Posts Tagged ‘Integrated care’

GPs not consulted on Manchester health devolution

- 3rd March 2015 3:51 pm

GP leaders in Manchester have slammed the lack of involvement of general practice in plans to hand £6bn NHS funding to a new devolved local authority body.

The plans are backed by 12 CCGs, 10 local councils, NHS England and other NHS bodies.

But chairwoman of greater Manchester LMCs Dr Tracey Vell said she was ‘disappointed’ the agreement had been signed.

‘The objectives involve general practice but general practice as a provider has not been given a stake so far in the process,’ she said.

CCGs, she added, cannot represent GPs as providers.

Read more at GP Online.

Reaction to Manchester’s devolved health spending

By Mike Broad - 25th February 2015 8:24 pm

Dr Mark Porter, BMA council chair

“There is no doubt that patients would benefit from more joined-up health and social care. However, any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn’t used to prop up a woefully underfunded social care budget.

“These wide sweeping changes will affect millions of people. We need to look carefully at exactly how they will affect the commissioning and delivery of services, and what the impact on patient care will be. We must also ensure clinicians have a central role in decisions over health care, something which was undermined by the Health and Social Care Act 2012.

“We need assurances on who is responsible if these changes go wrong. Doctors believe the secretary of state for health should have the duty to provide a universal and comprehensive health service, and must take responsibility for guaranteeing national standards in the of quality care across the country, especially if the delivery of care is to be devolved to local authorities.

“The NHS has just undergone unprecedented upheaval, there must be no more games with our health service and we need to avoid a situation where the NHS moves from being a national to a local political football.”

Richard Humphries, Assistant Director of Policy at The King’s Fund

“The news that Greater Manchester’s local authorities and NHS are close to agreeing a deal with NHS England to establish a new partnership for health and social care across the Manchester region is very significant.

“If implemented effectively, this could be a step towards a big prize - a single, seamless health and social care system delivering integrated care for people in Greater Manchester. It also provides an opportunity for councils and the NHS to work together to improve health and well -being in the region.

“While the ambition is welcome, more details are needed about how the partnership will work in practice and who will be accountable for £6 billion of NHS resources involved in the deal. It will be important to avoid the distraction of further organisational change and to clarify the accountability of the Health Secretary for the NHS as a whole alongside a greater role for local government.

“Manchester has been chosen to test out this new way of working because of the strength of local relationships. It is unlikely that many other areas are yet in a position to follow its lead.”

Rob Webster, chief executive of the NHS Confederation

“If we are to tackle the challenges that face the health and care system then local organisations will need to work in different ways. Leaders need to look beyond the boundaries of their individual organisations, instead developing shared priorities for their area and working collaboratively with other organisations to improve the health outcomes of their local community. The focus of politicians and arms length bodies must be to create the right environment to allow this sort of approach, offering support and looking to remove any barriers to new ways of working which improve patient care.

“What this example does demonstrate is the role CCGs are playing, working with partners in local government to drive improvements in care. It’s also positive that providers of healthcare have been engaged in this work. It’s vital that all sorts of providers, including community, mental health, acute, and ambulance, are fully involved in these plans.

“We are pleased to see that the changes in Manchester are being locally driven, rather than a centrally imposed initiative. Manchester’s plan is an example of changes resulting from good partnership working and strong relationships between health and care leaders, who are showing they can put the interest of the local population ahead of their own organisations.

“All political parties need to learn a lesson from this – as we set out in the 2015 Challenge, what’s needed is the space and stability to let these cultures develop. That means avoiding another top down reorganisation of structure at all costs. This model won’t be right for all parts of England – local areas need the freedom to develop solutions which are right for their individual situation.”

Manchester to gain health spending control

By Mike Broad - 8:10 pm

Greater Manchester is to gain full control of its health spending and trail-blaze new models of care, as part of an extension of devolved powers.

Chancellor George Osborne said the £6bn health and social care budget would be taken over by the region’s councils and health groups and come into force in April 2016.

The plan would see local leaders, and ultimately Greater Manchester’s new directly elected mayor, control how budgets are allocated.

The government hopes integrating health and social care services will ease pressure on hospitals and improve community services.

