HSJ Live 21.08.2013 Health tourism 'a myth'

5pm Some interesting reader comments on Crispin Dowler’s report today that nine CCGs are forecasting deficits for 2013-14; many are focussed on the apparent impossibility of CCGs saying anything accurate about their financial outlook, given current circumstances.

One commenter writes: “Issues with allocation adjustments, specialist funding, provider info systems misattributing to wrong commissioners, contracts not signed and not being novated properly… It’s a huge shambles and I can’t believe we are [at the] end of August and every CCG must still be reporting a work of fiction despite best endeavours. My CCG is probably ok [give or take] £15m.”

Another anonymous reader posts: “Our main providers cannot produce reliable activity data yet [so] we don’t know whether we are OK… Plus there is the Specialist Commissioning debacle where we don’t yet know how much we will lose, depends on the whim of the NHSE.”

A third, apparently CCG-based, reader notes: “Interesting that Blackpool showed their spec comm deduction as a deficit. We didn’t on the assumption that the figure would be corrected in the autumn. Based on preliminary indications we should be OK but some CCGs are in line for a big hit.”

3.07pm Further to the 2.40pm entry on PCT QIPP performance, HSJ’s finance reporter Crispin Dowler notes that the DH claims in its annual report and accounts that the NHS made efficiency savings of £5bn this year.

2.53pm BBC Radio 4’s flagship Today programme picked up on our story about rising mortality rates among the elderly.

Click here to hear an excerpt from this morning’s show. Here’s HSJ chief reporter Dave West’s original story, and his follow up from a couple of weeks later when he found out that the report was being scrapped.

2.40pm HSJ’s efficiency reporter David Williams has been trying to find out how well primary care trusts did on the quality, innovation, productivity and prevention programme before they were abolished at the end of 2012-13.

Sadly it appears that, while information on PCTs QIPP performance probably does exist, the Department of Health isn’t completely sure where it is and says looking for it would take too long.

The DH responded to his Freedom of Information request thus: “As you may be aware, strategic health authorities (SHAs) and PCTs were legally abolished on 1 April 2013.

“It may help to explain that the PCT cluster QIPP reports went to the SHA clusters, and the department did not receive them directly.

“The department does now hold some SHA legacy information and the PCT cluster reports may be held within those legacy files.

“However, we estimate that the cost of complying with your request would exceed the appropriate limit as set out in section 12 of the FOI Act. The appropriate limit has been specified in regulations and for central government it is set at £600.

“This represents the estimated cost of one person spending 3.5 working days (or 24 hours) determining whether the department holds the information, and locating, retrieving and extracting the information.

“In order to determine whether the department holds the information you are seeking, we would need to search the archives for all 161 closed SHAs and PCTs. This would take one person more than 3.5 working days (or 24 hours) to determine whether the Department holds the information for each PCT, and locate, retrieve and extract the information that falls in scope.”

It’s interesting that the DH wasn’t sufficiently interested in PCT QIPP performance to gather the reports into one place where they could be easily referred to.

2.28pm Heart UK has spoken up in defence of the NHS Health Check programme, which has come under sustained criticism over the past couple of days (see 10.21am, below)

The cholesterol charity’s support for the programme puts it at loggerheads with the RCGP, whose chair Dr Clare Gerada branded them a “waste of time”. 

Chief executive Jules Payne said: “We believe NHS Health Checks are vital to ensure the long term health of the nation.

“To suggest that these vital checks are a waste of time is, quite frankly, ludicrous. They offer an opportunity to address risk factors for a host of conditions – including heart disease – before they become a problem and help people to better understand risk factors and how they can address them in part through diet and lifestyle measures.

“Tackling heart disease must be a priority for the NHS and local authorities, and Health Checks are a cost-effective and straightforward way of picking up risk factors for heart conditions before it is too late. The Health Check programme is under threat and is not being implemented uniformly across the country and action must be taken to ensure it continues to save lives and public money.”

1.27pm Figures from the Health and Social Care Information Centre show that the NHS lost 5,660 non clinical staff last year.

Between May 2012 and May 2013 the number of full time equivalent “NHS infrastructure support” staff fell to 181,291 - a drop of 5,660 or 3 per cent.

Manager numbers were down 6 per cent, or 1,503 FTE, with senior managers falling by 1.5 per cent, or 162 ful time posts.

“Central functions” fell by 3,686 FTE in the past year, a drop of 3.9 per cent. However “hotel, property and estates” staff numbers only dropped by 309 FTE, or 0.6 per cent.

12.33pm Nine clinical commissioning groups are planning overspends this year, reports HSJ’s finance reporter Crispin Dowler.

The number of new commissioners planning to overspend in 2013-14 is at least triple the number of primary care trusts that planned or recorded deficits in any of the three years up until the government’s NHS reforms took effect this April.

Find out which CCGs are already expecting to overspend in 2013-14 here.

11.51am Michael White writes this week about Dame Sally Davies, the chief medical officer who provoked tabloid outrage this week when she admitted to having eaten hash cookies when she was a student.

“She may regret her characteristic candour in the privacy of Radio 3, but she shouldn’t,” he writes.

“A baby boomer born in 1949, Davies is from a student generation that dabbled in drugs, even if Bill Clinton (b.1946) didn’t inhale. It’s the socially conservative tabloids that are out of step, pandering to readers’ fears.”

11.39am The Guardian’s Healthcare Network has an interview with NHS England’s director for patients and information, Tim Kelsey. “I think over the next five to 10 years – which is the sort of time period we are talking about for the £30bn deficit – I would be betting we will be targeting about half of that through savings generated by technology productivity,” he says.

