A report on the future of the NHS: a rapid increase in the consumption of public money to provide worsening service?

Good Governance Institute | Published online: 29 September 2016

Image source: GGI

The Future of the National Health Service report presents the core arguments arising from the debate and explores recommendations and critical next steps required to safeguard the future sustainability of the health and care system.

The report analyses in some detail at the NHS in the midst of the most serious financial crisis since its inception and together with the wider care system, is experiencing the most austere era in its 68-year history. Both health and social care are facing a decade long funding squeeze which, it has been reported, will see spending as a share of GDP decrease leaving Britain behind many other advanced nations on this measure of spending. With an ageing population, a society in which the prevalence of long term medical conditions is ever increasing, the rising cost of care, a chronic underinvestment in social care and a reported cumulative 2015/16 provider deficit of £2.45 billion, the health system is teetering on the edge of a full blown crisis.

Read the full overview here

Read the full report here

A false economy: cuts to CPD funding for nursing, midwifery and the allied health professions

Council of Deans of Health | Published online September 2016

Image source: Council of Deans of Health

This report focuses on the impact of funding cuts across England to ongoing education and training for nurses, midwives and allied health professionals (AHPs) and the risks this poses to the NHS. With the constant evolution of treatments and technology, as well as rapidly changing roles for many healthcare staff, ongoing education and training is an essential foundation for safe, effective care. Health Education England (HEE), an arm’s length body of the Department of Health (DH), funds a measure of this education through Continued Professional Development (CPD) for the nurses, midwives and AHPs that make up more than 75% of the health professional workforce.

The funding supports the delivery of short courses, modules and programmes that meet the needs of the NHS workforce at national, regional and local levels. For 2016/17 this funding in England has been the subject of deep cuts of up to 45%, often without much warning and with little evidence of strategic planning at national level. Funding for postgraduate medical education has continued to be protected.

Although these cuts will adversely affect universities, the most significant impact will be on the NHS workforce and the NHS’s ability to meet its own strategic objectives. Given the profound changes that are expected to nursing, midwifery and AHP roles as demand for services grows and patient needs and service configurations change, this transformation is at risk without investment in education and training. CPD is also equally important for sustaining core NHS services, such as accident and emergency and intensive care, where specialist and advanced practice knowledge and skills are required for staff to be able to deliver safe, up to date care.

There is already evidence that the significant cuts to mentorship budgets are damaging mentorship training for NHS staff, which is central to the current strategy to expand preregistration programmes in the coming years. The Government’s strategic priorities and these funding decisions simply do not add up

Read the full report here

NHS Shared Planning Guidance

NHS Operational Planning and Contracting Guidance 2017 – 2019

NHS England and NHS Improvement have published this year’s operational and contracting planning guidance three months earlier than normal to help local organisations plan more strategically.

Image source: http://www.england.nhs.uk

For the first time, the planning guidance covers two financial years, to provide greater stability and support transformation. This is underpinned by a two-year tariff and two-year NHS Standard Contract.

It provides local NHS organisations with an update on the national priorities for 2017/18 and 2018/19, as well as updating on longer term financial challenges for local systems.

Key facts

  • The planning process has been built around Sustainable Transformation Plans so that the commitments and changes coming out of these plans translate fully into operational plans and contracts
  • The timetable has been brought forward to enable earlier agreement locally about contracts
  • Adjustments have been made to national levers such as tariff and CQUIN to support local systems in implementing service transformation
  • In line with our expectation of greater collaboration between organisations locally, there will be a single NHS England and NHS Improvement oversight process providing a unified interface with local organisations to ensure effective alignment of CCG and provider plans.

Long term conditions

NHS England has published The Long Term Conditions Year of Care Commissioning Programme Implementation Handbook.

Image source: http://www.nhsiq.nhs.uk/

The handbook is the main output of the Year of Care Commissioning Programme. It describes the experiences of five care economies working as part of the programme as they work towards developing capitated budgets for some patients and services.

A range of new posters are available showing how early implementer sites from the Long Term Conditions Year of Care Commissioning Programme are using their outputs from the programme to proactively support local service change decision making:

Sort film: Revolutionising person centred care for people with complex care needs

Is the NHS financially sustainable?

Latest updates from the Nuffield Trust

NHS Framework Documant 2008

The NHS is going through a decade of austerity, but demand for health care continues to rise. Clearly, the NHS needs more money in the short term, but what about the future?

This is the subject of a House of Lords inquiry into the sustainability of the health service up to 2030. New spending projections from the Office for Budget Responsibility estimate a rise in public spending to 8.8 per cent of GDP in 15 years. In analysis of the estimates, John Appleby argues that it will be possible to fully fund the NHS in the future. The bigger question is who will pay for it.