Manchester City Council confirmed 10 local authorities, 12 clinical commissioning groups, 14 NHS partners, NHS England and the government are in discussions on a “groundbreaking agreement for health and social care”.

A Greater Manchester Strategic Health and Social Care Partnership Board - effectively a glorified Health and Wellbeing Board - will be put on a statutory footing by the end of 2015-16.

It would set region wide strategies and priorities, with a joint commissioning board – made up of NHS England, the CCGs and councils – reporting into it.

Mr Osborne said: “This is what the NHS wants to see as part of its own future.

“And it’s also about giving people in Manchester greater control over their own affairs in that city, which is central to our vision of the ‘northern powerhouse’- so it’s a very exciting development.”

According a memorandum of understanding, the model will be built on the “principle of subsidiarity…ensuring that decisions are made at the lowest level possible”.

This suggests that while some commissioning decisions would be taken at a Greater Manchester-wide level, others would remain at the level of individual “localities”.

The document states that pooled budgets “at the locality level” – between individual CCGs and borough councils – would be in place from 1 April 2016.

Local health and wellbeing boards would agree strategies and priorities for delivery of integrated health and social care within their districts and in the context of the Greater Manchester-wide strategy and local priorities.

Local plans would be submitted to partnership board to ensure strategic coherence and consistency across Greater Manchester.

NHS England, CCGs and districts would pool relevant health and social care funds to a local joint commissioning board building from existing arrangements such as the Better Care Fund.

A Local Joint Commissioning Board will commission services in line with locality plan.

Richard Humphries, Assistant Director of Policy at The King’s Fund, said: “The news that Greater Manchester’s local authorities and NHS are close to agreeing a deal with NHS England to establish a new partnership for health and social care across the Manchester region is very significant.

“If implemented effectively, this could be a step towards a big prize - a single, seamless health and social care system delivering integrated care for people in Greater Manchester. It also provides an opportunity for councils and the NHS to work together to improve health and wellbeing in the region.”

Dr Mark Porter, BMA council chair, commented: “There is no doubt that patients would benefit from more joined-up health and social care. However, any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn’t used to prop up a woefully underfunded social care budget.

“These wide sweeping changes will affect millions of people. We need to look carefully at exactly how they will affect the commissioning and delivery of services, and what the impact on patient care will be. We must also ensure clinicians have a central role in decisions over health care, something which was undermined by the Health and Social Care Act 2012.”

Labour’s plan to better integrate health and care

By Mike Broad - 28th January 2015 11:44 am

The Labour Party has unveiled its 10-year plan for the NHS saying that while there would be no top-down, major reorganisations, they will develop a more integrated health and care system.

Labour leader Ed Miliband said the implementation of his national vision of integrated health and social care will be evolutionary.

Improving home care services is a key thrust of the plan. Health and Wellbeing Boards would become accountable for ‘year of care budgets’ which would cover the health and social care needs of those at the greatest risk of hospitalisation.

Providers would bear the costs if the health of patients under the budget deteriorated and they needed expensive hospital care. It’s aimed at tackling the problem of 15 minute social care visits.

Andy Burnham, shadow health secretary, said: “If social care in England is allowed to collapse, it will drag down the rest of the NHS. [It] is a root cause of the crisis in [accident and emergency]. For the want of spending a few pounds in people’s homes on decent home care, we are spending thousands of pounds keeping older people in hospital, even when they are able to leave. The increasing hospitalisation of older people is no vision for the ageing society.”

Burnham confirmed his desire to “work towards the notion of a single [health and social care] budget; a single budget for children and then a single budget for adults”.

Labour would also repeal key elements of the coalition’s Health and Social Care Act. Statutorily enforceable rules on NHS competition would be unpicked, with Labour claiming that £100m in savings could be generated by scrapping the competition rules.

Miliband endorsed the ‘NHS preferred provider’ policy saying the private sector has a role but as a supplement rather than a substitute.

Miliband said: “We can only join up the services when we have the right values at the heart of our NHS: care, compassion and cooperation, not competition, fragmentation and privatisation. These aren’t the values of our National Health Service. These aren’t the values of the Labour Party. These aren’t the values of the British people.”

Much of the detail in the 10 year plan has already been announced, particularly plans to recruit extra GPs and nurses. However, the announcement of a “new arm of the NHS” comprised of 5,000 home care workers employed within the health service is significant.

