A of leading national health bodies in England have published a series of nine targets that the NHS should aim to satisfy over the next six years.
The plan, which covers the period leading up to the end of the decade, is backed by £560 billion of NHS funding.
It collectively sets out guidance for the health service in a period of extreme financial and logistical challenges.
“Delivering the Forward View” sets out “steps to help local organisations plan over the next six years to deliver a sustainable, transformed health service and to improve quality of care, wellbeing and NHS finances.”
Included in the plan is a new, dedicated sustainability and transformation fund, which will be worth £1 billion in the next financial year, rising to nearly £3.5 billion by the end of the decade.
This is intended to “help get hospitals back on their feet, support the delivery of the Five Year Forward View, and enable new investment for critical priorities such as primary care, mental health and cancer services.”
Guidance included in the report is aimed at outlining a new approach to NHS services, ensuring that the health service can retain its quality of performance throughout the rest of the decade.
Simon Stevens, chief executive of NHS England, was positive about the provisions outlined in the document, outlining that it can play a major role in the stabilising of the NHS until the end of the decade.
“This guidance sets out the next steps to make the vision set out in the Five Year Forward View a reality. A new approach to how local NHS leaders plan to meet health needs across whole areas will sit alongside the new Sustainability and Transformation Fund. Together they will help to ensure the NHS has solid financial foundations from next year, and to transform how care is delivered up to 2021,” Stevens commented.
One aspect of the planning of the NHS that has not changed is the individual operational plans that must be put in place in the next financial year.
However, each health and care system within the United Kingdom must work collectively in order to produce a separate Sustainability and Transformation Plan (STP) to cover October 2016 to March 2021. This is a new aspect of the guidance.
The nine ‘must do’ targets for 2016/17 are:
1. Develop a high quality and agreed STP
2. Return the system to aggregate financial balance.
3. Develop and implement a local plan to address the sustainability and quality of general practice, including workforce and workload issues.
4. Get back on track with access standards for A&E and ambulance waits
5. Improvement against and maintenance of the NHS Constitution standards that more than 92 percent of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment, including offering patient choice.
6. Deliver the NHS Constitution 62-day cancer waiting standard, including by securing adequate diagnostic capacity; continue to deliver the constitutional two-week and 31-day cancer standards and make progress in improving one-year survival rates by delivering a year-on-year improvement in the proportion of cancers diagnosed at stage one and stage two; and reducing the proportion of cancers diagnosed following an emergency admission.
7. Achieve and maintain two new mental health access standards [and] continue to meet a dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia.
8. Deliver actions set out in local plans to transform care for people with learning disabilities.
9. Develop and implement an affordable plan to make improvements in quality particularly for organisations in special measures.
A major new plan aims to rehabilitate palliative care in the NHS in Scotland.
Ministers have unveiled the system following pressure to significantly overhaul the existing system.
In particular, £3.5 million of extra investment has been announced in order to aid care to the dying.
This will enable the Scottish government to widen access to treatment, regardless of diagnosis, age or background.
The new plan will be implemented over a five-year period as the NHS in Scotland aims to seriously improve palliative care.
This new strategy will see greater training for staff across health and social care on how to support patients and their families.
Commenting on the new scheme, health secretary Shona Robison was keen to emphasise that the NHS in Scotland requires a new openness around the issue of death and dying.
“Many people will have gone through the extremely sad process of looking after a loved one towards the end of their lives. This will always be a difficult experience, but our health and social care services have a crucial role to play in making it as dignified as possible, and ensuring that the patient’s wishes and needs are taken into account.”
Robinson also strongly supported the new framework and suggested that it would be successful in the aims of the Scottish government.
“Through this new framework we want to make sure that everyone receives high quality palliative care – tailored to their own symptoms and life circumstances.”
The new policy was authored by numerous health professionals and experts, with Professor David Clark, a Wellcome Trust investigator at Glasgow University, playing a central role.
Clark commented on his happiness with the final palliative care process and procedure that have been created, and expressed confidence in the future of the sector in Scotland.
“I am confident it will lead to widespread improvement in one of the most challenging issues of the day – how we care for people at the end of life.”
The new policy has been broadly welcomed by campaigners, considering the commitment to improving end of life care that it represents.
This is considered to be particularly important considering the growing population in the Western world.
Numerous countries are facing difficulties in this area, with, for example, Germany having recently resorted to transporting elderly patients to the Middle East.
Macmillan Cancer research has indicated its cautious optimism about the new policy, and has also stated that it will work closely with the Scottish government in order to implement it.
