Health and Medicine

Budget targets add more pressure to health service

'Public Expenditure’ (HC 1499) examines the progress of the health and care services in the face of increasing demands to their budgets.

The report details that hospitals are resorting to short-term "salami slicing" as they try to find £20 billion in efficiency savings by 2014-15.

Concern over clarity of alcohol intake guidelines

MPs have criticised Government recommended alcohol consumption in the report 'Alcohol Guidelines’ (HC 1536), stressing that people should have at least two drink-free days a week.

The Science and Technology Committee has raised concerns over Government advice on sensible daily drinking limits implemented in the 1990s and suggests that alcohol guidelines are reviewed.

Challenges facing hospitals yet to attain Foundation status are considerable

'Achievement of Foundation Trust Status by NHS Hospital Trusts' (HC 1566) is a report by the Committee of Public Accounts examining the responsibility for dealing with this huge challenge, and what is being done to protect taxpayers and patients when trusts need external help.

Nearly half of all Hospital Trusts have not yet achieved Foundation Trust status, but the Government wants almost all Trusts to do so by 2014.

Health care regulation a struggle for Care Quality Commission

The Care Quality Commission has so far not proved value for money in establishing itself as a health and adult social care regulator since forming in 2009, according to a watchdog.

'The Care Quality Commission: Regulating the Quality and Safety of Health and Adult Social Care: Department of Health’ (HC 1665) details how the Care Quality Commission had a difficult task in establishing itself, and has not so far achieved value for money in regulating the quality and safety of health and adult social care in England.

Complaint against Newcastle care services investigated

A joint investigation into the care given by the NHS and Newcastle City Council to a man with Down’s Syndrome found significant failings after a complaint was made by the man’s brother.

'A Report by the Health Service Ombudsman and the Local Government Ombudsman About the Care and Support Provided to a Person with Down's Syndrome’ (HC 1644) tells the story of Mr J, who was discharged into inappropriate, locked accommodation after being in hospital for seven months.

NHS should prove worth of expensive equipment

The Committee of Public Accounts recommends that the NHS records data to monitor the usage of high value equipment worth around £1 billion as confidence in its purchasing power is weak.

The report 'Managing High Value Capital Equipment in the NHS in England’ (HC 1469) highlights that by 2015, £20 billion of savings are required of the NHS, and the decision to spend £50 million on equipment annually over the last three years should be reinforced by monitoring use and cost.

Petty disputes central to NHS complaints

An annual review of how the National Health Service (NHS) deals with complaints found that the most straightforward of matters are not being managed at a local level.

In the report 'Listening and Learning: the Ombudsman's Review of Complaint Handling by the NHS in England 2010-22’ (HC 1522), the Health Ombudsman resolved 15,186 complaints that were often a result of poor responses by NHS staff.

Department must assist NHS trusts to attain foundation status

The Department of Health (DH) must advise a number of struggling National Health Service (NHS) trusts on how to meet standards required to become self-governing foundation trusts by 2014, the National Audit Office reports.

The report 'Achievement of Foundation Trust Status by NHS Hospital Trusts' (HC 1516) details that many NHS trusts are facing a range of financial, quality and governance issues in meeting foundation trust standards and DH and the NHS will now have to decide how they will deal with those facing the most severe problems.

Urgency for UK HIV and AIDS prevention

The health issue of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) is one of the most serious in the UK; preventative action is required as the number of people being treated has trebled since 2000.

By the end of next year 100,000 UK citizens will be living with HIV, the report, ‘No Vaccine, no Cure: HIV and AIDS in the United Kingdom’ (HL 188) discusses, and the Government must intervene to prevent further infection.

Report reveals electronic care records project failure

The Committee of Public Accounts believes that the initiative to create a fully integrated electronic care records system in the National Health Service (NHS) has been a highly expensive disappointment.

The report, 'The National Programme for IT in the NHS: an Update on the Delivery of Detailed Care Records Systems’ (HC 1070), finds that the central part of an ambitious £11.4 billion investment programme has not delivered its original vision despite costing over £7 billion.

Scrutiny over contemporary approach to tackling obesity

The Government’s interest in taking on a ‘nudge’ strategy to lower obesity has been criticised by the House of Lords as not being effective enough alone to change people’s lifestyles.

The report 'Behaviour Change’ (HL 179) from the Science and Technology Select Committee finds that the currently influential book 'Nudge' by Richard Thaler is unlikely to be effective used in isolation as there is no obligation for action.

Implementation of electronic patient records delayed

A high cost initiative to record NHS patient care electronically is expected to be applied nationally five years later than originally planned as reported in 'The National Programme for IT in the NHS: an Update on the Delivery of Detailed Care Records Systems: Department of Health’ (HC 888).