The home care workers would focus on “those with the greatest needs, including the terminally ill so they can stay with their family at the end of life, and those who are leaving hospital who need extra help if they are to move back into their homes”.

There is as yet no detail on the training and qualifications these employees would have, what kinds of organisations would employ them, or how much they would be paid.

Labour has pledged to pay for these new employees with a previously announced mansion tax, a levy on tobacco firms and a crackdown on tax avoidance.

It would also cut bureaucracy, raising doubt over the continuance of arm’s length bodies created by coalition legislation, such as the NHS Trust Development Authority and NHS England. Other potential targets for savings could include NHS commissioning support units, or clinical commissioning groups.

Labour also said it would enter into a new ‘compact’ with the 1.3m NHS staff to “lift morale and improve patient care”.

This would include appointing a new ‘NHS staff champion’ responsible for improving workplace culture and reducing bullying, work-related stress and sickness absence.

It follows the pay dispute between unions and the coalition government over its decision to reject the NHS Pay Review Body recommendation of a 1% pay rise for all NHS staff.

If Labour wins the general election in May the party says it will “recommit to the Pay Review Body process and pledge not to renege irresponsibly on pay deals like current ministers”.

Miliband said: “What our 10 year plan is designed to do is give people a sense of direction – there is a sense of direction, there is a party with a plan for where the NHS goes. We’re not sort of chopping and changing, we’re not doing what this government has done in instigating, a top-down reorganisation, but are giving a clear sense of direction.”

The leadership, however, is facing a backlash by Tony Blair supporters who have warned that his plans for the NHS risk playing into Tory hands.

Former health secretary Alan Milburn said the party was running a pale imitation of its losing 1992 general election campaign, as it retreated to its comfort zone over the NHS rather than setting out a strong economic vision.

Royal colleges support integrated care drive

By Mike Broad - 17th December 2014 8:47 pm

New models of care should be based on the needs of patients, service users and communities, rather than buildings.

This is the view of the Royal College of Physicians and the Royal College of General Practitioners, which have released a joint statement on integrated care.

The statement, which is also supported by other medical royal colleges and faculties, sets out the values, vision and commitments of both colleges in working together at a national level to promote person-centred care, integrated care and collaboration.

The two colleges are committed to involve patients, carers, and service users across the breadth of their work, and to breaking down traditional organisational boundaries in order to coordinate care and meet people’s needs.

Professor Jane Dacre, RCP president said: “Primary care and acute care have always worked together for the wellbeing of today’s and tomorrow’s patients. It is vital that we remove the artificial barriers between us, and this statement opens the door for us to work ever more closely together, celebrating the care that we provide for patients.”

The £3.8bn Better Care Fund, announced in June 2013, is the government’s attempt to encourage the integration of health and social care.

Dr Maureen Baker, Chair of the Royal College of GPs, said: “More integration and better, constructive working between primary, secondary and community care will be beneficial for GPs, the health service and our patients.

“GPs, our teams, and colleagues across the NHS are currently under pressure to cope with increasing patient demand with the resources available to us – and it is essential that we look at how we use these scant resources, in the best interests of our patients.

“This statement is a welcome demonstration of the widespread support for closer working between healthcare professionals across the NHS in order to deliver truly patient-centred care.”

New figures from NHS England suggest the system is creaking under the strain of increased patient demand despite the mild weather.

Integrated care key to improving respiratory med

By Mike Broad - 8th December 2014 10:35 am

Multidisciplinary virtual clinics are an innovative way to bring together hospital lung specialists and primary care clinicians to improve the care of people with long term lung conditions like Chronic Obstructive Pulmonary Disease (COPD), according to a study.

COPD is a smoking-related condition affecting nearly one million people across the UK. There is wide variation in the management and outcomes of this condition.

Evidence suggests many patients do not always receive important support and treatment to help them stop smoking, nor exercise and education through a pulmonary rehabilitation programme.

Furthermore there is an over-reliance on inhaled corticosteroids (ICS) in their treatment. This is despite ICS only being effective with a small number of patients and amid increasing concerns about their side-effects (e.g. pneumonia) and costs to the NHS.

