HEALTH AND SOCIAL CARE BILL : TUESDAY 11 OCTOBER 2011

“Moved By Earl Howe

That the Bill be read a second time.

The Parliamentary Under-Secretary of State, Department of Health (Earl Howe): My Lords, this is a Bill of profound importance for the quality and delivery of health and care in England, for patients and for all those who care for them. As such it has been, quite rightly, the subject of intense scrutiny, not only in another place, but also more widely. Indeed, the intensity of the spotlight directed at its content over the last few months is borne out by the number of your Lordships who wish to speak today and tomorrow. I look forward to the debate ahead of us.

In approaching this Bill, I believe it is instructive to look backwards to its roots as well as forward to what it seeks to achieve. In opposition, the two coalition parties asked themselves the same simple question: “How can we make the NHS better?”. In asking that question we were clear about several things. We were clear that the founding principles of the NHS-that it should be a comprehensive service, free at the point of use, regardless of ability to pay, and funded from general taxation-should remain sacrosanct. We were also clear that we should reject any system that discriminated between rich and poor. The NHS should aspire to the highest standards of service for all our citizens, but in seeking ways to make the health service better, it was necessary to identify the challenges that it faces. What are they?

The first, and most obvious, is rising demand for healthcare from a growing and ageing population and the increase in long-term conditions. The second is the rising expectations of patients about what should be on offer to them from a health service in the 21st century, including new drugs and technologies. The third is the financial challenge-the inexorably rising costs of providing services against an increasingly constrained budget.

Two key principles emerge from this analysis: the need for maximum efficiency in the way the health budget is spent; and the need to make the service patient-centred. For many years, politicians have spoken of the NHS as a patient-centred service, but how can a service be truly patient-centred if decisions about the treatments and pathways of care that are available to patients are taken at several removes from those who know best what the needs of patients are-namely, the patients themselves and the healthcare professionals who look after them?….”

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RCOG STATEMENT ON THE PM’s SPEECH ON THE LISTENING EXERCISE

“However, several key issues still remain.

These are:

In order for GP Commissioning Consortia to work, there needs to be a process involving service providers in the decision-making process since they have the front-line experience and knowledge of what services are needed in their respective specialties

There needs to be clearer explanation of the way in which competition in the NHS will work. While competition can be a spur to drive up quality and drive out inefficiencies, the extent of the private and charity sectors’ roles in the NHS need to be far better defined and delimited

There is real anxiety over workforce planning and the training and education of doctors in training, a critical factor in the future development of high-quality specialists. To be involved, ‘any qualified providers’ must provide training, subject to the same standards and conditions as NHS providers. These developments will have serious consequences on our medical workforce in the future.”

GOVERNMENT RESPONSE TO NHS FUTURE

My Black Cat is SCREECHING! Wonder why?

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GOVERNMENT RESPONSE TO NHS FUTURE FORUM

“The Government has announced that it accepts the core recommendations of the NHS Future Forum report and will make changes to its plans for modernisation of health and social care.

The key changes include:

Reaffirming that Ministers are accountable overall.

The original duty to promote a comprehensive health service will remain.”

My Black Cat is SCREECHING! Wonder why?

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BIG DATA :THE NEXT FRONTIER FOR INNOVATION, COMPETITION AND PRODUCTIVITY

Health Care Reforms : In the Witch Doctor’s opinion this document is very relevant to some of the thinking behind the proposed UK Health and Social Care Reforms. It was released this month by McKinsey Global Institute but it won’t let me cut and paste an extract. However, part of it covers US and global healthcare, and the perceived importance of data-mining of healthcare information to the economy. It makes an interesting read and illustrates one of the reasons why the WD does not think the “listening period” or Professor Steve Field’s comments in yesterday’s Guardian will result in an about turn.

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LETTER FROM DR CLARE GERADA, CHAIR OF COUNCIL, RCGP TO DAVID CAMERON”

“However we have a number of serious concerns and suggest the following recommendations:

1: COMPREHENSIVE HEALTH CARE
That the Bill should make it clear that the Secretary of State has a duty to provide, or secure provision, of a comprehensive health service throughout England.

