Andrew Lansley has started his work to shift what he sees as a 'top-down' responsive health service to one which is responsive first and foremost to the needs of patients. In his first speech as Health Secretary, Lansley's most significant proposal has been to give hospitals responsibility for patient care for 30 days after discharge and impose fines where patients are readmitted 'with a related problem' within this time frame.
Lansley is clear about his ambition to deliver health outcomes "as good as any in the world" and as promised he intends to "disempower the hierarchy and the bureaucracy". In its place will be 'patient- representative groups' who can influence quality standards and commissioning.
His ideas have been met with some mixed responses. The idea for fines may well switch the emphasis from target setting to patient-centric care, but questions have been raised over this approach, not least because some patients have complex conditions which do not immediately become apparent. It has also been suggested that such fines are still effectively an example of government imposing standards from on high. In addition this move could bring more pressure on the need for hospital beds at a time when finance is tight.
Cancer Research UK is set to launch a pilot scheme in autumn this year under which cancer patients will receive treatment designed to address the specific genetic mutations that cause their illness, rather than treatment based purely on where the cancer is in the body.
While the technique requires complex diagnostics, it is thought that the approach could be routine in five years time, offering better outcomes for patients and consequently reducing the expenditure required from the NHS since money will be targeted on treatment that clearly works. Genetically led diagnosis and treatment already exists in the USA where some 13 gene mutations are specifically traced and treated.
Already there are drugs available in the UK that target specific gene mutations, however because testing on these grounds within the NHS is patchy, the true effectiveness of such drugs has not been appreciated. Currently, even if a patient has their tumour analysed from a genetic perspective the tests are unlikely to go beyond searching for one or two mutations. Cancer Research UK's pilot scheme will see the introduction of six centres dedicated to the systematic analysis of tumour for known mutations. It is thought the scheme will deliver more personalised care for some 6,000 patients.
As may be expected by the introduction of new and sometimes radical ideas and policies, the coalition government's approach to the health service has already drawn criticism for creating conflicts of interest through the development of a new economic regular for the NHS.
Monitor, currently the independent regulator of the foundation trusts, seems set to take over the licensing of other health organisations from the Care Quality Commission. This expansion will mean becoming, in the words of Monitor's chairman Steve Bundred, a 'full-scale economic regulator' for the NHS, controlling who can work in the sector, setting the price the NHS pays for the provision of care, and taking the initiative in promoting competition in the sector.
It seems clear problems could arise for a single organisation charged with both setting the price foundations are paid for their work and ensuring those organisations succeed and thrive. Similarly, is it possible to truly promote competition if the organisation still has a responsibility to look after the foundation trusts?
Speaking to the Financial Times, Mr Bundred commented: “It may be that some of the issue needs to be addressed in the way the new organisation is structured and managed. It may be that some of it will be addressed through the legislation.
“There clearly needs to be a separation between the role in relation to foundation trusts and the role of promoting competition."
Research from the University of Washington, Seattle, suggests the UK
has the worst death rate among children under 5 of any other country in western Europe. While the mortality rate for these children has
fallen by three quarters in the last 40 years, it still stands at 5.3
per 1,000 children compared with 2.7 per 1,000, for example, in Sweden.
A number of factors have been cited for this result including unhealthy lifestyles, obesity among mothers, increased maternal age and even poor antenatal care. Child poverty is also seen as a big
factor in overall health, emphasising the ongoing need for early diagnosis and effective interventions wherever possible. The increase
in pre-term births has also had some impact on these figures - pre-term itself affected by increased multiple births and fertility treatments. That said, the UK's 33rd place is still better than the US where
deaths among under 5s stands at 6.7 per 1,000 giving the country a ranking of 42 in the world.
More positively, the researchers found child mortality rates had
improved on the whole around the globe. There were 12 countries recording mortality rates higher than 200 per 1,000 births in 1990
whereas this year no countries had rates that high. Immunisation programmes, malaria prevention and HIV interventions have all contributed to this improvement.
The NHS could generate additional funding from other countries and organisations using its knowledge and products, Health Secretary Andy Burnham announced today.
