/12. Most of the panellists called on the government to be more realistic about the challenges involved in finding the savings needed.

Only six identified back office efficiencies among the main ways productivity targets will be met, with a number sceptical about the savings to be made through this route

More positively, levels of hospital-acquired infections have fallen to their lowest level in recent years, while delays in transferring patients out of hospital remain stable.

The proportion of patients waiting more than six weeks for diagnostic services fell back to 1.46% in February. This reverses a steady increase since June 2010, but is still twice the level recorded in February 2010.

Professor John Appleby, chief economist at the King’s Fund said the report “highlights significant concern among NHS finance directors - who are well placed to report on the stresses in the system - about the prospects for the year ahead. With hospital waiting times rising, the NHS faces a considerable challenge in maintaining performance as the financial squeeze begins to bite.”

The government disputed the King’s Fund’s figures, saying they included some patients who delayed their own treatment and insisted the real figure for hospital inpatients waiting over 18 weeks is 10.2%.

Read the full report.

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Coalition criticised as inflation cuts NHS budget

The Guardian - 27th March 2011 9:39 am

The coalition is embroiled in a row over its health pledges after it emerged that the budget contained a cut in the NHS’s spending power of almost £1bn.

Labour accused ministers of reneging on their repeated promise to increase the NHS’s budget in real terms every year throughout this parliament.

Revised upward predictions of inflation in the budget by the Office for Budget Responsibility show that the NHS in England will undergo a cut of £1bn in its spending power by 2015. It also reveals that its budget will be cut in each of the next two financial years, alleged shadow health secretary John Healey.

He was supported by Professor John Appleby, chief economist at the King’s Fund, who calculated that the NHS would have £910m less to spend over that period. “It looks like the government won’t meet its pledge to give a year-on-year real rise to the NHS each year during this parliament,” he said.

Read more in The Guardian.

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