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Whose Health is it? The Treasury gets in on
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| Whose Health is it? |  Top  |
HM Treasury has now wandered onto the health turf with the publication of the interim report from the Wanless committee, set up to review key trends over the next two decades likely to impact on the NHS. Securing Our Future: Taking A Long-Term View sets out the evidence compiled so far in areas like health trends, public expectations, changing health needs, workforce and productivity issues, technological advances and differences between countries within the UK. An invaluable document for long-term planning. See www.hm-treasury.gov.uk. The report predicts that over the next 20 years most primary care and first routine NHS contacts will be provided by nurses and other healthcare professional rather than by GPs. Roles are expected to change significantly with much work currently done by GPs being switched to nurses and a large part of nurses' routine work being carried out by healthcare assistants. GPs are to become more specialised, managing more chronic conditions and even cancer in primary care as new drugs develop. So skill mixes are set for major change and this will be bound to impact on the industry. The report also makes comment that GPs need to double the amount of time they spend on clinical governance. For those wanting to know more on what the 'central' view on clinical governance is all about, a powerpoint presentation The Seven Pillars of Governance is available at www.doh.gov.uk/meddirbulletin/presentation.htm.
The Chancellor has said that the NHS won't get any more money until it reforms, but this is daft talk as it's already getting shed loads. So with Brown's Billions, the government has decided to go for broke but is it throwing good money after bad? They have already admitted that parts of the NHS have 'gone backwards' despite the already massive boost to health spending. What if the new money still makes no appreciable difference? Is the Treasury softening up public opinion to accept higher taxes to fund better health services? The Conservatives now seem to have finally abandoned the taxation-funding principle and Dr Liam Fox, the Tory health spokesman, wants to adapt the Swedish or Danish model for funding healthcare with social insurance
The NHS Alliance, NHS Confederation and the IHM all welcomed the Chancellor's commitment to a tax-funded, universally available NHS and his announcement of an extra £1 billion funding this year. "We were particularly pleased to learn that Derek Wanless had looked at alternative funding systems - and rejected them as too costly and ineffective", said Dr Michael Dixon, NHS Alliance chairman. "Like Gordon Brown, we hope that an enduring national consensus can be built around the central principles that a publicly-funded NHS is vital and that it should receive substantially increased long term investment", said Dr Dixon.
But NHS manager's real major concern continues to be that the reality of delegation of Shifting the Balance of Power comes with an extraordinary level of central direction strings. At the moment politicians are not only -1- setting the strategic direction and determining the levels of national funding, they are still trying to manage the detail at the sharp end as well. This not only undermines managers, it has a demoralising effect throughout the Service. The corridors of the NHS are thus not ringing with the hosannas of grateful staff and patients because of scepticism about the government's ability to deliver. See www.bmj.com/cgi/content/full/323/7325/1318 for a fuller analysis on Wanless and funding.
As regards STBOP, wrangling over the shape of the regional offices has been holding up final guidance and the government has not been getting an easy ride over its NHS Reform Bill. Approximately 60 candidates were shortlisted for the 28 StHA Chief Executive posts and these have now been announced, along with the Chairs. The boundaries have been confirmed and a few names have changed such as Anglia StHA becoming Norfolk, Suffolk & Cambridgeshire and West Midlands Central becoming Birmingham and the Black Country.
So beware, as we start this new year and all of Europe goes mad over Euros, yet another major NHS reorganisation gets closer. Prof David Hunter and colleagues, in an article, The redisorganisation' of the NHS (see www.bmj.com/cgi/content/full/323/7324/1262, reminds us that on taking office in 1997, Labour said that the NHS had suffered too much structural reform and yet this government has embarked on the largest, and least debated reorganisation of the NHS for two decades. "The NHS does not need a distracting and unproven reorganisation that, for all the rhetoric about devolution, leaves unchanged, or even strengthened, the capacity for the centre to micromanage the service into the ground. What is required is a fundamental rethinking of the relationship between central government and the NHS. The answer could lie in a move to regional government, with the NHS being transferred to the control of bodies like the Spanish regions or the Swedish County Councils." And we could become part of the Euro Zone too!