The study, developed by King’s Health Partners and Lambeth CCG, and presented at the British Thoracic Society’s Winter Meeting, shows that ‘virtual clinics’ that review individual COPD patient case-notes and agree treatment plans, including stepping down and stopping inappropriate ICS, reduced high dose ICS prescribing and a consequently saved £200,000 to the local healthcare economy.

In the study 94% of Lambeth GP practices hosted a virtual clinic, and the researchers believe that if the findings were applied across the NHS, thousands of patients could have better, safer care and millions of pounds could be saved for reinvestment in effective treatments and services for COPD.

Grainne d’Ancona, principal pharmacist at Guy’s and St Thomas’ NHS Foundation trust, speaking on behalf of the King’s Health Partners Integrated Respiratory Team, explains: “Drawing on the expertise of respiratory specialists, we were able to change the focus of COPD care in a number of cases.

“Where appropriate, the gradual withdrawal of inhaled corticosteroid treatment (ICS) was recommended; allowing patients to move away from high dose ICS, to effective interventions like smoking cessation and pulmonary rehabilitation.

“As a result of this collaboration, Lambeth CCG reduced its high dose ICS prescribing from above the London average to well below it in a matter of months. These findings show that integrated working through respiratory virtual clinics offers huge scope to improve care for the population and maximise value within limited NHS budgets.”

Another survey presented at the meeting reveals that nearly 8 in 10 (77%) said that integrated care improved health outcomes for patients with a long term health condition, with 87% highlighting continuity of care for patients as a key benefit.

Professor Martyn Partridge, Professor of Respiratory Medicine at the National Heart and Lung Institute, Imperial College London, said: “Respiratory medicine covers a huge range of conditions from tuberculosis, COPD and lung cancer to asthma and sleep apnoea.

“This diverse and demanding area calls on health care professionals to diagnose, manage and treat a huge range of diseases everyday. So the more we can work across both primary and secondary care, getting the specialist nearer to the patient, the better. Virtual COPD clinics are a prime example of the positive work happening right now with specialists sharing their knowledge and expertise with GPs - benefiting both patients and the NHS.”

Better Care Fund will require continued support

By Johnny Marshall, director of policy, NHS Confederation - 11th November 2014 12:00 pm

We recognise the hard work put in by all those involved in developing and agreeing Better Care Fund plans locally, including NHS providers and commissioners, working with local authority partners, but we also echo many of the valid observations and concerns expressed by the NAO regarding the quality of the planning and preparations behind this ‘ambitious’ policy.

We are pleased that the NAO report recognises the areas of concern we have highlighted on behalf of our members regarding the BCF planning, notably the tight timescales set  for submitting local BCF plans; the conflicting directives around the objectives behind the policy, the burdensome ‘tick-box exercise’ nature surrounding the planning process; and the frustration of local areas having to re-submit plans after the original April planning deadline.

We also reiterate our concerns about the ability of some local areas to achieve the reductions in levels of emergency activity and financial savings that the BCF requires.

We agree the BCF’s success rests on “assumptions” which “may still  be over-optimistic” regarding the ability of integrating services to reduce costs. It is our view that whilst there is much evidence that greater integration and personalisation improves outcomes, the evidence that it delivers financial savings is still in its early stages.

It will take time for the new models of care to allow us safely to disinvest in existing services. This is why we will need financial flexibility and extra resources to allow double running of some services while we move to the new models of integrated care. This will require us to consider health and social care spending together.

As the NAO report notes, ‘the Funds effectiveness will depend on local implementation’. This requires the continued development of strong working relationships between the different parts of the health and care system locally around shared outcomes. It is therefore essential that providers are properly involved in the BCF planning process in order to build in local expertise and manage risks to patient safety.

In particular we want to see better alignment with the regular planning cycle for providers and commissioners, allowing for practical timescales to allow time for open discussions to take place between all those involved across health and social care.

Initial NHS integrated care plans inadequate

By Mike Broad - 11:51 am

The quality of early preparation and planning for the Better Care Fund - which encourages greater integration of health and social care services - did not match the scale of ambition.

So claims a National Audit Office report, which suggests early local plans for the fund did not meet ministers’ expectations or generate the level of savings the government expected.

All plans had to be subsequently re-submitted.

