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The Volcanic NHS Shifting the balance of
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| The Volcanic NHS |  Top  |
What a busy month in the 'NHS World' last month!
First of all you should be excited by the fact that the NHS Modernisation
Board, set up to oversee the implementation of the NHS Plan, has published its
first annual report. You won't be surprised to learn that little headway seems
to have been made in reaching many of the targets set out in the Plan.
"Modernisation is patchy and there is still clearly a long way to go", says the
report. This is relevant to companies since knowing which areas are moving
faster than others (e.g. NSFs) is pertinent to determining appropriate and
timely responses at both national and local levels. Rhetoric v reality!…..
See
www.doh.gov.uk/modernisationboardreport.
…..And
Shifting the Balance of Power: the next steps finally saw the light of day as
final countdown to the arrival of the StHAs begins. The new STBOP paper sets
out the framework for the forthcoming changes but, in line with its own
philosophy, it leaves the practical arrangements, the how, when and where of
working arrangements and service delivery to be decided locally! As companies
will need to have an interface with these brand new organisations, there is a
need to find out exactly what is going on here. There is also stuff in the
paper about, not only devolving management authority to organisations, but of
devolution within organisations. Further, the changes are not just about
structure, but about behaviour with a shift from a more hierarchical approach
to a more networked approach, putting greater emphasis on team-work and on
patient and staff involvement. The new Chief Executives have started to appoint
their teams of Directors. So watch out for announcements soon on a new customer
base.......
…And the Department's response to the Bristol Royal
Infirmary Kennedy Report, 'Learning the Lessons', was also published last
month. Professor Sir Ian Kennedy was asked to inquire into the management of
paediatric, cardiac services in Bristol between 1984 and 1995 and his analysis
demonstrated a need for a fundamental reform of the relationship between
government, the healthcare profession and the public. The central message of
the Kennedy Report was the need to change the culture of the NHS so that
patients are able to become active partners in care - so that's the stuff about
'behaviour' highlighted above. Of course any changes in behaviour of
traditional industry customers is of direct relevance to companies! Bottom
line, the Government has largely accepted the broad approach set out in the
Kennedy Report but a lot was also rejected, although you wouldn't think so from
the spin! See
www.doh.gov.uk/bristolinquiryresponse/index.htm.
As
the National Health Service gets ready to face its biggest upheaval for almost
20 years, last month we also had an unexpectedly radical speech from Alan
Milburn on further 'redefining' the NHS! What is particularly interesting is
that the policy ideas Mr. M. revealed at a New Health Network seminar seem to
have emerged from backroom discussions, developed without consultation and yet
again sprung on the service through the media. So now the health service has to
grapple with the concepts of foundation hospitals, public interest companies,
mutuals, 'public service entrepreneurs' and the thought that management at
failing trusts could be franchised out to not-for-profit organisations. I
wonder if Mr. Milburn has focused on the fact that the foundation school
experiments do not seem to have had a noticeable effect on the education system
and that franchising has done little for the rail network!…… It is as
if Mr. Milburn feels he has to put one last stamp of his authority on the NHS
before he 'lets go of the reins' as promised. It does seem as if the Government
is panicking again over the lack of NHS modernisation and this is probably the
reason for more change on its way. For a full transcript of the speech so that
you can extract every little nuance (!), please see
www.doh.gov.uk/speeches/jan2002milburnnhn.htm.
