Wellards Academy Blog

Commentary: week ending 27 January 2012

2012-01-27T14:21:00.000Z

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

2012-01-20T14:43:00.000Z

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

2012-01-13T14:25:00.000Z

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

2012-01-06T14:50:00.002Z

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

2011-12-16T12:13:00.000Z

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

2011-12-05T09:34:00.002Z

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

2011-11-18T14:42:00.000Z

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?

Commentary: week ending 11 November 2011

2011-11-14T08:37:00.000Z

Pharma and medtech have always been told to provide more for less. It is the universal plaint of the customer. But at this week's Wellards Annual Conference the imperative was issued by the government's QIPP czar, who also informed a packed audience that its business model, founded as it is on a presumption of ever-growing healthcare expenditure, was 'broken'. He told delegates they must not sell pills and gadgets; they must sell better health for less money. It was not just innovation in products that was needed, but innovation in the way those products were sold — more focus on the customer's and the patient's needs within the framework of government policy. This mindset revolution is, of course, necessitated by the parlous state of the world economy. And if one of the other speakers at the conference, Dr Gordon Coutts, is right, it could take a lot longer than we all expect to drag ourselves out of the financial mire. So, the sooner those minds start changing, the better.

A curious case of doublethink afflicts the Health Secretary Andrew Lansley every time he hears good news about the NHS. Last year and this he attacked the health service for failing to measure up against other nations' systems. Yet when research appears, as it did this week with a glowing account by the US-based Commonwealth Fund, praising the NHS for being among the world's best he says 'that's great, but we could do better'. England and Wales have also been shown in a comparative study published in the British Journal of Cancer this week to have delivered significant improvements in cancer care. Of course we should not be complacent. Of course we can do better. Everybody can. But if we are among the best in the world then we must be doing something right under the system we have. Perhaps the present system only needed a rethink? Perhaps a healthcare revolution is not needed after all?

Friday 11 November at 9:30am site maintenance

2011-11-10T09:21:00.000Z

On Friday 11 November at 9:30am we'll be undergoing some maintenance on the website.

Although the site will still be accessible, it does mean that exams will be unavailable for a period of time in the morning.

We apologise for any inconvenience this may cause.

Commentary: week ending 28 October

2011-10-28T15:42:00.002+01:00

The Health and Social Care Bill looks set to pass into law in early 2012 after Liberal Democrat peers ended their wide-scale House of Lords opposition.

However, officials of the doctor's union the British Medical Association have continued to issue stern warnings about the need to change its provisions, including the urgent need to tighten up rules on conflict of interest.

A schedule for setting up the NHS Commissioning Board has been released by Department of Health officials - though naturally this depends on the Bill becoming law on time.

A new measure of hospital mortality published by the NHS Information Centre (NHSIC) has identified 14 hospital trusts where mortality rates are 'higher than expected'. Officials say that the indicators require 'careful interpretation', but it would be amazing if the NHSIC's mortality scores did not put cats among the pigeons in several areas.

Health economists led by Professor Karl Claxton of the York Centre for Health Economics have put forward what they believe is a robust methodology that drugs watchdogs at the National Institute for Health and Clinical Excellence could adopt as the basis for deciding whether particular treatments can be recommended for use on an 'only in research' basis.

The proposal, which has interesting implications for value-based pricing in pharmaceuticals is being considered as part of an update of NICE's methods expected this year.

Outcomes figures suggest that independent sector treatment centres may be providing better care for patients undergoing common surgical procedures, says the Royal College of Surgeons. However, the comparison may not stand scrutiny - the same analysis also showed that older and poorer patients are more often referred to NHS providers.

MPs on the Parliamentary Public Accounts Committee have complained bitterly about the hap-hazard way that some high tech equipment is purchased and managed by hospital trusts. The issue is particularly tense because about half of the most expensive scanning and linear accelerator machines in place are expected to require replacement in the next few years.

Things seem likely to change in this area following a DH pledge to publish data about the machines' usage by next year.

Some drug companies may have been fooled into thinking the Association of the British Pharmaceutical Industry Code of practice does not apply to new media such as the internet and mobile phones, a marketing conference heard this week. A series of cases are being considered by the Prescription Medicines Code of Practice Authority, said compliance expert Dr Rina Newton.

Some 11 new clinical areas are to be audited by the Healthcare Quality Improvement Partnership, bringing the total to 40 - is your area included? It might be useful to find out!

Commentary: week ending 14 October 2011

2011-10-14T17:00:00.000+01:00

All the hopes that opponents to the Health Bill invested in the House of Lords prior to this week's vote came to nothing as amendments that might have delayed its passage through Parliament, or even wounded it fatally, were swept aside. Perhaps that was to be expected. But it is surprising so little attention was paid to the many and varied petitions from respected bodies against the proposals as they are. Will they pass into legislation so smoothly over the next few months? Opponents, of course, have vowed to battle on.

Numerous reports on the pros and cons of choice and competition came out over the past week. Basically, some academics, and, of course, the government say they improve health services. Other, equally distinguished academics, say they do not and that they could actually be damaging. Might the truth lie somewhere in the middle? Who to believe between these competing views? You must exercise your power of choice.

The National Audit Office has identified at least 20 trusts out of 113 seeking foundation trust (FT) status that might not be financially or clinically viable in their current form. They are fighting against the clock to get their house in order as the deadline to become an FT looms ever closer. Options for failure, as we know, are merging with a successful FT or closure. Those that believe NHS efficiency demands fewer hospitals might welcome this outcome. But it is hardly likely to prove popular at a local level. Something politicians will be well aware of, especially as the deadline happens to coincide roughly with the run-up to the next general election.

Commentary: week ending 7 October 2011

2011-10-07T12:28:00.000+01:00

A scathing attack on the Health Bill from public health doctors and their colleagues this week captured many of the headlines. Proposals in the Bill would fragment the health service, instead of integrating it; destroy trust between patient and doctor; undermine medical ethics; waste money; weaken the NHS's capabilities; and cause 'irreparable harm', they say. It was a catalogue of potential catastrophes that chimes well with what many in the health service believe will happen over the next few years. In response, Health Secretary Andrew Lansley stood up at the Conservative Party conference and blithely repeated his view that the Bill was the only way to go. He has much to lose if his ideas are rejected. Does the country have much to lose if they are enacted?

Newspapers also latched onto the story from Yorkshire that a GP practice had written to patients telling them some 'minor' treatments would no longer be paid for by the NHS. At the same time they provided a list of centres where the treatments could be conducted - but at a price. And it just so happened that one of the organisations that provided treatment was owned by the practice. The Department of Health found this to be an inappropriate use of 'information provided by patients for the purposes of receiving NHS care'.

The DH's publication the Quarter gave information about six acute trusts that could end the year in the red. But it found that primary care trusts and strategic health authorities are forecasting a combined surplus of well over £1bn. And the government has released more information on its move towards personal health budgets. The budgets, which will allow patients direct control over spending on their healthcare, will be given to around 50,000 patients who are eligible for the NHS continuing healthcare initiative.

Wellards Industry Forum report

2011-10-07T10:51:00.002+01:00

Expert speakers generated valuable insights and lively debate at the Wellards Industry Forum on 15 September 2011, the King's Fund, London.

Get your two-page PDF report on the event

Commentary: week ending 30 September 2011

2011-09-30T16:12:00.002+01:00

NHS Confederation boss Mike Farrar says he wants political support in making 'tricky decisions' at a local level. The tricky decisions include closing hospitals, reducing the number of beds and making NHS staff redundant. He faces a fight. Few MPs and councillors will back decisions, however much they might agree with them, that would make re-election more difficult. It would take an MP of considerable moral fibre to face down a placard wielding electorate screaming for the local accident and emergency to be kept open.

Insulin manufacturers have responded to a report in BMJ Open that prescribers could have saved hundreds of millions of pounds by using human insulin rather than synthetic. They say human insulin is not appropriate for everyone and that synthetics offer great benefits.

And cancer researchers from King's College London have identified the cost of cancer care in the developed world as close to crisis. They say escalating costs must be countered with reduced use and more analysis of where savings can be made.

Commentary: Scottish news September

2011-09-29T14:43:00.000+01:00

This month saw strategies published for mental health and for ehealth. Labour called for an end to postcode prescribing, which it said still existed on new drugs, despite recommendations from the Scottish Medicines Consortium. Alcohol and public sector reform are among the Scottish Government's priorities as outlined in its programme for government.

Nursing numbers have dropped again - although the Health Secretary still says there will be no compulsory redundancies. And the draft budget was published, with more money for health; critics say it is not enough.

Commentary: Northern Ireland news September

2011-09-29T11:45:00.001+01:00

Health Minister Edwin Poots revealed his goals for the review of health and social care while public sector trade union Unison claims the reforms have a hidden privatisation agenda.

Belfast City Hospital's emergency department will close temporarily from November, after staff rallied to keep it open in October. And health workers are due to strike in protest at cuts.

Commentary: week ending 23 September 2011

2011-09-23T16:41:00.000+01:00

Potholes are appearing increasingly on the metaphorical road to health reform. A basic theme of the coalition government's plans is better information to drive quality improvement and yet the Audit Commission has discovered that data capture is not up to the job. High-profile commentator and former government primary care czar Professor David Colin-Thomé wants clinical commissioning groups (CCGs) to check up on GP referral patterns, presumably in an attempt to weed out 'underperforming' colleagues, or at least keep them in line — hardly a strategy to improve partnership, integration and mutual trust. A poll of emerging CCGs has exposed concern over what is expected of them in terms of size and budget. And there is the ongoing threat of opposition to the Health and Social Care Bill posed by Liberal Democrat peers as the Bill heads to the Lords — something highlighted by the King's Fund's Nigel Edwards when he addressed the Wellards Industry Forum last week. And the Foundation Trust Network is complaining that hospitals are being unfairly penalised for unavoidable readmissions under government rules.

Health Secretary Andrew Lansley's decision last year to cease performance managing the 18 weeks waiting times commitment seems rather naive — or perhaps the very opposite. Did he expect doctors and hospitals to strain every sinew to maintain the progress made over the previous few years after there were no incentives or penalties for doing so? If he did, he will be disappointed. There has been another decrease in meeting the targets, according to the latest figures.

In other news, the Nuffield Trust think-tank believes integrated care must be driven by passing on risks to healthcare providers. At the moment it says there are still incentives to focus on quantity of care, not quality. And figures suggest that while the improving access to psychological therapies programme is doing some good, there are still too few people exploiting its benefits.

Commentary: week ending 9 September 2011

2011-09-09T16:21:00.000+01:00

A rather muted couple of days debating the Health and Social Care Bill in Parliament ended in an expected vote in its favour – 316 votes to 251. It now goes to the House of Lords later in the autumn. If the trenchant criticism exhibited by the likes of Liberal Democrat peers such as Baroness Shirley Williams and Lord David Owen continues then the Bill still has many hurdles to clamber over before passing into law. Certainly, the BMA has promised continued opposition.

An interesting spat took place between the Prime Minister and the chair of the Royal College of GPs Dr Clare Gerada after David Cameron claimed her and other organisations supported the Bill. Not so, she said. But this has been a constant refrain over the last 18 months — the government says the health service is behind the reforms while health service representatives flatly deny this and back it up with polls showing overwhelming concern about the future of the NHS if the Bill is adopted. It seems the government has learnt many lessons from the Tony Blair Book of Spin.

A charity has claimed that the UK has the worst survival rates for pancreatic cancer in the world. Pancreatic Cancer UK says that in Britain only 3 per cent of patients diagnosed survive for five years and less than 20 per cent survive one year.

In other news: the Association of the British Pharmaceutical Industry wants more co-operation with the NHS in collating information on how drugs perform in real world situations — that is on the wards and in the homes of the drug takers; a former NHS chief executive has reiterated calls for more hospital closures in order to redirect resources to care closer to home; and a technology group has warned the NHS not to be seduced into adopting 'sexy' gadgets in its efforts to introduce innovation into its services.

Commentary: week ending 12 August 2011

2011-08-12T14:25:00.000+01:00

The issue of medicines waste and poor adherence to prescribing plans has rumbled on for years. The scale of the problem is highlighted this week by a report that suggests that jointly they lose the NHS £800m a year, half of which should be capable of being saved. Although less than some estimated in the past, this is a hefty sum and represents a significant proportion of the £4-5bn the government wants saved under the Nicholson challenge.