The Holyrood Health and Sport Committee has completed its research into specialist end-of-life care, and found that it shouldn’t be limited to merely cancer patients.
A committee of Members of the Scottish Parliament came to the conclusion that such care should be open to all patients.
In a damning indictment of healthcare in Scotland, the committee suggested that 10,000 people in Scotland are currently receiving insufficient access to palliative healthcare.
The commission also suggested that those with terminal illnesses other than cancer, the homeless and those with learning disabilities were less likely to receive palliative care at the end of their lives.
While decisions are currently made on a condition-based premise, the committee of Scottish MPs instead suggested that such critical decisions should be made on a case-by-case basis.
Increasing numbers of people suffering from terminal diseases are currently on the palliative care register, but the committee acknowledged that there is a serious issue with regard to access to palliative care for people with non-malignant diseases.
Scottish MPs concluded that palliative care should be a right not a privilege.
Commenting on the issue, committee convener Duncan McNeil, the Labour MSP for Greenock and Inverclyde, suggested that Scotland needs to take a much harder line on this issue.
“Our committee came to a firm conclusion that everyone who needs it should be able to access high quality, person-centred palliative care. We heard that this is not happening on a consistent basis and that people across Scotland have a different experience depending on where they live, their age and their condition.”
Prof David Clark of Glasgow University provided evidence to the committee which suggested that more than 10,000 Scots who could benefit from palliative care towards the end of their life died without receiving it.
This damning evidence was also backed up by accounts which suggest that homeless people and those with learning difficulties are significantly less likely to receive palliative care.
Health Secretary Shona Robison welcomed the report and stated that the Scottish government’s strategic framework on palliative and end-of-life care was due to be published by the end of the year.
“This framework will help ensure that everyone in Scotland – infant, child, young person or adult – no matter where they live and no matter what clinical conditions they have, will receive care from a health and social care system that recognises when time is becoming shorter. It will be supported by £3m funding over three years. The committee’s report will help inform the development of this framework.”
General health issues have been a major problem for Scotland over the last few years, with diminishing life expectancy in some of the worst hit areas underlining this trend.
In particular, it is been widely publicised that Glasgow is the city with the lowest life expectancy of any in the United Kingdom.
The quality of end of life care in the United Kingdom has been ranked as the very best in the world in a recent study.
A report conducted by the Economist Intelligence Unit was hugely complimentary regarding the quality and availability of such services within the UK.
The study examined 80 countries worldwide, and particularly praised the NHS and hospice movement within the UK, describing the quality of care in the country as “second to none”.
As would perhaps be expected, developed economies generally performed well in the study.
Australia and New Zealand ranked second and third in the report, but there was also some encouraging news for developing economies and the third world.
The Economist Intelligence Unit found that the quality of care in some of the poorest nations on the planet had improved considerably, with African nations ranking surprisingly highly in the study.
Mongolia was rated as highly as 28th by the Economist Intelligence Unit, with its investment in hospice facilities considered particularly important.
Meanwhile, Uganda, ranked 35th in the report, has managed to improve access to pain control through a public-private partnership.
Rankings in the study were calculated by utilising assessments of the quality of hospitals and hospice environments.
In particular, the Economist Intelligence Unit assessed staffing numbers and skills, affordability of care and quality of care.
And although the results related to Britain were encouraging, the overall picture was rather disturbing for the quality of end of life care worldwide.
Less than 50 per cent of the countries survey provided what the report classed as a good end of life care, with only 34 of the 80 countries reported on considered to be adequate.
Not only was this a relatively paltry number in terms of total nations, but the percentage of the global population that they represented was even smaller.
The 34 nations considered to be good in terms of end of life care only accounted for approximately 15 per cent of the adult population.
Yet despite the relatively poor level of end of life care indicated by the study, the report in fact suggested that this aspect of healthcare is becoming increasingly important.
An ageing population ensures that people around the world are increasingly facing “drawn-out” deaths.
Already there have been a demographic problems with greying populations in such countries as Japan and Germany, and this trend is expected to accelerate and encompass the rest of the developed world in the coming decades.
Report author Annie Pannelay praise the quality of end of life care in the UK, but also suggested that there is still room for improvement.
“The UK is an acknowledged leader in palliative care. That reflects its comprehensive strategy towards the issue as well as the improvements that are being made. But there is more that the UK could do to stay at the forefront of palliative care standards, such as ironing out occasional problems with communication or symptom control,” Pannelay commented.