2: CHARGING FOR HEALTH CARE
That commissioners or providers should not be able charge patients for health care services that are currently provided free by the NHS or are recommended by NICE.

3: ISSUES RELATING TO MARKET FORCES IN HEALTH CARE
That the Bill should place a duty on Monitor, the National Commissioning Board and GP Commissioning Consortia (GPCC) to enable collaboration to provide integrated services to meet patients needs without fear of a competition referral.

4: ISSUES RELATING TO EU COMPETITION
There needs to be clarity as to the legal implications of EU competition law (particularly when, and in what circumstances, it is enforceable) and other contractual and regulatory details.

5: ACCOUNTABILITY AND CONFLICTS OF INTEREST
Consortia must remain publicly accountable for all commissioning decisions, so that Board minutes and financial decisions are open to public scrutiny, including details of payments made to GPs or Practices for non-general medical services, including payments to private companies in which GPs have a financial interest.

6: RESOURCE ALLOCATION AND RISK POOLING
That there is clarity as soon as possible as to which allocation formula will be used for allocation to GP consortia for commissioning hospital care.

7: PRACTICE BOUNDARIES
The proposal to undermine the relationship between a local GP and local patients by abolishing practice boundaries is revised.

8: WORKFORCE AND TRAINING ISSUES
Given that the education and training proposals mark a revolution in medical education and could be harmful in primary care, we urge a careful and detailed reconsideration ahead of any implementation.

9: CONFIDENTIALITY
That there is as an absolute assurance that the Bill will not force doctors to breach their duty of confidentiality.”

THE GOVERNMENT’S HEALTH REFORMS : AN ANALYSIS OF THE NEED FOR CLARIFICATION AND CHANGE BY THE ROYAL COLLEGE OF GENERAL PRACTITIONERS

CONCLUSION

81. The future NHS must build on the strengths and values of today’s health service, in particular building on the strengths of general practice. The benefits of modern general practice are well documented, with significant evidence that a good relationship with a GP, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs.45

82. Irrespective of the outcome of these current reforms, the RCGP will continue to promote the development of high-quality, effective patient-centred care, with GPs at the heart of NHS service delivery.46

83. The RCGP recognises that the NHS needs reform and we would welcome the opportunity to work with the Government to further develop proposals to maximise benefits for patients

84. In the meantime we shall continue to offer leadership and guidance to members as they seek to deal with the consequences of the NHS reforms. We are engaging with our members to provide input to the Prime Minister’s Listening Exercise and will continue to develop further proposals for reforms of the NHS which place patients at the centre and promote family medicine. We shall also provide guidance, education and training opportunities, and through the RCGP Centre for Commissioning, shall ensure the sharing of good practice to assist GPs to develop the necessary skills to lead effective clinical primary care within the context of GP commissioning consortia.”

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HEALTH INVESTOR POWER FIFTY

“The Power Fifty is not a rich list. It is not about market capitalisation, or the number of contracts an organisation holds – it is about individuals. And more than anything it is about an individual’s power to influence the market, the power to shape the healthcare agenda of the day and the power to get things done. All of HealthInvestor’s Power Fifty have the same qualities in common – they have profile in the market and when they make decisions everyone is forced to sit up and take notice.

To make sure the Power Fifty is as relevant as possible, we’ve kept to a fairly strict set of guidelines when compiling the list. You’ll notice there are no public sector names. There are no representatives from the political class and there is absolutely no-one from the world of media or think-tanks. For us, the Power Fifty is all about the do-ers – those figures affecting real change in the sector. And looking at the list, it is clear that our readers feel the same way.”

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LIBERATING THE NHS: DEVELOPING THE HEALTHCARE WORKFORCE

“More than 1.4 million people work for the NHS in England and they are supported by many more people working in community care, in social care, and in public health services. They are the heart of healthcare in this country. Their skills, commitment, professionalism and dedication are key to improving the health outcomes of the nation.

The government is committed to delivering high quality care to the patients and public who depend on the NHS during periods of their lives. To fulfil this commitment, it is vital that every member of the healthcare workforce is supported by the highest possible standard of education and training.