Click here to read the whole thing.

11.26am The Financial Times reports this morning that the justice secretary has warned outsourcing giant Serco is in need of “corporate renewal” if it is to be considered for government contracts.

The paper quotes Chris Grayling as saying that both Serco and security group G4S “are going to have to go through a process of what I would describe as corporate renewal if they’re going to work with government in the future”.

It explains that Mr Grayling’s comments come after he last month announced that he was “referring G4S to the Serious Fraud Office and subjecting Serco to a forensic audit after it emerged that the contractors had billed the government for tracking the movements of offenders who had moved abroad, returned to prison or, in some cases, died”.

11.22am The Department of Health’s PRs aren’t happy with their former master’s tweeting (see 11.19am below).

The official DH media centre account replies: “Latest stats show 3,438 more clinical staff than May 2010. Full stats here http://bit.ly/16aOu47”.

Note they use the phrase “clinical staff”, not “nurses”.

11.19am Shadow health secretary Andy Burnham tweets: “Week after@HSJnews revealed Govt yet to take any action on Francis staffing recommendation, nurse job cuts under Cameron goes past 5k mark.”

He’s talking about Shaun Lintern’s story, here.

11.14am Health tourism in the UK is “a myth”, an international medical organisation has said today.

Doctors of the World UK has published its policy briefing in response to the public consultation on proposals to hinder access to NHS services for visitors and migrants by introducing charges and tighter tracking systems.

The body is the UK branch of Médecins du Monde.

Leigh Daynes, executive director of Doctors of the World UK said: “In our experience so-called ‘health tourism’ is a myth. Most patients at our London clinic have no knowledge or understanding about how to get care from a GP. The majority have come to this country to work, or to seek safety from persecution for political, religious, ethnic or sexual orientation reasons, not to get medical care.”

The organisation says losses associated with treating foreign nationals are around £12 million, or 0.01 per cent of the NHS budget, a figure “dwarfed” by the £16 billion contribution it says migrants make to the UK economy.

Restrictions would be costly to implement, and denying access to primary care means more people would be forced to access expensive emergency care.

“Restricting access to GPs is likely to cost the NHS more money,” said Mr Daynes. “Barring sick migrants from GP surgeries will result in many more admissions to A&E departments, which is costly. It is easier and cheaper to treat most illnesses early, and it has better health outcomes for individuals and communities.

“The current charging regime for overseas visitors should be made to work much harder.  Other patients who are considered ineligible for free care, such as students, should be insured.  But excluded and destitute migrants should be provided with the essential care they need, regardless of immigration status.”

Mr Daynes also argued that doctors “should not be forced to act as immigration officials”, as this could damage the “crucial” relationship of trust between them and their patients.

“Excluding undocumented migrants from care is an irrational misdiagnosis that will have serious unintended consequences on both the health of the nation and public purse.

“Political rhetoric about migration is unlikely to determine good health policy.”

Jeremy Hunt has made supposed “health tourism” a key area of focus this summer. Click here to read a short story setting out his policy intent, and here to read Michael White on the subject.

10.52am The Daily Mail reports today on research showing women whose maternity care is midwife-led are “more likely to have natural births without complications”.

It states that researchers from the School of Nursing and Midwifery at the National University of Ireland in Galway, Sheffield Hallam University and the University of Warwick found that “women under the care of the midwife needed fewer birth interventions than those under the care of consultants or GPs”.

10.51am Also in the Times today: dogs can warn people with diabetes when they are about to have a hypoglycaemic attack by sniffing out low blood sugar.

And, Adnan Sharif, a kidney consultant at the Queen Elizabeth Hospital, Birmingham, has said people should be able to jump the queue for a transplant if they are on the organ donar register.

10.32am Gloom from The Times this morning: “Health crisis ‘is looming’ for 2030”, according to one short piece on page 6.

Three quarters of adults in Britain are likely to suffer illness such as diabetes or heart disease by 2030, according to the Centre for Workforce intelligence. And, there will be a growing shortage of nurses.

10.21am Health checks for the over 40s have been dubbed a “waste of time”. Dr Clare Gerada, chair of the Royal College of GPs, said the government was promoting its NHS Health Check programme “against good evidence”.

Her intervention comes after The Times newspaper published a letter from Danish researchers criticising the programme. They said the health MOTs did not cut the chance of people dying.

10.13am New news on HSJ: A record number of requests have been made by hospitals and care homes to deprive people of their liberty.

There were 11,890 Deprivation of Liberty Safeguards (DOLS) requests made in England during 2012-13 - a 66 per cent rise on 2009-10, when the safeguards were introduced.

Last week MPs warned that DOLS are often used incorrectly. The Commons health committee warned of “confusion” around how to apply the safeguards, and described a “profoundly depressing” approach to their use.

10.06am In case you missed it yesterday: HSJ has now launched an app for Android tablet computers. Users can download it from the Google Play store.

The new app means Android users can access HSJ’s award-winning journalism on the move or save it to read offline. It contains every story from the most recent issue of the magazine, plus all the latest content from hsj.co.uk.

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10am New opinion on HSJ: A medical history of London’s hospitals. Geoffrey Rivett argues that by understanding the history of London’s hospital system, today’s healthcare leaders will help improve it.

8:40am: There has been an emphasis on developing leadership skills for all clinicians and managers in the NHS since Lord Darzi’s Next Stage Review in 2009 highlighted the importance of strong leadership at a local level to set standards for high quality personalised care.

Today on HSJ’s leadership channel, Ajay Belgaumkar and colleagues look at a structured programme for senior residents in leadership training that has created a new group of problem solvers across one trust.