Prof Sir Chris Ham and Richard Murray writing for The King's Fund 12 July 2018: The government has announced increases in NHS funding over five years, beginning in 2019/20, and has asked the NHS to come up with a 10-year plan for how this funding will be used. After eight years of austerity, growing financial and service pressures within the NHS and the damaging and distracting changes brought about by the Health and Social Care Act 2012, there is now an opportunity to tackle the issues that matter most to patients and communities and to improve health and care.
In our view, the centrepiece of the new plan should be a commitment to bring about measurable improvements in population health and to reduce health inequalities. Health outcomes in the UK are not as good as those in many comparable countries despite recent progress in some areas such as cancer survival rates (Dayan et al 2018). Action is required across government as well as in the NHS in order to give greater priority to prevention and to tackle the wider determinants of health and wellbeing. Goals for improving health should be set following widespread consultation with the public and stakeholders.
Improving health and reducing health inequalities depends on making further progress in integrating health and social care, building on the development of new care models, sustainability and transformation partnerships (STPs) and integrated care systems (ICSs). An immediate priority is to communicate more effectively about why integrated care matters and about the benefits it will bring to people and communities. Some of the additional funding that has been announced should be earmarked to support the further development of integrated care with a focus on the needs of older people with frailty, people with complex needs and children.
Reported in Care Home Professionals (12 July 2018): A new initiative aiming to be the UK’s biggest pen pal scheme is to partner nursery and primary school children with care home residents of the same name.
The initiative, dubbed ‘Letters from a Namesake’, aims to bring together two different generations to share experiences and life stories.
Launched by the nations’ biggest supplier of name tags and labels for schools and care homes, My Nametags, the educational scheme aims to help develop children’s letter writing skills, while tackling loneliness among care home residents.
My Nametags are appealing for care homes in all parts of the UK to come forward and sign up if they are interested in taking part.
Lars B Andersen, Managing Director at My Nametags, said: “The way the scheme will work is we will match people and children with the same names.
“For example, a ‘Mary’ from a local nursery will be given the opportunity to write to ‘Mary’ in a residential care home and vice versa.
“No personal details will be shared as all the letters, pictures and drawings will be sent to us and passed on directly. We’re excited to be launching the scheme, and hope that it will help the local community enormously by bringing these two very different generations together.”
Care homes wishing to take part can register their interest by contacting or calling 01993 823 011.
The International Longevity Centre - UK has published a report which presents findings from a new economic model on cost-benefit analyses for differing uptake and efficacy scenarios for the English flu vaccination programme.
Given the rapidly ageing population of the UK and growing pressures on the National Health Service, tackling influenza is an important challenge, especially during the winter months when flu and other related health conditions are most prevalent. Vaccinations are recognised as a crucial defence against flu outbreaks, helping to protect individuals directly and by creating herd immunity. However, all health systems face financial constraints, and understanding the costs and benefits of vaccination comes into consideration by those implementing health policy.
Key findings include:
- Vaccination averts between 180,000 and 626,000 cases of influenza per year in England
- Flu vaccination helps avert between 5,678 and 8,800 premature deaths per year
- The vast majority of hospital cases caused by influenza are among older adults. Over 1,800 individuals hospitalised in 2016-2017 were aged between 80 and 84 - higher than any other age group
- The human capital costs of influenza range from £90 million to £270 million
- The NHS flu vaccination programme costs £50,610 per death averted
Reported in the Guardian (3 July 2018): No health system has all the answers, and there are certainly lessons the NHS can impart. But if the NHS is to thrive it needs to draw on the knowledge and experiences of other countries.
New Zealand: integrated health and social care
In the early 2000s, the health system in Canterbury on New Zealand’s South Island was under pressure as a result of increasing demand, leading to questions about its sustainability. But since it introduced an integrated health and social care system in 2007, Canterbury has turned around its fortunes.
Sweden: paediatricians on the frontline
When it comes to the increasing pressures on the NHS, the spotlight often falls on Britain’s ageing population. But demand for services is also increasing among other age groups. In the UK the first port of call for parents is usually the GP, who will often have limited training in paediatrics. By contrast, in Sweden GPs and paediatricians are co-located in health centres where there is parental support, health education and promotions, all important for preventing ill health.
Reported in Care Home Professional (3 July 2018): A new law introduced by the government today is designed to streamline the complicated and bureaucratic Deprivation of Liberty Safeguards (DoLs) system.
The government said the new system will ease the burden on local authorities, saving an estimated £200m a year which will go towards frontline care and address the current backlog of 108,000 people whose safeguards have not been reviewed.
The bill is designed to ensure the system is less burdensome on people, carers, families and local authorities. It aims to introduce a simpler process with more engagement with families and swifter access to justice. It also allows the NHS rather than local authorities to authorise patients and enable a more streamlined and clearly accountable process, while considering restriction of people’s liberties holistically as part of their overall care package. The bill also aims to eliminate repeat assessment and authorisations when someone moves between a care home, hospital and ambulance as part of their treatment.