The social care management advisors Carter Schwartz have warned that the existing care system is threatened by the new proposed living wage.
This new labour scheme has been promoted by the Living Wage Foundation, with the intention of improving working conditions across the United Kingdom.
Analysis carried out by Carter Schwartz suggests that the living wage would force many independent operators out of the care home business, potentially leaving thousands of vulnerable people without support.
According to figures collated by the social care organisation, the higher wage will only cover around 60 per cent of existing staff, ensuring that wages in the sector inflate by £330 million pounds in the next year alone.
It is further projected that care sector wages would reach a total of £1 billion in the United Kingdom by the end of the decade, and Carter Schwartz believes that this would simply be unaffordable.
Commenting on the issue, Adam Carter, managing director at Carter Schwartz, suggested that the existing care home system is already stretched.
“Many care home operators already struggle to pay the minimum wage and continued local funding cuts are putting greater strain on budgets and limiting resources. With the funding gap expected to reach £4.3bn by 2020, the introduction of the living wage will only exacerbate the problem.”
Carter continued to underline some of the mathematics behind the opinion of the ‘boutique consultancy’.
“With suggestions that some of the larger domiciliary care providers are operating on margins of under 10 per cent, any increase in living wage will have a huge impact on their ability to keep services running. Whereas other sectors can absorb the extra costs by elevating their prices, health and social care providers are restricted to set contracts,” Carter explained.
However, it should be stated in mitigation that although the opinion of Carter Schwartz should be taken seriously, there are certainly counterarguments against the view of the consultancy.
It could be asserted that pay and conditions in the care system are already extremely poor, and thus the living wage campaign should be welcomed by those who wish to see care workers leading a more dignified existence.
While there are unquestionably economic issues related to the care home system, the view of Carter Schwartz could be viewed as scaremongering that fails to address the underlining root causes of the issue.
Instead of fearing the opportunity to offer care home workers a decent living wage because of the economic difficulties that will result, a more nuanced and mature debate: could instead result regarding the future of the care home system and how it can be funded going forward.
Indeed, the aforementioned Carter did seem keen to open up such a debate, and placed an onus on the government to act decisively.
“The government must to do more to address industry concerns, as without any additional support, it is very likely that some of our biggest care providers will be put in jeopardy, leading to a crisis in the sector, with too many people needing care and not enough support for them,” Carter asserted.
This issue could be another potential theatre in the ongoing battle between the Corbyn-led Labour party and the Conservatives.
Corbyn will doubtless be looking for the government to commit some resources to strengthening the care system in the coming years.
NHS England has issued a Patient Safety Alert in relation to the introduction of a new set of National Safety Standards.
The safety standards in question are related to the National Standards for Invasive Procedures (NatSSIPs) that were published on 7th September 2015.
NHS England has announced that an NHS-wide programme of work based around the standards will now be launched.
The organisation is asking providers across the NHS to review the existing clinical practice, in order to ensure that the NatSSIPs are embedded into local processes.
Local NHS providers are also encouraged to develop their own specific safety standards for invasive procedures.
The principle behind the NatSSIPs is that organisations will review their current local processes for invasive procedures and ensure that they are compliant with the new national standards.
This will be carried out by organisations working in collaboration with staff to develop their own set of ‘Local Safety Standards for Invasive Procedures’.
Patients and the general public should also be involved in the consultation process.
The main aim of the procedures is to reduce the number of patient safety incidents related to invasive procedures.
These can often lead to surgical Never Events, and the new NatSSIPs are being embedded into the NHS culture with the hope of reducing such incidents.
NatSSIPs effectively outline the minimum requisite standards for the delivery of safe healthcare during invasive procedures.
They also intend to underpin and build upon the key aspects of education and training within the NHS.
Although the NatSSIPs will be new to many healthcare professionals, they have already received an outstanding array of endorsement.
The NatSSIPs have been agreed and endorsed by all relevant professional bodies, including the royal colleges, the Care Quality Commission, the Nursing and Midwifery Council, the General Medical Council, Monitor, the Trust Development Agency, and Health Education England.
The NatSSIPs represents a commingling of national and local learning from NHS-wide analysis of Never Events, Serious Incidents and near misses.
This has occurred through the prism of a set of recommendations that will enable improved care for patients while they are undergoing invasive procedures.
The new agreement is not intended to replace the existing WHO Surgical Checklist, but instead to build upon and enhance it by examining additional factors within the NHS such as the requirement for education and training.