Following on from last week's news that Monitor found growing concern over foundation trusts' financial plans, this week we have a report from the Audit Commission that identifies financial weakness in NHS trusts' and primary care trusts' plans for the future. Scale and pace was a slogan when health reform critics were trying to get the government to change the Health and Social Care Bill. It seems the scale of the reforms, the pace of change, the demands of the quality, innovation, productivity and prevention challenge and the sheer complexity of much of what the government envisages could result in widespread financial damage to the fabric of the NHS.

GPs are unimpressed by the government's revision of plans to set up GP-led consortia. The idea now is to replace primary care trust with clinical commissioning groups that include non-GPs. A report from auditors KPMG found just over a third of GPs surveyed did not like the idea.

Commentary: week ending 5 August 2011

2011-08-05T11:26:00.000+01:00

The chronic obstructive pulmonary disease (COPD) quality standard published this week by the National Institute for Health and Clinical Excellence is the latest in what is supposed to be a very long list of standards intended to drive the quality agenda for the next five years or so. And it complements the national plan for COPD and asthma that was unveiled last month by the Department of Health. COPD treatment is one of the most pressing problems for the NHS, costly and resource-hungry. But it also represents a test case for the move towards care closer to home that sits at the heart of government health reforms.

Removing quality and outcomes framework (QOF) indicators for depression, as is recommended by an advisory body to the National Institute for Health and Clinical Excellence, seems rather self-defeating at a time of thrift and efficiency measures. Poor mental health is a huge drain on the public finances and depression is one of its commonest forms. Granted, if an indicator is not doing the right job it needs to be changed. But to leave GPs 'dis-incentivised' to tackle the problem, even if for only a year while other indicators are created, is rash. GPs may feel aggrieved that they are suspected of being driven by the pursuit of money rather than the common good but the QOF has proved successful in the past at focusing GPs' minds.

Bad omens for the future have emerged from a GPonline investigation into primary care trusts (PCTs) and their efficiency targets. Hardly have reform rumblings begun to register on the health service seismograph when it seems the majority of PCTs are missing the targets, storing up trouble - and debts - for the future when clinical commissioning groups take over. Couple this with Monitor's review of foundation trusts' plans for the coming year, which found growing fear of severe financial pressure, and the future looks less rosy and more a deep shade of red. At last year's Conservative Party conference an adviser to the Health Select Committee, Professor Nick Bosanquet, predicted financial disaster for the NHS in 2012. Is it all coming horribly true?

How can the government announce the first wave of local Healthwatch organisations when it has not yet sorted out how they will be funded? Last week on the Department of Health website a consultation document appeared on how to fund these bodies that are supposed to play a central role in local commissioning decisions and represent the voice of the people. The consultation was quickly withdrawn and a replacement will not be available until 15 of this month.

Commentary: week ending 29 July 2011

2011-08-01T09:20:00.002+01:00

Last week, with much fanfare, the government published its plans for the first wave of services under the any qualified provider model. It was fairly minor stuff but there are sayings we are all familiar with to do with wedges and thin ends. This week the Cooperation and Competition Panel produced a report warning that some commissioners (primary care trusts) have played less than nicely with the choice agenda and have been 'excessively constraining patients' ability to choose, and providers' ability to offer routine elective care services'. It fears 'there is a serious risk that unless practices that appear endemic among certain commissioners are addressed, the expected results from the policy of any willing provider... are not going to be realised to their full potential'. Of course, primary care trusts are on the way out. But who is to say the commissioning culture that most in the health service are familiar with will not live on?

MPs have flown off on holiday leaving behind a maelstrom of bad feeling over the health reforms. There has been little change in doctors' views of the reforms over the past few months — as resolutions by the BMA, and surveys by the Royal College of GPs and, curiously, the pension company Aviva, have highlighted — and the recommendations that came out of the NHS future forum listening exercise seem to have fallen way short of providing the tipping point in favour of government policy that Health Secretary Andrew Lansley must have been praying for even while being sniped at by retired Department of Health czars like Sir Roger Boyle. It all starts up again in September with another two days of debate — a period that hardly seems adequate considering the strength of feeling surrounding the issue.

Meanwhile, GPs are being asked to sign a petition against the reorganisation; the BMA has pledged to campaign publicly against them; and shadow health secretary John Healey is marshalling arguments ready for the next round of combat. All this and the Lords to come later in the year. As Bette Davis once remarked: 'Fasten your seat belts, it's going to be a bumpy ride.'

Commentary: week ending 22 July 2011

2011-07-22T15:06:00.000+01:00

The long-awaited outcomes strategy for chronic obstructive pulmonary disease (COPD) and asthma finally came out this week setting out six objectives to improve the way health services deal with these debilitating conditions. The Department of Health (DH) makes no bones about how costly COPD — the second most common cause of emergency admission to hospital — and asthma are and, in light of the savings demanded of the NHS over the next four years and general funding constraints, it is a resource pressure that must be dealt with. The government acknowledges that to implement its strategy effectively it must act at local and national levels and address the 'wider determinants of health'.

Promising a pricing system 'that gives clear signals about priority areas' the government has produced its response to the consultation on value-based pricing. But as our story this week shows, there are still many questions to ask on this controversial subject. How, for instance, will the system work? What is its definition of 'value'?

Another step on the long journey to implementation of the government's health reforms, particularly in regard to injecting more competition into the NHS, took place this week with the DH's plans to phase in a list of any qualified provider services from April next year. The government has advised that primary care clusters and others must engage in planning for this from October this year, a move that some might see as 'assuming the sale' seeing as the Health and Social Care Bill has yet to be accepted by Parliament. Nevertheless, interesting times for the industry, particularly medtech, as the short list of pilot services impacts on the use and supply of a range of medical devices.

Commentary: week ending 15 July 2011

2011-07-18T09:43:00.002+01:00

There is a sort of no-man's land between NHS providers and the Department of Health at the moment. The DH says efficiency savings must be made; the providers' finance directors say they will struggle to meet them. The King's Fund chief economist John Appleby reckons there are significant doubts that targets will be achieved. So what happens next? Will the government revise its plans? Unlikely. Can hospitals squeeze any more savings? According to them, unlikely. Impasse.

Unless you take into account the subject that just will not lie down: hospital beds. The government wants more care closer to home and even in the home as much as possible. Taking care out of hospitals saves money, it says, and by reducing the size of hospitals, the number of beds, staff, and concentrating specialist care in fewer, more dedicated centres you go a long way towards the £20bn savings over the next four years demanded by the Nicholson challenge. This was underlined this week by an All-Party Parliamentary Group (APPG) on Dementia report that said dementia patients could receive cheaper, more effective care in their own homes and by a Royal College of Obstetricians and Gynaecologists' document saying too many births were taking place in hospital.

All very well: but who among the political class will champion the closure of hospitals? How many MPs — including those on the APPG — would be willing to campaign to have local hospitals closed with all the emotion and loss of jobs and livelihoods, their own included that goes with that? Tricky one.

In other news, a report this week highlights the chaotic variations in lung cancer care around the country and the hyperactive King's Fund sets out the case for competition running successfully alongside integrated care.

Commentary: week ending 8 July 2011

2011-07-08T16:36:00.000+01:00

Ominous clouds of perpetual dissatisfaction gathered over Manchester this week. I am not just referring to the city's famous weather where the rain at times seemed to be intent on drilling holes in the pavement. These clouds were brought to you by the Department of Health's czar for improvement and efficiency, Jim Easton, and the chief executive of the Unipart Group John Neill at the NHS Confederation's annual conference.

Mr Neill told delegates all about the concept of kaizan. For those who do not know, kaizan is a concept originating in Japan and refers to a state of continuous improvement. Japanese business used it to create some of the most successful organisations in the world. Mr Neill applied it to Unipart and replicated the success. Now he believes it can be adopted by the NHS. But, he warned, it is not easy.

Mr Easton told his audience he saw no credible or defensible argument against the quality, innovation, productivity and prevention (QIPP) agenda that he is in charge of and that NHS managers must get on with implementing change and incremental improvements in efficiency. This sounds very much like kaizan: does this mean the health service can look forward to a never-ending demand for continuous improvement for the long term. The future of the NHS rests upon whether this enthuses or dismays its staff?

Pharma and medtech companies are no strangers to this world of constant change and may find the environment more comfortable than the traditional Whitehallian approach. Certainly their services should be in higher demand as the quest for innovation and joint working accelerates.

Transparency

The comparative clinical outcomes data to be published by the government will be invaluable to the industry in their efforts to tailor services and create value for customers. The move, part of the government's commitment to make the NHS the most transparent health service in the world, will provide information on clinical achievements and prescribing data by individual GP practices, the performance of hospital teams in treating lung cancer and other healthcare conditions.

Wellards site relaunch: Monday 4 July 2011

2011-06-29T12:58:00.003+01:00

We are currently working on the final stages of a redesign on Wellards.co.uk.

From Monday 4 July the site will have a fresh new look making it easier to navigate. The content will also be clearer and easier to understand, grouped into topics with related resources placed on the relevant page.

The changes mean that the site will be unavailable on Monday 4 July from 9am. We anticipate it will be available in the afternoon.

We apologise for any inconvenience this causes.

Commentary: week ending 24 June 2011

2011-06-24T14:02:00.000+01:00

An interesting dichotomy in GP views on the health reforms cropped up this week. Dr Michael Dixon, chairman of the NHS Alliance, was once again aggressive in his advocacy for more GP autonomy for decision-making on commissioning and leadership of the reforms. He fears GP commissioning could be defunct before it has even started because of the government's acceptance of NHS future forum recommendations last week. His position has been consistent from the beginning and it was little surprise that he would express disappointment at what he sees as a dilution of GP influence. In contrast, results of a survey published this week suggest many GPs lack confidence in their commissioning roles and NHS staff have a pessimistic view for the future of the institution for which they work.

Commentators worry about a two-tier commissioning process, where some clinical commissioning groups are ready to start far in advance of others. But the more worrying separation is between those who are desperate to lead and those who either do not believe in the process or have no confidence in their competence to do it, especially as the government has said GPs will not be allowed to offload responsibility for commissioning decisions onto private companies.

On the subject of GP fears over aspects of the Health and Social Care Bill, many will welcome the decision to give the National Institute for Health and Clinical Excellence (NICE) back its responsibility for recommending drugs to be used by the NHS. GPs were worried the decision as to which drugs could be used would be down to them, and could potentially poison the relationship between them and their patients, who would be angry if they did not get the drugs they wanted. NICE has been reinstated as the Aunt Sally for this purpose.

Commentary: week ending 17 June 2011

2011-06-17T12:03:00.000+01:00

Fierce critics of Health Secretary Andrew Lansley's Health and Social Care Bill were partially placated this week when the government accepted a long list of revisions from the NHS future forum. These will now go back to a public bill committee for scrutiny. Spokesmen and women from the BMA, Royal College for GPs and all the other usual suspects hedged their bets with 'this looks like the right direction but we have to wait for the details'. Those representing private enterprise, however, were less than pleased. David Worskett, of the NHS Partners Network, claimed the outcome had 'set back by several years' reformation of the provider side of the NHS – a statement that might be greeted with cheers by some and groans by others. Doctors' leaders have also started to question the proposed composition of clinical commissioning group's boards and what is going to happen to practice boundaries.

The question that must be at the back of many people's minds is: will the future forum report and the government's compliance put an end to Health Secretary Andrew Lansley's misery over his troubled legislation? Or will it simply lead to him being put out of his misery? Will the protests die down or, once interested parties have had a chance to peruse the changes closely, will new concerns surface? We must wait and see what the rewritten Bill looks like.

The NHS is moving closer to making its procurement processes more efficient with a plan to introduce bar coding systems, making it easier to track, break down and compare costs within the service. It is part of the Department of Health's measures to rationalise and standardise the way the NHS spends money.

Calls for nurses to receive more advanced training as the health service moves to more care closer to home as part of its bid to save £20bn over the next four years suggests an opportunity for pharma and medtech to refocus its marketing efforts. Nurses are already a growing market in the context of independent and supplementary prescribing, and as a consequence of government plans under the transforming community services agenda.

