NAPC News 30 April 2012

NHS Liberation Will Not Be Overnight

In his first interview, chair of the NHS Commissioning Board said that running two systems was ‘very risky’ and that a long process of really hard work’ had begun.

The NHS should not expect a ‘sudden overnight change on 1 April next year to an autonomous and liberated system’, Malcolm Grant told HSJ.

Professor Grant said the Board had to create a ‘transformatively different’ reformed service at the same time as meeting the ‘challenge of trying to bring £20bn cost reductions through the NHS’, and maintaining performance.

He continued: ‘Running two systems in parallel is very risky.  We don’t want to lose any momentum on QIPP or any of the achievements the present system, while we bring in the new.  {The change} will not be overnight; it is not that suddenly the lights are going to go off on 1 April and a whole new sunlight will be turned on.  It’s going to be a long process of really hard work.’

The Board’s chief executive, Sir David Nicholson, has taken a rigorously controlled top-down approach to management of the new service, which he has described as ‘grip’ during the transitions.

Professor Grant indicated that he supported such an approach because of the need to make huge efficiency savings.  However, he claimed hte grip would loosen and the ability of leaders transferring from the current system to change their ‘behaviour’ was a ‘fundamental question’ for the new NHS.

He said: ‘We have a lot of the same people, but it doesn’t necessarily follow they {will} behave in the same way.  You cannot behave in the same way. The model is no longer capable of being one of top-down organisation.

‘If {the new system} is not different and transformatively different, then we are wasting our time’, he added.  But it will not be a sudden overnight change on 1 April next year.... We are dealing with human beings and human beings have habits.  The critical thing will be leadership and ensuring we have to the best team nationally, and also the strongest teams in our regional and local offices.

Mandate Will Be A Test Of Political Grip

The government must use its first ‘mandate’ to prove its ‘willingness to truly release a tight political grip from the NHS’, Malcolm Grant said.

The independent Board will take over full responsibility for the £80bn NHS commissioning budget next April.  The mandate, which the Department of Health will consult on this summer, will set out the service’s funding and describe what it should deliver during 2012/13 and probably several years beyond.

The Board is concerned the government will use the mandate to load the NHS with a large number of instructions and process requirements. 

Professor Grant expressed concern that such an approach would ‘undermine’ the government’s own objectives.  He commented: ‘We see the mandate as an early test of the integrity of the new structure and of the government’s willingness to truly release a tight political grip from the NHS.  My preference is much more for simply expressed and measurable outcomes as oppose dot complex inputs and processes.’

He warned against an inevitable tendency for everybody to wish to insert some reference to every medical condition and said the Board would have to pass on any such requirements ‘as part of the operating framework for the CCGs.  He also predicted ‘a lot of argument’ about the outcomes expected from the service.’

Professor Grant said to help protect the Board’s independence any attempt {by government} to influence any action would need to be done in a publicly visible and accountable way.

Drug Company Attacks NICE For Rejecting New Lupus Treatment

GlaxoSmithKline has launched an attack on the NHS’ drug rationing body, accusing it of preventing innovation after it failed to approve the first new medicine in ten years to treat the condition lupus.

GlaxoSmithKline was unusually critical of the decision by the National Institute for Health and Clinical Excellence, and also the Scottish Medicines Consortium, to reject its drug, belimumab, (brand name Benlysta).

EU Migrants To Get Free UK Healthcare

In a move that could cost taxpayers hundreds of millions of pounds, the Brussels-based European Commission insisted that immigrants from within the EU were entitled to stay and use the service indefinitely even if they do not pay UK taxes.

The Eurocrats ordered the British government to abolish the current rules stating that the unemployed EU citizens cannot stay in the country for more than three months unless they have their own health insurance.

Astra Chiefs In Surprise Exit As Sales Slump

AstraZeneca shareholders saw over £2.2bn wiped off the pharmaceutical group’s value as a boardroom shake-up following a period of investor unrest led to the abrupt departure of chief executive, David Brennan.

On a turbulent day for the £34bn company, AstraZeneca’s chairman, Louis Schweitzer, also said he would step down three months earlier than planned.  Pre-tax profits slumped 38pc to $2.1bn, sending Astra’s shares tumbling 174.5p, or 6.14pc, to £26.66.5p.

BMS Faces SEC Inquiry Over Sales Practices

US drug company, Bristol-Myers Squibb, revealed in a filing at the end of last week that the US Securities and Exchange Commission had launched an investigation into its sales and marketing practices in various countries.

Local Suppliers To Provide Most Data Support To CCGs

A leaked NHS Commissioning Board document suggests the majority of data ‘intelligence’ services supplied to clinical commissioning groups will have to be provided by local commissioning support units, rather than on a national scale.

High level business intelligence services will account for no more than 4 per cent of the total running cost of CCGs, the guidance indicates.  The document also says a standalone commissioning support service is being set up for communications and that a ‘free market’ approach will be taken to back office functions.

The document, published in early April, said business intelligence services should be priced at 50p-£1 per head of population.  This compares with the total CCG running cost allowance of £25 per hear.  It means that no more than £50m per year will be spent on ‘scale’ business intelligence function, or less than £230,000 per CCG per years, based on 220 CCGs.

The document defines business intelligence providers as ‘data management and integration centres that provide data validation, integration and storage’ and work to ‘cleanse, validate and link national and local data sets.’

Derek Felton, of Ernst and Young, which is working with the Department of Health on the development of commissioning support services, said: ‘Some things do not have economies of scale.  CCGs will need much more than data integration, they need very strong information analysis, but that needs to be done more locally.’

It is understood that the communications service is being led by Stephanie Hood, former South East Coast communications director, and is undergoing the same authorisation process as the 25 commissioning support services being set up by primary care trust clusters.

Like other commissioning support services, it will be hosted by the NHS Commissioning Board from April 2013 until no later than 2016, when it will become a standalone private or voluntary sector organisation.  The communications support service will also be able to enter into a commercial partnership or joint venture arrangements with a non-NHS body.

NHS commissioning support services have no choice but to use the national services if they wish to supply communications services to their CCGs.

The Board document stresses that commissioning support services wishing to provide services such as IT support, finance, human resources and payroll functions will have to meet private industry standards.

A Board spokeswoman said this was because there was ‘an existing large and mature market for business support services that many existing NHS organisations are already procuring their business support services from.’

111 Rush Leaves Staff In Limbo

NHS Direct staff in the North East still do not know whether they will be transferred to the new NHS 111 service due to go live in 12 months.

The North East’s 111 contract, the first to be awarded, saw NHS Direct lose out to a partnership between North East Ambulance Service and out of hours provider, Northern Doctors Urgent Care Ltd.

Differences between the two services mean NHS Direct staff are not covered by the Transfer of Undertakings (Protection of Employment) rules but the Department of Health agreed in October that Cabinet Office guidelines that protect terms and conditions should apply.  However, by then, the North East’s procurement process was already well advanced.  It had been advertised without reference to a requirement to take on staff.]