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Welfare Reform on the Web (December 2011): National Health Service - primary and community care

Health at work: an independent review of sickness absence

C. Black and D. Frost for the Department for Work and Pensions

London: TSO, 2011 (Cm 8205)

This review presents an analysis of the sickness absence system in the UK, the impact of sickness absence on employers, the state and individuals, and factors which cause and prolong sickness absence, leading to employees moving out of work and onto benefits. The review recommends that GPs should no longer be responsible for signing long term sick notes. Instead the Government should fund a new Independent Assessment Service (IAS). The IAS would provide an in-depth assessment of an individual's physical and/or mental function. It would also provide advice about how an individual taking sickness absence could be supported to return to work. It also recommended expenditure by employers targeted at keeping sick employees in work (or speeding their return to work), such as medical treatments or vocational rehabilitation, should attract tax relief. This should be targeted at basic-rate taxpayers. The authors estimate that this will cost around 150 million a year, but will result in gains to employers of up to 250 million. A key aim of the Review has been to increase job retention. However, some long-term health conditions are simply incompatible with an individual's current job. The review recommends that that the State should offer a free job-brokering service for anyone with a sickness absence period of 20 weeks or more. There are inefficiencies and delays in the benefits system. It takes an average of 17 weeks for people claiming Employment Support Allowance (ESA) to be assessed and then over 60 per cent are actually found fit for work (accounting for those who successfully appeal against being found fit, the proportion found fit is still over 50 per cent). This builds an unacceptable delay into the journey to get people back to work. The review therefore recommends that the Government ends the ESA assessment phase altogether. People should go onto ESA only if they qualify after a Work Capability Assessment (WCA) or as now, if they have sufficient medical evidence not to need a face-to-face WCA. This recommendation should be supported by reformed processes within Jobcentre Plus, to prevent high numbers of claimants being inappropriately directed towards ESA. The report estimates that this change could save the State up to 100 million a year, with an increase in economic output of up to 300 million.


Help long term patients return to work, GMC tells doctors

J. Meikle

The Guardian, Nov. 1st 2011, p. 9

Doctors are being told to do more to keep patients with long-term illnesses in work and to encourage them to adopt healthy lifestyles. New draft guidance from the General Medical Council (GMC) says doctors 'must support patients in caring for themselves to empower them to improve and maintain their health'. The move is politically sensitive given the government's drive to cut the number of people on incapacity benefits. The guidance adds: 'This may include encouraging patients, including those with long-term conditions, to stay in or return to employment or other purposeful activity. You may also advise patients on the effects of their life choices on their health and wellbeing and the possible outcomes of their treatments.'

Junior staff given work of paramedics

S. Rainey and S. Adams

Daily Telegraph, Nov. 7th 2011, p. 10

Emergency Care Assistants (ECAs) were being used as 'first responders' and put in charge of ambulances attending potentially life-threatening situations at a time of major NHS cuts. The ECAs had only basic first aid training, unlike paramedics who were trained for three years, and could not administer life-saving drugs.

Primary care

D. Carlisle (editor)

Health Service Journal, Nov.24th 2011, supplement, 10p.

This special supplement presents: 1) case studies of integration of primary and secondary care; 2) an exploration of how GPs can be engaged in improving patient safety; 3) an examination of the role of primary care in reducing emergency hospital admissions; and 4) a description of how a productivity programme based on lean principles can allow GPs to spend more time with their patients.

Procurement concerns slow CCG choice

D. Williams and D. West

Health Service Journal, Nov. 10th 2011, p. 4-5

New Department of Health guidance published in November 2011 stated that clinical commissioning groups were unlikely to have commissioning support contracts in place by April 2013, when they were due to take over from primary care trusts (PCTs). Once they became statutory bodies at that date, they would need to undertake formal procurement processes to contract for commissioning support in line with normal public sector rules. This would take a year. At least initially, they were likely to have to use existing PCT staff.

Public health

Health Committee

London: TSO, 2011 (House of Commons papers, session 2010/12; HC 1048)

The report comments on Government plans for major changes to the public health system in England. Changes will affect all three domains of public health:

  • health protection (addressing environmental threats to population health)
  • health improvement (tackling health inequalities and lifestyle issues impacting on health and wellbeing)
  • healthcare public health (applying public health expertise to the provision of healthcare services).
A new dedicated public health service, Public Health England (PHE), will become operative from April 2013. The Committee believes PHE must be visibly and operationally independent of Ministers. Major new responsibilities for public health will also be assumed by local authorities, but the Committee finds that the lack of a statutory duty on local authorities to address health inequalities in discharging their public health functions is a serious omission in the Government's plans. The Committee also calls for:

  • the Secretary of State for Health to be given an explicit statutory duty to reduce inequalities in public health as well as to protect the public from dangers to health
  • the Department of Health to set public health budgets, both nationally and locally, that take account of objective measures of need
  • the Chief Medical Officer to give professional leadership in respect of both the medical and public health professions
  • the Government to review its opposition to proposals on regulation of health professions
  • the role of the Public Health Interventions Advisory Committee of the National Institute for Health and Clinical Excellence to be clarified.

Revealing the principles for successful boards

J. Webber

Health Service Journal, Nov. 17th 2011, p. 26-27

Under the Health and Social Care Bill, Health and Wellbeing Boards will be created to strengthen the link between health and local government. They will be made up of representatives from across a local area, including clinical commissioning groups, councillors and local officials, patient groups and public health directors. Drawing on this expertise, they will set the strategic direction for improving health and wellbeing across their area. Their effectiveness will ultimately depend on how well they can build collaborative relationships between their members. Relationships between the different organisations represented on boards will come under strain, and they will need to be strong enough to take the pressure. It is vital that, where strong relationships between local organisations do not already exist, bodies across health and local government engage with each other to gain a shared understanding of the challenges the boards face and what can be done about them.

Study shines light on how quickly GPs spot cancer

S. Boseley

The Guardian, Nov. 25th 2011, p. 19

Nearly three-quarters of patients with cancer who go to their GP are diagnosed after one or two visits and sent to a specialist within a month, but others see a GP five times or more before cancer is identified. Early diagnosis and treatment of cancer improves patients' chances of survival. Delays in diagnosis have long been blamed for the UK having poorer survival rates than other European countries. Until now there has been no good data on why significant numbers of cancers in UK patients are not picked up as early as they should be. Some have suggested that Britons are reluctant to bother their doctor with worrying symptoms, while others have speculated that GPs do not readily enough suspect cancer. The study by the Royal College of GPs attempts to throw some light on GPs' performance, although it cannot give a simple reason for late diagnosis.

Women 'should not be forced' into abortion counselling

R. Smith

Daily Telegraph, Nov. 23rd 2011, p. 17

Guidance from the Royal College of Obstetricians and Gynaecologists issued in November 2011 recommended that women seeking an abortion should be offered independent counselling, but not forced to accept it. It also said that it was safe for women to take drugs at home to induce an abortion, even though this was not permitted under laws in force. The guidance was welcomed by abortion providers and was published ahead of a planned reform of services by government.

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