Payment by results: updated course

2011-06-15T16:34:00.000+01:00

Payment by results

A thorough grounding in the complex subject of payment by results (PBR) will provide a good advantage for pharma and medtech representatives in their negotiations with customers.

Wellards has produced an updated course, comprising two papers and an exam, describing what PBR is and its implications for pharma and medtech as well as customers.

PBR is the name for the way money flows through the NHS in England from commissioners to providers. It has been in operation since 2004 and was introduced gradually to reduce the risk of financial destabilisation.

Log on to wellards.co.uk for the payment by results course.

Understanding the Irish Pharmaceutical Healthcare Association (IPHA) Code

2011-06-13T16:21:00.000+01:00

Wellards is pleased to announce the launch of two courses on the Code of Practice of the Irish Pharmaceutical Healthcare Association (IPHA).

Understanding the IPHA Code 2011 (sales), looks at the scope of the code, methods of promotion, product authorisation, promotion at exhibitions and symposia, the nature and availability of information, claims and comparisons, disparaging references, distribution of promotional material, pharmaceutical company employees, samples, gifts, grants and other forms of support, use of consultants, and non-interventional studies.

Understanding the IPHA Code 2011: meetings, examines correct practice when providing hospitality and sponsorship: what industry can provide, location, smaller and larger meetings, international events and corporate hospitality.

These courses are ideal for sales staff who have to abide by the principles of the code in the field, or for those in head office roles seeking to disseminate training on code compliance in Ireland.

Both modules are accompanied by a online exam and are available to all subscribers to wellards.co.uk.

Commentary: week ending 10 June 2011

2011-06-10T11:20:00.000+01:00

Prime Minister David Cameron is probably hoping his intervention this week on changes to the Health Bill will ease pressure on his beleaguered Health Secretary Andrew Lansley. But what concessions has Mr Cameron actually made? He will not drop the move to greater competition in the NHS; the economic regulator Monitor, promoter of competition, will just be lumbered with an extra responsibility of encouraging integration. How it will reconcile those two duties is yet to be confirmed and will need some dainty footwork by whoever re-writes the Bill. GP consortia will be given a more flexible timetable for setting themselves up. But presumably there will have to be a deadline of some sort, or some GPs might not see the necessity of joining or creating consortia at all. Details on 'clinical senates', how they are constituted, their governance and accountability are yet to be described. Apart from these gobbets, the speech contained little new. The PM used it as an opportunity to reaffirm what has already been said on countless occasions. We must wait and see if the report generated by the listening exercise, which is due next week, has any more for us.

The use of 'chemical cosh' antipsychotics has once again come under the spotlight. The Dementia Action Alliance has called for all patients receiving the drugs to get a clinical review. It hopes this will lead to those patients for whom the drugs could be dangerous or for whom alternative treatments would be more effective being spared the potentially fatal effects. A Department of Health report in 2009 claimed over-use of antipsychotics accounted for 1,800 deaths and more than 1,600 strokes each year.

Elsewhere, researchers have warned that the number of adverse drug reactions is on the rise. They blame over-reliance on animal testing, the effects of which they say do not always transfer well to humans. And the King's Fund and Cancer Research UK have recommended ways the UK can improve cancer survival rates.

Commentary: week ending 3 June 2011

2011-06-03T14:52:00.000+01:00

Scrutiny of the Health and Social Care Bill seems to go through trends. When it first came out everyone concentrated on GP consortia. A while later it was the NHS Commissioning Board (NHSCB), then the role of any willing provider, competition and Monitor. This week the accountability of all the new organisations has come under the forensic examination of the King's Fund think-tank. It identifies weak accountability measures in both primary and secondary care under the Bill, which it says could lead to lower quality services that in turn could force intervention from oversight bodies like the NHSCB, thus undermining the government's aim of less top-down interference.

The first strong indication that big changes are afoot for the Bill came in a Daily Telegraph article by Health Secretary Andrew Lansley where he acknowledged 'substantial and significant' changes could be considered following completion of the government's listening exercise this week. We are now embarked on the 'mulling over ' exercise that is supposed to resolve everyone's concerns by the end of June. Significantly, while his article restated the reasons and need for reform, Mr Lansley did not place a badge of 'untouchable' on any of his proposals.

Amid all the controversy, it must be remembered that the Bill does have its supporters. The NHS Alliance and the National Association of Primary Care are two that represent a good many clinicians. Both this week sent messages to the government urging it speed up reforms and give GP consortia more autonomy in the way they structure themselves.

And in a week that saw a lot of news about private and public care homes, the charity Age UK has called for an extra £3bn to be pumped into the NHS sector just to stop it from collapsing.

Commentary: week ending 27 May 2011

2011-05-31T09:48:00.000+01:00

Delays to Health Secretary Andrew Lansley's plans for health reform were always on the cards from the moment Prime Minister David Cameron announced the infamous 'pause to listen, reflect and improve' back in early April. Fresh scrutiny of a redrafted Bill by MPs at committee stage mark II is now almost certain. Will this mollify its most fervent critics? Will a redrafting, based on recommendations from organisations like the NHS Confederation and long-term critics like the BMA, tip the balance of support in the government's favour? At the very least deputy prime minister Nick Clegg's intervention this week calling for less emphasis on hard and fast deadlines will meet the concerns of some primary care trust and strategic health authority managers whose major worry is the integrity of the health service.

However, pharma and medtech companies could be forgiven for throwing their hands up and going into a deep sulk. What will a delay of unspecified duration and uncertain outcome do to their medium to long-term planning?

Will the message about inefficient procurement get through to hospitals? For months the Department of Health has been prodding the health service to sign up to its campaign for establishing a central database of prices so that costs can be compared directly. Now the Public Accounts Committee says NHS trusts are wasting money by paying over the odds for some things while making cuts in less obvious areas. The committee found the biggest supplier, NHS Supply Chain, is the most expensive and has called for a review.

What have chairman of the Health Select Committee Stephen Dorrell, the NHS Confederation, think-tank the King's Fund and the BMA got in common? They all reckon integration of health services is the answer to the NHS's long-term problems of funding and growing demand. In comparison competition takes a back seat. Look out for increased emphasis on this topic in round two of the Health and Social Care Bill.

In other news the government has pledged to carry on funding cancer networks. And there has been a damning report by the care Quality Commission into the standards of care for the elderly.

Commentary: week ending 20 May 2011

2011-05-20T16:53:00.001+01:00

Two crucial elements of the coalition government's health reforms came under attack this week. Firstly, deputy prime minister Nick Clegg, leader of the party that partners the Conservatives in government, decided to flex what muscle he has and demand that the proposed economic regulator Monitor is stripped of a duty to promote competition. In a second blow, think-tank the King's Fund published a well-argued report that cast doubt on the wisdom of stripping thousands of managers out of the NHS at a time when organisation and control are so badly needed.

These moves, coming on top of so much other opposition to the Health and Social care Bill, indicate Prime Minister David Cameron and his Health Secretary Andrew Lansley have lost control of this flagship piece of legislation since the 'pause for reflection' was announced last month. It is probably impossible now for it to avoid radical rewriting, with many of its central policies scrapped or amended so much as to be unrecognisable. Politics, rather than the health needs of the nation, and a good deal of face-saving compromise are likely to be the order of the day from now on. And that bodes ill for an NHS that craves clear direction and that most agree is in need of reformation.

The Association of the British Healthcare Industries has rejected criticisms of the medical devices industry detailed in an article in the British Medical Journal. Consultant cardiologist Peter Wilmhurst claims the standards for European medical device regulation are 'unsatisfactory, unscientific, and in need of a major overhaul'.

Sneak preview of the new Wellards website

2011-05-20T14:01:00.001+01:00

We're currently working on a fresh new design for the Wellards website which we plan to launch this summer. We hope the new site will be easier to navigate, with well-structured content that is clearer to read and understand.

Homepage

News

Online learning

Wellards index

Reorganising public health course

2011-05-20T10:02:00.000+01:00

The Reorganising public health course will help you get to grips with the government's ambitions for public health. It looks at the proposed structure and responsibilities of the reorganised public health system and how it is to be funded as well as describing the industry's role in improving public health.

To find out more information on what public health is and the proposed timetable of changes, take a look at Reorganising public health in the Wellards courses section.

Commentary: week ending 13 May 2011

2011-05-16T10:25:00.000+01:00

Not a week goes by without Health Secretary Andrew Lansley finding himself more deeply mired in controversy over the future of the Health and Social Care Bill. His Conservative parliamentary colleagues have rushed to support him: nearly always a sign of a moribund career. Now deputy prime minister and Liberal Democrat leader Nick Clegg, stung by local election results last week and accusations of general wimpiness, has leapt into the fray and promised he will secure changes to the Bill, despite having put his name to it when it did not seem so politically damaging. All this might be very entertaining for journalists and disinterested observers, but it leaves the NHS in a state of abject confusion.

This confusion is extending to pathfinder consortia finances. They are supposed to be getting £2 per head of their registered populations as start-up money for the long journey ahead. The National Association of Primary Care says it has discovered money being withheld wholly or partially by primary care trusts and has demanded that it be handed over properly.

And the health reforms are causing damage in other areas. According to a cancer campaign group, funding cuts could prevent GPs getting the commissioning support they need from cancer networks.

Despite these funding cuts, however, junior health minister Earl Howe has told a meeting at the National Institute for Health and Clinical Excellence (NICE) that the government is not opposed to increases in NHS drug spending under the value-based pricing regime due in 2014.

The scourge and cost of venous thromboembolism was highlighted this week when the thrombosis charity Lifeblood said litigation payouts for missing dangerous blood clots in the NHS could reach £250m by 2015 unless hospitals observed NICE guidelines.

Commentary: week ending 6 May 2011

2011-05-06T12:13:00.000+01:00

There seems to be a growing body of opinion that sees Health Secretary Andrew Lansley's days as numbered. By general consent the Health and Social Care Bill's passage through Parliament is a complete mess and Lansley's stewardship of this flagship policy has been deeply flawed. Names are mentioned as replacements; Liberal Democrat David Laws and the current chairman of the Health Select Committee Stephen Dorrell. If appointed, neither one of these men is likely to leave the Bill untouched. Will there be wholesale changes? Will we be starting from scratch? The government is in the middle of a listening exercise with health service stakeholders to gauge their feelings on the state of play. It must be hoped that some form of consensus comes from this and that the seismic shifts that people in the NHS are suffering at present are quietened.

Some, perhaps most, people in the NHS might be gratified to see the government attempting to take on board the opinions of those most affected by the reforms. But it has rattled others. NHS Alliance chairman Dr Michael Dixon senses the possibility that there could be drift from emphasising the role of GPs at the heart of commissioning services. He has warned this could be demoralising for his colleagues.

However, a few more holes are being picked in the rapidly unravelling fabric of the Bill by Parliament's Public Accounts Committee. In its NHS landscape review it says putting GPs in charge of buying services could risk patient safety and warns that the lack of incentives for GPs may undermine the drive for better deals between providers and commissioners, and improved patient care.

On top of the reorganisations and reforms NHS trusts are now being warned that they could have to make more efficiency savings than they expected. The government's 4 per cent a year for five years was bad enough. Now, according to foundation trust regulator Monitor, a worst case scenario could see that figure rise to as much as 7 per cent.

Commentary: week ending 21 April 2011

2011-04-21T16:16:00.000+01:00

Referral to treatment waiting times are getting longer, according to Department of Health figures. Last summer many predicted this would happen after the coalition government announced in its revision to the operating framework that it was dropping the monitoring of some targets. Despite deputy NHS chief executive David Flory trying to explain away the rises as a blip during a flu outbreak, health economist John Appleby, of the King's Fund think-tank, warned things might get worse and said the NHS was under 'tremendous' pressure.

Prime Minister David Cameron has promised 'substantive' changes to the Health and Social Care Bill while simultaneously claiming that Health Secretary Andrew Lansley is doing 'an excellent job'. Health policy expert Professor Kieran Walshe, of the University of Manchester, disagrees. His response to a question on a live blog question and answer session for the Guardian included some sharp words of criticism for the manner in which the Bill has been handled. He suggested it could be used as a case study for 'how not to do it'.

