Reported by the Health Service Journal (28 September):
- NHS England and NHS Improvement “entirely open” to health economies dropping payment by results, says Simon Stevens
- Follows planning guidance proposals for whole system control totals
- NHS England chief executive says alternative proposals must “stack up in the round”
Simon Stevens, speaking about the perverse incentives of the payment by results tariff, said areas may for example choose to move instead to “allocate funding on a programme basis”.
Planning guidance published by the two national bodies last week said groups of organisations will soon receive “whole system” control totals – designed to enable flexibility in financial flows. However, it did not discuss a shift away from payment by results.
Speaking to NHS leaders at the HSJ Commissioning Summit last week, Mr Stevens said: “We are entirely open to the prospect that you choose to abandon [payment by results] as the currency for deciding where the funds should go.
“There’s absolutely nothing stopping any health system coming forward and saying, ‘We want to move the money around between us in the following ways, which would have the following impacts on what the control totals would look like for individual trusts or [clinical commissioning groups]’.”
NHS England, in collaborations with ADASS (Directors of Adult Social Services) has published a quick guide entitled: Discharge to Assess. This is one of a series of quick, online guides providing practical tips and case studies to support health and care systems to reduce the time people spend in hospital, at the point that they no longer need acute care.
It provides practical tips and advice to commissioners and providers on discharge to assess (D2A) models, including best practice from across the country and should be read alongside the 2015 NICE guideline, Transition between inpatient hospital settings and community or care home settings for adults with social care needs.
Unnecessary delay in discharging older patients from hospital is a systemic problem with a rising trend - the National Audit Office reported that between 2013 and 2015 recorded delayed transfers of care rose 31 per cent and in 2015 accounted for 1.15 million bed days. For older people in particular, we know that longer stays in hospital can lead to worse health outcomes and can increase their long-term care needs. Wherever possible, people should be supported to return to their home for assessment. Implementing a discharge to assess model where going home is the default pathway, with alternative pathways for people who cannot go straight home, is more than good practice, it is the right thing to do.
BMA press release (25 September): A new BMA report warns that the UK’s fragmented health and social care system is failing older patients as it is unable to cope with the increasing pressure from an ageing population with more complex needs.
This follows warnings from the King’s Fund and Nuffield Trust1 that vulnerable, older people in England are having to fend for themselves because government-funded care is being scaled back, with spending on care by councils falling by a quarter in real terms in the five years up to 2015.
“Growing older in the UK”, the BMA’s series of expert-authored briefing papers on ageing and health2, highlight the increasing demand and inadequate resources facing the UK’s health and social care system. [Jim George and Finbarr Martin were amongst the contributors to the briefing papers].
Reported by ITV (25 September): The NHS is at risk of a "brain drain" and hundreds of surgeries face closure if older family doctors are not retained, the Royal College of GPs (RCGP) has warned.
The doctors' membership body said some 594 practices across the UK, including 467 in England, are at risk of closing because three quarters or more of their GPs are aged 55 or over. RCGP chairwoman Professor Maureen Baker has written to Health Secretary Jeremy Hunt to urge him to make retaining the older workforce just as much of a priority as recruitment. She also warned that a pledge to boost GP numbers to 5,000 by 2020 in NHS England's General Practice Forward View could not be achieved through recruitment drives alone.
Her calls echo those of other GP leaders who have said excessive workloads are affecting doctors, who are increasingly turning to part-time work.
The BGS Education and Training Committee are in the process of reviewing the higher specialty grid topics and providing more detailed guidance. The guidance on competencies for community practice is now published here. We hope to be publishing guidance on palliative care and old age psychiatry in due course.
The External Affairs team have today launched the RCP’s new policy report Underfunded, underdoctored and overstretched – the NHS in 2016. The report draws on the experiences, views and concerns of consultant and trainee physicians, which, added to national evidence, highlights the many challenges the NHS faces. •
- The NHS is struggling to cope under with increasing patient need and inadequate funding, resulting in workforce pressures which risk patient outcomes. The RCP are committed to working with parliamentarians, health professionals and the public to find solutions to these challenges; solutions that will build a truly integrated, high quality healthcare system for patients now and in the future. The RCP believe the NHS needs:
- Increases to NHS funding: Realistic targets for efficiency savings, protected funds for transformation and investment in sustainability.
- More doctors: Increases in the number of medical students and doctors in training to be hospital specialists and incentives for doctors to work in challenging areas of medicine.
- A supported and valued workforce: Hydration facilities in hospitals and management and leadership opportunities for trainees.
