Six month review of the health service’s improvement organisations has finished, but may be subject to a further extended implementation phase, plus the rest of today’s news and comment

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2.50pm Here’s another one, this time courtesy of the Greens:

2.45pm Here’s an interesting note from the political parties’ health debate on the BBC’s daily politics show this afternoon:

2.07pm Professor Chris Ham and Nigel Edwards, chief executives of the King’s Fund and Nuffield Trust think tanks respectively, have written a joint letter to the Guardian stating that the NHS funding debate is in need of a “dose of realism”. Read the full letter here.

12.52pm Clinical commissioning group leaders and some NHS England officials are questioning a move by Jeremy Hunt to impose a ‘league table’ style points ranking for CCGs, well placed sources have told HSJ.

The health secretary’s proposals include using quality and performance indicators to create a “points” score for CCGs’ overall performance. The same approach would be used to rate CCGs’ performance on specific population categories, such as the “frail elderly” or people with mental health problems.

Mr Hunt has told NHS England the ratings should be used for its CCG assurance regime for 2015-16. They are also to be published on the public MyNHS website, which the health secretary has championed.

However, some staff in NHS England, along with CCG leaders, are opposed to and are questioning significant elements of the proposals, HSJ has learned.

12.50pm The Health and Safety Executive has been criticised for not intervening over the deaths of mothers and babies at the University Hospitals of Morecambe Bay Foundation Trust.

James Titcombe, whose son Joshua died at the trust in October 2008, has criticised what he called an “arbitrary policy decision” by the HSE not to bring prosecutions over poor care at the trust’s Furness General Hospital between 2004 and 2013.

However, he praised Cumbria Constabulary for its decision to investigate poor care at the trust. He said: “Without the police investigating, other families would not have come forward and the wider pieces of the jigsaw would never have been put together. We are very grateful to the police.”

12.48pm Government policies that support UK pharmaceutical science and enhance export income are costing the NHS millions and undermine the National Institute for Health and Care Excellence, a report has claimed.

In an essay published today by the Journal of the Royal Society of Medicine, health economists Professor Alan Maynard and Professor Karen Bloor describe an inflationary regulatory system that lacks accountability, is not evidence-based and subverts the efficiency of the technology appraisal work carried out by NICE, a target of pharmaceutical industry hostility since it was established in 1999.
Professors Maynard and Bloor, of the Department of Health Sciences at the University of York, point to the evaluation of end-of-life products such as cancer drugs. In 2009 NICE was instructed to increase the threshold of the cost-QALY ratio (where a QALY is one year of good quality life) for these drugs from £30,000.

Provided firms do not exceed regulated rates of return on historical capital set out in the Pharmaceutical Price Regulation Scheme agreements, they are free to set their own prices. Professor Maynard said: “This has added billions to NHS costs, partly because the cost-per-QALY threshold is relatively high, contentious and is not evidence-based.”
Also singled out for criticism is the Cancer Drugs Fund, which allocates £280m per year to non-NICE approved cancer drugs on a case-by-case basis.

Professor Maynard said: “The Coalition government renewed and increased the Cancer Drugs Fund to serve two political goals: the garnering of votes from public interest groups and the subsidisation of the pharmaceutical industry.

“This is an inefficient and inequitable scheme, not least because it discriminates against other diseases which may be equally in need of additional funding.”
To illustrate how policy may support the pharmaceutical industry at the expense of the NHS, the authors give an example of how switching patients with age-related macular degeneration from one drug to another very similar drug that is licensed for the treatment of colorectal cancer could save the NHS in England £100m each year.

However, licensing issues and the threat of legal challenges from the pharmaceutical industry is thwarting NHS commissioners seeking greater efficiency in the use of their constrained budgets.
Professor Maynard concludes: “Government continues to subvert the efficiency of technology appraisal work carried out by NICE in order to subsidise industry. Does this benefit the UK taxpayer and NHS patients? Or does government tacitly wish to tax the NHS with high pharmaceutical prices of sometimes inefficient drugs and, in so doing, increase the wealth of industry?”

10.54am The coalition government derailed a programme that aimed to save lives by reducing salt in food, The Guardian reports.

Health experts writing in the BMJ claimed that stripping the Food Standards Agency of its responsibility for nutrition in 2010 slowed progress in cutting premature deaths linked to high blood pressure.

The Guardian also carries an interview with shadow care minister Liz Kendall.

