NHS England has lost a major judicial review over the power to commission a preventative HIV drug.
The decision, taken at the Royal Courts of Justice, ensures that the healthcare body will be forced to include pre-exposure prophylaxis (PREP) in its “prioritisation process”.
Mr Justice Green asserted that NHS England had “erred in deciding that it has no power or duty to commission” PREP, and in his judgment the organisation has a “broad preventative role”.
In his summing up statements, Green commented that NHS England had “mischaracterised the PREP treatment as preventative when in law it is capable of amounting to a treatment for a person with infection”, and it any event the body had the power to commission preventative treatments because it supported “the discharge of its broader statutory functions”.
The judge said at its core the judicial review was about “the allocation of budgetary responsibility in the health field”, and explained that NHS England had erred in its responsibilities by blacklisting PREP.
“NHS England says it has no power to provide the service and the local authorities say that they have no money. The claimant is caught between the two and the potential victims of this disagreement are those who will contract HIV/AIDS but who would not were the preventative policy to be fully implemented.”
NHS England has indicated that it intends to appeal against the decision, and has also warned that other medicines could be sidelined if the body is forced to fund PREP.
Nine treatments are apparently under threat as a result of the court verdict.
NHS England have indicated previously that it was impossible for the organisation to fund PREP, as the body did not have the legal power to commission the medicine.
The healthcare organisation instead asserted that the responsibility lied with local authorities.
In response to this assertion, the National AIDS Trust launched the judicial review which has ultimately tesulted in the assertions of NHS England being reversed, pending appeal.
However, despite the court verdict, it is not inevitable that NHS England will commission PREP.
NHS England will instead put PREP through its prioritisation process, which it intends to re-run in October.
Deborah Gold, NAT’s chief executive, commented that the judge’s decision was a “vindication for the many people who were let down when NHS England absolved itself of responsibility for PREP”.
Izzi Seccombe, the LGA’s community wellbeing portfolio holder, was also positive about the prospects for HIV sufferers as a result of the verdict.
“By successfully challenging NHS England’s interpretation of the law, we believe this will provide much-needed clarity around the future roles of councils and the NHS on prevention services.”
NHS England has indicated that the amount of spending on GPs and primary medical care services will grow at a higher rate than other health services in the existing financial year.
The critical health organisation was outlining the NHS budget for the next five years.
In its statement, NHS England indicated that general practice will receive extra cash in the region of 5 per cent of its funding annually for the next five years.
To achieve this, the primary medical care allocation formula is being updated “to account for changes in GP workload since the original ‘Carr Hill’ methodology was developed over a decade ago.”
These additional allocations will ensure that the clinical commissioning groups will receive a real terms budget increase.
An additional £450 million of new funding is also being made available for primary care, CCGs and specialised care.
This nearly half of £1 billion investment is intended to support the ‘DevoManc’ partnership deal, when health services are devolved there.
NHS England stated that “with adjustments made so that extra funding for local health services is targeted at those parts of the country with the greatest health needs, where the population is growing rapidly, and where there are additional and historic pressures because of rurality.”
The additional investment in GP services has been warmly welcomed by some of the most esteemed doctors’ groups in the country.
Dr Maureen Baker, Chair of The Royal College of General Practitioners, particularly welcomed the investment.
“This is good news for general practice, the NHS as a whole and most importantly our patients. It is testament to the power of our ‘Put patients first: Back general practice’ campaign that has brought home the harsh reality of years of underinvestment in our services and the impact this has on patients and our profession,” Baker commented.
The Chair of the Royal College went on to point out that this latest investment is extremely important considering the historical context of investments in general practice.
Patient consultations have risen massively over the last few years, with 370 million now taking place annually in the United Kingdom. This is an increase of 60 million from 2010.
“Over the same period investment in our service has consistently decreased and the number of GPs has remained relatively stagnant,” Dr Baker stated. “This money will help us to employ more GPs, more practice staff, and offer more and enhanced services, including longer appointments for those who need them.”
Dr Mark Spencer, NHS Alliance co-chair, added: “It is no secret that general practice is facing increasing strain and demand, and this funding will go some way to relieve part of the pressure facing practices across the country.”
Spencer was also concerned about cuts to pharmacy.
“However, general practice must not be viewed in isolation, and the news that community pharmacy is to receive a substantial cut in funding gives cause for concern.”