| NICE Conference & Stuff | Top |
The annual NICE Conference bash was held last month. Clinical Excellence 2001, at the ExCel Conference centre in the wastes of the London Docklands, proved to be the largest of the NHS conferences last year with over 1700 delegates. But one did almost needed a degree in conference participation to work one's way around the huge number of parallel sessions, streams and satellite meetings. There was certainly lots going and just about anybody who was anybody was there. I guess the really big news from the conference had to be that announced by Lord Hunt when he 'formally' notified the NHS that from January 1st this year, NICE guidance is 'compulsory' - previously reported here in October. Many expressed concern that the new rules requiring treatments approved by NICE to be funded within 3 months from the date of publication of each Technology Appraisal Guidance (TAG) would mean that other services would have to be cut. The NHS Alliance said that the government's decision to force HAs and PCTs to fund all treatments recommended by NICE was 'too simplistic' and as a result services like specialist nurses would have to be limited to fund the cost of NICE approved treatments. "We support the government's intentions, but not the way they are doing it," said Dr Mike Dixon, NHS Alliance Chairman. "I hope we will not see another kind of rationing, based on whether or not the treatment any particular patient needs has been looked at by NICE." Note the new directions apply to England only and HAs and PCTs will be expected to meet the costs of treatments recommended by NICE out of their general annual allocations. GPs continue to moan that they are now facing financial penalties for following NICE prescribing guidance and are having their budgets slashed and development money taken away to compensate for massive prescribing overspends. This story line will run and run through 2002!
The conference also marked the 'official' launch of the six professionally led National Collaborating Centres, developing clinical guidelines and audit advice for the NHS. See NICE Press Release 2001/039 (www.nice.org.uk) for full details of the NCCs and partners and the various Directors and Chairs. If you are into Guidelines, this 10-page document is the one to get! Some 35 clinical guidelines and 8 clinical audits are now in progress.
The NICE crew had lots of sessions at the conference. In a plenary session, NICE, The Process and the Programmes, Prof David Barnett, Chair of the NICE Appraisals Committee discussed the 'evidence gap' that existed between licencing and appraisal (efficacy versus effectiveness) and that NICE was unique in the world as its final determination 'injects' into health policy making in order to rationise the use of available resources. He described what they had learnt so far, particularly over size of remit and the 'difficulties' with controversial -2- topics. For instance large topics like the multi-drug appraisals in the atypical antipsychotics assessment with a 1000 page assessment on 8 different drugs and very large company submissions. This had had a significant impact on human resources, he said, and perhaps they had 'bitten off more than they could chew.' As regards evaluation of health economic data, more independent analysis was needed in the future, he said and further research was needed in HE methodology. He also recognised that the TAGs had a significant effect on the local NHS - budget impact, issues of prioritisation and consideration of lost opportunity costs, workload issues, staffing levels, training and development. Sir Iain Chalmers asked an interesting question at this session - the evidence given by Industry in its submissions is voluntary and/or in confidence. How do we know all is being given? He suggested that this was not as transparent as it might be because there was no legal requirement to provide this data…
In a session, HTA and Guideline Development in Scotland, Karen Facey from the HTBS and Juliet Miller from SIGN presented. As suspected, rumours of the death of HTBS were premature and it will apparently now form an agency within the National Clinical Governance Board (working title). See the SHOW website for a consultation document Integrating Scotland's Clinical Effectiveness Organisations, with the proposed new structures. I also have slides of these two presentations for anyone interested. Email alan.jones28@virgin.net for copies. Details on the long awaited Citizen's Council were also finally announced at the conference. It is planned that the Council will have up to 30 members who will be representative of the England and Wales population - now that's a challenge! Industry and lobbying groups will not be allowed and they are keen to avoid the usual suspects that get involved in CHCs etc - just Jo and Josephine Public. It is planned that the Council will meet in public every 6 months - interesting! The ABPI in fact launched their latest Media Briefing on NICE at the conference (MedBrief018; www.abpi.org.uk).