Report published by the National Audit Office (29 June 2018): The vanguard programme, one of NHS England’s attempts to better meet patients’ needs and deliver savings by developing new care models to integrate health and social care services, has not delivered the depth and scale of transformed services it aimed for at the beginning of the programme, says today’s report by the National Audit Office (NAO).
Money originally intended to enable the initiative to transform services was instead spent on helping to relieve short-term financial pressures in the NHS by reducing trusts’ financial deficits, weakening its chances of success.
A key objective of the programme was to design new care models that could be quickly replicated across England. NHS England selected 50 sites to act as ‘vanguards’ which might entail, for example, joining up GP, hospital and community and mental health services in an integrated network or single organisation in one area to improve healthcare for patients.
NHS England’s early planning assumption was £2.2 billion of funding for new care models between 2016-17 and 2020-21, but it used much of the funding to reduce deficits faced by hospitals. Actual direct funding of vanguards was £329 million over three years from 2015-16, with another £60 million spent by NHS England on central support for vanguards. Consequently, with less funding for transformation, the original intention to expand the programme was not realised.
Parliament UK (27 June 2018): The Housing, Communities and Local Government and Health and Social Care Committees' joint report calls for a sustainable funding solution for adult social care.
The report calls for the introduction of a ‘Social Care Premium’, either as an additional element of National Insurance or with the premium paid into dedicated not-for-profit social insurance fund that people would be confident could only be used for social care.
To ensure fairness between the generations, the premium should only be paid by those aged over 40 and extended to those over the age of 65, with the money being held in an independent, dedicated and audited fund to help gain public trust and acceptance for the measure.
Individuals and employers should pay a new contribution into a dedicated fund set aside to help pay for the growing demand for adult social care and implement funding reforms, with the current system ‘not fit to respond to the demographic trends of the future’, say report into Long term funding of adult social care report.
NHS England (22 June 2018): Innovative ‘red bags’ that help care home residents admitted to hospital be discharged quicker are being rolled out across the country.
The bags, which contain key paperwork, medication and personal items like glasses, slippers and dentures, are handed to ambulance crews by carers and travel with patients to hospital where they are then handed to the doctor. The simple initiative started three years ago in Sutton, South West London, and now all areas of the country are being urged to adopt the scheme with a toolkit launched today to help. It’s an example of how the NHS is integrating care, working in partnership with social care, to create a seamless pathway for patients so they only have to tell their story once.
Since April, the first parts of the country formally begin to work as integrated care systems, a key milestone as England makes the biggest national move to integrate care of any major western country.
So far the initiative in Sutton has showed:
- Reduced hospital stays by three to four days, saving £167,000 a year
- Stopped patients losing personal items such as dentures, glasses and hearing aids worth £290,000 in a year
- Improved communication between care home and hospital staff saving time, resources and duplication.
See also: ‘Red Bag’ scheme introduced in care homes across Portsmouth area (Portsmouth News); 'Red bags' will get patients home from hospital more quickly (Nursing Notes)
BGS London (22 June 2018): The British Geriatrics Society is calling all healthcare professionals to review the Gosport Independent Panel Report, and to learn from these shocking events which led to the deaths of over 450 patients who were given opiate painkillers “without medical justification” from 1989 to 2000 at Gosport War Memorial Hospital in Hampshire.
The Inquiry found there was a “disregard for human life” and an “institutionalised practice of shortening lives” at the hospital. In response to the Inquiry’s findings the Society is also calling for increased knowledge of best practice and clinical guidelines, especially in relation to prescribing and pain management in older people. The Society fully supports the families’ ongoing quest for truth and accountability.
Dr Eileen Burns, President of the British Geriatrics Society commented:
“It is a sombre day for all healthcare professionals caring for older people. We must diligently read this report if we hope to learn from these tragic events and prevent future tragedies. We urge regulators and the wider health and care system to do the same.
The Society will continue to strive to ensure that older people receive high quality healthcare, regardless their situation or clinical diagnosis.
Our sympathies lie with the families at this difficult time, and we hope Inquiry’s findings will help them to gain the answers they seek.”
How are your services performing? The NHS Benchmarking Network offers you the opportunity to find out!
“The NHS Benchmarking Network provides a unique source of information in this key area. The joint experience of working with the Acute Frailty Network has highlighted that many of the issues relating to DToC can be overcome by early assertive holistic assessment. I strongly encourage all providers of older people’s acute care to sign up this year”
Professor Simon Conroy, Clinical Lead, Acute Frailty Network
What is NHS Benchmarking?
The Benchmarking Network works with its 330+ members to understand the wide variation in demand, capacity and outcomes evident within the NHS. It concentrates on areas that are poorly served by routine NHS statistics. Member organisations are able to take part in any of the Network’s benchmarking projects. The list of members can be found here.