PSNC was informed last week of a 6 per cent reduction in the community pharmacy contractual framework.
As winter occupancy problems grow for the NHS, official statistics indicate that 12 hospitals in the health service face serious difficulties.
According to reports, these dozen institutions are so full that there was not a single bed available at any of the hospitals.
Commenting on the reports, the Labour Opposition has suggested that the figures are indicative of a health service under unprecedented and intolerable pressure.
Other hospitals have been badly hit by bouts of norovirus. The worst affected trust was the Royal United hospital Bath NHS foundation trust, which had 169 beds closed on Monday last week as a result.
Figures acquired by NHS in England indicate that hospitals in Cheshire, Norfolk, Essex, London, Devon and Wiltshire all completely ran out of beds last weekend.
In addition, there were less than 10 beds free in a further 27 NHS trusts over the same period.
Commenting on this is grave ituation, Andrew Gwynne MP, Labour’s Shadow Public Health Minister, was critical of government policy.
“These figures show an NHS under deep pressure with hospitals facing unprecedented levels of demand. Twelve hospital trusts in England did not have a single spare bed available last weekend, and many more were dangerously full.”
The statistics follow figures showing that levels of “bedblocking” in the NHS reached a record high long before winter was underway.
And the NHS is also facing problems related to meeting targets for seeing patients in a satisfactory timeframe.
Just 92.3 per cent of patients were seen within four hours in October – the lowest on record for this month, compared with 93.7 per cent this time last year.
All available evidence seems to point to the fact that the NHS is struggling logistically to deal with the demands of winter.
This meshed with the opinion of Nuffield Trust chief executive Nigel Edwards, who predicted that this winter hospitals were going to find it “even more difficult to cope” unless the health service invested in intermediate care beds to get patients out of hospital.
There were 1,923,326 attendances at A&E in October – the highest number for the month since current records began in 2010.
This figure is 1.6 per cent more than October last year.
An NHS England spokesperson commented on the situation.
“Nobody could argue there isn’t ongoing pressure on the NHS. Despite this our staff continue to provide quality services in the face of increasingly high levels of demand throughout the healthcare system. Front line services are treating record numbers of patients. We continue to admit or treat and discharge more than nine out of ten patients within four hours – a higher standard than any major western nation.”
Despite pressure from campaigners, NHS England has indicated that it will not publish results of a national audit prompted by the death of a baby girl.
The organisation has been exploring the quality of investigations that were carried out after the tragic incident took place.
But the commissioning body has indicated that although it accepted the recommendations of an independent review, it will not make public the methodology or findings of a national audit suggested by it.
The process had been instigated by the untimely demise of baby Kate Stanton-Davies.
Kate tragically died at a midwifery unit run by the Shrewsbury and Telford Hospitals Trust in March 2009.
It is accepted that there were numerous failures made at the unit at the time of Kate’s death.
The parents of the child have reacted angrily, not unreasonably pointing out that they expected to see a process that could be described as transparent.
Yet NHS England has described the ongoing reaction to the investigation as an internal matter.
NHS England is the existing supervising authority for midwives practising in England.
As part of this responsibility, the organisation commissioned expert Debbie Graham to review events surrounding Kate’s death.
This followed a jury inquest and an investigation by the Parliamentary Health Service Ombudsman in 2013 which both concluded that the death was avoidable.
Both processes also concluded that there had been huge failures in the care throughout the time that Kate stayed in the hospital.
Graham went on to heavily criticise the local supervisor, suggesting that the quality of investigation carried out have been entirely unfit, particularly in terms of containing multiple inaccuracies.
The report had stated at the time that NHS England should carry out an audit in order to “seek assurance that the weaknesses in the investigatory process identified in this review are no longer inherent in the current process.”
Yet it seems now that the results of this process will never be made public. It is those understandable that parents of the infant are extremely disappointed by the process.
According to investigations, Kate was born “hypothermic, pale, floppy and grunting” at Ludlow midwifery led unit in Shropshire, in March 2009.
Her mother had been incorrectly classified as being low-risk.
That decision will be viewed as controversial, and indeed there will be question Marks regarding precisely why it has not been published.
It seems that these questions will go unanswered.
NHS England has announced a new index with the intention of rating the technological capabilities of providers across the NHS.