Surgery may seem like a radical option when it comes to tackling the obesity epidemic. But, according to a group representing surgeons, bariatric surgery involving gastric bands and gastric bypasses not only tackles the weight issue itself but reduces the incidence of type 2 diabetes, hypertension, high cholesterol and sleep apnoea.

Nationally, it could save many millions of pounds – well worth taking into consideration in light of the financial mess the country is in and the savings demanded of the NHS. But bariatric surgery is deemed to be elective and it, along with other procedures, is seen in some quarters as 'low-value'.

Another group, the Federation of Surgical Speciality Associations, wants a re-evaluation of just what low-value means and whether it would be a false economy to dismiss some treatments which could have short-term financial costs but long-term financial benefits.

The new NHS explained

2011-04-18T16:19:00.000+01:00

The new NHS explained covers all the most important aspects of the Health and Social Care Bill 2011 and analyses how the reforms are likely to impact pharma and medtech. Topics include the creation of GP consortia and the NHS Commissioning Board, the changing role of Monitor and its responsibility for promoting competition, the idea of any willing provider, an increased focus on public health, and a description of the government's philosophy behind what have been described as the most radical health reforms since the NHS began more than 60 years ago.

By the end of the course, which includes an exam, the reader should have a solid grounding in the landscape of the new NHS and a good understanding of how the government intends to develop the English health service over the next four years.

Not got time to read the course right now?

Then take a look at the Wellards fast-facts on The new NHS explained for a quick guide to what you need to know.

Commentary: week ending 15 April 2011

2011-04-15T11:55:00.001+01:00

A bad seven days for the coalition government and its plans for the NHS. Since hitting the pause button in the previous week, we've had coalition rifts, a damning vote of no confidence in the Health Secretary, which led to an apology (of sorts), and a slinking Ed Miliband smelling blood.

On one of his first 'listening exercises', Lansley opted to speak to 60-odd nurses rather than address the full Royal College of Nursing congress, just after the delegates had delivered their vote of no confidence in him. He took the opportunity to say sorry, but only for failing to get his message across.

Elsewhere, the Department of Health is still pushing ahead with its plans for the transition. Sir David Nicholson has assured NHS chiefs that the GP consortia will still take control of commissioning in two years time. But the Health Bill breather has led to a three-month delay for some important milestones, including the end of strategic health authorities, which will be hanging around a bit longer than expected.

As the months advance, expect to hear more on the effects of the financial pinch. We now have firm evidence of the difficult decisions GPs are being presented with, as primary care bodies increase their use of blacklists and reduce the supply of medicines in prescriptions.

Once the primary care trusts become another relic of NHS management history, how will the new GP consortia wrestle with the massive issue of managing their large slice of the health budget?

Maybe the General Medical Council is one step ahead of the game, as it's decided to support GPs who wish to prescribe unlicensed or off-label drugs.

Would you have voted the same way as the nurses?

Continue the debate on the Wellards Linkedin discussion group.

Commentary: week ending 8 April 2011

2011-04-08T14:30:00.000+01:00

Is Stephen Dorrell positioning himself for a political comeback as the coalition government's next Health Secretary? As chairman of the Health Select Committee he has presided over at least two highly critical reports of the current Health Secretary's plans for reform. The latest, published this week, takes most of the core proposals and suggests plausible alternatives. Andrew Lansley, beleaguered from all sides and seemingly losing credibility fast, must also feel a bit fragile and, perhaps, a little vulnerable after the Prime Minister David Cameron and his deputy Nick Clegg were drafted in to help him 'sell' his big ideas to the health service and wider public. Should Mr Lansley be watching his back a little more closely and is Mr Dorrell, a former Health Secretary himself, likely to be wielding the knife? Perhaps we should all pause for thought on that one.

And on the subject of pausing and thinking, as mentioned above the government has taken advantage of a 'natural break' in the passage of the Health and Social Care Bill through Parliament to 'pause, listen and engage with all those who want the NHS to succeed'. That will be just about everybody, one suspects.

The second of that famous double act 'Scale & Pace' headlined again this week. A think-tank, sympathetic to the Conservative-led government, has picked up a refrain first heard last year in the wake of the White Paper Liberating the NHS that the government is attempting to push the reforms through too fast. Policy Exchange says slowing down implementation would help deliver 'real and lasting transformation'. Perhaps that is why we are pausing.

Elsewhere, the National Institute for Health and Clinical Excellence has published the latest of its quality standards, these are on depression, glaucoma and diabetes.

Commentary: week 1 April 2011

2011-04-01T14:44:00.000+01:00

One of the architects of the Liberal Democrat party wants his own health ministers to be removed from their positions in government. That and Lord David Owen's raft of sharp criticisms of the likely ramifications of coalition health reforms has injected additional fizz into the journey of the Health and Social Care Bill through Parliament. Lord Owen has a high profile history in government and his opinion cannot lightly be dismissed, particularly as he was once a Health Secretary. With his and fellow Lib-Dem Baroness Shirley Williams's opposition in the House of Lords, the next stage of parliamentary scrutiny looks set to be even livelier than the last.

The National Audit Office (NAO) features in two of our stories this week. It has uncovered wide variations in prices paid for top-line medical equipment. This follows calls in February from Department of Health efficiency czar Jim Easton for a price information sharing scheme that would highlight inconsistencies in procurement and hopefully save trusts money. In a second story the Association of British Healthcare Industries (ABHI) has responded to an NAO report that claims NHS procurement is disorganised and not cost-effective. ABHI said it felt there was little benefit for companies selling to the NHS through procurement organisations.

A number of responses rushed in to beat the deadline for the consultation on the government's public health White Paper Healthy lives, healthy people and the Care Quality Commission has discovered that council run care services get a better rating than privately run services.

Your guide to the GP consortia course

2011-04-01T11:04:00.002+01:00

With England's GPs expected to take over managing 80 per cent of the NHS budget and consortia representing a major strand of the coalition government's new NHS it is essential that you understand the impact these changes will have on the industry and your customers.

Your guide to the GP consortia explores England's commissioning consortia groups, with a focus on structure, patient choice, GP commissioning freedoms, management, finances and the NHS Commissioning Board.

Not got time to read the course right now?

Then take a look at the Wellards fast-facts on GP consortia for a quick guide to what you need to know.

Log on to wellards.co.uk for the Your guide to GP consortia course and fast-facts.

Commentary: week 4 March 2011

2011-03-25T14:55:00.002Z

Dissatisfaction persists with the Health and Social Care Bill, even among the government's own ranks. MP Sarah Wollaston, a practising GP herself, in January this year said the government's proposals had 'thrown a grenade' at the NHS. Bravely, she grabbed the grenade and lobbed it back at the government in an article for the Daily Telegraph, claiming the Bill could be a Trojan Horse, which, once embedded in legislation, could eat away at the NHS's vital ethos.

The Budget had little to say on the subject of the NHS but provided some comfort for pharma and medtech with a mention or two of help for biosciences and innovation.

Dr Mark Porter, chairman of the BMA's consultants' committee, hit the headlines once again this week warning of 'devastating consequences' for hospitals if the Bill's proposals for increased competition in the NHS market go forward. He said treatments viewed as of low value, for instance cataract surgery, could be lost and whole departments could be at risk.

Results of the King's Fund's two year inquiry into the state of GP practice were unveiled this week showing wide variations in performance and quality of care. The UK's general practice system is 'the envy of the world', according to King's Fund chief executive Professor Chris Ham. But the inquiry concluded that in order to maintain that reputation GPs would have to up their game.

More information on the performance of individual doctors and surgeons should be made available to patients, according to the Society for Cardiothoracic Surgery in a report. The conclusion is sure to chime sweetly with the government's ideas for an information strategy and feed into its consultation on access to NHS data.

How to conduct a meeting within the ABPI Code 2011

2011-03-21T10:19:00.004Z

New course live on Wellards:
How to conduct a meeting within the ABPI Code 2011
Guidelines to help representatives plan and run meetings in compliance with the 2011 version of the Association of the British Pharmaceutical Industry Code of practice.

Log on for more info.

Commentary: week ending 18 March 2011

2011-03-18T14:12:00.000Z

Despite intimations of radical action in the run-up to this week's BMA special representative meeting, delegates managed to restrain their firebrand tendencies and voted to carry on much as they have been. They granted the union's leadership permission to continue with a policy of 'critical engagement' – as BMA council chairman Dr Hamish Meldrum described it: 'The BMA will continue to publicise and oppose the damaging aspects of the Bill.'

With similar bathos, the Liberal Democrat rebellion last weekend, when delegates to its spring conference voted to oppose the Health and Social Care Bill, fizzled out around mid-week when newspapers reported Prime Minister David Cameron had no intention of abandoning the government's NHS reforms or even changing them much. Lib-Dem opposition will continue, no doubt, especially through influential headline names like Baroness Shirley Williams. But it must be galling to the Tories' coalition partners to discover in what esteem their principles are held.

MPs on the Public Accounts Committee showed commendable restraint in their report on hospital productivity. While noting that unprecedented levels of investment in the health service from 2000 had not resulted in commensurate productivity increases, it implied the government target of increasing efficiency by up to 6 per cent a year (King's Fund figures) were not realistic, particularly in light of the fact that the organisations tasked largely with producing these efficiencies are to be abolished soon.

More concern was generated in a King's Fund report that predicted a £1bn shortfall in funding for social care by 2015 – a worry when you take into account the expected increase in demands on social care as a consequence of more care closer to home, an ageing population and possible hospital closures. And the government is now aiming to reward doctors through the quality and outcomes framework for not referring patients to hospital.

Money and resources are really what it all boils down to. And one of the most resource hungry areas - long-term conditions (LTCs) - is a constant background threat. Health Secretary Andrew Lansley said his reforms were essential because the NHS would not be able to cope with the growing burden of LTCs if it stays as it is.

Commentary: week ending 11 March 2011

2011-03-11T14:07:00.001Z

How far can you treat a national healthcare system like commercial enterprise? Not very far, if you agree with the BMA. It says government proposals to regulate health organisations in the same way as privatised industries like gas, water and telecoms distort the ethos of a national health service and could provoke Monitor, which is charged with promoting competition under the health reforms set out in the Health and Social Care Bill, into focusing on the wrong things. BMA spokesman Dr Hamish Meldrum's quote that 'whatever you think of privatisation of other services, it is certainly not the right model for the NHS' will resonate with many of his clinician colleagues.

Chairman of the Health Select Committee and former Health Secretary Stephen Dorrell was right a few weeks back to state that the most pressing problem for health managers was not implementing the government's health reforms, but finding the efficiency savings demanded under the 'Nicholson challenge' – that is £20bn that can be reinvested in services by 2014/15. Almost two thirds of managers surveyed by the NHS Confederation said it was their most important priority.

As many suspected when the coalition first formed in May 2010, the weak point in its cohesion could be prominent maverick Liberal Democrat party luminaries such as Baroness Shirley Williams or independent-minded backbenchers. Several of them are questioning the coalition's NHS reforms, particularly the emphasis on competition, in an early day motion (EDM) and at the Lib-Dems spring conference held this weekend. Although very few EDMs (formal motions submitted for debate in the House of Commons) ever actually get debated, they are useful for publicising the views of discontented MPs.

The turbulence surrounding the NHS is striking at the heart of NHS management. The Royal College of Nursing has reported the loss of at least 12 experienced nursing directors in the Northeast since it was announced primary care trusts would be abolished by 2013. And the nursing union suspects the same trend is true for the rest of the country.

Commentary: week ending 4 March 2011

2011-03-07T09:30:00.000Z

What price 'price'? Or more accurately, 'price competition'? For months Health Secretary Andrew Lansley has been content to allow the health service to fret over the ramifications of the maximum tariff and competing for services on the basis of how much they cost.

But over the last couple of weeks, in the face of intensified opposition from a host of Health and Social Care Bill critics, two of his right-hand men, Sir David Nicholson and David Flory, have sought to clarify the situation by claiming it was never the government's intention to compete on price. It was always on quality, they say. To be fair, the White Paper Equity and excellence: liberating the NHS and its giant offspring the Bill are couched in language sufficiently ambiguous to make this interpretation plausible.

However, this week Andrew Lansley has been forced into an embarrassing climbdown and promised to amend the Bill to clear up this little misunderstanding.