The
policy bombshell actually has echoes of the Conservative reforms - working for
patients, self-governing Trusts etc, and one could almost have heard all of
this from former Health Secretary Kenneth Clarke, who pushed through the Tory
changes! So, a strong sense of déjà vu then. Of course the devil
would be in the detail and there is currently none! So what some people are now
asking is - are we beginning to move down a long road at the end of which all
health service provision rests in private hands and that this road begins with
the first step to allow private sector managers to run NHS hospitals under
franchise. In this scenario, while healthcare would remain free at the point of
use for all, according to need and regardless of means, the state would no
longer own or operate the facilities in which it was provided…. The answer
here must be that we don't know yet, but, for sure, this will be a major
talking point amongst your customers!!…
| NICE submits | Top |
Lots of NICE things have also happened this month….. First of all the Health Select Committee began its scrutiny of the Institute and just about everybody who is anybody has been invited in to give 'evidence'. In their evidence, both the Drug and Therapeutics Bulletin and the British National Formulary, arguably the UK's two most influential clinical publications, suggested that the process of appraisal of drugs by NICE was flawed, that a number of significant decisions had been based on dubious evidence and particularly criticised NICE's lack of willingness to discuss their concerns. "The kind of flaws we have found on NICE guidance are far ranging….sometimes NICE says things that we find difficult to put in the BNF because they are not quite true."!! Other groups have also weighed in with some criticism over something or other - certainly everyone seems to have been showing off their own particular vested interests! Indeed from the documents submitted and presentations made so far, it is pretty clear that nobody seems best pleased with NICE. But, just maybe, by displeasing everybody, NICE has got it just about right?!….
Actually, the most interesting submission so far has to be one by NICE itself. In its 'memorandum of evidence' (see www.nice.org.uk) you can read the most extraordinary self congratulatory 'essay', as if none of this criticism existed at all. There is a particularly impressive long list of all the things it has done since start up and it goes on (and on….), "There is overwhelming national and international (!) opinion that NICE guidance is credible, appropriate and produced to an exacting standard. There is no other body in England and Wales capable of producing clinical practice guidance of the quality and range achieved by NICE. No other body producing clinical advice operates in a manner that is as inclusive and transparent. Although it is not the only source of guidance, NICE is now the only body with the credibility, resources, professional networks, and robust methodologies to provide a single national focus for developing clinical standards for the NHS." Interestingly, the authors of the document do admit that inevitably its advice will not always be received with universal approval as many of the topics referred to NICE represent areas of genuine uncertainty or disagreement. "The decisions NICE makes are sometimes difficult, and the Institute will seldom satisfy every possible interest. But they are keen to point out that its guidance is independent of any vested interests…
The document also says that the Board would like the work programme to be constructed in a more inclusive manner and so expect in 2002 then, that NHS staff will be increasingly asked to propose either appraisal or clinical guideline topics and also that PCTs (and Acute Trusts) will have an opportunity to become involved with the actual appraisals themselves as consultees. Certainly this paper is of direct relevance to companies, as it re-emphasises the need for earlier referral of new technologies to ensure faster access (or not). "NICE is anxious to publish appraisals of significant, novel health technologies as soon as possible after licensing" - e.g. within 3 months. For new drugs this would involve starting the appraisal process around the time of submissions for marketing authorisation. The document refutes ABPI concerns that appraisal should wait until the drug has been marketed for 2-3 years as it says that this would deny NHS patients access, create confusion and its experience thus far suggests that Industry's fears are unfounded. A useful document overall to look through.
If folk are into clinical audit then note that Principles of Best Practice in Clinical Audit will be launched at the Conference Clinical Audit 2002 on 12/13th February at Church House, Westminister, organised by HealthCare Events. The book will be distributed to NHS from early March. Finally and by no surprise, NICE has announced that the appeals against the Institute's Final Appraisal Determination (FAD) on the MS drugs have not been upheld. In other words, beta interferon and glatiramer for MS will not be recommended to the NHS in Technology Appraisal Guidance issued on Monday 4th February. So, it is up to the direct discussions still going on between the manufacturers and the DoH to see if the drugs are going to be available at another price!
| Medicines & Prescribing & Pharmacy | Top |
Do you read Bandolier? In January's issue, you
will actually find quite a lot on medicines - particularly on 'class effects'.