It is intended that this new initiative will eventually become part of the statutory regulatory regime in the health service.
The process is already underway, with NHS England having commenced gathering baseline data for the so-called digital maturity index.
And NHS England believes that the existing method for measuring the technological capabilities of providers is too supplier-focused.
There is also a concern that the previously utilised approach does not provide enough data on meaningful use or interoperability.
The new digital maturity index will be published for the first time later in this financial year, although NHS England has emphasised that the first iteration of the index will be a beta release.
This index will be based on information collected by NHS England, with the organisation already having distributed questionnaires to NHS organisations earlier this month.
The documents in question will collate data on the existing digital capabilities of key organisations throughout the health service.
This latest initiative is part of an overall ethos in the NHS of moving toward a paperless NHS system by 2020.
The move comes two years after the national commissioning body launched the clinical digital maturity index, in partnership with private provider Digital Health Intelligence.
But NHS England has evidently decided that their understanding of how local organisations in the NHS are utilising Digital technology is presently insufficient.
In particular, NHS England will be focusing on the extent to which digital services are joined-up, and how efficiently technology is put into operation.
The organisation was keen to emphasise ahead of the release of the new index that simply possessing satisfactory digital technology capabilities would not be considered sufficient in itself.
This new index will also place significant emphasis on interoperability. NHS England conceded that existing indexes were unable to assess this adequately, and looked forward to being able to do so in the foreseeable future.
NHS England has been working with Leeds University, academic health science partnership UCLPartners, and 35 other organisations in order to develop the new index.
With the digital maturity index having already been piloted in real-world settings, it is now considered ready to be rolled out over the NHS as a whole.
Humber, Salford Royal, and University Hospital Southampton are among the foundation trusts that have tested this new digital index ahead of its ultimate implementation.
Obtaining funding from the government for technology project continues to be an ongoing issue for the NHS as a whole.
NHS England struggled last year when the Department of health withdrew nearly £200 million from its technology programme in order to deal with demand caused by winter weather.
With the government having challenged the NHS to achieve efficiency savings in the region of £25 billion by the end of the decade, it is clear that technology has a major role to play.
Experts are warning that a series of crucial health services in England could be under threat due to funding issues.
In particular, services aimed at smoking, obesity and sexual health are especially vulnerable.
The news can be placed in the context of a decision by the Chancellor of the Exchequer, George Osborne, to cut the existing public health budget.
Osborne announced that £200 million would be shaved off the overall budget beginning in January.
This fund is currently held by councils, and thus is not part of the government’s overall promise to protect the NHS.
Yet experts operating within the health service believe that the money is vital in order to ensure that pressure is relieved on the NHS as a whole.
A total of 11 groups, including the Academy of Medical Royal Colleges, Royal College of Nursing, NHS Confederation and Faculty of Public Health, have signed a letter to George Osborne urged the Chancellor of the Exchequer to reverse his plans.
The letter particularly suggested that reducing the funding would lead to increased ill-health and inequality in the general population.
Another subject touched upon by the letter was the fact that the Chief Executive of NHS England, Simon Stevens, had called for extra funding for the health service ahead of the general election.
Prof John Ashton, of the Faculty of Public of Health, stated: “The legacy of a decision to cut the public health grant will be major further burdens on the health service within the foreseeable future. Avoidable ill health, heart disease, sexual health problems, unplanned pregnancies – these are the kind of things which are being affected by this irrational cut to funding.”
The letter comes in the light of the recent fiscal results of the NHS that suggest that the publicly funded health service will be £2 billion in deficit by the end of the financial year.
It is clear that the NHS faces massive funding difficulties despite the promise of the Conservative government to increase spending by the end of the decade.
In addition to the financial problems related to this issue, it is also suggested that the spending cuts will significantly exacerbate inequality in the UK.
Rob Webster, chief executive of the NHS Confederation, is particularly concerned about this prospect.
“There is an unprecedented consensus that we can only address the problems facing the NHS if we invest in the future of our nation’s health by helping people to stay well. Open any report from any director of public health in any part of the country and you can see health inequalities and poor health putting pressure on NHS services and blighting people’s lives. We need the upcoming spending review to protect public health budgets,” Webster asserted.
The government responded by stating that the health service is indeed a priority for investment, but also indicated that difficult decisions need to be made across government departments to reduce the overall spending deficit.