Nigh on 90 per cent of doctors, the very people Mr Lansley must rely on to implement his reforms successfully, think the Bill's proposals will fragment the health service, if a survey of 1,600 of the BMA's members is to be believed. The majority are against proposals that lie at the Bill's heart. Given clinicians' concerns, expressed vociferously and constantly over the past eight months, as well as the frequent need to clarify and change, it is difficult to see how this complex and controversial legislation can remain viable in its present form. And if the government bows to pressure and applies wholesale amendments or even ditches the Bill altogether, where does that leave its credibility and where does that leave the hapless Andrew Lansley?

Misdiagnoses

The potential for up to 100,000 people in England to have been misdiagnosed with diabetes has consequences for patients, clinicians, pharma and medtech; particularly when you consider some 1m more are thought to be undiagnosed diabetics and there is a general presumption that the burden of diabetes on the health service is likely to worsen with the obesity epidemic and people living to an older age. The Royal College of GPs' trial of a potentially more accurate diagnostic system is to be welcomed.

Pathfinders

Meanwhile, the creeping introduction of core elements of the Bill continues despite the fact that Parliament is still examining the proposals at committee stage. Another tranche of pathfinder consortia has been announced. They now cover two thirds of England.

The National Institute for Health and Clinical Excellence has issued 29 possible quality and outcomes framework indicators for consultation.

And a trenchant critique of the government's value-based pricing ideas, from the NHS Confederation's Nigel Edwards, questions whether the initiative will achieve its objectives.

Commentary: week 4 25 February 2011

2011-02-25T15:29:00.003Z

More criticisms have emerged on the Health and Social Care Bill. The BMA, whose members have represented consistent opposition to the Bill, has highlighted concerns about patient confidentiality. One of its regional meetings was described as 'incredibly anti the reforms' and there is ongoing talk of a ballot on industrial action. Ed Miliband exploited his keynote speech at the Welsh Labour conference to attack the Prime Minister's 'big society' ideas and public service proposals. In effect, he said the NHS was too important to be left to the market. And the Co-operation and Competition Panel has cast doubt over the future of the government's 'any willing provider' system by questioning the consistency of contracts.

Another week, and more back tracking from the DH over details of its health policy. Last week NHS chief executive Sir David Nicholson tried to distance the government - none to convincingly - from a widespread presumption that it would introduce price competition on provider services. This week David Flory, Sir David's deputy, back-pedalled on an operating framework intention not to pay hospitals for readmissions within 30 days of discharge.

An important development for medtech this week was the National Institute for Health and Clinical Excellence's guidance on hypertension management. The proposal that in future diagnosis of primary hypertension should be confirmed using either ambulatory blood pressure monitoring or home blood pressure monitoring is likely to throw a lot more business its way.

Commentary: week 3 18 February 2011

2011-02-18T14:08:00.000Z

Was it a U-turn or just a clarification? Sir David Nicholson's letter to NHS chiefs was certainly designed to quell fears about the complex interaction between competition, integration and the any willing provider model at the heart of the Health and Social care Bill 2011. That it comes after damning criticisms by the Commons Health Select Committee and the threat of a major rebellion by the BMA's membership is, well, timely? Are we likely to see more 'clarifications' as the Bill makes its way through Parliament? All this comes as the Office for Health Economics has announced a commission to investigate whether competition is good or bad for the NHS. A question many will feel should have been sorted out well before now.

The NHS Alliance has so far adopted a 'gently, gently' approach to its concerns over the Bill. One of the government's most vociferous supporters over the reforms, the alliance says it is important to preserve the wealth of 'organisational memory' invested in primary care trust and strategic health authority managers. At the same time 24,500 of these managers are due to lose their jobs by 2013. Perhaps the government would like to clarify that for us? And while it is in the mood it could respond to requests to explain how GP-led consortia and public health proposals are to work together – apparently, GPs do not know.

However, the government will be relieved its ideas on value-based pricing got the thumbs up from the respected Centre for Health Economics at the University of York.

Commentary: week ending 11 February 2011

2011-02-11T16:18:00.000Z

Health Secretary Andrew Lansley this week attempted to crack some fairly stubborn resistance on the 'hearts and minds front' in regard to his Health Bill. In his article for the Guardian, pitched at a rather simplistic level, he took what could be interpreted as a disingenuous stance along the lines of 'GPs have rushed in to set up loads of shadow consortia so they must agree with me'.

Supporters of his controversial plans will be hoping he can come up with more compelling arguments, as he was immediately challenged by the BMA's Hamish Meldrum. Dr Meldrum told MPs that a survey of 20,000 clinicians found around 70 per cent of respondents were 'pretty sceptical and pretty pragmatic' about Lansley's proposals and were only falling in line because they wanted to make the best of a bad situation.

Mr Lansley must feel the siege will never end: even the NHS Alliance, which up until now has been fairly sanguine about the reforms, is calling for urgent clarification on some of the core issues.

NHS chief executive and NHS Commissioning Board boss elect Sir David Nicholson has acknowledged that 20 or so acute and mental health trusts will probably not make the foundation trust deadline of 2014. This throws up plenty of questions about how failure in this area will be handled, particularly in regard to mergers, closure and accountability.

Away from the Bill, Pfizer's decision to close its research unit in Kent has prompted questions over the future of R&D in the UK. And it looks like the beginning of the end for Labour's unloved flagship policy of a Darzi centre in each of the primary care trusts' areas. They might be done away with once the NHS Commissioning Board grabs its share of power.

Commentary: week ending 4 February

2011-02-04T15:12:00.002Z

No sooner does the DH present the NHS with one piece of enormous legislation to chew on in the form of the Health Bill, than it showers it with a weighty wheelbarrow full of mental health strategy. Tackling mental ill health is, of course, a hugely important part of the overall health strategy – not only for England but globally. The government estimates that it costs the nation £105bn a year. It stands to reason then that dealing with it early and preventing it happening in the first place would go a long way towards tackling the national debt and the Nicholson challenge of saving £20bn by 2014/15. In comparison to the aforementioned figures, the £400m that the government has promised for the development of more effective psychological therapies pales into insignificance.

Stung by last month's criticisms from fellow MPs, the Health Secretary Andrew Lansley and his department responded to the Select Committee's comments on the reforms with a point by point attempt at rebuttal. However, reading the response is a bit like a wander down memory lane, with the same old statements trotted out to answer new criticisms. The Bill has now progressed to the committee stage after comfortably passing its second reading on Monday. Will it get a rougher ride from now on?

A National Audit Office (NAO) report this week claims the NHS could save hundreds of millions of pounds each year simply by rationalising its procurement methods; it does not even have to buy less. Why this has to come two or three years after the recession set in is a moot point. Nevertheless, if the NHS adopted NAO advice it would certainly be a help on the way to the £20bn mentioned above.

Commentary: week ending January 28 2011

2011-01-28T14:46:00.000Z

For months Andrew Lansley has been busily assuring the health service that his reforms would mean less Whitehall interference in how the NHS is run. But following presentation of his Health Bill to Parliament last week the major talking point among critics is how much central government control has been proposed. The Health Secretary and his arm's-length attack dogs, the NHS Commissioning Board and Monitor, are set to wield swingeing powers over the whole health service landscape. They may be reserve powers, held back for use in emergencies only. But the very fact they are there will have GP consortia and providers trying to second guess the Secretary of State every step of the way for fear of being dissolved or taken over at the behest of their political masters. So much for 'liberating the NHS'.

The parlous state of dementia care was highlighted again this week. People living with dementia are not getting the care they need, according to the Alzheimer's Society, and through no fault of carers, upon whom the onerous responsibility of ensuring a decent life for their charges mostly rests. The future looks less than rosy. There will be more older people with a consequent increase in the number of dementia sufferers and the costs of dealing with the condition. At a time of financial constraint across the NHS, the society's plea for commissioners to invest in training and services is likely to be just another on a long list of priorities.

Understanding hospital pharmacy: new course

2011-01-28T12:00:00.000Z

Our new training course explores the role of the hospital pharmacy, including an explanation of the pharmacist's role in deciding drug policy.

By the end of the course, you should be able to:

explain the importance of medicines in hospital, and the functions and responsibilities of the hospital pharmacy team in the dispensary and stockroom, on wards, in clinics, and in manufacturing units
describe how hospital pharmacists provide advice, ensure patient safety through clinical and safety checking, and take part in medicines procurement and medicines supply
outline how the hospital pharmacy team manufactures, prepares and tests some of the medicines used in the hospital
understand the contribution pharmacists and pharmacy technicians make to achieving cost effectiveness in buying and using medicines
recognise the different job roles found in hospital pharmacy
appreciate hospital pharmacy's contribution to implementing national guidelines and trust policy
understand how hospital pharmacy works with GPs and other prescribers in primary care, and with community pharmacy

Ask Professor Wellard

2011-01-24T16:03:00.002Z

Recent questions answered by Professor Wellard this month include:

Are there any Association of the British Pharmaceutical Industry restrictions on giving customers books?
Can you confirm if the value-based pricing system that is coming in 2014 applies to all of the UK?
Do pharma companies charge value added tax on their products when selling to wholesalers?
Is cataract 'rationing' taking place in any primary care trusts?
Is the Health Protection Agency being abolished?
What is the difference between a nurse prescriber and an advanced nurse prescriber?

Do you have a question? Ask Professor Wellard.

Commentary: week ending 21 January 2011

2011-01-24T09:10:00.003Z

The proposals set out in the Health and Social Care Bill, presented to Parliament on Wednesday, are the most radical since the NHS's inception more than 60 years ago. The Health Select Committee calls some of the proposals in the White Paper Equity and excellence: liberating the NHS a 'surprise' in its report into commissioning, then goes on to list a series of damning indictments on its contents and likely outcomes. It says the changes will mean 'significant institutional upheaval', that they are not clear or well-planned, and that they have not been sufficiently scrutinised despite some measures already being introduced, eg, GP-led consortia pathfinders.

One cannot help thinking there was something a little desperate about Prime Minister David Cameron's enforced defence of the government's plans for public services in his speech on Monday. His comments on the NHS have been well rehearsed for some months; but the fact he has to keep repeating them suggests he knows there is a lot more convincing to be done. With few exceptions, most of the reaction from health bodies, academics and sector observers is of the type: 'We agree there should be change and modernisation, just not this kind of change and modernisation.' One prominent critic dubs them a 'massive gamble', which is a little daunting in the light of NHS Confederation acting chief Nigel Edwards's observation that the public 'will never forgive us' if it all goes wrong.

Considering all the hoo-ha surrounding the introduction of any willing provider and the maximum tariff, NHS chief executive and appointed chief of the NHS Commissioning Board Sir David Nicholson's comments that price competition between hospitals could be 'extremely dangerous', is also extremely worrying.

The Bill itself provides more detail on the plans and has surprised some by indicating that the Health Secretary is likely to hold more power over the NHS Commissioning Board than was suggested by his and the government's mantra of decentralisation. There is also more detailed information on commissioning consortia, local authorities, public health and how it affects pharma.

A second wave of pathfinders has been announced. They now cover half the population, and with another two waves expected in the coming months it will soon be blanket coverage.

Commentary: week ending 14 January 2011

2011-01-14T15:37:00.000Z

The BMA's GP committee chairman Dr Laurence Buckman reckons the Health Bill, due Monday 17 January, will get a 'mauling' in Parliament. The build up of grass roots opposition to many of its proposals would suggest he is right. And Labour will consider it a duty to harry the government on this flagship piece of legislation, especially as it considers the NHS belongs to it.

One of the main planks of the NHS reforms is its ushering in of the any willing provider model backed by a maximum tariff, which many see as an open door for competition red in tooth and claw. But it seems even pro-market agitators can see flaws in these measures. One has called them a 'retrograde step'.

The Academy of Medical Sciences has produced a report, mostly supported by the pharma and medtech industries, calling for a single, independent research regulator to smash through the bureaucracy it says is holding back medical advances in the UK. The Health Research Agency would liaise with research establishments and trusts to ensure there is no duplication of effort when conducting trials on innovative technologies.

And four of the top organisations representing the pharma and medtech industries have created a group to promote their sectors to investors and the government.