A digital NHS?

In recent years, the digital agenda in health care has been the subject of a number of promises and plans, ranging from the Secretary of State’s challenge to the NHS to ‘go paperless’ to the commitment set out in the NHS’s Five Year Forward View to ‘harness the information revolution’.
This briefing from The Kings Fund asks if expectations been set too high? And is there sufficient clarity about the funding available to achieve this vision?

The paper looks at the key commitments made and what we know about progress to date, grouped under three broad themes:

  • interoperable electronic health records
  • patient-focused digital technology
  • secondary use of data, transparency and consent.

It identifies barriers to further progress and opportunities for delivering on the digital agenda.


The NHS in 2016

The Royal College of Physicians (RCGP) has published Underfunded, underdoctored, and overstretched: The NHS in 2016.

Image source: http://www.rcplondon.ac.uk/

This report is the first of a series in the RCGP ‘Mission: Health’ campaign which will be focused on three major themes working for health, delivering health, and creating health.  In this report, the RCGP believes that the NHS needs a new plan for the future which is  designed to meet the UK’s health and care needs in the long term, and to value, support and motivate NHS staff.

Additional link: RCGP press release

Improving access to mental health services

Much remains to be done to secure urgently needed improvements in mental health services, the Public Accounts Committee says in its report.

Image source: http://www.publications.parliament.uk/

In a new report, the Committee concludes that while the Government has a “laudable ambition” to improve these services, “we are sceptical about whether this is affordable, or achievable without compromising other services”.

The Committee finds pressure on the NHS budget will make it very difficult to achieve ‘parity of esteem’ between mental and physical health. The report also finds commissioners and providers are not sufficiently incentivised to deliver high-quality mental health services for those who need them.

Full report: Improving access to mental health services

Report summary available here

Video: The global impact of dementia #WAM2016 | via @AlzDisInt

Alzheimer’s Disease International | Published online: September 2016

September is World Alzheimer’s Month, an international campaign to raise awareness and challenge stigma. It’s a time for action, a global movement united by its call for change, but also a time to reflect on the impact of dementia, a disease that will affect more and more people as the years pass.


Find out more here

Publication Bias and Nonreporting Found in Majority of Systematic Reviews and Meta-analyses in Anesthesiology Journals

Hedin, R. et al. (2016) Anesthesia & Analgesia. 123(4) pp.1018–1025

Background: Systematic reviews and meta-analyses are used by clinicians to derive treatment guidelines and make resource allocation decisions in anesthesiology. One cause for concern with such reviews is the possibility that results from unpublished trials are not represented in the review findings or data synthesis. This problem, known as publication bias, results when studies reporting statistically nonsignificant findings are left unpublished and, therefore, not included in meta-analyses when estimating a pooled treatment effect. In turn, publication bias may lead to skewed results with overestimated effect sizes. The primary objective of this study is to determine the extent to which evaluations for publication bias are conducted by systematic reviewers in highly ranked anesthesiology journals and which practices reviewers use to mitigate publication bias. The secondary objective of this study is to conduct publication bias analyses on the meta-analyses that did not perform these assessments and examine the adjusted pooled effect estimates after accounting for publication bias.

Methods: This study considered meta-analyses and systematic reviews from 5 peer-reviewed anesthesia journals from 2007 through 2015. A PubMed search was conducted, and full-text systematic reviews that fit inclusion criteria were downloaded and coded independently by 2 authors. Coding was then validated, and disagreements were settled by consensus. In total, 207 systematic reviews were included for analysis. In addition, publication bias evaluation was performed for 25 systematic reviews that did not do so originally. We used Egger regression, Duval and Tweedie trim and fill, and funnel plots for these analyses.

Results: Fifty-five percent (n = 114) of the reviews discussed publication bias, and 43% (n = 89) of the reviews evaluated publication bias. Funnel plots and Egger regression were the most common methods for evaluating publication bias. Publication bias was reported in 34 reviews (16%). Thirty-six of the 45 (80.0%) publication bias analyses indicated the presence of publication bias by trim and fill analysis, whereas Egger regression indicated publication bias in 23 of 45 (51.1%) analyses. The mean absolute percent difference between adjusted and observed point estimates was 15.5%, the median was 6.2%, and the range was 0% to 85.5%.

Conclusions: Many of these reviews reported following published guidelines such as PRISMA or MOOSE, yet only half appropriately addressed publication bias in their reviews. Compared with previous research, our study found fewer reviews assessing publication bias and greater likelihood of publication bias among reviews not performing these evaluations.

Read the abstract here