A study on statins is outlined where decisions were being taken by clinicians
and policy-makers between older, more expensive statins, and newer, cheaper
statins. "….assumption of a class effect is usually done to justify
choosing the cheapest drug in terms of acquisition costs. One group chose the
cheaper statin with less information, and the other the older and more
expensive statin with masses of patient experience. Can you guess who choose
what?…… So this is about the weight of evidence versus acquisition
costs…. Remember Bandolier has a wide NHS readership and is well
respected, so these kinds of comments are important. Negative quotes will need
to be countered but positive quotes could also be used by marketing! See
www.ebandolier.com.
In a Health Service Journal
article last month on PCTs and the fact that they will now be taking on 75% of
NHS funding, the author had to have a go at prescribing costs. "Prescribing
costs are another concern as PCTs are responsible for managing GP prescribing.
Our national database on spending in this area calculates that over £130m
could be saved in prescribing costs. To achieve this, the prescribing of
premium priced drugs needs to be more economical….although most PCTs are
taking on their own prescribing expert, there is little experience in the
strategic management of prescribing, which is what PCTs need…." So, expect
continued downward pressure on prescribing costs in 2002. The first,
centrally-funded training courses for the extension of nurse prescribing
started on 7 January. Further courses will begin in February and March and
continue throughout the year. See
www.doh.gov.uk/nurseprescribing. And finally, following the
allocation of £1 million to HAs last September to support clinical
governance in community pharmacy, Guidelines on Good Practice has now been
disseminated. See
www.doh.gov.uk/clinicalgovernance/communitypharmacy.htm.
| Primary Care | Top |
The DoH, in conjunction with the Sowerby Centre for Health Informatics at Newcastle (SCHIN), has produced an 'on-line' resource for appraising and appraisee GPs. See www.appraisals.nhs.uk. SCHIN is also, of course, the home of PRODIGY, whose winter 2001/2002 newsletter has just been mailed out. A new CD Using the Computer in the Consulting Room has also just being issued. Email: prodigy-enquiries@schin.ncl.ac.uk for copies of either. The role of GPs with a Special Interest (GPSIs) is being developed and a national network of GPSIs is now being established. Questions currently being asked about what this role brings are - can patients access GPSIs without adding new steps to their journey? How can a GPSI provide systems of 'advanced access' without detriment to patients or their general practice? What is the role of GPSIs in training and dissemination of knowledge to other GP colleagues? What is the impact on waiting times for secondary care within the PCT? It will be important for companies to track this development in their relevant therapy areas. And finally, Solihull PCT have been the first to advertise for a Director of Public Health in the HSJ. It would seem these folk do not necessarily need to be doctor trained and that epidemiological skills will be OK!
| Undeliverable NSFs | Top |
Prof. Malcolm Johnson, Prof. of Health & Social Policy at Bristol University, has warned that only 50% of the key targets of the NSF for Older People are deliverable. Prof. Johnson, who is also Director of the International Institute on Health & Aging, has said that standards for mental health, for instance, were unachievable. Prof. Alan Maynard has also pointed out that as the NSFs have not been properly costed, they will "require determined management if rhetoric is to be translated into practice. They could be nothing more than a public declaration of intent: an empty policy wheeze". Alan's comments coincide with the publication of the latest issue of York University's Health Policy Matters. See www.york.ac.uk/healthsciences/pubs/hpmindex.htm.
| Cancer Services | Top |
The NHS Cancer Plan continues to be implemented. Each of the 34 Cancer Networks is to be given £10K to spend on tapping into the knowledge and experience of people with cancer - and to ensure that the results are fed back into service development. Also a new network of cancer research centres is being set up (see www.ntrac.org.uk). The January 2002 Newsletter (Edition 5) from the Cancer Action Team is now available for all the latest cancer news. See www.doh.gov.uk/cancer to download a pdf copy.
| Newsletter Corporate 'NHS Inform' | Top |
Therapy specific, corporate newsletters, written by Alan Jones of AJC Healthcare, are employed within many Sales Teams throughout the UK Pharmaceutical Industry, as a source of crucial NHS intelligence.
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)