ABPI Code of practice 2011: what is different? (sales and marketing)

2011-01-10T09:25:00.001Z

The Association of the British Pharmaceutical Industry (ABPI) has updated its Code of practice for 2011, which comes into effect from 1 May 2011. Although the changes are not vast, they will fundamentally affect the way the industry operates.

The 2011 code updates cover promotional aids, declarations and donations, whilst also providing further detail on joint working between the industry and the NHS.

Find out more about what has changed in the ABPI Code of practice 2011 sales and marketing papers in the Wellards e-learning > Code of practice and compliance section.

Wellards briefing on... The operating framework

2011-01-10T09:23:00.000Z

The operating framework for the NHS in England 2011/12 describes the tasks facing the health service in its first full year of transition to the system outlined in the White Paper, Equity and excellence: liberating the NHS.

Our short briefing summarises the details and explores the implications.

Log on and visit the Wellards e-learning section.

Commentary: week ending 7 January 2010

2011-01-07T14:49:00.001Z

Disgruntled doctors are demanding the BMA puts up more resistance to the government's health reforms. A strongly worded letter to the body's top brass wants them to disengage with the 'damaging reforms' that the authors believe will destroy the NHS. This is not just a few dissenters but a band of high-profile, well respected clinicians who will expect to be listened to. To 'go public' with their concerns suggests previous, more low-key efforts may have gone unheeded. But one cannot help feeling they have left it a bit late, especially when you consider the Health Bill proper is due in a couple of weeks. And as Wellards asked back in the autumn: is Health Secretary Andrew Lansley open to persuasion?

The general discontent is sure to be excited further by health service leaders like Nigel Edwards and Dr Hamish Meldrum assuring us that this year will be 'tough'. On top of that Dr Meldrum described the government's pace of NHS reform as 'break-neck'. Sounds dangerous.

The effects of this toughness are bound to be felt throughout the NHS, not least in areas like care for the elderly, particularly those living with dementia. It is an increasing problem worldwide but the costs of treating it in the UK are rocketing. How will the health service tackle this and maintain or improve quality care against a background of efficiency drives and efforts to free beds in hospitals? A group of MPs and peers have launched an inquiry into cost-cutting measures and best practice.

Commentary week ending 17 December 2010

2010-12-20T12:15:00.000Z

Of course, the operating framework is the big talking point this week, even though much of its contents had been announced in documents released by the Department of Health (DH) over the last year. That payments were moving towards a maximum tariff was mentioned in last year's (Labour) framework and the coalition's revision in the summer did not remove it - a pretty strong indication that that was what we were going to get. Now the health service must prepare for the move towards price competition between any willing provider, a number of them private companies. Will this lead to a downward spiral in quality? Some NHS leaders fear so, despite the DH's increasingly desperate sounding exhortations to focus on delivering quality services and meeting the productivity challenge.

GPs received pleasant news that they would get 'up to a maximum' of £25-35 per head of population for their management costs. Many Jeremiahs had predicted a figure as low as £9-12. The fact that the announcement is couched in such general terms should not worry GPs too much. Anything below £25 would certainly dent the government's credibility and be greeted with howls of protest now the bar has been set.

NHS chief executive Sir David Nicholson's appointment as head of the soon to be created NHS Commissioning Board - a core organisation of the health White Paper reforms - was something of a surprise. Not so long ago observers were shaking their heads in doubt over his future. Now this arch survivor has landed one of the plum jobs in the new NHS set-up. He will have a job on his hands. One of the board's main duties will be to coax GP consortia into successful existence, but already some pathfinder consortia are predicting overspends on their budgets.

The operating framework is inextricably linked with the government's controversial White Paper reforms set out in Equity and excellence: liberating the NHS. The influential Commons Health Committee has warned that spending plans for the revamped NHS are based on assumptions that will 'test services to the limit'. And a host of organisations, in their responses to the consultation on Liberating the NHS, have warned severally of the expense of implementation while trying to save money; government failure to engage with criticisms of the plans; potential lack of co-ordination; failure to include nurse leadership; and the old favourite 'the scale and pace of change'.

Understanding the ABPI Code of practice 2011

2010-12-17T19:29:00.002Z

The 2011 Association of the British Pharmaceutical Industry Code of practice includes changes to promotional items and the reporting of meetings, sponsorship and market research payments.

The aim of the code is to ensure that the promotion of medicines to health professionals and administrative staff supports high quality patient care. However, it cannot cover every possible eventuality. Therefore it is as important to understand the underlying principles behind each clause as it is to understand the specific rules that the code contains.

This course will help you explore the main clauses of the code that relate to your role as either a marketing or representative employee.

Wellards offers two specific courses on the code, written with these two audiences in mind. Visit E-learning and review either Understanding the ABPI Code of practice 2011 (marketing) or Understanding the ABPI Code of practice 2011 (sales).

The 2011 code comes into effect on 1 January 2011 with a transitional period before becoming fully operational on 1 May.

Bribery Act

2010-12-17T19:28:00.001Z

In force since April 2010, the UK Bribery Act covers offences of bribing another person, being bribed and improper business activities relating to bribery. The Act applies to all organisations operating in the UK.

The Act also covers bribery of officials in foreign countries. Knowledge, understanding and absorption of the implications of the Bribery Act are essential for healthcare companies to stay working within the law.

Failure to prevent bribery within an organisation is also an offence under the Act and companies are advised to put in place adequate processes to ensure their employees are aware of the Act and understand its implications.

The course covers:

the background to the Act and why it was considered necessary
a section-by-section guide to what it says
implications for healthcare, medtech and pharma companies

The course has been developed with the full support of the Association of British Healthcare Industries (ABHI) and has been compiled with its assistance and expertise.

Wellards site maintenance: 21 December 2010

2010-12-15T11:34:00.002Z

We are undertaking some essential maintenance on the Wellards Academy website.

The changes mean that the site will be unavailable on Tuesday 21 December at 9am. We anticipate it will be available in the afternoon.

We apologise for any inconvenience this causes.

Commentary: week ending 10 December 2010

2010-12-10T15:30:00.000Z

The streets of Westminster were not the only place to witness dissension this week. The corridors of the BMA and Royal College of GPs (RCGP) also echoed to the grumble of unhappy voices over the government's value-based pricing scheme, which the two bodies have decided to oppose as one. The plans would effectively hand the decision over whether a patient received innovative medicines treatment to GPs rather than leave it with the National Institute for Health and Clinical Excellence (NICE). The arguments have been well rehearsed over the months since July when the idea was first mooted in the health White Paper Equity and excellence: liberating the NHS: in essence, GPs do not like it because they fear it could make them the target of public anger if patients perceive a rationing of services.

A list of 52 pathfinder GP-led consortia was announced this week signalling Health Secretary Andrew Lansley's determination to press ahead with his Liberating the NHS reforms despite widespread and long-standing opposition. One prominent NHS manager has indicated his fear the reforms could end up a 'bloody awful train wreck'. Is his a lone voice, or are NHS managers up and down the country voicing the same concerns privately? As fuel to the fire they might point to data showing a rise in the number of times the former 18 week waiting time target was breached since it was dropped in the revision to the operating framework earlier in the year – one of Mr Lansley's first decisions. Will his other decisions prove as successful?

In other news, NICE is seeking to knock months off the time it takes to assess quality and outcome framework indicators; and health organisations have urged the government to take a stronger line on imposing public health initiatives rather than rely on the 'nudge' approach advocated in its public health White Paper Healthy lives, healthy people, published last week.

Commentary: week ending 26 November 2010

2010-11-26T14:05:00.000Z

The topic of waste medicines rumbles on year after year and the report this week from York Health Economics Consortium and the School of Pharmacy at the University of London adds more evidence to this seemingly intractable problem. The figures – £300m – might seem small in comparison to the £15-20bn of efficiency savings needed by 2014, but as one of our leading retailers suggests 'every little helps'. If half of this figure, which the report's authors say is avoidable waste, can be clawed back it means jobs saved, more operations performed and safer patients.

The atlas of variations revealed this week has generated good coverage across the media and represents a useful business tool for pharma and medtech suppliers. It gives them the chance to enter negotiations with buyers armed with crucial information. However, data gatherers may not find it yields the clarity of definition they desire and there may be room for refinement in future releases.

Health minister Anne Milton can be excused for stating what is probably obvious to most in the NHS when she says nurses should have a seat at the commissioning table in the proposed and perhaps misnamed GP-led consortia. As the most frontline of frontline staff their hands-on experience will be an essential ingredient in the decision-making mix.

Perhaps GP delegates at the NHS Alliance conference last week returned to their surgeries that bit happier after reassurances from health minister Earl Howe that the government is seeking to 'straighten out' the problem of debts that consortia may inherit from primary care trusts. They must hope, for the sake of the success of consortia, that it does not end up a fudge.

Commentary: week ending 19 November 2010

2010-11-19T15:38:00.000Z

Support for important proposals in the health White Paper appeared to weaken still further this week, as physicians' leaders voiced serious criticisms.

Royal Society former president Baroness Finlay of Lllandaff told the House of Lords that liberalising competition between healthcare providers and hospitals would damage collaboration between health professionals, and undermine healthcare.

Incoming Royal College of General Practitioners chair Dr Clare Gerada said the reforms needed to be 'sorted out', as debts inherited from primary care trusts would cause health inequalities. She also expressed serious misgivings about handing responsibility for drug rationing to GPs.

Dr Gerada's comments mark a significant change in direction for the college, which had previously supported the White Paper despite divisions among doctors.

Also, an NHS Alliance-GP newspaper survey of GPs and health service managers revealed a thin 54 per cent majority in favour of the reforms.

Pharma came under attack over orphan drugs this week. An open letter published in the BMJ said companies given sole manufacturing rights were charging exorbitant prices and called on government to change the rules on this group of products.

Officials reported that the DH-sponsored quality, innovation, productivity and prevention (QIPP) initiative had proposed a scheme that could save hundreds of millions of pounds each year by scrapping back offices and setting up a national call centre for GP appointments.

Finally, pharma marketing and sales personnel will be glad to know that the Association of the British Pharmaceutical Industry Code of practice is now available. It comes into effect on 1 March 2011.

Commentary: week ending 12 November 2010

2010-11-12T14:43:00.000Z

The Department of Health business plan, published this week, reaffirms the government's commitment to driving through Health Secretary Andrew Lansley's health reforms. It sets out a revised schedule for various transition targets, among which are bringing forward and setting a definite month for the abolition of primary care trusts (PCTs) and strategic health authorities (SHAs).

Health sector observers say the move might help stem the predicted hemorrhaging of disaffected management talent through injecting more certainty into transition arrangement. But will it? Health minister Earl Howe certainly hopes so; and not just because it eases the transition from PCT to consortia; he is also worried about handing out redundancy cheques to leavers who may well rejoin the NHS a short while later under a different guise.

NHS chief executive and national quality board chairman Sir David Nicholson is also hoping to keep management personnel 'engaged', as he writes in his open letter to the Health Secretary, otherwise he believes the White Paper proposals may be put in jeopardy.

Meanwhile, the first few tentative steps towards reform have taken place with GP groups in London and Manchester applying for pathfinder status. Once underway their role will be central to government plans, exploring the potential of GP commissioning and highlighting any pitfalls that may lie ahead.

A report has condemned the quality of care for older patients following surgery. It says only a third of the patients who died in hospital within 30 days of surgery had received good care. It comes at the same time as a report from the National End of Life Care Intelligence Network, which states that the health service faces a future where it must care for rising numbers of people dying, particularly in care homes, who have conditions such as dementia and Alzheimer's.

Commentary: week ending 5 November 2010

2010-11-05T15:22:00.000Z

It seems fairly certain that the National Institute for Health and Clinical Excellence (NICE) is to lose its powers over deciding which drugs should be available for use on the NHS, with this responsibility passing on to the GP-led consortia due to be up and running by 2013. As might be expected, the move has excited some controversy and is bound to generate many column inches of polemic over the coming months surrounding value-based pricing, cost, fairness and health equality to name but a few subjects. NICE will still have a role in ascertaining a drug's effectiveness and in devising quality standards for numerous treatment pathways. However, the inescapable fact is its influence is being eroded.