The National Audit Office (NAO) reports that electronic care records systems are being put in place across the National Health Service (NHS) under the National Programme for IT at a far slower rate than anticipated and the core aim that every patient should have an electronic care record under the Programme will not now be achieved.

Control of health services to be decentralised

In an attempt to focus on patient outcomes and meet fiscal savings targets the Government intends to reform the National Health Service (NHS) by localising decision-making.

The Public Accounts Committee comments on proposals outlined in the Health and Social Care Bill in 'National Health Service Landscape Review’ (HC 764) by examining the Bill’s value for money risks and implications.

Health services must not be compromised despite plans to save billions

Productivity levels in the National Health Service (NHS) must be significantly improved despite £20 billion year-on-year savings until 2014-15.

'Management of NHS Hospital Productivity’ (HC 741) finds that Government spending on the NHS has increased by 70%, from £60 billion in 2000-01 to £102 billion in 2010-11 with around 40% spent on services provided by acute and foundation hospitals but level of service has not reflected this.

Committee analyses cancer patient services since announcement of strategy for reform

The report 'Delivering the Cancer Reform Strategy’ (HC 667) examines the performance levels of the Department of Health and NHS in delivering cancer services.

Early support should be given to tackle mental health problems

A document released by the Department for Health emphasises the need to focus on mental health at a young age.

The 'No Health Without Mental Health' strategy outlines how early intervention and prevention will help tackle the underlying causes of mental ill-health.

Transport system overhaul for fiscal and environmental improvement

Revision of current funding for the UK transport system is essential to help create economic growth and reduce carbon emissions.

In the White Paper ‘Creating Growth, Cutting Carbon’ (Cm. 7996), the Department for Transport (DfT) outlines the need to offer green alternatives for car drivers where possible, as two thirds of all journeys are under five miles.

Health and Social Care Bill outlines action required to improve health in the UK

The ‘Health and Social Care Bill’ (Bill 132-I,II) implements the policies and procedures outlined in key government publications released in 2010.

The Bill extends on the ideas set out in the White Paper 'Equity and Excellence: Liberating the NHS’ (Cm. 7881) which were further developed in the report, 'Liberating the NHS: Legislative Framework and Next Steps’ (Cm. 7993).

Department calls for major change as lifestyle-driven health problems escalate

The Department of Health (DH) aims to radically reform the state of public health in England as the standard of living for the poorest reaches alarming levels.

Andrew Lansley details in 'Healthy Lives, Healthy People' that Britain is now the most obese nation in Europe, with some of the worst rates of sexually transmitted infections recorded, and there needs to be a radical shift in the way these serious problems are dealt with.

Human tissue of deceased used without consent by UK Nuclear Organisations

An investigation into the legitimacy of testing on human tissue by UK Nuclear Organisations over a period of nearly 40 years has been released.

'The Redfern Inquiry’ (HC 571) concludes that, in many cases, the families had been wronged. Organs were removed at post mortem and provided for analysis despite being of no possible relevance to the cause of death.

Quality of cancer care has increased since Reform Strategy published in 2007

Since the Department of Health (DH) released its 2007 report ‘Cancer Reform Strategy’, the quality of cancer care has improved considerably in key areas with more efficient delivery rates.

'Delivering the Cancer Reform Strategy' (HC 568) studies three of the Strategy’s focal points:

More doctors needed in deprived areas as health levels worsen

The Committee of Public Accounts has stated that people in deprived areas of the UK urgently need better access to General Practitioners (GPs) as their health continues to weaken.

The report ‘Tackling Inequalities in Life Expectancy in Areas with the Worst Health and Deprivation’ (HC 470) details that the inequalities in health outcomes between the most affluent and disadvantaged members of society is continually increasing.

Standard of complaints handling by the NHS assessed in first report

Health Service Ombudsman for England, Ann Abraham, comments on how the National Health Service (NHS) has coped with handling complaints in the year 2009-10.

'Listening and Learning: the Ombudsman's Review of Complaint Handling by the NHS in England 2009-10 (HC 482)’ details that the NHS is missing a rich source of free and readily available information about patients by failing to listen and learn from complaints.

Public to be given more power in plans to localise NHS

The Government proposes to put patients at the heart of the National Health Service (NHS) in a radical restructure of the current service, as discussed in ‘Equity and Excellence: Liberating the NHS’ (Cm. 7881).

The public will have greater choice and control over how healthcare services are coordinated through a blend of Conservative and Liberal Democrat ideas to improve patient experience and outcomes.

