15 July 2010 - Equity and Excellence: Liberating the NHS. The new white paper on the NHS in England was released on 12 July. Until details are available about the outcomes framework, the 150 quality standards, or other details that specifically affect the provision of respiratory care, IMPRESS will not add commentary to what is already available from other policy analysts. However, the briefing papers are all available here:
- The white paper
- summary slides
- letter from David Nicholson, CEO of the NHS in England describing transition arrangements, and a tighter central control of quality and finance whilst the decentralised model takes shape
- slides about the transition timelines
There are some references to respiratory care:
OECD comparision of avoidable asthma admissions. See here and also EUROCARE-4. on cancer, although lung cancer statistics are not currently available.
21 May 2010
The New Secretary of State for Health, Andrew Lansley, announced that from now on all service reconfigurations must
• focus on improving patient outcomes;
• consider patient choice;
• have support from GP commissioners; and
• be based on sound clinical evidence.
He has therefore put a hold on NHS London plans pending demonstration of GP support.
December 2009
Operating Framework for 2010/11. See separate IMPRESS page.
December 2009: NHS 2010-2015: from good to great. Preventative, people-centred, productive.
This presents the medium term vision for the NHS in England. Here are some of the implications for respiratory care:
1. Prevention: continue to build on smoking cessation successes and NHS Constitution messages about people taking responsibility for their lifestyle. Heralds new tobacco control strategy due out shortly and role of partnership with local authorities.
2. People-centred, productive: sets an expectation for “transformed services” for COPD, diabetes and dementia. Particular mention of high comparative (OECD countries) admission rates for asthma. Consultation on strategy for COPD and asthma highlighted “this could include the following:”
1. Reviewing registers
2. Active case management
3. Education and support
4. Structured hospital admission and early discharge
3. Reminder of the long term conditions strategy, including personal health budgets and personalised care planning. Note that two SHAs have web resources on this:
South West
And East of England
There is also an NHS Evidence example of good practice.
4. Review of tariff system to incentivise right pathways of care – limiting payment for activity in excess of planned levels (might have cash limits). In addition to the levers such as CQINS, and non-payment for Never Events. Over time this might mean new locally negotiated incentives to reduce bed days through early discharge schemes and hospital at home, rather than admission avoidance pressures (where these are not felt to be appropriate).
5. Strong focus on encouraging NHS providers to work together – see page 58. Including, para 4.45 looking seriously at vertical integration – argues this is not the right time to spend effort on creating new structures and new organisations. Vertical integration is likely to mean mergers between hospital trusts and community services. Although the social enterprise model is supported only 20 have been supported by end Dec 2009 under Right to Request. This seems to reemphasise the new commitment to use preferred NHS providers, and so has not found favour with the third or private sector although the commitment to the third sector in supporting people with long term conditions is still there (there is likely to be renewed debate about whether choice is affordable).
6. Greater support and performance management of PCT commissioners – both required to go more local, but also for underperforming PCT s to be taken over by high-performing.
7. Pay restraint: page 46 and page 47: “explore the pros and cons of offering frontline staff an employment guarantee locally or regionally in return for flexibility, mobility and sustained pay restraint.” This is not offered to management or commissioning.
High Quality Care For All – the Next Stage Review by Lord Darzi June 2008 Click here and see IMPRESS summary here.
Clinical commissioning: our vision for practice-based commissioning. Click here. This is the latest report on practice-based commissioning
Implementing care closer to home: convenient quality care for patients (DH, May 2007) Click here.
Commissioning Framework for Health & Well-being (DH, March 2007) Click here.
Our Health, Our Care, Our Say’ a new direction for community services (DH, January 2006) Click here
Healthy lives, brighter futures – The strategy for children and young people’s health - Feb 2009 Children's Strategy - opportunities for children with asthma and other respiratory diseases
Respiratory – a consultation Strategy for Services for Chronic Obstructive Pulmonary Disease (COPD) in England was launched on 23 February 2010. It also has a chapter on asthma. Consultation closes 6 April 2010. Both BTS and PCRS-UK will be responding. A second consultation document, Impact Assessment is worth downloading. It contains estimates of the costs and benefits of the strategy.
End of life
High quality care for all adults at the end of life (DH 2008) Click here
Smoking: A smokefree future: a comprehensive tobacco control strategy for England
Carers: Carers at the heart of 21st century families and communities. This requires that PCTs should work with local authority partners and publish joint plans on how their combined funding will support breaks for carers in a personalised way.
Scotland
Wales
Northern Ireland