Many predicted it; some feared it; some welcomed it: in the wake of the government's health reforms package private healthcare companies are circling juicy tidbits of the NHS in anticipation of profits to come. Capita has been quick off the blocks, eyeing NHS Direct and NHS Blood and Transport. Shadow health minister John Healy characterises the situation as companies 'licking their lips... for a potential bonanza'.

The 'unacceptable' overuse of antipsychotics to control dementia patients could soon be coming to an end after care services minister Paul Burstow laid down an ultimatum to doctors. He wants a two thirds cut in use by November 2011 – a recommendation from Professor Sube Bannerjee's report into the practice published last year.

The Wellards conference this week provided more insight and questions into the machinations of government regarding the health White Paper's proposed reforms. NICE chief executive Sir Andrew Dillon was less than certain decentralisation was a good thing for healthcare, claiming the 'imperial' approach favoured by the highly successful computer company Apple had not done it much harm. And Department of Health director of alignment and coordination Sophia Christie believed that, in contrast to some DH signals, there would be money made available for incentivising GP commissioning.

Commentary: week ending 29 October

2010-10-29T08:54:00.001+01:00

Discontent over Health Secretary Andrew Lansley's reforms rumbles on. A King's Fund survey of 1,000 doctors shows misgivings over the proposals' power to deliver on their aims. And a right of centre think-tank, Civitas, has pronounced that the government's commissioning plans will not work if GP-led consortia are too small. However, Mr Lansley has once again repeated his intention to plough ahead.

The necessity to create more capacity and/or efficiency in the health service was underlined with announcements that the number of people diagnosed with cancer and diabetes is on the rise. On top of that, the imperative to tackle the increasing problem of dementia, one of the most money-hungry conditions the NHS has to deal with, has prodded 45 organisations, including the Department of Health, to band together to help solve the problem. Psychiatrists are also seeking attention from government on the issue of mental health. The Royal College of Psychiatrists says the subject is at the heart of the public health agenda.

The government has launched a consultation on its plans to set up a cancer drugs fund worth £200m a year for three years. It says the fund will help patients access innovative drugs prior to the pharmaceutical price regulation scheme (PPRS) reform in 2013. Speaking of which, health minister Earl Howe has announced that the government will 'honour in full' the terms of the PPRS until it expires.

Commentary: week ending 22 October 2010

2010-10-22T15:02:00.000+01:00

Health seems to have escaped the worst of Chancellor George Osborne's cuts this week with the tiniest of real terms increases announced for the duration of this Parliament - 0.1 percent. However, observers point out that mounting pressure on NHS resources from an ageing population and the rising numbers of long-term condition patients is likely to eat up any funding increase in no time.

A flurry of pledges and resources to help bewildered GPs navigate the confusing world of commissioning have emerged. Health Secretary Andrew Lansley has announced a series of support packs for aid in designing and commissioning services. The first, on cardiac rehabilitation, is already available. It will be followed by packs on dementia and chronic obstructive pulmonary disease. Mr Lansley also announced a programme for pilot GP-led consortia to ease enthusiastic pioneers through their first, few tentative steps.

And there is more: the National Association of Primary Care and the Royal College of GPs have each teamed up with an expert partner to provide advice and guidance for GP-led consortia.

Public service union Unison's bid to put a break on NHS reform by forcing the government to consult the public and others on its plans has failed. But the union, the biggest with around 1.3m members, has vowed to fight on.

Commentary: week ending 15 October 2010

2010-10-15T14:38:00.000+01:00

Intensive lobbying from the pharma industry over the past few months seems to have paid off. The government this week published its decision not to press ahead with generic substitution, which would have given pharmacists the right to substitute a generic drug for a branded one even if the latter was specified on a prescription. One of the main reasons given: potential harm to the patient.

It will be interesting to see how this pans out in light of the need to save money over the next four years to meet the £15-20bn efficiency drive imposed by government. After all, no one disputes that generics are usually cheaper than brand drugs.

NHS reforms dominated attention yet again. Health Secretary Andrew Lansley, speaking at the Royal College of General Practitioners' Harrogate conference, moved to ease concerns over the public's perception of GPs once they start having to make difficult decisions on spending their limited budgets. However, it was the any willing provider proposal that most excited GP leaders' fears and the potential damage that could be inflicted by exposure to private health services.

And as if to remind us that Liberating the NHS reforms have a long way to go before they are fully implemented the government has informed primary care trusts (PCTs), which will cease to be in 2013, to carry on with pharmaceutical needs assessments; PCTs have also been issued with best practice advice for prescribing schemes.

Commentary: week ending 8 October 2010

2010-10-08T15:22:00.003+01:00

It looks like Health Secretary Andrew Lansley has a fight on his hands to push through his health reforms intact. At a downbeat Conservative Party conference this week his health White Paper Equity and excellence: liberating the NHS was met with less than fulsome approval.

Delegates in the health service demanded more detail and clarification about exactly what it meant for them. Even people you might expect to greet it enthusiastically, such as members of the Conservative Medical Society, seemed decidedly underwhelmed, although dutifully vowing to try to make it work.

Doubts hovered markedly over the 'scale and pace of change' and how it would be funded, mentioned by many of the most prominent health organisations in their responses to the White Paper consultation, which is due to close Tuesday 12 October.

Questions present themselves: how married to every detail of his revolutionary pet project is Andrew Lansley? Can the transition timetable be slowed to help the service adjust? Can the scale of the changes be tempered? Is he willing to listen to dissenting voices? Can he snub his nose at those he is most reliant on to drive through his changes? In short, how open to compromise is Andrew Lansley and Liberating the NHS?

With the consultation almost over and analysis of the responses to follow, answers to these questions should be forthcoming in the next weeks and months.

But it must be said, there are some who just cannot wait to get on with it. Even as a senior health adviser cheerfully predicted an impending financial and structural disaster in the NHS caused by the reforms, the first pilot GP-led consortia were leaping into being in Cambridgeshire. Andrew Lansley must hope the hunger for change exemplified by this is shared by many more in the health service.

Commissioning course published

2010-10-05T15:27:00.001+01:00

The reform of commissioning is a central part of the coalition government's plans for the NHS and much uncertainty still surrounds how the White Paper will be implemented.

As GPs gain more responsibilities over commissioning services and primary care trusts face a bleak future, industry will need to be alert to the opportunities that the proposed changes may bring.

The Wellards commissioning course outlines what commissioning is, why it was introduced and what the potential impact it may have on NHS providers.

Take a look at the commissioning course in the Wellards e-learning section.

Wellards launches Diploma on healthcare in the Republic of Ireland

2010-10-01T15:08:00.001+01:00

Who runs the health service in Ireland? What is the role of the Health Service Executive? Is healthcare free at the point of delivery? For the answers to all these questions and more take a look at the new Wellards Diploma for the Republic of Ireland.

The diploma is made up of six papers covering structure, prescribing, quality, contracts, finance and policy. Each paper has a 10 question exam to test your knowledge.

On successful completion of the diploma candidates will have a better understanding of the Irish healthcare system, including subjects such as how it is financed and who agrees the supply of medicines in the country.

If you would like to find out more visit the Wellards Diploma Republic of Ireland in the Wellards e-learning section.

Commentary: week ending 1 October 2010

2010-10-01T14:29:00.002+01:00

Doctors' leaders have slammed the health White Paper Equity and excellence: liberating the NHS as having the potential to undermine the long-term future of the NHS.

The coalition government's Health Secretary Andrew Lansley has reminded GPs that management costs for consortia have still not been decided despite widespread fears they could be as low as £9 per patient.

The health union Unison has secured a date for a High Court hearing into the legitimacy of the White Paper reforms. The case will take place on the 13-14 October.

Commentary: week ending 24 September 2010

2010-09-24T14:04:00.002+01:00

Dementia once again dominated headlines this week when figures from the World Alzheimer's Report suggested the cost of the disease had reached £385bn – equivalent, the authors say, to the world's 18th largest economy.

Researchers claim quality and outcomes framework targets have damaged the quality of care for diseases not covered by the scheme.

The government is to pump £9m into 59 campaigns around England that aim to help people identify the early signs of cancer.

Commentary: week ending 17 September 2010

2010-09-17T14:17:00.000+01:00

Hints at how primary care trusts could merge their functions in the run-up to the implementation of the Equity and Excellence: liberating the NHS reforms have been issued in the NHS chief executive's latest letter to the health service.

The Royal College of General Practitioners has published guidance on how consortia could set themselves up in preparation for the Liberating the NHS reforms. It says consortia covering populations of less than half a million should seek to form federations with other consortia.

A report warns of an escalation in colon cancer and links it to the worldwide obesity epidemic.

Commentary: week ending 10 September 2010

2010-09-10T11:54:00.000+01:00

Increasing stock shortages of branded drugs have sparked concerns among 80 per cent of pharmacists, a survey has revealed. And more than 40 per cent of those surveyed said the situation was causing distress to patients.

The Office for National Statistics says patients in England are surviving cancer for longer. But figures show there are clear variations between the regions in survival rates.

More than a £1bn could be saved over a three year period if primary care trusts followed National Institute for Health and Clinical Excellence guidelines on obesity, according to a report from the Office of Health Economics. It says only a small percentage of people eligible for bariatric surgery, which helps people reduce their weight, is receiving the treatment.

Commentary: week ending 20 August

2010-08-20T12:08:00.001+01:00

The past seven days have revealed the true cost of building and maintaining over a hundred of England's impressive hospital developments. Private finance initiatives will cost the NHS billions of pounds, but the Department of Health remains adamant that the schemes present good value for money.

Commissioners planning to save money and provide cost-effective care will look forward to the next series of quality standards. The National Institute for Health and Clinical Excellence has announced the next nine clinical areas it will be providing information on.

Health Secretary Andrew Lansley's plan to scrap mixed-sex wards was applauded for its intention, but derided for its implication (too costly to implement). Unfortunately for the Audit Commission, it will not be asked to measure the financial impact of any such changes, as the coalition government has decided its days are numbered.

Commentary: week ending 13 August

2010-08-17T12:29:00.000+01:00

The public service union Unison has accused the NHS chief executive of illegally forcing fast-pace reforms on the health service without allowing the public to have their say on the proposals.

An unofficial world class commissioning review of primary care trusts has revealed that overall PCTs have improved in the majority of their competency tests.

The National Institute for Health and Clinical Excellence's decision to not recommend an asthma drug for children under the age of 12 has been criticised. NICE has said that the benefits do not justify the high cost. However, the Scottish Medicines Consortium has approved the drug in Scotland.

Wellards site maintenance: 1 September 2010

2010-08-17T12:27:00.002+01:00

As the Wellards Academy website has grown to meet the needs of its users, it has become clear that the structure of the website needs reorganising.

After taking into consideration the views of our subscribers, we will be moving to a new site layout from September.

The changes mean that the site will be unavailable on Wednesday 1 September from 9am. We anticipate it will be available by the evening. (Guidance on using the new site structure will be available on the logged-in homepage.)

We apologise for any inconvenience this may cause.

Commentary: week ending 6 August 2010

2010-08-06T14:21:00.000+01:00

The NHS Information Centre has released figures showing a huge rise in the number of treatments prescribed for diabetes over the past five years.

The National Institute for Health and Clinical Excellence has produced a list of proposed outcome measures for the quality and outcomes framework. They include two indicators for diabetes, a dementia indicator and six for mental health.

GPs' confusion over their commissioning role rumbles on with some expressing concern about the possible future involvement of the private sector.

The Department of Health has published a manual on NHS procurement that supersedes the primary care trust procurement guide published in March this year.

New course - NHS White Paper: Liberating the NHS

2010-08-02T15:11:00.003+01:00

The coalition government's first health White Paper, Equity and excellence: liberating the NHS, was published in July 2010, just two months after the general election. It proposes far-reaching structural reform and reinforces the role of the market in the NHS in England. Many new organisations will be established and some existing ones abolished, while others will have their functions modified. Although NHS spending will not be cut, the changes will be implemented under severe financial restraint.

On its launch, the paper was greeted as representing potentially the most significant change in the NHS's history.

This course examines the following areas:

principles underlying the White Paper
NHS structure
financial matters
involving patients and the public
improving outcomes
implications
legislation
timetable for reform

Log on to wellards.co.uk for the NHS White Paper: Liberating the NHS course.