Hospitals are well-maintained by privately funded hospital contracts

The design, construction and management of privately funded National Health Service (NHS) hospitals is satisfactory or better, according to the National Audit Office.

Private Finance Initiative (PFI) hospital contracts, awarded and managed by local Trusts, ensure the upkeep of services including cleaning and catering and require buildings to be maintained in a specified condition. Currently there are 76 operational PFI contracts in England supported by the Department of Health.

Secure checks on foreign doctors must be made

'The Use of Overseas Doctors in Providing Out-of-Hours Services’ (HC 441) reports that foreign General Practitioners (GP) offering out-of-hours services must be completely vetted to improve standards.

The Health Committee urges that language and medical skills must be improved by European Economic Area (EEA) doctors due to poor English and general practice capability.

Lord Darzi proposes NHS overhaul

2008 marks the 60th anniversary of the creation of the National Health Service (NHS). In July 2007, Secretary of State for Health Alan Johnson announced that Professor Ara Darzi (now Lord Darzi of Denham) had been asked to carry out a wide-ranging review of the NHS.

'High Quality Care for All: NHS Next Stage Review Final Report by Lord Darzi' (Cm. 7432) sets out the Government's 10-year plan for the future of the NHS. It incorporates the views and visions of 2,000 clinicians and other health and social care professionals from every NHS region in England and has been developed in discussion with patients, carers, and the general public.

Dental services 'deteriorating'

In April 2006 the Department of Health (the Department) reformed the General Dental Service. Primary Care Trusts (PCTs) were given the power to commission dental services, the patient charging system was simplified, and under the terms of a new dental contract dentists were remunerated according to the number of Units of Dental Activity (UDA) completed. The Department issued a number of criteria for success.

This Report, 'Dental Services' (HC 289-I), assesses how far the Department's criteria have been met.

Modernising Medical Careers (MMC) programme investigated

The Modernising Medical Careers (MMC) programme of work was established in 2003 to address difficulties in poor training and indifferent career prospects and a new Foundation programme was introduced in 2005, the Specialty Training system was reformed, and the SHO grade scrapped in 2007.

As a result of inadequate preparation during the implementation of the reforms, in 2007 the MMC programme was plunged into crisis.

Health of the working population reviewed

Around 175 million working days were lost to illness in 2006. Some 7% of the working-age population is workless and receiving benefits because of long-term health conditions or disabilities. This represents a significant cost to the economy - in cost of benefits, healthcare, forgone taxes, lost production, sickness absence, informal care - estimated at between £103 and £129 billion.

This Review from Dame Carol Black (the National Director for Health and Work), 'Working for a Healthier Tomorrow', establishes the first baseline for the health of the working population. Its vision for health and work in Britain is based on three principal objectives: prevention of illness and promotion of health and well-being; early intervention for those who develop a health condition; and an improvement in the health of those out of work.

GP salaries up by average of 58% as working hours fall

Each year general medical practices provide some 290 million consultations. The new contract which was implemented in April 2004 (increased spending began in April 2003) changed the basis for commissioning primary care services. Instead of contracting with individual General Practitioners (GPs), Primary Care Trusts (PCTs) commission services from some 8,325 GP practices with around 33,000 GPs.

'NHS Pay Modernisation: New Contracts for General Practice Services in England' (HC 307) examines the negotiation and implementation of the new contract and how well it is working in practice.

Prescription costs examined

This Report, 'Department of Health: Prescribing costs in primary care' (HC 173), from the Committee of Public Accounts, examines the cost of prescriptions in primary care.

Care for vulnerable babies examined

This National Audit Office (NAO) Report ‘Caring for Vulnerable Babies’ (HC 101) examines the reorganisation of neonatal services in England.

Government should withdraw all NHS funded homeopathy urges inquiry

'Evidence Check 2: Homeopathy’ (HC 45) examines the Government's policies on the provision of homeopathy through the National Health Service (NHS) and the licensing of homeopathic products by the Medicines and Healthcare products Regulatory Agency (MHRA). This was prompted after a Government response in September 2009 indicated that scientific evidence was not used to formulate the licensing regime operated by the MHRA.

This inquiry is an examination of the evidence behind government policies on homeopathy, not an inquiry into homeopathy. The task was to determine whether scientific evidence supports government policies.

Air travel health issues examined

In this Report, ‘Air Travel & Health: An Update’ (HL 7), the House of Lords Select Committee on Science and Technology sets out the current situation and still finds issues that remain of concern, particularly the risk to air travellers of venous thromboembolism (VTE).

