NHS visitor and migrant cost recovery programme

Department of Health and Social Care | August 2018 | NHS visitor and migrant cost recovery programme

The Department of Health and Social Care  has released guidance and documents for NHS organisations and frontline staff .

Migrants, visitors and former residents of the UK must pay for their care when they’re in England. In April 2015, changes were made to the way the NHS charges overseas visitors for healthcare. This is so that the NHS does not lose out on income for services these people receive.

This collection includes guidance and a range of resources, including template letters and posters, to help NHS organisations manage overseas visitors and recover the costs of healthcare where appropriate (Source: Department of Health and Social Care).

Full details at Department of Health and Social Care

There is also a resource –Overseas Visitors NHS Cost Recovery Programme– available from E-Learning for Healthcare here

Calculating the cost of pollution

University of Oxford | June 2018 | Pollution from cars and vans costs £6billion per year in health damages

A new study reveals that the cost of traffic pollution is in all likelihood costing the NHS in excess of £6 billion a year. The study commissioned by Global Action Plan,  a collaboration between researchers from the Universities of Oxford and Bath,  found for the first time that the health impact costs of diesel cars are significantly higher than petrol, electric and hybrid vehicle.

The study’s findings indicate that the emissions for diesel vehicles are approximately 20 times more than electric vehicles and at least five times more than those associated with petrol vehicles.

Dr Alistair Hunt, Lecturer in Environmental Economics, University of Bath, said: ‘Our research for the first time illustrates the individual cost that each car and van has on the NHS and wider society. Every time these vehicles are driven, they are having a significant impact on our health, equivalent to £7,714 for an average inner London car over its lifetime.’

This is the first time a study has generated location-specific per vehicle costs calculated for cars and vans. The team used the  impact analysis, alongside pollutant emissions and miles driven to create a robust model of individual vehicle damage costs.  A report based on the study has been released, it shows the varying costs for cars and vans that use fuel types, and also shows the difference difference that comes from where the pollution is created. (Source: University of Oxford)

It can be downloaded here 

Clinical negligence in hospital trusts

The House of Commons Public Accounts Committee has published 5th Report Managing the costs of clinical negligence in hospital trusts.  The committee found that despite the spiralling costs for clinical negligence for trusts over the last decade, the government has been disappointingly slow and complacent in its response. The committee highlighted that there still seems to be a prevailing attitude of defensiveness in the NHS when things go wrong, and a reluctance to admit mistakes, which is likely to be leading to more clinical negligence claims.

Attitudes on cost-effectiveness and equity: viewpoints of medical professionals

The aim of this study is to determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making | BMJ Open


Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.

Full reference: Li, D.G. et al. (2017) Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals. BMJ Open 7:e017251.

Practical value in the NHS

The King’s Fund has previously highlighted the fact that addressing waste and variability in clinical work can create better value in the NHS. But what does value mean to people working in the NHS – and how it is being applied in practice? | The King’s Fund Blog


‘Value’ sounds like a familiar concept but it can mean different things to different people. One definition of value in the health and care sector is ‘health outcomes per dollar spent’, so attempts to increase value can look at either improving quality or reducing cost.

In early July we held a roundtable discussion with health service providers to better understand their approach to value improvement – initial research for a new project intended to understand the practical barriers and challenges that frontline clinical, operational and managerial leaders have encountered in pursuing better value health care. Experts who attended – including a chairman, chief executive, chief nurse, deputy chief operating officer, change leader, and representatives of national bodies – agreed that the emphasis should be on patient care. Clinicians are more likely to engage in a programme that revolves around the quality of services, and better care is typically less wasteful, so as one participant put it, ‘if you focus on quality, money will fall out’ [spending will reduce]. Consultants will often drive through successful programmes with change management teams, but we also discussed the role of junior doctors, nurses and therapists, who frequently witness low-value care and understand how to fix it. We know that substantial changes in practice can be delivered as we have seen, for example, in generic prescribing, reduced length of stay and the move towards day case surgery.

Read the full blog post here

NHS continuing healthcare funding

The National Audit Office has published Investigation into NHS continuing healthcare funding. This investigation sets out the facts relating to NHS continuing healthcare (CHC) funding and, in particular, access to CHC funding. It covers

  • Who is eligible for CHC funding and what the assessment process is
  • How long the assessment and decision-making process takes
  • Access to CHC funding
  • The cost of CHC to the NHS
  • Variation in access to CHC funding
  • Arrangements for reviewing access to CHC funding.

NHS Commissioning of Specialised Services

This Commons Library briefing paper looks at the commissioning of specialised services by the NHS in England, for patients with rare or complex conditions | House of Commons Library


How the commissioning process works is set out in further detail, as well as analysis of the financial management and transparency of specialised commissioning, and recent reforms introduced by NICE and NHS England, including reforms to the Cancer Drugs Fund.

The specialised commissioning budget for 2017/18 is £16.4 billion, 14.9% of the total NHS budget, and is set to rise to 15.8% by 2020/21 to reflect the increasing use of new treatments for previously untreatable conditions.

In its 2016 report, the National Audit Office (NAO) highlighted problems that NHS England had experienced in living within its budget. Some of the reasons for this included an underestimation of the budget required to effectively commission services when NHS England took over commissioning responsibility in 2013, as well as a lack of effective data on how services are commissioned on a regional basis, and problems with effective negotiation of prices with pharmaceutical companies.

This briefing paper looks in details at some of the issues highlighted by the NAO, and recent changes to the commissioning process that allow for a greater degree of cost control.