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NAPC Bulletin 12 June 2012

News From NAPC

Dr Charles Alessi this week attended a meeting of the Future Forum, NHS Constitution Committee.  He also chaired on behalf of NHSCC, an Informed Customer Event in Leeds.

A meeting also took place with KPMG.

Other meetings took place with a range of companies offering products to CCGs.

What CSSs Will Learn Very Quickly

‘What CSSs will learn very quickly is that they need to develop an appealing commissioning support product and then create a marketing strategy to persuade CCGs to buy it’, according to Roger Hymas.

It sometimes just takes a spark, a seemingly trivial event, which changes lives, organisations, industries, even countries forever.  It’s not the snappiest of titles, but ‘Emerging NHS Clinical Commissioning Groups and Commissioning Support Services’, a survey recently carried out, could be one of them.  It’s just possible that we’ll look back on this document as one that helped re-define the NHS forever.

The irrefutable message to take from the research is that CCGs want choice in the support services they will use in the future.  They are saying they will not settle for the risk of just working with CSSs in whose geographical areas they are located.  They are open to offers from other CSSs, the private and voluntary sectors, as well as local authorities.  Some CCGs even say they will do some or all of it themselves.

Go to the bottom of page 33 and you see where they want commissioning to be different.  There was ‘notably lower confidence that [CSS] leadership would deliver commissioning support in a new, innovative way’.  They don’t want it the PCT way anymore.  They want CSSs to find inspirational solutions and show them how to use them.

With this extraordinary leap, the Department of Health has seen a declaration of customer power by CCGs.  This means we are going to have a market, because CCGs will demand choice.  From there, it is inevitable that traditional market behaviour will take over where the principal determinants will be, as they always are, quality and price.  CCGs will do what is done in most industries and start to source ‘product’.

As Theodore Levitt made the point in his Harvard Business review paper, ‘Differentiation of Anything’, ‘all goods and services can be differentiated and usually are.  Though the usual presumption is that this is true more of consumer goods than of industrial goods and services, the opposite is the actual case.  To the potential buyer, a product is a complex cluster of value satisfactions.  Products for people and organisations are problem-solving tools’.  This paper is still in print and although the language is quaint, for about £3 from Amazon, it is a starting point for CSS chief executives to develop their product strategy.

CCGs will need a comprehensive range of solutions.  Closest to the state of the art for commissioning support products is with the Third Party Administrators, who provide essentially a range of outsourced services to the US health plan industry.  TPAs continuously improve their products with a vigour that suggest they are in an arms race.  Every day they are competing against a range of like-minded organisations, who are out to increase their share of the US commissioners’ business.  Verisk Health is a good example, another is an organisation called GPA. 

The other place to look is, of course, the commissioners’ websites themselves.  There you will find a finely honed array of selling messages in what is one of the world’s largest and complex consumer markets.  A preference of Roger Hymas for a long time has been Group Health, followed by the mighty Kaiser Permanente and Geisinger.  He recommends these as they are all not-for –profit membership organisations, which keep them closer to the ethos of the NHS.  CCGs should in particular look at how they fashion their products and communicate them to consumers.  There is a considerable investment in personal health maintenance and self care.

As CSSs develop their products they should evaluate the strength of their offer across commissioning domains which have been laid out by the Department of Health.  Then, as the product inventory is carefully crafted, they should look at how they can draw on examples such as Verisk and GPA.  CSSs should then demonstrate how their differentiated product makes them the most appealing supplier.  And they must do it quickly.  Speed to the market will be critical because CCGs willneed to start making their choices of CSS very soon.

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Elderly Care Cuts Will Cost Us Dear

The elderly are being put at risk because of ‘dangerous’ cuts to home-based care, a charity warned yesterday.  And the cutback could actually end up costing the country billions because of the increased burden on health services, according to the British Red Cross.

Its survey of GPS and members of the public revealed older people were becoming more isolated, the number of falls and accidents was rising and there was a growing pressure on the NHS.

Watchdog Gets First Tip-Off Over New Drug

An experimental drug in development by GlaxoSmithKline line to treat anaemia could also be a race winner for athletes desperate to perform better by boosting the production of red blood cells.

Astra’s Positive Drugs Test

AstraZeneca has made progress with trials of its dapagliflozin diabetes treatment.  The US Food and Drug Administration had asked for more data on its effectiveness, which analysts  thought was due to concerns over liver toxicity, but on Sunday it announced results from a study that showed the drug ‘demonstrated significant reductions in blood sugar levels’.

The drug could be worth £323m in annual sales.

Atkins Diet ‘Heart Disease Risk’

Doctors have warned that the Atkins diet may be bad for the heart as the low carbohydrate regime is responsible for increased cholesterol levels.

The diet, almost free of carbohydrates such as bread, pasta, rice and potatoes can cause constipation, bad breath and kidney stones.

The link was uncovered by a 25 year study looking at diet and heart disease risk factors among 140,000 people in Sweden.  Professor Ingegerd Johansson, of the University of Gothenburg, who led the research, said: ‘While low-carbohydrate/high-fat diets may help short-term weight loss, these results demonstrate that long-term weight loss is not maintained and that this diet increases blood cholesterol, which has a major impact on risk of cardiovascular disease.

Aspirin Cuts Risk Of Kidney Failure After Heart Surgery

A new study by Jefferson Medical College in Philadelphia has shown that taking aspirin before heart surgery reduces the risk of acute kidney failure after the operation.

Acute renal failure or injury is a common complication after heart surgery and has a significant impact on patients’ survival.  However, taking aspirin within five days of the operation could almost halve the number of people who develop postoperative kidney failure.

In the study of 3,219 patients, 2,247 took aspirin before their operation, while 972 did not use the drug.  Eighty six patients, who took the aspirin, or 3.8 per cent, developed renal failure, while 65 of the 972 patients, who did not take aspirin, or 6.7 per cent, also developed the condition.

Thousands At Risk With Undiagnosed Diabetes

Almost one in 70 people is living with undiagnosed diabetes and runs the risk of ‘devastating’ complications, Diabetes UK has warned.

There are an estimated 850,000 cases of undiagnosed Type 2 diabetes in Britain, meaning about one in 74 people has it but does not know.  Previous research suggests it can go undiagnosed for up to ten years and that 50 per cent already had signs of complications by the time they were diagnosed.

Barbara Young, chief executive of Diabetes UK, said: ‘When you consider the potentially devastating consequences of type 2 diabetes, it is shocking that so many people have the condition and do not know it’.

Ten Year Low For Cervical Cancer Tests

Cervical cancer testing among women in England is at a 10 year low, with 20 per cent not being screened.

Although testing saves 5,000 lives each year in the UK, Jo’s Cervical Cancer Trust said many women think it is unnecessary or do not know the causes, symptoms, or how to prevent the disease.

Boys As Young As Six Getting Anorexia

Boys as young as six years old are being treated in hospital for anorexia, it has been revealed.  Some are so dangerously thin that they have been given life saving medication.

Between 2007 and 2011, 167 boys aged under 18 were given emergency treatment at hospitals or specialist units, according to figures from NHS trusts in England and Wales.

Legionnaires’ Cases Increase

The number of cases of Legionnaires’ disease has increased slightly.   Confirmed cases in Edinburgh had increased by one to 37 and the number of suspected cases to 45, also a rise of one.  On Sunday, 15 patients were in intensive care, and 26 on general wards.

Health officials probing the source of the outbreak, but Scottish Health Secretary, Nicola Sturgeon, indicated the worst could be over.