Mental Health Crisis services reviewed

This National Audit Office (NAO) Report, 'Helping People Through Mental Health Crisis' (HC 5), examines the role of Crisis Resolution and Home Treatment services (CRHT) in helping people through mental health crisis.

Improving health services in England and Wales

This report, 'State of Healthcare 2007: Improvements and Challenges in Services in England and Wales’ (HC 97), is the fourth annual State of Healthcare Report from the Healthcare Commission.

Abortion 24 week limit examined

‘Scientific Developments Relating to the Abortion Act 1967’ (HC 1045-I) discusses key scientific and technological issues relating to the law on abortion.

Report evaluates the Department for International Development's HIV and AIDS Strategy

Progress has been made on providing HIV/AIDS treatment in developing countries but the 2010 target of universal access to treatment will not be met. 'Progress on the Implementation of the DFID's HIV/AIDS Strategy’ (HC 49-1) reports that the disease remains a significant development and public health challenge in many developing countries.

Report reveals poor value for money in dementia services

The Department of Health has developed an ambitious and comprehensive strategy for dementia, 'Living Well with Dementia: A National Dementia Strategy (February 2009)'. Yet, despite the Department stating that dementia is now a national priority, it has not been given the levers or urgency normally expected for such a priority and there is a risk that value for money will remain poor unless these weaknesses are addressed urgently.

Dementia was not included in the Department's tier 1 Vital Signs indicators for the NHS through which it monitors performance. Other levers such as joined-up commissioning and comprehensive performance information are not yet fully developed. Achieving transformation in the proposed five years will be very challenging.

Report examines the failings of the Mid Staffordshire NHS Foundation Trust

Concerns about mortality and the standard of care provided at the Mid Staffordshire NHS Foundation Trust resulted in an investigation by the Healthcare Commission which published a highly critical report in March 2009, followed by two reviews commissioned by the Department of Health.

These investigations gave rise to widespread public concern and a loss of confidence in the Trust, its services and management. ‘Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust: January 2005 - March 2009’ (HC 375-I & 375-II) was set up primarily to give those most affected by poor care an opportunity to tell their stories and to ensure that the lessons learned were fully taken into account in the rebuilding of confidence in the Trust.

Specialist allergy centres needed

Allergy in the United Kingdom has now reached epidemic proportions.
This Report ‘Allergy’ (HL 166-I) examines the provision of allergy treatment in the UK.

Clinical governance in primary care

Following serious concerns about clinical and organisational failures in the NHS during the 1990s (such as Alder Hey, the Bristol Royal Infirmary and Shipman), the Government identified the need for a more systematic approach to improving quality and safety in healthcare.

This Report ‘Clinical Governance in Primary Care’ (HC 302) examines the introduction of the clinical governance framework in the NHS.

Mental health ‘deprivation of liberty’ safeguards introduced

The main purpose of the Mental Health Act 2007 is to amend the Mental Health Act 1983. It also introduces "deprivation of liberty safeguards" through amending the Mental Capacity Act 2005 and extends the rights of victims by amending the Domestic Violence, Crime and Victims Act 2004.

NHS spending on prescription drugs examined

The National Health Service spends £8 billion a year on prescription drugs in primary care in England. This has grown 60% in real terms over the last decade and the trend continues to be upward.

Digital hearing aid waiting times examined

One in seven people in England suffer from hearing loss of some kind, and the advent of digital hearing aids has proved of great benefit to many patients.

This publication from the House of Commons Health Committee, ‘Audiology services’ (HC 392)’ examines the Modernising Hearing Aid Services (MHAS) programme to improve audiology services introduced in 2000.

Disability discrimination laws "should protect mental health"

This Report ‘Improving the Mental Health of the Population: Can the European Union help?’ (HLP 73- I) from the House of Lords European Union Committee brings together evidence on the impact of mental health problems from a wide range of individuals and organisations.

NHS IT “behind schedule”

The National Programme for IT in the NHS was set up to utilise information technology to help provide high quality services to patients, using centrally managed procurement to provide impetus to the uptake of IT and to secure economies of scale.

Expenditure on the Programme is expected to be £12.4bn over ten years to 2013-14.

NHS consultant contract reviewed

This National Audit Office (NAO) Report ‘Pay modernisation: a new contract for NHS consultants in England’ (HC 335) examines the contract for NHS consultants agreed in 2003 and widely implemented by April 2004.

The contract was needed to increase the size and commitment of the consultant workforce if it was to deliver the NHS reform agenda and comply with the requirements of the European Working Time Directive to reduce consultants’ hours.

New out of hours care ‘shambolic’

Approximately nine million patients receive urgent primary out-of-hours care in England.