Reported by the National Health Executive (20 September)|: Support for older patients after they were discharged from hospital led to a reduced rate of readmission and improved patients’ welfare, new research shows.
The ‘Hospital to Home’ service in Leicester and Leicestershire led to 9.2% of patients aged over 75 being readmitted within 30 days, against 15% nationally.
The pilot scheme, from Leicestershire County Council, was staffed by 143 Royal Voluntary Service volunteers, who offered six weeks of practical and emotional support to patients aged over 55 who lack a social network.
David McCullough, chief executive of the Royal Voluntary Service, said: “A stay in hospital can be disorientating and it’s particularly hard to settle back into your home if you have no one there to give you a word of encouragement, make you a cup of tea or check you’ve got your medication.
“These are all simple things but this analysis proves just how vital that support is to the recovery of an older person who has been in hospital. No one should have to go home alone unless they choose to and it’s in no one’s benefit that they do, not the older person nor the NHS as they are more likely to be readmitted if they are not given the support they need after leaving hospital.”
Among patients who took part in the programme, 70% said their social contact had improved, 52% said it had boosted their confidence and 47% said it had increased their happiness levels.
See also: Call for cross-party commission into NHS and social care 'crisis' (Nursing Times)
Reported in Care Management Matters (20 September): A new care home dementia study has identified a failure to reduce antipsychotic prescribing. A study by five universities found that there was no sustained reduction in the prescribing of antipsychotics to dementia patients in UK care homes, following the Government’s 2009 National Dementia Strategy (NDS), which recommended a review of their use in light of potentially serious side effects.
The research – led by Professor Ala Szczepura at Coventry University and published in the medical journal BMJ Open – examined prescribing data between 2009 and 2012 from over 600 care homes across the country. It concluded that there was no significant decline in antipsychotic prescribing rates over the four-year period.
Antipsychotics were originally developed for use in patients with schizophrenia or psychosis, but the study shows that ‘off-label’ prescribing of these drugs to treat the behavioural and psychological symptoms of dementia is a common practice in care homes.
The 2009 Banerjee Report, commissioned by the Department of Health as part of the NDS, examined the use of antipsychotics for people with dementia, concluding that the drugs had a ‘substantial clinical risk’ associated with them and that their overuse ‘must not be allowed to continue’. However, researchers from the universities discovered that – although dosages were usually acceptable – prescribing levels did not reduce over the four years, and length of treatment was ‘excessive’ in over 77% of cases by 2012, up from 69.7% in 2009 (meaning it exceeded not only the recommended six-week course, but also the maximum advised treatment length of 12 weeks).
See also: "Chemical cosh" of powerful drugs still routinely used to knock out dementia patients in care homes (Telegraph)
Reported in the Guardian (21 September): Long delays caused by NHS drive for ‘efficiency savings’ causing misery for mainly elderly patients, charity says. Patients in England are having to wait up to 15 months to have cataracts removed from their eyes amid increasing rationing linked to the NHS’s deepening financial woes, a new report has revealed.
People in the north London borough of Enfield face the longest wait – 467 days – between being referred for cataract surgery and actually having it, according to research by the charity RNIB published on Wednesday. That is more than double the longest delay – 222 days – the RNIB found when it first examined waiting times for the procedure in England in 2013. That occured in Heywood, Middleton and Rochdale in greater Manchester.
Other areas with notably long waits include those covered by the GP-led NHS clinical commissioning group (CCG) in Swindon (180 days), Havering in Essex (176 days) and Southampton (174 days).
See also: Patients wait up to 15 months for cataract ops, in 'devastating' lottery (Telegraph)
Nursing Times: A free training package aimed at educating health and social care staff about dementia has been launched by Health Education England.
The training package was launched today by Health Education England through a collaboration with the University of Bedfordshire, Oxford Brookes University, University of Northampton and University of West London. It provides an introduction to dementia and how it affects people and their loved ones. Part of it included a review of existing dementia awareness training, with the findings then used to develop the subsequent training package.
Melsina Makaza, senior lecturer in mental health nursing and dementia lead at Bedfordshire, jointly led a pilot of the package involving 1,500 clinical and non-clinical staff from a variety of health and social settings in 2015.The package can be delivered to any health and social care staff group, including doctors, nurses, GPs, midwives, social workers, porters, administrative staff and cleaners, according to HEE. It also includes videos featuring the lived experiences of people who have dementia, talking about their experience and how the dementia affects them.
The package is free to access and it has been designed with busy health and social care staff in mind.