Commentary: week ending 23 July 2010

2010-07-26T08:35:00.004+01:00

A week on, and an influx of associated NHS White Paper documents has revealed further thinking behind Andrew Lansley's plans for the English health service. The launch of several consultations means it is now time for the Health Secretary to absorb the thoughts of everyone else.

The changes, which we now know will cost £1.7bn this year, include plans for the proposed NHS Commissioning Board to hold a 'reserve power' to assign GP practices to consortia where necessary. On the flip side, Lansley has told the Health Service Journal that the consortia will have the freedom to choose their own size and geography.

After some uncertainty, we have learned the two-week wait for cancer patients to see a specialist will remain in place. The future of this, and other clinical targets, will become the responsibility of the NHS Commissioning Board once it has been formally set up in 2012.

Elsewhere, the National Institute for Health and Clinical Excellence has claimed its recommendations are overwhelmingly positive, with 80 per cent of its technology appraisals resulting in approval for use on the NHS.

Wellards will endeavour to keep track of the changes relating to the White Paper and keep our customers informed over the coming weeks. For ease of access, our ongoing coverage is located in the White Paper updates section and provides a round-up of articles, including diagrams of the proposed landscape and a timeline of crucial events.

Commentary: week ending 16 July 2010 - Big changes, many questions

2010-07-16T16:46:00.000+01:00

Some say it is the biggest change in English healthcare provision since the NHS Plan in 2000; others that it is the biggest since the 1970s; still others go so far as to say it is the biggest since the NHS was created in 1948. Whichever way you look at it, the government White Paper (WP) Equity and excellence: liberating the NHS represents a fundamental shift in the way healthcare is delivered in England. For the pharma, medtech and healthcare sectors it will now be a case of analysing the text to extract nuance and meaning, opportunity and threat.

The WP changes the way the NHS functions as a commissioner and provider. Pharma companies need to understand how it affects them and their industry as a whole; specifically those representatives who at the moment interact with primary care trusts (PCTs) and strategic health authorities (SHAs). They need to ask: how have pharma's customers interpreted the WP? Companies need to move fast as Sir David Nicholson has enjoined NHS managers to press ahead immediately with those reforms that do not need legislative change.

No doubt, healthcare development managers will keep an eye on how things are going. Some companies will discover the need to upskill and retrain their workforce to deal with the kaleidoscopic organisational changes presented to them; some will seek to explore the opportunities for diversification thrown up for more private enterprise involvement.

The increased role given to local government should attract interest, particularly because pharma tends to have little or no contact in that area and will need to reassess its customer base and account management functions to realign it more in terms of local health economies.

More than one commentator has raised concerns that the WP poses a threat to the ethos of the NHS. The argument goes that as well as the increased opportunities presented for private companies to provide health services in the reconfiguration, some commissioning consortia will undoubtedly fail, opening the way for other private companies to take over their role. No one can say they have not been warned.

Of course, unanswered questions are many. Here are some for consideration:

• how will the new local health economies work and how do you unearth sales opportunities?

• who are the new decision-makers and how do you get to see them?

• what criteria determine the success of commissioning groups? What metrics will the government put in place?

• who will decide which drugs go into formularies?

• what budget timeframe will be in place for cost-offset?

• what will happen in London?

• will there still be a role for the traditional representative once all the reforms have been implemented?

• how will the GPs' role of commissioner and provider be resolved under the government's Transforming community services agenda?

• how will the government's much-heralded 'information revolution' work?

• how does the White Paper affect the Association of the British Pharmaceutical Industry's proposals for joint working?

• will PCTs and SHAs go quietly after being asked to co-operate fully in the transfer of power and responsibility from them to GP consortia?

• what are the implications of all trusts taking the foundation route?

• what will be the results of an outcomes-based payment system?

• how is pharma going to tackle the move to value-based pricing in regard to its dealings with GP consortia, the National Institute for Health and Clinical Excellence and the NHS Commissioning Board?

Wellards will endeavour to keep track of the changes relating to the White Paper and keep our customers informed over the coming weeks.

Commentary: week ending 9 July 2010

2010-07-09T15:19:00.000+01:00

The public health debate took centre stage this week with Health Secretary Andrew Lansley announcing his 'vision' that would encompass more individual responsibility and financial input from private enterprise.

GPs are split on how well prepared their colleagues are for taking on more commissioning responsibility as promised in the forthcoming White Paper.

The BMA has warned of the difficulty of refocusing on health outcomes rather than processes, as proposed by the government.

Commentary: week ending 2 July 2010

2010-07-02T15:16:00.001+01:00

Three quality standards that are set to frame the way health and social care services are delivered throughout the NHS have been presented to Health Secretary Andrew Lansley. They are the first of an estimated 150 due to be created by the National Institute for Health and Clinical Excellence over the next five years.

The BMA conference heard doctors' leaders slam the rise of competition and bureaucracy in the health service.

NHS chief executive Sir David Nicholson has highlighted concerns about GP commissioning performance and the timetable for the introduction of GP budget holding.

Wellards Partnership Forum

2010-07-02T09:33:00.008+01:00

In response to high demand for information and analysis on NHS/industry joint working, the first Wellards Partnership Forum, held last month, offered delegates the chance to interact with a high profile panel of speakers and gain insight into the subject.

We surveyed delegates before the day to find out what they thought of the coalition government's plans for the NHS and found the overwhelming majority are still waiting to make up their minds about the new Department of Health team and its plans.

Q: How happy are you with England's new Department of Health team led by Andrew Lansley?

Very happy: 5 per cent
Happy: 13 per cent
Undecided: 79 per cent
Unhappy: 3 per cent
Very unhappy: 0 per cent

Q: Do you support the Department plans to change the role of strategic health authorities?

Yes: 47 per cent
Undecided: 47 per cent
No: 5 per cent

Q: Do you feel further value-based pricing (VBP) measures would be:

A step forward in linking the price of pharmaceutical products to their effectiveness in treating patients: 24 per cent
Simply a device for cutting drugs spending: 58 per cent
Undecided: 18 per cent

Q: Have you seen any evidence of the quality, innovation, productivity and prevention (QIPP) programme having an impact on the NHS?

Yes: 26 per cent
Undecided: 24 per cent
No: 50 per cent

(Note: due to rounding, figures may not add up to 100 per cent)

Speakers' presentations are now available on Wellards.

Wellards events calendar

Wellards Industry Forum (London): 30 September 2010, King's Fund, London

Wellards Industry Forum (Manchester): 13 October 2010, Radisson Hotel, Manchester Airport

Wellards Annual Conference: 3 November 2010, Royal College of Physicians, London

Commentary: week ending 25 June 2010

2010-06-25T15:05:00.000+01:00

Delegates at the NHS Confederation annual conference in Liverpool heard Health Secretary Andrew Lansley reiterate his commitment to improving health outcomes and make them the defining principle of how the NHS operates.

The revamped operating framework for 2010/11 has trailed a series of commissioning packs, to be produced in the next few months, intended to guide purchasers through the commissioning process for conditions like cardiac rehabilitation, dementia, diabetes, chronic obstructive pulmonary disease, end-of-life care and stroke. The document also makes immediate changes to a number of access targets.

The emergency Budget has protected NHS spending but the industry still waits to see how other departmental cuts will affect the health service.

The National Institute for Health and Clinical Excellence has brought out changes to its guidance on chronic obstructive pulmonary disease. It has changed aspects of diagnosis and management.

Revision to the operating framework 2010/11

2010-06-23T13:47:00.001+01:00

Less than two months after coming to power the coalition government has published a revision of the operating framework for 2010/11. The move sees access targets dropped, updated guidance and a number of initiatives earmarked for inclusion in the 2011/12 operating framework due before the end of the year.

Measures such as adopting an 'any willing provider' model for community services, and a series of commissioning packs that are in the pipeline for care pathways are likely to be of deep interest to the pharma and medtech industries.

Wellards has produced a presentation on the Operating framework (revision) for the NHS in England 2010/11, available to download here.

Commentary: week ending 18 June 2010

2010-06-18T16:51:00.001+01:00

The Department of Health is making the health service wait for the promised revised operating framework and speculation is mounting about its impact on the future of the NHS.

The future of commissioning, particularly whether and when GPs will be handed greater powers at the expense of primary care trusts, is gathering support among primary care representative bodies.

Doctors at the local medical committee annual conference have raised concerns over the former government's Transforming community services agenda and vertical integration.

Long-term conditions course

2010-06-15T09:51:00.001+01:00

With more than 17.5m people suffering with long-term conditions (LTCs) in the UK, it has become an increasingly important subject.

The Wellards Long-term conditions course describes the consequences of LTCs on patients, the NHS and the industry. It also looks at how the quality, innovation, productivity and prevention (QIPP) programme will work with LTC services and the impact of the financial crisis on service provision.

To find out more log on and visit the courses section.

Commentary: week ending 11 June 2010

2010-06-11T14:26:00.000+01:00

The transforming community services agenda looks set to be retained by the coalition government following a Department of Health announcement that primary care trusts should continue with moves to separate themselves from their directly-provided community services.

Health Secretary Andrew Lansley believes the integration of healthcare services will be helped by a coalition move to deny payments to hospitals if a patient is readmitted within 30 days after leaving care.

Professor Chris Ham, chief executive of the King's Fund said the quality, innovation, productivity and prevention programme is the 'biggest leadership challenge the NHS has ever faced'.

Commentary: week ending 4 June 2010

2010-06-04T14:49:00.002+01:00

The controversial report from consultants McKinsey, commissioned by the Labour government to look into NHS finances, has at last been officially released. Health Secretary Andrew Lansley has been quick to distance himself from its recommendations, claiming they are an example of top-down management thinking.

Long-term conditions lobbying groups had their hopes dashed after the coalition government postponed abolishing prescription charges for the people they represent. The government said a decision would have to wait until after the next spending review in the autumn.

A King's Fund report says patient choice has not proved as powerful as expected in driving quality improvement and increasing competition.

Commentary: week ending 28 May 2010

2010-06-01T09:37:00.002+01:00

The government underlined its commitment to change in the health service with a list of initiatives set out in the Queen's speech.

Rumours over the past few months of big changes in the structure of the English NHS have been borne out with the announcement that strategic health authorities' responsibilities will be scaled back and re-focused.

There was bad news for advocates of statins as a wonder-drug when researchers released findings claiming they can increase the chances of developing liver disease, kidney failure, muscle damage and cataracts in some people.

Commentary: week ending 21 May 2010

2010-05-21T15:52:00.000+01:00

A week after the new government took form, a raft of policy pledges have been issued in the coalition's programme for government. They include a commitment to a real terms increase in health spending for the next five years.

The Royal Pharmaceutical Society of Great Britain claims moves to prevent drug shortages in the NHS have failed.

Health Secretary Andrew Lansley has stirred up the debate over implementation of Lord Darzi's reforms by ordering a stop to what he describes as 'top-down reconfiguration of the NHS'.

Sites unavailable on Wednesday 26 May

2010-05-20T14:33:00.001+01:00

We are undertaking some essential maintenance on the Wellards websites.

The changes mean that the sites will be unavailable on Wednesday 26 May from 9am. We anticipate they will be available by the evening.

We apologise for any inconvenience this causes.

Commentary: week ending 14 May 2010

2010-05-14T12:28:00.000+01:00

Coalition government has reappeared after an absence of more than 60 years and with it comes a new Health Secretary: Andrew Lansley. Mr Lansley, Tory shadow health secretary for the last six and a half years, has already warned the healthcare sector that a lot of cost cutting has to be done and a lot of efficiencies must be made.

The National Pharmacy Association is taking legal advice on whether primary care trusts should be allowed to influence GPs to favour branded generics over unbranded ones.

The weak pound could ensure drug shortages continue in the UK until well into 2011, according to the British Association of European Pharmaceutical Distributors.

Commentary: week ending 7 May 2010

2010-05-07T15:44:00.001+01:00

Amid plans for the 'clustering' of primary care trusts (PCT) in seven strategic health authority (SHA) regions and predictions that this might lead to mergers, the director of the NHS Confederation PCT Network has urged PCTs and SHAs to think carefully about local needs.

The government has asked the National Institute for Health and Clinical Excellence to consider an unlicensed drug for the treatment of an age-related eye condition.

Health economist Alan Maynard has described senior clinicians calls for more centralisation in the health service as 'myopic'.