Commentary: week ending 27 January 2012

Former health secretary Stephen Dorrell's Health Select Committee is unhappy with the scale and pace of health reform, particularly as it seems to be interfering with the 'more important' work surrounding the savings demanded under the Nicholson challenge. This is not the first time Mr Dorrell and current Health Secretary Andrew Lansley have locked horns. A year ago commentators were debating how long it would be before the committee's chairman would slip into Mr Lansley's seat on the front bench. And while all this is going on the forces of Health Bill opposition are massing in the form of virtually every clinician representative group at a summit to discuss their next move. Plus, the 'reforms are unnecessary' argument was echoed by more MPs this week when members of the All Party Parliamentary Group on primary care and public health came out against them. Occupying Richmond House right now must feel like manning the barricades of the Alamo.

Finally, the government has managed to produce the long-promised public health outcomes framework. And it had a little surprise in it, stumping up £5.2bn in funding rather than the £4bn suggested by many for the past year or so. Local authorities will get less than half of that, however, and when you divide it among all the councils it does not seem a very impressive figure at all — around £40 per person each year. That is about the cost of a slap-up fish supper, chocolate sundae, a few pints, couple of bags of pork scratchings and a pack of ciggies. The Local Government Association professes itself confused as to how the money will be apportioned but wants it done on the basis of who needs it most; an eminently sensible suggestion. One of the most important ideas of the health reforms, though hardly original, is to cut ill-health off at source and prevent it in the first place. That is what public health is all about. There is an old adage: £1 spent in primary care is worth £10 in secondary. So, can we expect more money to be channelled in the public health direction soon?

Commentary: week ending 20 January 2012

The Health and Social Care Bill may be coming to the end of its journey through Parliament but the row that surrounds it seems to be gaining pace. This week unions representing nurses and midwives decided to make official their opposition to the proposed legislation. They join the BMA and others. Health Secretary Andrew Lansley decided to put a sinister spin on it by claiming it was part of a ploy to pressure the government into rethinking its stance on pay and pensions. We will see what the nurses think about having their position interpreted as a cynical tactic to gain a few more quid in their pay packets.

Better monitoring and reporting of branded medicine supplies is needed, according to the British Association of Pharmaceutical Wholesalers. And pharmacy group Numark believes product quotas by drug manufacturers are being used as 'weapons of commercial protection'. Both these appeals came from submissions to an All-Party Pharmacy Group inquiry into medicines shortages. Change is in the air and pharma and pharmacy look like they need to prepare for it.

In other news, revised targets for healthcare associated infections have been announced; the government has stumped up £100m for emerging clinical commissioning groups to help them through winter demand pressures; and systems for cardiac rehabilitation need a shake-up, according to a heart charity.

Commentary: week ending 13 January 2012

It usually takes a major row, sometimes on a global scale, before regulatory bodies knuckle down to imposing stricter rules on how things are done. And it looks like the breast implants scandal is going to have very wide ramifications for the whole of the medtech industry. The Association of British Healthcare Industries has flagged up the fact that proposals for tightening up the way products are tested are already in the pipeline in Europe. But this latest case, of what the Lancet editor called 'astonishing regulatory failure', will inevitable quicken and broaden the process.

The NHS future forum has published another bunch of recommendations and the government has duly accepted them. It all seems a very smooth process. How much collaboration behind the scenes goes into what ideas are to be recommended and which ones the government will find acceptable we do not know. Most probably none. But nothing the future forum came up with is likely to challenge the government's ideas or its drive to implement them through the Health and Social Care Bill.

Two stories this week highlight ideas on the future of hospitals and the pros and cons of mergers. It is a problem likely to exercise the minds of managers, accountants and policy analysts for some time to come.

Commentary: week ending 6 January 2012

Almost half of hospital beds could be used for private patients, if an amendment to the Health and Social Care Bill is accepted. Understandably, this aroused quite a lot of controversy, particularly as it was slipped out during the Christmas holidays. Labour has dubbed it yet another move towards a US-style commercial health system. Defenders say it enables hospitals to generate much-needed funds that will help NHS patients. However, the original Bill placed no limit at all on how many beds could be used.

NHS Confederation chief executive Mike Farrar has reiterated his call to make the best of any changes or reconfigurations necessitated by the recession and the government's health reforms. For many years people like Mr Farrar have tried to point out that some hospital care is expensive in comparison to care at home — a point also made in a King's Fund report this week — and that not only could the NHS save money but care closer to home could improve patients' lives as well.

Continuing on the theme of reassessing the way things are done in the NHS, the government has again underlined its commitment to the introduction of more telehealth and telecare technology. The whole system demonstrator, that ended last year, concluded that innovation in this sphere produced benefits for patients and the service. In that light the extra few million promised by the government is very welcome, but perhaps the funding should be ramped up to match the expectations this technology excites.

