Media Centre

NAPC News 6 August 2012

Roger Hymas‘ Thought For The Day

Just imagine that London had won the right to hold the 2016 Olympics and not 2012. Would Danny Boyle have been allowed to include the twirling NHS bed scene in the Opening Ceremony? Or would the Lab/LibDem coalition (remember there will be a General Election in May 2015) have leant on the LOCOG to exclude it, as not being just as secure a part of the British way of life as it still seems today in 2012?

The NHS, universal access to free health care, will be the second most important issue for the next election after the state of the economy, as it always is. The two, of course, are intertwined: if GDP doesn’t grow, the funding of the NHS becomes less secure.

Organisations like the Institute for Fiscal Studies are already saying that the ‘Nicholson Challenge’ could be five or ten billion larger by the election. Jim Easton, NHS performance director, quite reasonably, is opining that the solution won’t come from trusts tinkering with a few hospital departments. It’s only fundamental structural change that will create the opportunity for tens of billions of savings.
The vision set out in the 2010 White Paper was, of course, for GP commissioners to lead the revolution. The NHS would be saved by an organisational change ‘so large that it would be visible from outer space’.

Nowadays, organisational re-structuring, even in the smallest enterprise has to go through an established and time consuming process which respects employment law and the rights of the individual. The size of the mission is much, much greater for the NHS as one of the world’s largest employers. I’m guessing that at least 100,000 NHS employees will have been directly affected by the reforms by the time they’re over. Each is, of course, a personal story affecting the individual and his or her family. At this truly personal level, it’s not unreasonable for Maslow’s hierarchy of needs to kick in. For the NHS employee, securing a new post to pay the mortgage becomes the critical issue, certainly much more important than working on this year’s Commissioning Intentions.

But this is exactly what’s happening across the NHS. Read the monthly board minutes for any commissioning organisation. They are full of OD, HR, structure governance and ‘macro’ finance reports. The impression you come to is that hardly anybody seems to be doing any real grass roots commissioning.

When will it start? My best guess is not before the end of this financial year. By then the regional appointments to the Commissioning Board will have worked their way through; SHAs and PCTs will have been finally disbanded and the CCGs and CSSs hopefully will be fully staffed.

Along the way, the impetus to create a commissioning-led NHS will have lost three whole years – 2010/11 with the White Paper; 2011/12 with the clustering of PCTs/SHAs and 2012/13 with the establishment of the NHSCB, CCGs and CSSs. I’ve not added in the learning time it takes for new organisations to become effective, but you could quite reasonably add another year, taking us well into 2014.

Spring 2013, with the new organisations finally in place is, of course, just two years from the next election. It might just be possible to twitch the nose of the NHS super tanker by May 2015. But, in the intervening period, waiting times will be up, Labour will be attacking the coalition over the NHS re-organisation and MPs in marginal seats will be blocking local hospital downsizing. I can’t remember who it was who said that it takes two parliamentary sessions (ie 10 years) to affect a sustainable change, but it certainly does. That’s why Lansley was so fast out of the blocks in 2010.

So is there any hope that things could be different? Here, for what they are worth, are my top five suggestions:

1. Get CCGs to build real impetus. Task them with the real commissioning agenda. Set simple goals. For example, start Commissioning Intentions in September (not November, or not at all as was the case for many PCTs last year). Secure small wins with care pathway improvement and include the views of practices as CCGs prepare for the 2013/14 contracting round.

2. CCGs have to re-engage with grass roots GPs, many of whom have been disillusioned by the way that former PCT staff seem to be intent on preserving the status quo, rather than driving revolutionary change. Remember it’s GPs who prescribe and refer, not PCTs or CCGs. Practices need to be fully onboard, otherwise the whole strategy will fail.

3. Turn the NHSCB regional staff into enablers rather than checkers. If the authorisation process becomes too rigid, GPs will be turned off. The NHSCB has got to be a supportive organisation, not a punishing one.

4. Look for ways to create incentives for performance achievement. Introduce mechanisms for highlighting differences in the attainment of goals. Reward the top performers. Use intelligent peer pressure on the others. In particular, watch out for treatment practice variation.

5. Maybe most importantly of all, get some ‘quantitative easing’ into NHS finances. The money has got to flow out of PCT clusters to deliver sustainable improvements at the front line. CCGs must invest in the necessary new commissioning systems. CSSs also have to deliver worthwhile support to help secure productivity gains. A symbiotic system is essential: cash starved private sector organisations who are ready to deliver the critical commissioning solutions have got to get some orders.

If I were the PM’s political advisor or in the Treasury, these would be the practical items at the top of my agenda as I tried to influence change at the DH. But, more importantly, now is the time for strategy to give way to execution. The Prime Minister, as he re-structures the Cabinet in September, might be tempted to bring in a real bruiser to be the next Health Secretary – the return of Ken Clarke, for example, to drive through real change. But expect instead someone more emollient, a politician who can put the best spin on how Conservatives (detached by then from the LibDems) will maintain the tradition of the NHS, come what may, and secure the promise of the Opening Ceremony’s dancing beds! Certainly those currently in power will hope those indelible images don’t come back to haunt them.

Mumps Cases Expected To Rise Among Students

The Joint Committee on Vaccination and Immunisation has warned that England is facing a surge in cases of mumps in coming year as children who did not have the vaccination in the wake of the MMR scare now go to university.

Two Treatments For ME And CFS Are Cost Effective

Two treatments that are known to be effective for patients with chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) also represent good value for money, according to UK scientists.

Researchers at King’s College London’s Institute of Psychiatry led the latest study, which confirmed that both cognitive behaviour therapy (CBT) and graded exercise therapy (GET) were cost effective approaches. However, a third intervention, adaptive pacing therapy, was not shown to be cost effective.

Professor Paul McCrone, director of the Institute’s Centre for the Economics of Mental and Physical Health, welcomed the findings and said there was a strong case for the NHS to invest in CBT and GET.

‘Our research suggests this investment would be justified in terms of improving quality of life for patients and could actually save costs to society if the impact on family members is taken into account,’ he commented.

The study, which is published in the journal, PLoS One, also involved Oxford University’s Professor Michael Sharpe, who said the treatment could be ‘cost saving to society.’

However, Dr Charles Shepherd, medical adviser to the ME Association, cast doubt over the findings. He claimed that they did not match the feedback they consistently received from people with ME and CFS, where CBT was often found to be ineffective; GET made the condition worse in around half, and pacing was by far the most effective and acceptable form of treatment.