Speaking about the new safety standards, Dr Mike Durkin, NHS England Director of Patient Safety, commented on the importance of the new procedures.“Through this alert providers are asked to embed the NatSSIPs into their own local safety standards to support staff in providing the very best care and treatment for their patients. This is the first time national safety standards have been set and endorsed by all relevant professional bodies. The engagement and support of these organisations provides the leadership to ensure the standards will be wholeheartedly embraced across the NHS.”
You can access more information on NatSSIPs by clicking here.
As the debate regarding seven-day care in the NHS rumbles on, the British Medical Association (BMA) have had their say on the subject.
Analysis has recently been published in the British Medical Journal which suggests that weekend admissions lead to fewer but sicker patience than during weekdays.
The discussion on the topic follows Prime Minister Mr David Cameron’s assertion that the NHS must develop a seven-day culture in order to meet the demands of a contemporary health service.
Responding to the issue, Dr Mark Porter, BMA council chair, indicated his support for the concept:
“Doctors want the care we provide for sick patients to be of the same high standard, seven days a week. Urgent action on this has been undermined by calls for the entire NHS to be delivered on a seven-day basis without any clear prioritisation,” Porter commented.
Porter also underlined that the British Medical Association is fully committed to the concept of seven-day care, and indeed suggested that this will even become a priority for the organisation in the foreseeable future.
“The BMA wants better access to seven-day urgent and emergency care to be the priority for investment. This will ensure seriously ill patients receive the best care at all times. Nine in 10 consultants already work around the clock delivering this care,” Porter pointed out.
But despite the support for the concept from the British Medical Association, there are still question marks over the logistics of the concept according to Porter.
Numerous senior health figures in the United Kingdom have already queried the practicality of what Cameron is suggesting, and Porter is certainly no exception to this rule.
“Additional services will require not just more doctors, but extra nurses, diagnostic and support staff,” Porter not unreasonably asserted.
The BMA council chair also suggested that the government must resolve to flesh out the details of this particular scheme as quickly as possible.
Although David Cameron has indicated his belief in a truly seven-day NHS, there has been insufficient detail to back up the concept, let alone any information regarding how it will be delivered.
Porter critiqued this aspect of the concept, and placed the issue into a wider context.
“David Cameron promised a ‘truly seven-day NHS’ but there has been no detail to define what he means, how he plans to fund and staff it, and its impact on weekday services. Given the current funding squeeze on NHS Trusts, the only way for many hospitals to increase the number of doctors over the weekend would be to reduce the number providing care during the week,” Porter stated.
Porter concluded his comments on the matter by delivering something of a mild ultimatum to the government.
“If the government really want to deliver more seven-day services then they need to show patients, the public and NHS staff their plan for how this will be delivered at a time of enormous financial strain on the NHS and when existing services and staff are under extreme pressure.”
A BMA Survey of consultants found that 80 per cent currently work evenings and weekends in addition to the normal working week. Only 1 per cent of existing consultants utilise the so-called ‘weekend opt-out’.
These figures indeed suggest that the opinions of Porter are entirely sound, and that the government will have to make considerable changes to the NHS, not least with regard to recruitment, in order to even come close to achieving its supposed vision.
A report published today (Tuesday 21 July 2015) by the independent consumer champion Healthwatch which focuses on the patient experience has been welcomed by the NHS Confederation.
The report, entitled ‘Safely Home’, has been praised for its focus on individual patient experience and good system-wide healthcare coordination.
“Every patient has a story about their care and the vast majority are positive, but when it goes wrong it’s often because of gaps and boundaries which exist across the health and care system”, said Phil McCarvill, deputy policy director of the NHS Confederation. “Our members are already making progress in connecting different health services and delivering individualised, person-centred care, and will be keen to reflect on Healthwatch’s findings.
“The scale and complexity of the NHS can sometimes make the experience of care feel less tailored to individual’s needs. Delivering compassionate, dignified care must be the top priority of everyone who works in the NHS and change is needed wherever patients’ experience falls below that standard. There’s no one-size-fits-all solution so we need local leaders to continue working with key partners, such local authorities and the voluntary sector, to shape services and ensure the delivery of care in the right way, the right place and at the right time.”
The NHS Confederation has confirmed that it will work closely with Healthwatch and other partners to develop this agenda.
Mr McCarvill continued: “The NHS Confederation’s Commission On Improving Urgent Care For Older People is already working with partners across the health and care system to develop practical activities that help personalise care and connect services.
“Making services more joined-up is also helping to bring mental and physical care closer together, which is a priority as the NHS strives to improve its support and identification of poor mental health.”