A report by the Care Quality Commission has painted a worrying picture of the standard of safety across the NHS and care sectors in England.
Results compiled by inspectors from the organisation suggest that safety within this key aspect of the healthcare system can be considered a significant concern.
The Care Quality Commission was particularly focused on problems in hospitals, and found that over 75 percent of the institutions that it visited in this healthcare niche had notable safety problems.
This was also reflected, albeit to a lesser degree, in the care and nursing home sector, where 40 percent of institutions surveyed under the new inspection regime of the commission also had safety difficulties.
Problems in this department were also extended to GP services, where safety issues were prevalent in one-in-three surgeries.
So far more than 5,000 organisations have been inspected; nearly half of hospitals, 17 percent of care services and 11 percent of GP surgeries and out-of-hours providers.
And the major issue identified by the Care Quality Commission was a lack of staffing.
This problem will inevitably be placed in the context of the delay of a report into nursing levels of by the Conservative government.
Increasingly the picture emerging from the NHS in 2015 is of a health service in crisis, facing both personnel and financial difficulties.
And this worrying impression is now clearly spreading into safety issues. This will surely be a massive concern to healthcare professionals and taxpayers reliant on the NHS alike.
Aside from staffing issues, the Care Quality Commission also found that the way medicines were managed within the health service, along with lessons learned, or lack thereof, from mistakes were also major issues.
Among the individual cases flagged up were:
– A&E patients being kept on trolleys overnight in a portable unit without proper assessment
– staff at a GP surgery not undergoing basic life-support training in the past 18 months;
– medication mistakes at a care home – including delays giving drugs and signs of overdoses
The findings are contained in the Care Quality Commission’s annual report, and effectively represent a mid-term update of the new tougher Ofsted-style inspection regime.
Critics of the state of the NHS will inevitably conclude that the results here are a rather damning indictment of the current situation in the health service.
It has already been reported that there is a £30 billion deficit that needs to be plugged by the end of the decade, with the Conservative party pledging just £9 billion to meet this probably optimistic figure.
With staffing, financial and deficit issues all becoming extremely prevalent, there is something of a perfect storm developing in the NHS that surely needs decisive and stringent political action in the foreseeable future.
Indeed, Rob Webster, of the NHS Confederation, described the existing situation as a “toxic environment”.
Commenting on the report, the Royal College of Nursing general secretary, Janet Davies, outlined her view that financial problems are a major factor in the results obtained by the Care Quality Commission.
“Whether nursing care is delivered, in hospitals, care homes or the community, it depends on having the right number of staff with the right skills and support. There must be more investment in training nurses, keeping nurses and listening to nurses.”
This latest news comes hot on the heels of a financial report on the NHS which suggests that the health service will run up a deficit of £2 billion in the existing fiscal year.
NHS England and NHS Employers have jointly launched a pledge intended to improve services provide to people with learning disabilities.
Local NHS organisations are being encouraged to sign up to the pledge in order to ensure improved provisions to people with learning disabilities across England.
The pledge was opened for signatures at a workshop event held for employers in Bristol.
The pledge is split into three separate stages:
▪ Step one – commitment. Organisations are asked to confirm their Two Ticks accreditation. This is designated to organisations by Jobcentre Plus, with the government-run employment organisation recognising employers who commit to taking positive action to encourage applications from people with disabilities. A commitment must also be shown to employing people with learning disabilities.
▪ Step two – ready. This is centred around creating an action plan related to the employment of people with learning disabilities.
▪ Step three – success! This third pledge is based on actual evidence that companies are indeed employing more people with learning disabilities. At this stage, companies are also encouraged to share their particular success stories.
The NHS Learning Disability Employment Programme was originally launched back in June.
It is a joint initiative between NHS England and NHS Employers, intent on ensuring that people with learning disabilities are not discriminated against in the workplace or by employers.
The programme is intended to be a make pillar of the NHS Five Year Forward View, intended to ensure that the NHS workforce is truly representative of local communities.
In particular, a new national network providing advice, ideas and impetus to all NHS organisations has been set up, and this encompasses all local hospital trusts to national bodies.
These organisation are being encouraged to remove red tape related to learning disabilities, and actively take steps in order to accelerate the employment of people with learning disabilities in the NHS.