Through 2001 folk have been talking about a fundamental review of NICE, particularly the ABPI, but nothing materialised. Now the House of Commons Health Select Committee is to scrutinise the Institute in an official inquiry beginning this month, to assess its independence and how successful it has been in meeting its key goals and objectives as envisaged in A First Class Service. The HSC will also consider how clear and credible NICE's guidance has been; whether NICE guidance is accepted locally and acted upon and whether NICE has enabled patients to have faster access to effective medicines. Certainly with all this stuff going on, it is bound to be an interesting year ahead for NICE!
| Medical Education again! | Top |
Last autumn, we reported on some interesting comments in the BMJ following a Pharmaceutical Marketing publication on Medical Education (BMJ 2001;322:1312). Well the BMJ has picked up this area again. conference. Sellings drugs - with a little help from a journalist (www.bmj.com/cgi/content/full/323/7323/1258/a) asks exactly how are journalists recruited to work on behalf of corporate clients? Referring back to the PM guide which said, "…the best marketing, is editorial…readers believed claims made in editorial sections far more than claims made in an advert," the article says, "those in the business of promoting drugs - or more genteely described as 'pharmaceutical marketing' by its practitioners - know that one of the biggest factors in determining the financial fate of a drug is the quality of media coverage in specialist medical journals." So this is about the fact that readers do not know that writers are by paid by a drug manufacturer. "Fancy a trip to Paris? You will fly business class, stay at a luxury hotel and dine well. The pharmaceutical industry is well known for using such incentives to build relationships with key opinion leaders in the medical profession. Less well known, perhaps, is that journalists are also the recipients of such largesse."
| Primary Care | Top |
Primary Care is of course going to undergo tremendous change this year when it effectively takes over the funding reins. Please see my article in this month's Pharmaceutical Times for a more detailed 'exposition. The DoH's GP Bulletin for December (www.doh.gov.uk/gpbulletin/index.htm) has some interesting stuff - GP Specialists, envisaged in the NHS Plan, are now to be called 'GPs with Special Interests', stuff on GP Appraisal, Primary Care Cancer Leads and PMS. Regarding the latter read the latest at www.doh.gov.uk/pricare. Chief Executive posts for the West Sussex Health & Social Care NHS Trust and West Kent NHS & Social Care Trust were advertised, the first of the Mental Health Care Trusts. See www.wsussexhealth.org.uk/HA84 for the consultation documents.
| Prescribing | Top |
Guidance on primary care prescribing & budget setting 2002/03 has been issued. See www.doh.gov.uk/pricare/pcts.htm. The National Prescribing Centre (NPC) has produced a Competency Framework for Nurse Prescribers. It provides a useful summary of the history of nurse prescribing and next steps. See Maintaining Competency in Prescribing: An Outline Framework to Help Nurse Prescribers at www.npc.co.uk. This has to be a sensitive area for the Industry and this is clearly recognised in the Framework. Some 'behavioural indicators' are "critically appraises the validity of information (e.g. promotional literature)"; "works within the NHS organisational code of conduct when dealing with the pharmaceutical industry" and "recognises and deals with pressures that result in inappropriate prescribing" (p.17). Ray Rowden in November's Pharmaceutical Marketing (pps 27-28) reports on a survey amongst current nurse prescribers of attitudes to the Industry which showed that many are already wary.
| Mental Health | Top |
The Mental Health Promotion Project continues to develop and with its objective of supporting the implementation of NSF Standard 1, regional and local mental health promotion networks have now been mapped. See www.doh.gov.uk/mentalhealthpromotion/index.htm. The NSF Workforce Action Team (WAT) for Adult Mental Health has produced an interim report setting out the results of the exercise to map the education and training that is being commissioned and provided in mental health. See www.doh.gov.uk/mentalhealth/watmapexfinalreportdec2001.pdf. A 'Capable Practitioner' document has also now been published on the NSF website at www.doh.gov.uk/nsf/mentalhealth.htm.
