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The NHIS Update

The NHIS update is intended to give a monthly overview of some key issues affecting the NHS. Full access to the National Health Intelligence Service allows these stories to be put into context, by providing background information and facilitating on-going investigation.  

If you do not work for the NHS – be grateful. If you do – we advise keeping your head down for the next 18 months or so  
In May 2005, Mrs H promised that an overhaul of family doctors, dentists and pharmacists would be central to the forthcoming white paper on personalised healthcare. Then a white paper on primary care was scheduled for Autumn 2005, but was subsequently transmuted into one on ‘Health outside Hospitals’. One key development was rumoured to be the establishment of super-surgeries to provide outpatient services and the kind of diagnostic services previously offered by hospitals, and we were promised a public consultation.
In July 2005, a joint white paper designed to deliver integrated health and social care systems was announced by Care Services Minister Liam Byrne, hotly followed by Health Secretary Patricia introducing a public consultation to shape the white paper on improving community health and care services.
For those of you who may have been confused by this proliferation of white papers, we can provide enlightenment. They are all the same white paper embracing all of the same topics. It will appear at the turn (i.e. the end) of the year and, in addition to overhauling family doctors, dentists and pharmacists, creating supersurgeries, integrating health and social care and opening up the primary sector to foundation trusts and the private sector, it will result in a few organisational changes.
When the dust settles, there will be nearer 150 PCTs. Probably, unless there are local arguments to the contrary, these will have common boundaries with the 150 social service organisations. Over the period, the number of SHAs is likely to drop to about ten and the number of GP practices will fall dramatically.
Business as usual then.
If you do not work for the NHS – be grateful. If you do – we advise keeping your head down for the next 18 months or so, and occasionally joining in the rallying cries of “coterminosity” and “fit for purpose”. If you are a patient, then just hope that you can detect a benefit. Because the NHS in England is £500 million in deficit, or it could be £750 million, an interim and very odd solution being mooted is that SHAs with cash lend it to SHAs without cash and charge them 10% p.a. interest. There has also been discussion about getting rid of a few thousand jobs to save cash, so perhaps the white paper will solve this by cutting admin and achieving coterminosity of income and expenditure.
Did you read about a ‘choose and book’ poll taken in Birmingham which showed that patients believed the private sector was superior to the NHS on 12 of out 14 factors, including cleanliness and management? The two factors on which the NHS won were cultural sensitivity and dealing with things that go wrong. If there were to be a move to the private sector as suggested by the survey, the local NHS organisations would lose £35 million of business – which would cause a bit of trouble.
If Choose and Book is really a stick with which to beat the NHS, so that hospitals are forced to improve their cleanliness and management, surely there must a way of doing this without the very obvious risk of destabilising the NHS. In July, the Healthcare Commission published the outcome of a review of foundation trusts. It seems that, as well as moving into primary care, there is a possibility that they will start taking over other hospitals and developing what is being called the ‘Debenhams branded boutique model’, in which successful trusts sell their wares and exploit their brand, via franchised outlets.

                    If you have problems or want to know more, email info@nhis.info.  

cdm Monitor  
Informing the NHS about  
key resource developments  
for the management of  
chronic disease   

If there had been no firm distinction between primary and secondary care, then life would be easier  
The idea of vertical integration is very refreshing – but it seems the DoH is not in favour. It is what ought to have happened sixty-odd years ago, but then the government lost out to the medical lobby. If there had been no firm distinction between primary and secondary care, then life would be easier. The patient pathway would be across a level field, without the ditches and humps that have to be negotiated now. As for ‘branded boutiques’ – I know what my old granny would have said. In July, the ‘stars’ were awarded for the last time; but there is little point in trying to assess what they meant, which rather sums up their value. In future, NHS Trusts will get an annual health check.
Also, we took over the EU Presidency – which seems to be a reason for spending money on a few ‘jollies’ for various healthcare worthies with the odd gala dinner thrown in. The rate at which people are stopping smoking was reported to be 300,000 a year. It was announced that patients facing long waits for diagnostic tests in their local hospital will be offered the choice of going to another hospital. A further £15 million, available for 05/06, was announced to help transform sexual health services across the country.
The General Dental Council gained new powers, and manufacturers were invited to tender for a contract to supply a limited amount of H5N1 vaccine for the putative flu pandemic. Finally, updated numbers and rates of MRSA bacteraemias were provided.
If you have problems, want to know more, or wish to gain access to the National Health Intelligence Service, email info@nhis.info
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