Although attracting people to this programme has proved challenging, more than 50 major employers have registered their interest.
NHS England and NHS Employers remain optimistic that more businesses will follow suit in the near future.
More than 50 major employers have registered their interest so far, and it is hoped that they and many more will be quick to sign the pledge.
To assist with this process, NHS England and NHS Employers launched guidance in September which outlines how to open up meaningful jobs to people with learning disabilities.
The benefits to employers of doing so is also outlined. It is particularly suggested that this could include savings associated with reduced employee turnover, accessing a wider pool of talent and experience, and creating a more inclusive and accessible organisation.
Local voluntary, community and social organisations, local authorities and Jobcentre Plus representatives will also be invited to attend the events being run to promote this initiative.
Further events are planned in Manchester on 25 November and London on 9 December.
The head of NHS England has thrown his hat into the immigration debate, encouraging the government to reconsider its policy toward nurses.
New proposals from the government will see lower paid nurses from outside the EU deported.
But Simon Stevens acknowledged the rather well-publicised fact that the nursing profession faces a shortage of qualified employees at present.
Naturally nursing is absolutely critical to the everyday functioning of the NHS, and leaving the health service short of nurses is tantamount to handcuffing it.
Stevens is merely the latest high profile source to offer a negative opinion of government policy.
The deportation approach has already been criticised by employers’ groups and the nurses’ union, both of which consider it to be a disastrous piece of legislation.
It is already projected by some experts that the policy could ultimately cost millions in recruitment, in addition to the staffing difficulties that it could create.
Both of these groups have already urged the Home Office to add nurses to the list of shortage occupations, effectively exempting them from the new legislation.
Additionally, it has been suggested that the £35,000 salary threshold is far too low, and that this should be reconsidered for the nursing profession.
Under existing rules, workers from outside the European Economic Area who are earning less than £35,000 after six years in the UK will be deported.
Most experts seemingly agree that this will lead to organisational difficulties, if not outright chaos.
Meanwhile, speaking at the Institute of Directors annual convention in London, the NHS England chief executive became the most prominent healthcare figure in the UK to offer a forthright opinion on the subject.
“Understandably we’re having a national discussion about how to get immigration right. My responsibility is to point out that, at time when the need for nurses is growing, when publicly funded UK nurse training places will take several years to expand, and when agency staff costs are driving hospital overspends right now, we need to better join up the dots on immigration policy and the NHS,” Stevens stated.
The Chief Executive also compared nursing to ballet dancing, calling into question the logic and rationality of the existing legislation.
“Most nurses I speak to struggle to understand why our immigration rules define ballet dancers as a shortage occupation but not nursing. However, most nurses I speak to struggle to understand why our immigration rules define ballet dancers as a shortage occupation but not nursing. And most hospitals tell me the idea that we would seriously consider deporting some of our most experienced and committed nurses solely because they’re not earning £35,000 clearly needs a rethink,” Stevens commented.
Stevens is just the latest individual to criticise the government policy.
The Royal College of Nursing has already estimated that in the region of 3,500 nurses could be affected by the legislation.
This could effectively cost the NHS over £20 million in recruitment alone, with the ultimate financial and organisational cost considerably higher.
And the union claims that the figure will rise to in the region of 30,000 nurses by the end of the decade, should workforce pressures lead to increased international recruitment.
This mammoth number would require in the region of £180 million to recruit replacements alone.
The chief executive of NHS England has announced a new vanguard model that is crucial to the future of the health service.
Simon Stevens has unveiled the radical new scheme that will have a significant impact on local hospitals across the NHS network.
Thirteen new hospital vanguards will be created as a result of the new model, which represents a new and distinct phase in implementing the well-publicised NHS Five Year Forward View.
These 13 hospitals will become Acute Care Collaboration Vanguards.
Acute Care Collaboration Vanguards are intended to act as beacons of excellence in hospital services and management, while serving a wide geographical region.
Thirty-seven Vanguard hospitals had been launched previously, but the focus of these establishments had been significantly different from this new acute care-focused raft.
The existing vanguards were mostly focused on integrating care between GPs, social and community care, mental health and hospital services within their local area.
Hospitals nominated to join this new programme represent some of the most notable and efficiently run institutions in British healthcare.