There is increasing demand from Governments and organisations abroad to share knowledge, provide services, or even replicate parts of the NHS. A new organisation – NHS Global – will help NHS organisations to make the most of the global opportunities on offer. The total global market for healthcare was around $4.1 trillion in 2007 and is growing at a significant rate – the NHS is home to world-class innovations that could benefit from a share in this market.
NHS Global will build on the success of organisations such as BBC Worldwide, which markets programmes abroad and invests money back into the BBC. Some NHS organisations are already sharing their expertise internationally, such as the NHS Institute and Moorfields Eye Hospital.
Health Secretary Andy Burnham said:
“A key part of responding to the economic challenge that the NHS faces will be realising the full potential of innovation, not only making effective use of our knowledge and skills at home, but also making money abroad that can be reinvested back into the NHS. So we will invite NHS staff to come forward with their suggestions for the NHS innovations which we could take to the world and in the coming months we will commence a consultation on these proposals.”
Professor Lord Darzi, UK Global Health and Life Sciences Ambassador, said:
“From my own experience I know that the NHS is home to some of the most exciting healthcare innovations in the world. There are new ideas and techniques being developed every day to provide our patients with an ever higher quality of care. There is significant international demand for NHS products and knowledge and it is important that NHS organisations are supported in making the most of this opportunity.
Full press release here
A rescue plan that promises to save the NHS £1 billion and realign the NHS IT programme to support health service reform, has been published by health think tank 2020health.org.
The report argues that getting NHS IT right is “critical” for a new government, but that it should resist clarion calls to scrap the late-running NHS IT programme.
It argues that new IT-enabled ways of working are essential to enable the NHS to meet ever-growing health demands, while also being able to achieve tough productivity targets.
Author John Cruickshank warns of a risk of “hiatus” for NHS IT after the election in May.
His report, 'Fixing NHS IT – an Action Plan for a New Government’ sets out what it describes as a “rescue plan” for NPfIT.
It urges that core parts of the national infrastructure should be retained - including the N3 network, PACS and the Electronic Prescription Service - but the Summary Care Record should be reviewed.
The report calls for “a radical reorientation and downsizing of the central IT organisation” to ensure it becomes more transparent and accountable to the NHS. It then calls for an accompanying strengthening of IT provision at the local level.
It adds that the delivery of the overall vision for the Care Records Service “remains at least five years away."
Instead, the approach it recommends is to accelerate the benefits from exploiting the new NHS infrastructure, while halting or redirecting failing parts of the programme.
In total 30 recommendations are made, all to be carried out within 12 months of a new government taking office.
Source, Jon Hoeksma e-health-insider 23rd March 2010
In a move to take an integrated approach to European Healthcare, the European Commission will unveil its model for e-Health in April 2010.
The model will provide secure, electronic access to patient summary records and e-prescriptions across all European healthcare systems, and is described as an "inspirational model" by Neelie Kroes, European Commission vice president.
During her address at an e-Health conference in Barcelona in March, Kroes emphasised the need to “work together to deliver tools for patients that prevent health problems and personalise their healthcare”.
The plan forms part of the European Patients Smart Open Services (epSOS) pilot, which allows patients to receive appropriate treatment in any EU member state.
The government’s roll out of the NHS electronic summary care record system is still the best way forward to help ‘protect the vulnerable, the sick and the old’ according to Gillian Braunold, Clinical Director for the NHS Summary Care Record Programme.
“In providing key information to emergency carers, the NHS's summary care record offers patients better protection”
In an article published on 12th March in the Guardian, Braunold states that the investment in this new technology ‘will enable information sharing to happen when patients receive unscheduled or emergency care’.
Braunold also highlighted that the benefits are starting to emerge in areas where the summary care record has already been piloted.
“Implementing new technologies in a complex NHS has many challenges, but we are beginning to see benefits emerging in areas where the summary care record was first piloted. GPs working out of hours are telling us they have increased confidence in their decisions. They feel able to change some of their prescribing decisions in the light of having access to up-to-date information about the patient.”
“Patients retain complete control over access to the electronic summary care record and anyone with concerns about having one can opt out. I want people to understand as much as possible about them, how they are used and their ability to view them via a secure website called HealthSpace. I welcome the current public debate that is helping raise awareness about the initiative and look forward to seeing more patients benefiting from their use.”
The Guardian full story
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