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

stethoscope-562567_960_720

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.

Every £1 spent on public health in UK saves average of £14

Every £1.00 spent on public health returns an extra £14 on the original investment, according to a systematic review published in the Journal of Epidemiology & Community Health. | via OnMedica

tablet-254581_1920

Researchers identified 52 suitable studies published over four decades that had calculated a return on investment (ROI) for local and national public health initiatives and/or had worked out the overall value for money of a project or proposal—otherwise known as the cost-benefit ratio, (CBR).

Analysis of the data from these studies showed that the average ROI for a public health initiative was 14.3 for every unit cost spent on it, while the average CBR was 8.3.

When the overall impact of all 29 interventions was assessed, the ROI on local initiatives was 4.1, meaning that every £1 spent returns £4 plus the original £1 investment, while the average CBR was 10.3.  Even larger benefits accrued for national policies. Analysis of the data from these showed that the average ROI was 27.2 while the average CBR was 17.2.

The authors of the research warn that recent cuts made to public health budgets in the UK are therefore a “false economy” and are set to cost an already overstretched NHS and the wider economy “billions”.  They calculate that the recent £200 million cuts to public health funding in the UK will cost more like eight times as much – £1.6 billion.

Full reference: Masters R, Anwar E, Collins B, et al Return on investment of public health interventions: a systematic review Journal of Epidemiology and Community Health, published online first: 29 March 2017

Cuts to sexual health services are putting patients at risk, says King’s Fund

Cuts to sexual health services in parts of England are placing the care of patients at risk, a new report has warned | The BMJ

closed-1860909_960_720.jpg

The research by the healthcare think tank the King’s Fund concluded that budget cuts of more than 20% to genitourinary medicine (GUM) services in some parts of the country had led to service closures and staffing cuts that have harmed patient care. Experts said that the findings were particularly worrying given that numbers of diagnoses of sexually transmitted infections such as syphilis and gonorrhoea were rising.

Current pressures on services were also having a negative effect on staff morale and leading some staff to consider alternative careers, the report warned.

Problems identified in the Genitourinary medicine services:

  • Public health budgets were cut by £200m (6.7%) in 2015-16

  • Around a quarter of local authorities cut GUM spending by more than 20% between 2013-14 and 2015-16. Around one in seven increased spending by this amount

  • The commissioning of sexual health, reproductive health, and HIV services has been split between local authorities, CCGs, and NHS England, resulting in fragmentation

  • New attendances at clinics rose from 1.6 million in 2011 to over 2.1 million in 2015

“You give a blank sheet of paper to local government to do something really exciting, and then you take the money away”—consultant

Read the full article here

Read the original King’s Fund report here

Budget announcement is ‘good news’ for health and social care

Spring Budget 2017 | NHS Confederation

pounds-1680568_1920

Chancellor of the Exchequer Philip Hammond yesterday announced a series of measures to support better integration of health and social care. The move has been welcomed by the NHS Confederation as news that the government has ‘finally woken up’ to the struggles faced by hospitals and community services.

Yesterday’s announcements included:

  • an extra £2bn in funding for social care across the next three years, with £1bn available in the next year to allow local authorities to act now to commission new care packages. This funding will act as a bridge to the Better Care Fund, which becomes available towards the end of this parliament
  • a Green Paper to be published in the autumn setting out the options for the future funding of social care
  •  £100m investment to go towards accident and emergency departments in 2017-18 to help them prepare for winter and provide more on-site GP facilities
  • £325m investment in a small number of STPs that are ready ahead of schedule, to allow the plans to proceed
  • further investment where necessary for other STPs, with a further announcement in the Autumn Budget around a multi-year capital investment programme for the implementation of STPs across England

Related:

 

 

NHS protest: Tens of thousands march against ‘hospital cuts’

Tens of thousands of people – including NHS workers, campaigners and union representatives – have marched in London to protest against “yet more austerity” in the health service | BBC News

33224782896_1d01f96eeb_z

Image source: james o’hanlon – Flickr // CC BY-NC-ND 2.0

Protesters on the #OurNHS march wanted to draw attention to plans which could see hospital services in nearly two-thirds of England cut back. Union leaders say many NHS services “are on their knees”. The Department of Health says it is investing an extra £4bn in the NHS.

Organisers say that “at least 250,000” people took part in the march, which began in Tavistock Square and ended in Westminster, where speakers including Labour leader Jeremy Corbyn addressed the crowd.

Read the full news story here

Smoking cessation services face cuts

Smoking cessation services are being hit as cash-strapped local authorities and Clinical Commissioning Groups (CCGs) look to save money | OnMedica

cigarette-1271874_960_720.jpg

Evidence obtained under the Freedom of Information Act by The Observer reveals that an increasing number of CCGs have been instructing GPs to stop providing the services with many CCGs arguing it is no longer their responsibility as local authorities are now responsible for public health.

Local authorities hold a £2.8 billion ring-fenced public health budget but, as the grants have been pared back in other areas, councils have pulled their funding for stop smoking services.

Read the full article here

BBC analysis of STPs: Hospital cuts planned in most of England

Hospital services in nearly two-thirds of England could be cut or scaled back, BBC analysis of local plans shows.

scissors-1911562_960_720

The BBC analysis found:

  • Plans to reduce the number of hospital sites in Leicester, Leicestershire and Rutland from three to two
  • In the Black Country a £700m funding gap means one hospital may have to be closed
  • Maternity and children’s services being “centralised” on to one site in Lincolnshire
  • A warning in West Yorkshire and Harrogate that having five hyper-acute stroke services may “no longer be viable”
  • The downgrading of two out of three A&Es in Mid and South Essex, with only one retaining specialist emergency care
  • In South West London, proposals to reduce the number of major hospitals from five to four
  • Plans in Nottinghamshire to significantly downsize City Hospital and reduce the number of beds across Nottingham by 200
  • In Cambridgeshire and Peterborough, consideration being given to centralising specialised orthopaedic trauma services at two local hospitals

Overall, a third of the 44 plans look to reduce the number of hospitals providing emergency care, while in another third of areas they have said they will consider moving non-emergency care to fewer sites.

Read the full analysis here