NAPC News 27 January 2012

NAPC News 27 January 2012

Commissioning Board Warns Of 11 Key Risks

The NHS Commissioning Board has admitted that key risk to its success include the haemorrhaging of senior leaders during the reform transition and a shortage of staff to commission specialist and primary care.

The organisation has set out the 11 most significant risks in a document showing the first detailed proposals for its own design, structure and functions.  It was published today.

The document, Design of the NHS Commissioning Board, says one of the main risks to its ‘resilience’ will be trying to run its functions with ’50 per cent less resource by 2014/15.’

The paper highlights concern about whether the Board will have the ‘capacity’ for its largest direct commissioning tasks – specialised services, primary, dental, pharmacy and eye care services.

Under the NHS reforms, the Board will take over those functions, as well as overseeing the entire NHS commissioning budget and clinical commissioning groups’ performance from April 2013.

Other key risks include ‘potential loss of senior leaders, especially cluster CEOs’, ‘ensuring key posts are filled to support transition’ and [not] ‘giving staff greater clarity about the system architecture, HR options and process.’

Another key risk identified by the Board is that  it may face ‘differences with DH’ about the tasks the Board has to carry out with its £492m annual running cost budget, and ‘pressure’ to take on more.

Commissioning Board managing director, Bill McCarthy, speaking to HSJ, said the biggest risk was staff leaving because of uncertainty.  He went on to say that addressing the problem would be about giving them the right support, right help and as much clarity as early as possible about how they would find a place in the new system.

The document revealed the structure of the Board’s local office.  They will cover the same areas as the 44 PCT clusters outside London.  In the capital, more functions will be carried out by the regional, citywide ‘sector’ and there will be a yet to be announced number of ‘local operations teams’ below that.  It is understood that, so far, three teams are proposed for London.

The other regional sectors cover, the South, North and Midlands and East, matching strategic health authority clusters.  The sectors will have a total of just 200 staff – fewer than national and local levels – in what the document describes as an ‘hourglass model’.  The regional NHS, it is said, will be much smaller than at present.  Around 3,500 are currently employed in SHAs.

However, the document says the Board, in particular the regional sectors, will have a role in major service change.  It says the sector ‘medical and nursing leads’ will work closely with academic health science centres on major reconfigurations issues.

The document sets out how the Board will directly commission specialised services.  A single national director in the operations directorate will manage contracts.  There will be input from all directorates, for example clinical advice from medical and nursing, as well as contract guidance from the commissioning development directorate.

The Board wants some functions, including legal services, to be outsourced.  The document also indicates it will publish a ‘five to 10 year strategy to improve outcomes’.

NHS Urged To Create DNA Database

Patients’ DNA should be linked to their anonymised medical records and be made available for research and diagnosis, according to the Human Genomics Strategy Group.

Professor Sir John Bell, the leader of the Strategy Group, said that the NHS was unprepared for ‘ a step change in medical practice and public health’ triggered by the rapid development of gene technology.   He continued: ‘Many uses of genomics are set to enter the mainstream of clinical practices within the next three to five years’.

Roche Bids $5.7bn For Gene Business

Roche of Switzerland has made an offer for Illumina, an American gene technology specialist.

The $5.7 billion bid from the world’s largest maker of cancer drugs is an attempt to crack the market in gene sequencing, which can be used to model how a patient may react to treatment.

Roche said that combining with Illumina would accelerate the use of genome sequencing in diagnostics and provide a further push to genetics and genome research.  It said the offer was 64 per cent higher than Illumina’s share price before Christmas, when speculation about a deal first emerged. 

The offer came after Illumina’s directors had made clear that they were not interested.

Roche has begun a tender to see how many shareholders might be willing to take up an offe in the absence of a recommendation from the Illumina board.

Construction And Property

The Health Secretary, Andrew Lansley, announced plans for NHS Property Services Ltd, the government owned group, to take over property owned by primary care trusts and sell surplus land and buildings.

Hospitsl Give UP On £7.6m Debt Owed By Foreign Patients

Two major hospitals in the South East have been forced to abandon their pursuit of more than 90 per cent of debts owed by overseas patients.

Basildon and Thurrock General Hospital NHS Trust in Essex has written off 97 per cent of debts owed by patients from abroad. 

Newham University Hospital Trust in east London has been forced to disregard 96 per cent of money owed from overseas.

The total owed by foreign patients in the South East stands at £26 million, of which £18.4 million is still being actively pursued.

UK Lyme Disease Risk Much Greater Than Thought

Ticks carrying the bacteria responsible for Lyme disease are much more common in the UK than previously thought, according to a recent study.

Scientists at the University of Bristol asked vets across England, Scotland and Wales to examine dogs for ticks.

A total of 3,534 dogs were inspected between March and October 2009, 14.9 per cent of which were found to have ticks.

Analysis revealed that 2.3 per cent of these ticks were infected with the Borrelia burdorferi bacterium, which causes Lyme disease – a chronic infection that affects both dogs and humans.

Publishing their findings in their journal, Comparative Immunology, Microbiology and Infectious Diseases, the study authors concluded that 0.5 per cent of dogs carried infected ticks far higher than previous estimates.

Faith Smith, from the University’s School of Biological Sciences, said: ‘Lyme disease appears to be a rapidly growing problem in the UK, with important health and economic impacts in terms of loss of working hours and potential decrease in tourism in tick hotspots.

‘Without considerably better surveillance and routine diagnostic testing, Lyme disease is only likely to become more prevalent.’

The Health Protection Agency advises people to take preventative measures against tick bites, such as wearing long trousers tucked into sock when walking in tick infested areas.

Britons should also visit their GP if they develop a rash or other symptoms after sustaining a tick bite.

Women With Faulty BRCA Genes Are More Likely To Survive Ovarian Cancer

Women with ovarian cancer who have a faulty BRCA gene are much more likely to survive the disease than those without these gene faults, a study has found.

About ten per cent of women with epithelial ovarian cancer – the most common form of the disease – carry BRCA1 or BRCA2 faults or ‘mutations’.

Scientists at the University of Cambridge have now discovered that, despite having up to 40 per cent chance of developing ovarian cancer by the age of 70, women with faulty BRCA genes are more likely to survive the disease.

Their study, which is published in the Journal of the American Medical Association, combined the results of 26 international trials.

Analysis revealed that 44 per cent of women with BRCA1 faults and 52 per cent with BRCA2 faults were still alive five years after diagnosis, compared with just 36 per cent of women without BRCA faults.

Lead author, Dr Paul Pharoah, from the University of Cambridge, said: ‘Our results could change the way ovarian cancer is treated.

‘Women with BRCA faults respond better than we thought to current treatments, but it’s important that researchers now look at what treatment approaches work best for women without those genetic faults.’