The Better Care Fund will pool £5.3 billion of existing NHS and local authority funding in 2015-16.

The aim is to deliver better, more joined-up local services to older and disabled people in the community and keep them out of hospital and avoid long hospital stays.

However, the government’s early planning assumption was that the Fund would save the NHS £1 billion in 2015-16, current plans forecast £314 million of savings for the NHS.

While the report recognises that the government programme to integrate local health and social care services is an innovative idea, it questions the potential for savings.

The Department of Health and the Department for Communities and Local Government developed the Fund’s policy, with NHS England and the Local Government Association responsible for the delivery and implementation of the fund.

It was agreed that local areas would develop plans for spending the fund with minimal central prescription, in order to drive local innovation from the bottom up, and reflecting the fact that no savings target had been formally agreed for the fund during Spending Round 2013.

As a result, there was no central programme team, no programme director and limited risk management and no analysis of local planning capacity, capability, or where local areas would need additional support, the report says.

In addition, the initial scheme guidance did not mention the scale of savings expected from the fund.

All 151 local health and wellbeing boards submitted plans in April 2014 for how they would spend their fund allocations in 2015-16.

But NHS England concluded in May that the Fund plans would deliver only £55 million of financial savings, not the £1 billion the Department of Health and NHS England expected.

The departments concluded that the plans required further development and ministers did not approve any plans in April, as originally intended.

Planning for the fund paused between April and July 2014 while the government reviewed and revised the Fund’s scope and how the £1 billion pay-for-performance part of the fund would work.

In July 2014, the departments revised and improved the fund’s governance and programme management, requiring local areas to submit new plans in September 2014 for expected approval in late October.

However these changes to the fund reduced from 11 months to five months the time available for local areas to prepare for the implementation of the fund from April 2015.

The Local Government Association does not agree with the changes in the Fund’s scope. It has said that the revisions undermine the Fund’s core purpose as promoting locally led integrated care and reduce the resources available to protect social care and prevention initiatives.

Under the fund’s revised conditions, local areas were asked to aim for at least a 3.5% reduction in their total emergency admissions over 2014 levels. Expecting such reductions within one year is ambitious against a trend of rising emergency admissions and feedback from local areas suggesting that some areas will struggle to meet this target.

Local areas have proposed reductions of 3.1%.

Almost two-thirds of the revised plans were either approved by ministers or approved with support and only 5 plans were not approved. The biggest risk area identified is to the protection of social care services with 21 local areas assessed as having significant risks.

Amyas Morse, head of the National Audit Office, said: “The £1 billion financial savings assumption was ignored, the early programme management was inadequate, and the changes to the programme design undermined the timely delivery of local plans and local government’s confidence in the fund’s value.

“Ministers were right to pause and redesign the scheme in April this year when they realised it would not meet their expectations.

“The fund still contains bold assumptions about the financial savings expected in 2015-16 from reductions in emergency admissions. To offer value for money, the departments need to ensure more effective support to local areas, better joint working between health bodies and local government, and improved evidence on effectiveness.”

Make hospital trusts integrated care organisations

By Mike Broad - 24th September 2014 2:31 pm

Shadow health secretary Andy Burnham said the Labour Party would address the “ever-increasing hospitalisation” of older people by transforming all hospital trusts and NHS bodies into integrated care organisations.

Speaking at the party’s annual conference, Burnham said a Labour government would create a National Health and Care Service - with better social care “unlocking the money” and allowing more people to receive care in their homes and communities.

Terminally ill patients would have the right to free palliative care at home, he also announced.

Yesterday, Ed Miliband said he would inject £2.5bn into the NHS to pay for 20,000 more nurses, 8,000 more GPs, 5,000 more care workers and 3,000 midwives by 2020. This would be funded by a crackdown on corporate tax loopholes, a “mansion tax” and a levy on cigarette makers.

Burnham said: “It makes no sense to cut simple support in people’s homes only to spend thousands keeping them in hospital. We can’t afford it. It will break the NHS.”

As part of a shake-up of palliative care, he said patients would be given the right to die at home “where clinically possible”.

Up to 60,000 people on an “end of life register” could potentially be offered free care at home in their final few months, starting with those with substantial social care needs.