Our investment in education and training is an investment in patient safety and improving healthcare outcomes.

Education and training are integral in ensuring the values and calibre of staff. They are also central to achieving the continuing development of the workforce, which is required as technology advances and opportunities for further improvement of the nation’s health develop.

It is central to our vision that the healthcare professions provide leadership in ensuring the quality of education and training – so that locally and nationally we can all be confident about the standards being achieved.

We must also ensure that healthcare providers have the right number of staff with the right skills to provide excellent standards of care both now – and for the future.
Following the reforms outlined in the White Paper Equity and Excellence: Liberating the NHS, we want to empower healthcare providers, with clinical and professional leadership, to plan and develop their own workforce. They know what services their patients and local communities require – and they know what staff they need to deliver excellent, responsive healthcare. Therefore they are best placed to commission the education and training that will achieve the right workforce. To do this they will need to work closely with education providers.

This consultation seeks your views on the changes needed to support the development of the healthcare workforce to enable equity and excellence in healthcare. We look forward to your responses.

Andrew Lansley

Secretary of State for Health”

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HOSPITAL BASED CARE : 10 MOST EXPENSIVE HOSPITAL STAYS

HealthLeaders magazine, March 16, 2011

HOSPITAL BASED CARE

“The 10 most expensive hospital stays by diagnosis in the United States accounted for close to 11.5 million discharges and were responsible for $117 billion in costs in 2008. And while the overall average length of stay in community hospitals has dropped by nearly 20% in the years from 1993 to 2008, the number of discharges during that time increased more than 16%. Here is a look at some trends in hospital-based care.”

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HUTTON REVIEW OF FAIR PAY IN THE PUBLIC SECTOR

“High quality public services require high calibre leaders to deliver them, especially in difficult fiscal conditions. A key challenge for Government is to maintain and improve the standard of public service leadership as the structures of public service delivery are reformed. Vital to this will be to ensure that public service leaders are adequately and fairly rewarded for their contributions, and that the public service ethos – that sense of mission and public duty that motivates many to work delivering public services – is maintained. This requires that a delicate balance be struck. If senior public servants are inadequately rewarded, it will be ever more difficult to attract and retain individuals of the calibre required. At the same time taxpayers are right to demand value for money from public resources, and an assurance that their money is not being wasted on excessive executive salaries. Without that assurance, trust in public services cannot be maintained.

Yet public understanding of both senior public service roles, and senior public service pay, is often very poor. A quarter of the public believe that public sector executives are currently paid more than their counterparts in private businesses, while in fact executive pay in large listed companies far outstrips that in even the largest and most complex of public bodies. The public also often have limited knowledge of what senior public servants actually do, so are not in a position to judge what level of reward is fair for these roles. Meanwhile the absence of a consistent framework of senior pay principles denies citizens reassurance that rewards are fairly matched to responsibilities and performance, and leaves a gap in which mistrust of public servants can grow.

The UK therefore needs a framework for fairness in senior public service pay. This framework should be based on the principle of fairness as due desert: reward should be proportional to the weight of each role and each individual’s performance; should be set according to a fair process; and should recognise that organisations’ success derives from the collective efforts of the whole workforce. This fairness framework will ensure that senior pay in public services is fair and seen to be fair, and will preserve the ability of public services to recruit talented individuals while reassuring the public that their tax money is not being unfairly creamed off by ‘fat cat’ public sector executives. This report presents the Fair Pay Review’s conclusions, and sets out twelve recommendations to the Government that together form the framework for fairness.”

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THE HAPPINESS CHALLENGE WORKBOOK

“About this workbook
This workbook is intended for you, so please write things which are a true reflection of how you feel. There are no right or wrong answers.

The Happiness Challenge was put together by Action for Happiness to support a BBC Breakfast feature on happiness. Action for Happiness is a charity which aims to encourage and enable the move to a happier society. Find out more and join the movement at www.actionforhappiness.org

The Happiness Challenge was developed in partnership with Headspace which specialises in teaching mindfulness meditation. You can find out more at www.getsomeheadspace.com”

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