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NAPC News 27 February 2012

Ed Miliband is appealing to Liberal Democrat peers to rebel and vote against the Government’s NHS reform Bill, when it comes before the House of Lords.

The Health and Social Care Bill has become the most contentious item in the government legislative programme.  Liberal Democrats have tabled a series of amendments to the Bill for today’s debate, and Tim Farron, the party’s President, has urged that all new elements of competition within the NHS should be stripped out of the legislation.

Inertia Not Competition Undermine Reforms Say King’s Fund

The government’s critics maintain that competition will undermine the core values of the NHS to the detriment of patient care.  Some of these critics go further and claim that competition will result in the privatisation of much health care provision and the end of the NHS, as we know it.

History and the evidence suggest the need to treat these claims with caution, if not scepticism.  Ever since the Conservative government introduced the internal market reforms in the early 1990s,  opponents of choice and competition have warned that the future of the NHS is under threat, yet it is performing better today than ever before.  As Nick Timmins showed in a recent analysis for the Financial Times, the private sector’s share of the market for the elective care for the NHS patients has remained stable, giving the lie to the argument that widespread privatisation of provision is inevitable.

In the light of this kind of evidence, there is a much greater risk that inertia, rather than privatisation, will block the changes that are needed to address the Nicholson challenge and bring about improvements in the quality of care and patient safety.  Inertia is a result of the size and complexity of the NHS and the pressures facing staff to respond to the demands placed on them; it is often easier to live with the current situation than to seek ways of working differently and more effectively.

It is also a legacy of the command and control culture that often results in leaders waiting for permission to act, rather than seize the initiative to do so.  The Health and Social Care Bill and associated reforms risk reinforcing inertia because of the complexity of the relationships between the NHS Commissioning Board, clinical commissioning groups, health and wellbeing boards, clinical senates and clinical networks.  Unlike former health secretary, Alan Milburn, who warned that the reforms could lead to a car crash, in reality there is a much greater likelihood of a traffic jam as organisations negotiate how to make the changes happen.

To be sure, the NHS has shown in the past decade that it is capable of addressing long-standing weaknesses in access to car and quality, but it has done so at a time of unprecedented investment. For the foreseeable future, there will be no extra spending other than that needed to allow for inflation, and the challenge is, therefore, to do more with the same instead of more of the same.  Doing more with the same calls for a degree of innovation rarely seen before that is implemented at a pace that reflects the urgency facing the NHS in the most challenging period in its history.

Some of the innovations that are needed may come from the greater involvement of private and third-sector organisations able to bring different ways of delivering care to the table.  There is also an opportunity to learn from experience in other countries where new models of care have been established, unconstrained by the traditions that sometimes inhibit change in the West.

Much of the innovation that is needed will depend on NHS providers and commissioners showing the way by challenging established models of care and demonstrating how improvement can come ‘from within’.  To convince the sceptics who argue that the NHS is too big and lumbering to innovate, three things must happen.

First, NHS leaders must be ruthless in identifying and copying best practice wherever it exists.  After all, much innovation is really adaptation of ides initiated elsewhere, and shameless plagiarism is an underrated virtue.

Second, to be able to do this, leaders must create time to look outside their organisations, while also attending to operational imperatives. Experience of working with leaders over the years suggests that the most powerful learning often occurs through seeing how other organisations work and this should become a priority.

Third and perhaps most important, there is a need to invest in the training and development of staff to enable continuous improvements in the quality of patient care. High performing health care organisations such as Jonkoping County Council in Sweden and Intermountain Healthcare in Utah, US , do this systematically and are rightly admired for the results they achieve.

To return to the starting point, the most effective response to concerns that the core values of the NHS are under threat is to show that it can adapt rapidly to the challenging environment in which we live.  After, all if NHS organisations demonstrate that they can deliver high quality and responsive care, they have nothing to fear from a further dose of choice and competition.

Coalition In Talks To End Defeat Over NHS Reforms

Andrew Lansley faces a third defeat in Parliament this week over NHS reforms amid growing confidence among Lib Dem, Labour and crossbench peers that they will force through more changes.

Mr Lansley could be dealt a severe blow today, when the Royal College of Physicians holds an emergency meeting to discuss his proposals.  It will consider surveying its members on whether they accept or reject the Bill.

Mr Lansley has produced a briefing document for Conservative MPs that claims that the government will end up ‘in no man’s land’ and face chaos if the Health and Social Care Bill is dropped or drastically altered.

Treat Patients With Dignity Staff Told

Doctors and nurses are being instructed to treat patients with ‘dignity, kindness and compassion’ in new guidance issued by the National Institute for Health and Clinical Excellence (NICE).

NICE drew up its new quality standards and guidance after care, especially for elderly patients’ nutritional needs and privacy after these were criticised by the NHS Ombudsman, the Care Quality Commission, Age UK and the Patients’ Association.

Cancer Patients Have To See GPs Three Times Before Disease Detected

A Cambridge University-led study has suggested that up to a quarter of cancer sufferers have to see their GP three times before they are referred to a specialist.

One in 13 breast cancer sufferers and one in ten skin cancer patients had to visit their GP at least three times before referral.  Lung, stomach, colon and ovarian cancer patients were also ‘substantially’ more likely to have needed to make three or more visits to their GPs. 

The delays could prove critical for many patients, as the later the cancer is caught, the lower the chances are of making a full recovery.  However, GPs pointed out that they individually probably see one case or less of each particular type of cancer a year.

Many cancers, notably those of internal organs, also have symptoms very difficult to spot early on or are easily confused with more common, less serious conditions.

Scientists Map Genetic Code Of Breast Cancer

Researchers have confirmed that they have now ‘fully sequenced’ the DNA of the most common form of hereditary breast cancer, raising hopes for better diagnosis and treatment.

The team from the Breakthrough Breast Cancer Research Centre at the Institute of Cancer Research mapped the DNA of two breast cancers caused by a faulty BRCA 1 gene.

The researchers said the cases caused by the BRCA 1 gene are ‘usually aggressive’ and ‘do not benefit’ from targeted drugs such as Tamoxifen and Herceptin.

Professor Jorges Reis-Filho, who co-authored the study, said: ‘Our work shows that each tumour can look very differently genetically.  Now we understand this, we can start to identify the best treatment strategies to save more lives.

£700 Device To Help Detect Cancer

Scientists claim that they have created a disposable DNA sequencer that plugs into a computer like a memory stick.

Clive Brown, chief technology officer at Oxford Nanopore Technoloiges, which has developed the device said: ‘It’s not just the speed and cost that’s important, it’s the ease of use – it is dramatically simple than any other sequencer’.

The device will cost less than £700 and could one day be used in the home to help diagnose diseases such as cancer and heart diseases.

Transplant Breakthrough As Livers Kept Alive Outside Body

Scientists have created a machine, which can keep donor livers functioning outside the body.  The breakthrough, a British first, could save the lives of hundreds of people needing liver transplants every year,

The machine was developed by Organox, a company linked to Oxford University, which was set up by Professor Peter Friend, director of the Oxford Transplant Centre.

Livers taken from organ donors are currently packed in ice for up to 12 hours to prevent them from decay while they are transported, but this technique can affect the blood vessels and cause excess fat on the organ to solidify.

The new machine keeps the liver in a solution at body temperature and feeds it with blood, oxygen and nutrients.  The technique also allows doctors to monitor how well the organ functions and means livers can be stored for far longer, up to 24 hours, before being transplanted.