| Cancer Services | Top |
A 12 page report, The NHS Cancer Plan: Making Progress, is available at www.doh.gov.uk/cancer/makingprogress.htm summarising, from the government's perspective at least, where we are with in the implementation of the NHS Cancer Plan. 279 PCT cancer lead clinicians have now been nominated as part of the DoH/Macmillan Cancer Relief initiative. Also the joint report from the Commission for Health Improvement and the Audit Commission is now out. This looks at the implementation of the recommendations of the 1995 Calman-Hine report on the commissioning of cancer services. The report focuses on the period 1995 - 2000, before the publication of the NHS Cancer Plan. The report is available at www.chi.nhs.uk.
| Respiratory Health | Top |
The BTS have done a good job in publicising their report The Burden of Lung Disease (www.brit-thoracic.org.uk). It suggests many more specialist respiratory nurses, consultants and surgeons are required and that lung disease is at least as important as cancer and heart disease and a NSF would be nice. Other groups like the RCN have rejected this approach. A DoH spokesperson reminded the BTS that much of the morbidity and mortality is due to lung cancer and not COPD and asthma and that was why the burden of respiratory disease was so high and that this was already being tackled!….
| Diabetes NSF | Top |
The first part of the National Service Framework (NSF) for Diabetes has been published The second part, the 'delivery strategy' will arrive in the summer. The twelve recommendations include patient-held records and personal care plans and the NSF clearly recognises the key role of primary care. Said Dr Michael Dixon, Chair of the NHS Alliance, "There is clear evidence that the quality of care in diabetes has often been variable, and that patients have fallen into an invisible gap between primary and secondary care - between GPs and specialists. The emphasis throughout is on locally agreed protocols to meet national standards. We welcome the explicit recognition of the cumulative effect of NSFs on primary care and anticipate that the strategy for delivery will take full account of the extra demand on primary care and the resources needed. We must not risk unbalancing those areas not covered by NSFs,"
| Bandolier & EBM & the Industry | Top |
Bandolier's November issue can't resist having a go at the industry, "Bandolier sometimes despairs of healthcare industries. Evidence should be their meat and drink, yet they shrink from helping us by giving us the evidence the way we want it, in unbiased, independent, systematic reviews. Though there are exceptions, too often they are afraid of what's on the other side of the hill. So after incredibly expensive research, carried out over a whole afternoon, Bandolier has come up with the answer. Anyone from industry bearing an unbiased, independent, systematic review of a company's product will be rewarded with a Bandolier mug. That should do it!"…. I wonder!…….
| Hospital Stuff | Top |
An article in the McKinsey Quarterly Journal is being heavily sold to the NHS at the moment and is worth a look at for those with an interest in hospitals. Hospitals get serious about operations is at www.modernnhs.nhs.uk/newsdesk/operations.pdf and has stuff about service improvement and redesign techniques - very much the sort of work of the Modernisation Agency. A letter from David Fillingham, MA Chief Executive, commends the article to NHS Chief Executives and asks that they draw the article to the attention of their boards. See www.modernnhs.nhs.uk/newsdesk/df-mckinsey.doc. The Audit Commission has come out with a very bleak picture of hospital pharmacy services. A Spoonful of Sugar claims that thousands of patients are being killed by medication errors/adverse reaction to drugs. It also recommends as too few Trust Boards have understood the importance of the link between effective clinical governance and medicines management and that the role of the Chief Pharmacist should be elevated to the equivalent of Clinical Director.
| Newsletter Corporate 'NHS Inform' | Top |
Therapy specific, corporate newsletters, written by Alan Jones of AJC Healthcare, are employed throughout the UK Pharmaceutical Industry, as a source of crucial NHS intelligence, within many Sales Teams.
To discuss how your team could benefit from regular up to date analysis of the NHS changes and issues that directly impact on your business, please contact Alan Jones of AJC Healthcare (alan.jones28@virgin.net)