They include The Royal Marsden, Northumbria Healthcare Trust, the Christie, the Royal Free London, Moorfields, Salford Royal, and University College London Hospitals NHS Foundation Trust.
Each of these establishments will now be extending their geographical reach, playing a major role in driving inefficiency and improvement in the NHS.
Now that these new Vanguard institutions have been named, each will test three new approaches in response to ideas of full report on proposed by frontline clinicians and managers.
– Excellently-performing individual NHS hospitals able to form NHS Foundation Groups to raise standards across a chain of hospitals.
– Individual clinical services at local District General Hospitals being run on site by specialists from regional centres of excellence.
– Forming ‘accountable clinical networks’ integrating care across District General Hospitals and teaching hospitals for key services, including cancer and mental health.
Speaking to the Confederation of British Industry in London, Stevens had the following to say on the matter.
“The era of go-it-alone individual hospitals is now being superceded by more integrated care partnerships – both within local areas, and across different parts of the country. The scale of the interest in these new vanguards from across the health service shows the NHS is up for radical reform.
“Our new approach to hospital partnerships will help sustain the viability of local hospitals, share clinical and management expertise across geographies, and drive efficiency beyond the walls of individual institutions.
“We’ve got some of the world’s best hospitals and specialists in this country, and it’s right they should be able to extend their reach more widely, as the vanguard programme will now allow them to do.”
Ed Smith, Chair of Monitor and the new Chair-designate of NHS Improvement, added: “Today’s new vanguards represent the evolution from the era of standalone hospitals, begun in the 1962 Hospital Plan for England, and reinforced by the creation of foundation trusts in the early 2000s. These were right at the time, but the economic and clinical circumstances facing the NHS are now different, and our response needs to evolve.”
The Monitor regulatory body has deferred the foundation trust application of an NHS trust based in Liverpool.
Monitor has delayed a decision on the Royal Liverpool and Broadgreen University Hospitals NHS Trust’s application to become a foundation trust for 12 months.
This trust provides specialist and acute services to more than 465,000 people across Liverpool.
Monitor carried out a stringent assessment on the trust, and concluded that financial planning within the body needs further attention.
The regulatory agency therefore took the decision to delay the application of the Merseyside-based trust for another year.
The Royal Liverpool and Broadgreen University Hospitals NHS Trust must now work on improving the deficiencies that Monitor established in its assessment of the organisation.
However, it wasn’t all bad news for the Liverpool trust. Monitor did conclude that the body had shown significant improvement with regard to the way that it manages the quality of care.
It seems that the concerns of Monitor were largely related to the fiscal situation of the health trust, and could have been exacerbated by the general state of the NHS.
Many trusts across the United Kingdom have experienced financial difficulties over the last few years, and indeed Monitor is currently assessing the efficacy of several such bodies and organisations.
Monitor also acknowledged that the Royal Liverpool and Broadgreen University Hospitals NHS Trust had made significant progress with its attempts to strengthen its board, but that the organisation still had important steps to take in order to ensure that the trust was viable.
In particular, the regulatory body stressed the need for the Liverpool-based organisation to further develop robust plans in order to provide good value-for-money services for patients in the longer-term.
Commenting on the decision of the regulatory organisation, Miranda Carter, Executive Director of Provider Appraisal at Monitor, explained he context of deferring the decision on whether Royal Liverpool and Broadgreen should become a foundation trust for a year.
“In light of the new hospital it is building we want to give the trust more time to improve its financial plans. The next year will also give the trust time to induct new board members and to develop its plans to participate in Healthy Liverpool to improve care across Liverpool,” Carter explained.
The existing NHS structure encompasses 151 trusts spread across their entirety of England, which accounts for 60 per cent of all the trusts in the NHS as a whole.
Foundation trust status enables patients to have a greater and more direct to say in their specific healthcare.
Additionally, foundation trusts were conceived in order to enable these organisations to have greater freedom in crafting services to match the needs of individual regions.
NHS foundation trusts are effectively free from central government control, able to retain any surpluses for further investment, and intended to be directly accountable to local communities.
It is also notable that local people serve as members and governors in such bodies.
Although the Royal Liverpool and Broadgreen University Hospitals NHS Trust has been denied this honour and responsibility for the time being, the verdict from Monitor suggests that there is light at the end of the tunnel for the NHS trust.