Health & Care Review

Health & Care Review

April 24, 2018

Keeping up with all the latest developments in health and care policy could almost be a full time job and PSNC regularly receives questions from LPCs and pharmacy contractors about what is going on in the wider health and care landscape beyond community pharmacy. To help answer some of these questions and to help contractors and LPCs stay up to date, PSNC provides this update service outlining the latest information in an easily digestible format. Weekly updates are published on our website and contractors can ensure they do not miss them by signing up to PSNC’s email newsletter service here.

The reviews extend the work we have been doing for some time to help LPCs stay informed about the NHS changes, and they inform the more detailed PSNC briefings which we continue to publish on this topic; these can be accessed in the Healthcare Landscape section of the website.

People growing older with learning disabilities should get regular health checks, says NICE

The National Institute for Health and Care Excellence (NICE) has published new guidance which advises that health and social care workers help organise regular health assessments for older people with learning difficulties because they may find it difficult to express their needs and be heard. The guideline describes how to help people with learning disabilities as they grow older to ensure they receive appropriate support at the right times, preventing delays in care.

Older people with learning disabilities are more likely to develop serious health problems and die of them because of late diagnosis. They may also find it more difficult to access health services because of hearing or sight problems.

NICE is advising that annual health checks are recorded in a ‘health action plan’ that can be updated annually. This personalised plan details what help and support the individual needs to stay healthy and provides other information about support needs and lifestyle issues. The guideline also advises local authorities to ensure there are opportunities for people growing older with learning disabilities to socialise and be active in their communities.

The state of care in independent acute hospitals

The Care Quality Commission (CQC) has published the findings of an inspection programme for 206 independent acute hospitals in England in 2015.

CQC found that the majority of acute hospitals are providing high quality care for patients; as of January 2018, 62% were rated as good and 8% were rated as outstanding.

However, while the report highlights many examples of good care, it also shows variation in quality and clear scope for improvement. CQC had the greatest concerns about safety and found that 41% of hospitals were rated as requires improvement and 1% as inadequate in this area. In some cases, CQC found that a lack of formalised governance procedures meant that hospitals were not effectively monitoring the work of consultants and inspectors also saw that safety procedures were not always fully embedded.

The findings from these inspections have helped to inform CQC’s plans to further develop its approach to regulation for all independent healthcare services.

Women and HIV: Invisible No Longer

The Terrence Higgins Trust has launched a new report in collaboration with Sophia Forum to highlight the needs of women affected by Human Immunodeficiency virus (HIV).

Key facts highlighted include:

  • women make up one third of people living with HIV in the UK, yet are left out of research, decision-making, service design and delivery;
  • almost half of women living with HIV in the UK live below the poverty line;
  • nearly one third have avoided or delayed attending healthcare in the past year due to fear of discrimination; and
  • on HIV prevention, little effort has been made to define who women at risk of HIV are. Nearly half the respondents (42%) felt that barriers prevent them from testing for HIV, and no woman surveyed had yet chosen to access PrEP.

The two organisations are calling for gender parity in the UK HIV response, specifically address women’s need in research, HIV prevention, data collection and support services.

Prostate Cancer: Britain’s Growing Problem

A male cancer charity, Orchid, has published a new report which highlights a trend in late prostate cancer diagnoses and calls for urgent action to be taken.

The report reveals that:

  • 37% of prostate cancer cases are diagnosed in the late stages (stages 3 and 4);
  • 42% of prostate cancer patients saw their GP with symptoms twice or more before they were referred;
  • 23% of all cancer cases are diagnosed through A&E, with the majority of these cases at late stage; and
  • Prostate cancer cases are set to rise dramatically over the next decade.

Recommendations for urgent action by policy makers to address Britain’s growing prostate cancer problem include:

  • public awareness of symptoms by Public Health England and local authorities;
  • healthcare professionals’ adherence to treatment standards;
  • improved diagnostic tests introduced by NHS England; and
  • continuation of investment and development for research into diagnostic testing and patient risk profiling.

Changes to QOF 2018/19

NHS Employers and the British Medical Association’s General Practitioner Committee agreed changes to the Quality and Outcomes Framework (QOF) effective from 1st April 2018.

The key changes are:

  • the average practice list size had risen from 7,732 as at 1 January 2017 to 8,096 at 1 January 2018; and
  • The value of a QOF point will increase by £8.06 from £171.20 in 2017/18 to £179.26 in 2018/19.

QOF indicators and thresholds for 2018/19 continue unchanged.

Developing new models of care in the PACS vanguards: a new national approach to large-scale change?

NHS England has commissioned the King’s Fund to publish a report as part of a package of support provided to primary and acute care system (PACS) vanguard sites. The report features the accounts of those who have led the development of the PACS model, nationally and locally, to reflect on the process. It is not evaluation of the PACS model but rather offers insights and experiences of those leading a major programme at the national level and those living it at the local level.

Key messages include:

  • national bodies can support large-scale change in the health and care system by acting as catalysts of locally led innovation;
  • in the PACS vanguard sites, relatively modest transformation funding has helped to catalyse significant amounts of innovation in terms of both frontline services and wider structures supporting system-wide collaboration;
  • relationships were strengthened in vanguard sites and this needs to happen before more formal changes to contractual arrangements or organisational structures are considered;
  • spreading and scaling-up innovations from the vanguards sites is the challenge to which system leaders are now turning; and
  • further work is needed at the national level to remove legal, regulatory and financial barriers that inhibit integrated working across organisational boundaries.

Allied Health Professions (AHPs) supporting patient flow

NHS Improvement and NHS England have published a quick guide to demonstrate how NHS emergency care, in particular patient flow through the health and care system, benefits from allied health professionals (AHPs). Each section gives a brief overview of the contribution AHPs can make to safe, effective patient care and flow, followed by case studies.