The Labour MP says she finds it “extremely frustrating” that much needed reform of the way the NHS operates has been largely absent from the health debate in the run up to the election.

She defended Labour’s decision not to guarantee the NHS the extra £8bn called for by the Forward View: “We aren’t going to try and con people by making a promise when we can’t show exactly how it’s funded.”

Ms Kendall also denied that Labour’s plans amounted to another top down reorganisation.

“There’s no way on God’s fair earth that it would amount to another reorganisation. I don’t believe that. It’s the job of government to say, ‘This is our vision – one point of service, one team – but how you deliver that locally is down to you’.”

10.52am The Times reports that fragmented families mean parents take children to emergency departments with worries that grandparents could have taken care of, according to the president of the Royal College of Paediatrics and Child Health.

Hilary Cass said increasing waiting times for GPs and a consumer culture that led people to expect 24/7 service had also contributed to growing pressures on A&Es and a 28 per cent rise in hospital admissions for children over the past decade.

10.25am Responding to the King’s Fund report ‘Workforce Planning In The NHS’, Danny Mortimer, chief executive of the NHS Employers organisation, said: “The Kings Fund report is a useful addition to current thinking on planning the NHS workforce. 

“Workforce planning doesn’t of course exist in isolation but is informed by clarity in service planning. It’s helpful that the new models of care - established by the Five Year Forward View - are currently being assessed for the benefit of patients. 

“It’s important that any future policies support the ability of local NHS organisations to deploy staff in the best way to support high quality and efficient patient care. This will allow them to build on the examples of innovation we see across the NHS.

“NHS Employers is working with organisations across the system to increase the supply of shortage groups and to support health care providers to retain and develop their existing workforce.” 

10.23am Commenting on The King’s Fund report, Workforce planning in the NHS, Saffron Cordery, director of policy and strategy at NHS Providers, said: “The NHS is one of the world’s largest employers and it treats a million patients every 36 hours.

“The cost and complexity of workforce planning on this scale cannot be underestimated. Today’s report is a welcome spotlight not only on the immediate workforce pressures but also on the long term structure to ensure that we have a service that is fit for purpose, and that can deliver the new and more integrated models of care outlined in the Five Year Forward View.

“Providers of NHS care have provided more and better care within tightening resources and they have a central role to play to deploy a suitably skilled, motivated workforce in the right numbers, to the right places, at the right times.

“Within the wider system of the Local Education and Training Boards and Health Education England, it’s important that the provider voice is heard in designing and determining the roles of the future because it is the clinicians and managers developing new models of care on the ground who have the best insight into current and future workforce needs on their patch.

“This means more of a joined up approach to managing the NHS workforce with changes at a national level to support NHS providers as they develop strategies locally and across health systems.

“The report’s focus on workforce planning experience within mental health, general practice and community nursing is key. As generalist roles develop in response to the increasing proportion of patients and service users with multiple needs, and the movement between specialisms, for example, emergency care and general practice or health and social care, NHS providers will have to adapt to more care delivered in the community and to the increasing use of new roles such as physicians assistants.

“We will continue to work with the national bodies to understand the nature of workforce pressures and what can be done to address them. We also look forward to contributing on behalf of our members to the issues raised in this report through the new Workforce Advisory Board chaired by Health Education England to ensure that NHS staff are fully supported in both the short and the long term”.

10.22am A King’s Fund report published this morning finds that “major disconnects” between health organisations’ strategic goals and workforce trends.

It reveals that:

  • The greater strategic priority given to mental health has not translated into staff numbers on the ground.
  • The rate of increase in the number of GPs has been dramatically outstripped by increases in the medical workforce in secondary care – a trend at odds with the ambition to deliver more care in the community. 
  • Despite long-standing ambitions to raise the level and range of community services provided, it is difficult to see any increases among key staff groups. Any such increases have been limited to areas with specific national targets.
  • The information needed to guide workforce planning locally and nationally has not kept pace with the growing plurality of providers delivering NHS-commissioned services. There are large data gaps on primary and community care, use of agency and bank staff, vacancy rates, and independent and voluntary sector providers.

7.00pm A six month review of the health service’s improvement organisations has finished, but may be subject to a further extended implementation phase, HSJ has learned.

The review of NHS improvement and leadership capacity, led by NHS England deputy chair Ed Smith, was launched in October on the back of the NHS Five Year Forward View.

Its final report has been sent to the chief executives of national NHS bodies in recent weeks but will not be published until at least after the general election, several senior sources have told HSJ.