He also announced new rights for carers, including ring-fenced funding for a respite break, the right to an annual health check and assistance with parking charges.

Burnham re-iterated the party’s desire to repeal the Health and Social Care Act, and stop the ‘privatisation’ of the NHS.

The NHS would once again become the preferred provider of healthcare services.

He said: “The market is not the answer to 21st century health and care.

“People out there know a minimum wage, zero hours approach will never secure the care they want for their mum and dad.

“So our ten year plan for the NHS is founded on people before profits. We will free the NHS from Cameron’s market and, yes, repeal his toxic Health and Social Care Act.

“We will ask hospitals to collaborate once again and reinstate the NHS as our preferred provider.”

Health secretary Jeremy Hunt questioned why Burnham didn’t mention key NHS failures that happened under Labour - such as Mid Staffs - and suggested his 10-year plan represented another ‘top-down’ reorganisation.

Reaction to Miliband: “We need a meaningful plan”

By Mike Broad - 23rd September 2014 6:37 pm

Dr Chaand Nagpaul, Chair of the BMA’s GP Committee

“GPs care immensely about our patients, and feel dismayed by the constraints impacting on services and undermining our ability to do the best for them.

“The GP service is under unprecedented strain, and is unable to meet the needs of a growing ageing population and the increasing volume of care moving out of hospitals. GPs are working beyond their capacity, seeing a record 340 million patients every year, up by 40 million compared to 2008. Demand on GP services has far outstripped supply.

“A commitment of more GPs will be vital towards meeting the demands on general practice. However we must first address the challenge of getting more doctors to choose to become GPs at a time of falling recruitment and increasing numbers retiring early.

“The figures speak for themselves. A fall of 15% in the number of doctors training as GPs last year, and 451 training places unfilled. We need to address the root causes of this if there is to be any prospect of increasing GP numbers.

“We are already working with NHS England on the best way to create the right environment to make general practice an attractive and rewarding career and whoever is in government next year needs to make this a priority.

“With the NHS facing a perfect storm of rising demand and a £30bn funding shortfall, patients and the public need to see a detailed, meaningful plan from politicians on how they will create a sustainable infrastructure and capacity in general practice to deliver on current and future needs.”

NHS Confederation chief executive Rob Webster

“We will wait for the whole image to emerge when Labour set out their spending plans. It is vital, for example that investment in health services is matched with a settlement in social care that allows a similar, much needed transformation.

“This early and clear commitment is a sign that politicians have taken on board calls to address the challenges facing the NHS and social care. In the 2015 Challenge Manifesto, published earlier this month, the most influential coalition of health and care bodies called for adequate funding for the NHS so that services could be transformed to better meet 21st century needs. More of the same is not an option. So, we asked for longer term funding and a transition fund of at least £4 billion in new money spread over two years. Today’s announcement overlaps with these asks and begins a process by which we can engage in a real debate about the future of health and care.

“The very nature of health service delivery means that most NHS spending goes on staff costs – on nurses, GPs, speech therapists, midwives, oncologists, porters, cleaners and all the other professions that make up the NHS team. So it is right that money for service transformation is targeted at ensuring we have more staff with the right skills working in the right places. Often this is in the community, and includes GPs, community-based nurses, mental health specialists, and staff who can help people live more healthily, for longer, in their own homes.

“Linking transformation to staffing needs to be done in ways that will support local models and the numbers announced today should reflect local plans rather than a top-down allocation of posts.

“No matter how big the pot, a transition fund alone cannot and will not deliver the extent of change needed to tackle the challenges facing the NHS and social care. We need the next government to commit to making much faster progress towards implementing new payment mechanisms that support integrated, personalised care and reward good outcomes for patients, not just activity. And we need the stability which a 10-year funding settlement for health would offer, creating a framework for the kind of change which NHS leaders are chomping at the bit to deliver for patients and local communities.

“What we are missing, however, is a firm commitment from all political parties to ensure none of their proposals will impose yet another top-down structural re-organisation. It is vital that the health service has the stability to implement service changes that reflect local people’s needs and wishes, and take account of the local landscape.

“We have been very clear that the time for action is now. Ed Miliband has today made a powerful speech, which contains much promise. Once the applause from conference delegates has faded, it is vital that he and other politicians move swiftly from words to deeds.”