Yet another of the controversial health reform policies took a step forward, or otherwise, this week, when pilots to investigate what would happen if GP practice boundaries are abolished were announced. They start in April and the government sees them as a way of liberating patients' choice of by whom and where they are treated. GP leaders have criticised the plans as liable to unbalance patient registers, particularly in areas where there are high volumes of commuters, and warned there is very little enthusiasm for the move among their colleagues.

Commentary: week ending 16 December 2011

The latest release of the Atlas of Variation has once again highlighted worrying differences in the quality of care around the English NHS. The information shows a 25-fold variation in the prescribing of anti-dementia drugs, differences in diabetes care and other anomalies. It also provides advice to commissioners and providers to reduce variation. This will, of course, prove invaluable to pharma and medtech companies, as will publication by the NHS Information Centre of GP practice prescribing data.

PCT allocations for 2012/13 will not thrill too many. They are pitched just 0.1 per cent above a forecast inflation figure for the year in question and forecasts are notoriously poor and could be subject to all kinds of effects in a times of economic confusion. A mere 0.2 per cent out and finance directors will be tearing their hair out.

The Public Accounts Committee has a gloomy assessment for the prospects of those hospitals yet to attain foundation trust status. Many of the 113 outstanding will probably not make it, according to a report. London is in a particularly bad way. Time is running out for trusts to get their plans and finances in order. Patients are set to lose out most if this does not happen with mergers or reconfigurations devastating access to local services and disrupting people's lives. Linked to this is a report from the King's Fund think-tank that claims the planned abolition of NHS London in 2013 will leave a 'strategic vacuum' in the capital.

In other news the Office of Fair Trading has decided to refer the private healthcare market to the Competition Commission to investigate whether or not their practices distort competition.

Commentary: week ending 2 December 2011

Cancer treatment and referral rates played a part in the government's criticisms of the NHS when it introduced its health reform agenda last year. Were its concerns justified? This week we heard from the Royal College of GPs that referrals on whole are dealt with in a speedy manner. Last month we heard from several sources that NHS performance matched or bettered the best in the world. There should be no complacency; but neither should there be extreme anxiety. And one of the main planks of the government's drive to reform would seem to bear little weight.

In the wake of the announcement of the operating framework last week Foundation Trust Network boss Sue Slipman claimed a 'perfect storm' could be heading the way of hospitals this winter as they attempt to cut costs, deal with inflationary pressures, improve efficiency and hope for the promise of government intervention if things get too far beyond them.

An upbeat message came from Sir Ian Carruthers, who is leading on NHS chief executive Sir David Nicholson's innovation review. At a medtech conference this week he said reform could be achieved if everyone put their minds to it. The trouble is that not everyone's mind is made up about it. An interesting point to note is that he said the review, due to be published on Monday, would recommend all National Institute for Health and Clinical Excellence technology assessments must be implemented or NHS organisations would need a very good reason why not.

And the government has announced that clinical practice data, to be provided by the NHS Information Centre, will supply 'industry, academics and other professionals with unequalled levels of information about the journeys of patients through the care system and the outcomes of different treatments'. This will prove extremely valuable to pharma and medtech in planning their relationship with commissioners.

Commentary: week ending 18 November 2011

How significant is shadow health secretary Andy Burnham's pledge to repeal the Health and Social Care Bill once/if Labour get into power? It is what a lot of Bill critics have been asking for and his announcement at the Royal College of Midwives annual conference could be seen as playing to the gallery. But then that seems to be the main occupation of any politician. His post-speech interview with the Guardian newspaper tempered the news. Labour would not introduce yet another giant reorganisation to bring the NHS back to what it was in May 2010. It would scrap market-based reforms and the 'most damaging aspects of [Health Secretary] Lansley's plan'. We are not yet half way through a full-term government. There is still plenty of time for things to change. Indeed, Mr Burnham has not given up on the battle to stop the Bill as it goes through the House of Lords now. But how will the clinical commissioning groups and private companies, busy preparing for the brave new world of Andrew Lansley's reforms, respond to Mr Burnham's challenge?

Mr Lansley has also caused a furore by refusing to publish a document that details potential risks of the health reforms. He said it would be 'misleading'. However, the information commissioner disagreed, saying disclosure served the public interest more than keeping the document's contents hidden.

Burnham and Lansley clashed more than once this week. The shadow health secretary jumped in with 'told you so' after the government said it would have to tackle the slip in waiting times since it took power — a problem rooted in the revision to the operating framework in summer of 2010 that told the NHS monitoring performance on some waiting times would cease. Andrew Lansley appeared indignant that the NHS should be so lax as to allow its standards to slip. But the situation is embarrassing for him personally, suggesting the problem is bad enough for him to have to take the flak for failing to treat it seriously in the first place.

Private healthcare company Circle is to take over the running of Hinchingbrooke Hospital in the New Year; the first non-NHS organisation to make such a deal. There are many conditions attached to the deal that curtail full-blown control over hiring and firing of staff. Nonetheless, the unions are unhappy and see it as the 'thin end of the wedge'. Others, such as the Royal College of Nursing are more sanguine. But what is the long-term future for such deals if Labour moves into Downing Street?