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Welfare Reform on the Web (December 2010): National Health Service - funding

27,000 nursing jobs to go as NHS braces for cuts

J. Laurance

The Independent, Nov. 12th 2010, p. 26

The Royal College of Nursing (RCN) has said that almost 27,000 nursing posts have been earmarked for cuts, more than three times the amount identified in April 2010. Peter Carter, RCN chief executive, urged trusts to make proper assessment of the impact of the cuts before implementing them. The NHS was awarded a real terms increase in funding of 0.1% as part of the comprehensive spending review, but 1bn a year of that money is due to be diverted to social care and 300m will go on next year's VAT rise leaving the NHS facing a real term cut of 0.5%. In addition, the service needs to find 20m worth of savings by 2014 to cope with the cost of an ageing population and medical advances.

(See also The Guardian, Nov. 12th 2010, p. 23)

Back office efficiency and management optimisation

Foundation Trust Network

QIPP Programme Team, Department of Health, 2010

This report estimates that NHS organisations could save 600m - 1bn by sharing back office functions. It also reveals that the Department of Health is planning to produce a national business case for back office and commissioning support sharing by primary care trusts - and later GP consortia. However the proposed savings would involve significant staff cuts. The report also supports the government's proposals for 'cash limits' on GP consortia management spending, and says this should be subject to audit. It did not estimate savings possible in GP back office costs, but noted that the area offered significant potential for increasing efficiency.

Beware raiders of the lost cause

D. Brown

Health Service Journal, Nov. 11th 2010, p. 16-17

The coalition government is proposing the reintroduction of local pay bargaining into the NHS. The author argues that this will lead to massive duplication of effort, and will be more costly than the current Agenda for Change framework, which introduced a national structure of pay bands covering all non-medical NHS staff.

Bridge over troubled waters

N. Plumridge

Public Finance, Oct. 22nd-Nov. 4th 2010, p. 14-17

The coalition government has announced plans for a radical reform of the NHS, including transfer of commissioning from primary care trusts to GP Consortia. There are concerns that the costs of this upheaval will impair the service's ability to realise savings of 15bn-20bn required by government. On the provider side, the government will require the GP Consortia to contract for services with any willing provider, including private firms and voluntary organisations. However, there are doubts about the enthusiasm of the independent sector for entering the market.

Coalition pledge to protect NHS from cuts is 'urban myth'

S. Lister

The Times, Nov 12th 2010, p. 18

A report by the Royal College of Nursing published in Frontline First warns that the 27,000 frontline NHS jobs earmarked for cuts during the next 3 years will mean that waiting lists for operations will rise as job loses mount.

Cost of NHS temporary medical cover tops 750m

R. Ramesh

The Guardian, Nov 10th 2010, p. 7

According to the Royal College of Surgeons (RCS) the cost of hiring doctors to cover for colleagues because of European law restricting the maximum hours that medical staff can work (48) has topped 750m. The RCS has called on government to exempt doctors from the regulation and hold talks to re-write junior doctors contracts so that they could work longer hours, but many in the medical profession dispute the analysis. Shree Datta of the British Medical Association (BMA) junior doctors committee has said the escalation in costs has nothing to do with European regulations, but is the result of hospitals experiencing shortages of staff due to recruitment freezes.

(See also Daily Telegraph, Nov.10th 2010, p.8)

Doctors call for action to stop drug firms raising prices

R. Smith

Daily Telegraph, Nov. 17th 2010, p. 20

Senior doctors have claimed that drug companies are misusing rules intended to encourage them to develop new treatments for rare diseases. Instead of developing new drugs they are obtaining licences for existing ones and then raising the price by up to 700% after a slight modification. Some NHS hospitals are refusing to fund drugs that were previously cheaply available. (See also Independent, Nov. 17th 2010, p. 10 and Guardian, Nov. 17th 2010, p. 4)

Dorrell: the 'main game' is delivering efficiency

S. Gainsbury

Health Service Journal, Nov. 18th 2010, p. 12-13

Report of an interview with Stephen Dorrell, chair of the Commons Health Select Committee, in which he argues that the main priority for the NHS has to be achieving up to 20bn in productivity gains, rather than abolishing primary care trusts and replacing them with GP consortia. He is however concerned about the lack of detail in the NHS White Paper about the regime for monitoring GP commissioning consortia, due to the risk of significant financial deficits, and argues that the health secretary cannot abdicate ultimate responsibility for the care delivered by the NHS through decentralisation.

Going back to the 1980s?

I. Torjeson

Health Service Journal, Nov. 11th 2010, p. 20-23

Experts in healthcare finance debate the impact of cuts in government funding on the NHS. In order to manage in times of financial stringency, the NHS will need to reduce staff costs through pay freezes or redundancies, and rely more on local accountability and delivery. Spending on mental health and community services and drugs is likely to be cut. Savings could be made if GPs were put in charge of commissioning out of hospital care and NHS organisations shared or outsourced some back office functions.

Hospital care for worst-injured soldiers 'costs 2m a month'

P. Curtis

The Guardian, Nov. 23rd 2010, p. 16

Acute care for the troops most seriously injured in Afghanistan is costing the government more than 500,000 per week. The military ward at Birmingham NHS foundation trust receives over 2m from the Ministry of Defence (MoD) every month. The figures do not include the costs of Hadley Court, the Surrey long term rehabilitation facility funded internally by the MoD.

Midwives voice fears over raising workload

D. Campbell

The Guardian, Nov. 16th 2010, p. 10

Women giving birth are not receiving proper care because NHS maternity units are having to deal with staff cuts, recruitment problems and reduced budgets, the Royal College of Midwives has warned. A survey conducted among heads of midwifery units in England has revealed that 30% have had their budget cut and 33% have been asked to reduce their budget.

(See also: The Guardian, Nov. 18th 2010, p. 12)

Millions wasted on cancer treatment

J. Laurance

The Independent, Nov. 18th 2010, p. 17

The NHS is wasting hundreds of millions of pounds on cancer treatment with no measurable impact on outcomes according to a report by the government's Cancer Reform Strategy.

Trends in programme budget expenditure

R. Jones

British Journal of Healthcare Management, vol. 16, 2010, p. 518-525

Each year primary care trusts (PCTs) in England provide a breakdown of their expenditure into programme budgets covering 23 different categories of disease such as cancer, mental health and circulatory disease. Analysis of these costs over the past six years showed a sudden increase in spending on mental health, neonates, particular cancers, respiratory diseases and social care in 2007-2008. Such sudden increases in demand for healthcare appear to occur at regular intervals and may be associated with the outbreak of an unidentified infectious disease, possibly aided by regional variation in vitamin D status.

Under the microscope

J. Appleby

Public Finance, Nov. 5th-18th 2010, p. 18-19

The 2010 Comprehensive Spending Review has confirmed that the NHS in England will receive a real terms rise in funding over the four years to 2014/15, but it is very small. It equates to around 90m per year, or just over 7 hours running time for the NHS, and will not cover cost increases. It leaves the NHS with an extraordinarily challenging target to improve its productivity to the value of between 15bn and 20bn over three years.

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