Less waste, more health: A health professional’s guide to reducing waste

The Royal College of Physicians has published a report which explains how health professionals can positively influence societal health and wellbeing by making simple changes to procurement and disposal of medical supplies.

The report features a range of case studies and offers 12 practical recommendations on waste management, principles of purchasing and cultural influence to positively influence the health of patients, aid financial savings and shape the impact of the NHS on the environment.

Integrated Commissioning for Better Outcomes: a commissioning framework 2018

The Local Government Association and NHS Clinical Commissioners in partnership with the Department of Health and Social Care, Association of Directors Adult Social Services, Think local Act Personal and Care Providers Alliance has published the Integrated Commissioning for Better Outcomes Framework 2018. This is a practical tool for council and NHS commissioners to support improving outcomes through integrated commissioning. The framework covers four areas:

  • building the foundations;
  • taking a person-centred, place-based and outcomes-focused approach;
  • shaping provision to support people, places and populations; and
  • continuously raising the ambition.

The tool was developed from the Commissioning for Better Outcomes Framework 2015 and has been updated to better reflect the changing commissioning landscape.

The standards are designed to support a dynamic process of continuous improvement and can be used:

  • to support cross-organisational reflection and dialogue on how well integration in local commissioning arrangements are working;
  • as a benchmarking diagnostic tool in critical self-assessment by system partners; and
  • in a peer to peer review or peer challenge to promote sector led improvement.

 Faster action needed on lessons of WannaCry attack

The Public Accounts Committee has published a report on the WannaCry cyber-attack on the NHS in May 2017. The attack caused widespread disruption to health services with almost 20,000 hospital appointments and operations cancelled and five accident and emergency departments diverting patients as they were unable to treat them.

The report indicates how the Department of Health and Social Care (DHSC) and its arm’s-length bodies were unprepared for the relatively unsophisticated cyber-attack. Whilst DHSC and NHS bodies have learned lessons the report indicates that there is still work to do to improve cyber-security.

The Committee has set six recommendations to be met with a progress update by a June 2018 deadline that include DHSC and its national bodies to:

  • consider and agree implementation plans setting out a clear timetable that has clear roles, responsibilities and oversight arrangements at both local and national level;
  • set out clear coordinated communications during a cyber-attack;
  • support local organisations to improve cyber security and be ready for a cyber-attack;
  • provide a national estimate of the cost to the NHS of WannaCry and an update on costed plans for vital security investment;
  • provide guidance and support for local systems to be updated; ensure IT suppliers to the NHS are accredited and that local and national workforce plans include a focus on IT and cyber skills; and
  • make cyber security a priority and work with wider government to share lessons and promote best practice.

Patients get the green light for smarter choices after latest GP pilot

NHS England has published new trial results from the Behavioural Insights Team on a pilot system which makes it easier for GPs to understand hospital waiting times for their patients.

The e-traffic light system could help reduce hospital waiting times while offering patients a clearer choice of treatment and is set to be rolled out across the country after a successful NHS trial.

A tweak to the GP referral system sees a red light appear against a hospital with longer waiting times while a green light shows those with spare capacity, meaning doctors can offer patients potentially quicker routes to treatment and help them make more informed choices.

Results from two London trials have been promising – red lights reduced referrals to overbooked hospitals by nearly 40%, while green lights increased referrals to hospitals with available capacity by 14% this winter.

Media monitoring

On Monday 16th April 2018, the following stories were published:

  • NHS hospitals are owed around £139 million from health tourists who have failed to pay for their treatment in England, reports The Mail.
  • The Telegraph reports on research that suggests women taking common painkillers during pregnancy could make their grandchildren infertile. Also reported by The Mail and the BBC.
  • ‘GP at Hand’ app cuts off patients from regular NHS doctor, reports the Times. Tens of thousands of people have downloaded the ‘GP at Hand’ app which offers remote consultations with doctors, however when they sign up they are removed from their GP’s books and registered to a practice in west London.
  • The Mail reports that obesity is set to take over alcohol as the leading cause of liver disease in the next few years.

On Tuesday 17th April 2018, the following stories were published:

  • The Independent reports that there has been a significant increase in violence against NHS staff, especially in the hospitals with the longest waiting lists. Also covered by The Mail.
  • The Taxpayers’ Alliance claims that the NHS could save £800 million a year by reducing the number of bodies which perform very similar functions, reports The Mail and The Sun.
  • The Times reports that experts think school children should be taught about nutrition and healthy eating to help them grow up to be better parents. This is similar to several stories saying that having an unhealthy lifestyle prior to becoming a parent can still impact on the children you have later. Covered by The Independent, The Telegraph, iNews and ITV News.

On Thursday 19th April 2018, the following story was published:

  • The Guardian reports that almost two-thirds of healthcare assistants are performing roles usually undertaken by nurses due to the NHS staffing crisis.

On Friday 20th April, the following stories were published:

  • The BBC and The Mail pick up the story about more patients having multiple conditions. The BBC reports that researchers say that being a patient is now ‘a full time job’, whilst The Mail says that these patients typically receive worse care.
  • GP Online report that the majority of GP practices reported cuts to public health funding. 77% of the 250 GP partners who responded to the survey reported that funding had been withdrawn or reduced for at least one public health service their practice provides. Smoking cessation, sexual health and weight management services were among those most affected, GPs said.
  • ITV News reports that Chief Medical Officer Dame Sally Davies is warning that ignoring antibiotics misuse could led to the end of modern medicine.
  • Dementia patients are nearly 20% more likely to be given unnecessary prescriptions due to difficulties with communication, reports The Mail. Taking these unnecessary drugs can then increase dementia patients’ risk of suffering falls due to sedation and drowsiness.


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