In April 2004, the Department of Health gave GPs the chance to opt out of providing this service and transfer responsibility to the Primary Care Trust.

Mental Health Bill human rights examined

This Report from the Joint Committee on Human Rights 'Legislative Scrutiny: Mental Health Bill' (HC 288/HL 40) examines the provisions of the 'Mental Health Bill' (HLB 1) in relation to human rights compatibility issues and considers significant omissions from the Bill which could have enhanced the protection and promotion of human rights.

Health professionals should "revalidate" fitness to practice

This White Paper 'Trust, Assurance and Safety: The Regulation of Health Professionals in the 21st Century' (Cm. 7013) sets out a programme of reform to the UK's system for the regulation of health professionals.

NHS, armed forces and prison officers’ pay reviewed

These Reports review the salaries of the armed forces, senior civil servants, prison offers and health professionals, including doctors, dentists and nurses.

Recommendations set out in these Reports are applicable from 1 April 2007.

Primary Care Trusts “improving quality and safety”

Primary Care Trusts (PCTs) are responsible at the local NHS level for the statutory “duty of care”, largely through implementing clinical governance.

“Clinical governance” involves improving the overall standard of clinical care, reducing variations in access to services, and ensuring that local decision-making is based on the most up to date effectiveness principles.

Key NHS patient safety objective achieved

The National Patient Safety Agency was established in 2001 to improve patient safety in the NHS.

It aims to ensure that the risk of avoidable harm to patients is minimal, that concerns about doctors’ and dentists’ performance are resolved so that return to safe practice is enabled where appropriate, and that participants in research are protected through an fair, transparent, quick and efficient ethics system.

New single fund for health research proposed

The Cooksey Review proposes a structure for funding health research, with the objective of obtaining maximum benefit and eliminating duplication of effort.

The Review found that the UK is at risk of failing to reap the full economic, health and social benefits of public investment in health research, with two key gaps in the translation of health research:

• Translating ideas from basic and clinical research into the development of new products and approaches to treatment of disease and illness
• Implementing those new products and approaches into clinical practice.

NHS plans investment and reform

The Department of Health releases its Autumn Performance Report 2006. The Report looks at progress made in the Department’s commitments to delivering better public services, examining public service agreements and analysing targets.

Obesity costs around £1bn a year

The Committee of Public Accounts, in their report ‘Tackling Child Obesity - first steps’ (HC 156), set out a number of conclusions and recommendations on tackling child obesity.

Child obesity in the UK is increasing, with a steady rise in the number of children aged 2-10 who are obese from 9.9% in 1995 to 13.4% in 2004. Overall, it is estimated obesity already costs around £1 billion a year and the UK economy a further £2.3 to £2.6 billion in indirect costs.

The Committee suggests that the Public Service Agreement target set by three Government Departments (Health, Education, and Culture, Media and Sport) needs to improve in both their responses to this matter and leadership.

Key NHS patient safety objective achieved

The National Patient Safety Agency was established in 2001 to improve patient safety in the NHS.

It aims to ensure that the risk of avoidable harm to patients is minimal, that concerns about doctors’ and dentists’ performance are resolved so that return to safe practice is enabled where appropriate, and that participants in research are protected through an fair, transparent, quick and efficient ethics system.

Primary Care Trusts “improving quality and safety”

Primary Care Trusts (PCTs) are responsible at the local NHS level for the statutory “duty of care”, largely through implementing clinical governance.

“Clinical governance” involves improving the overall standard of clinical care, reducing variations in access to services, and ensuring that local decision-making is based on the most up to date effectiveness principles.

Hybrid embryo research ban examined

This Report ‘Government Proposals for the Regulation of Hybrid and Chimera Embryos’ (HC 272-I) is a response by the House of Commons Science and Technology Select Committee to the publication of Government proposals to prohibit the creation of human-animal chimera or hybrid embryos for research for the time being, published as ‘Review of the Human Fertilisation and Embryology Act’, (Cm. 6989).

NHS "lack of planning" over use of temporary nurses

Properly managed, the use of temporary nurses can play an important role in helping hospitals achieve flexibility. However their high use can have a detrimental impact on patient care and satisfaction.

In 2001, the Department of Health anticipated that a growth in the National Health Service (NHS) workforce would lead to a decline in the use of temporary staff but, in spite of this intention, temporary nurses still account for the same percentage of the nursing budget (around 9%).

Human Tissue and Embryos Draft Bill: key concerns

This Report ‘Human Tissue and Embryos (Draft) Bill’ (HL 169-I / HC 630-I) from the Joint Committee on the Human Tissue and Embryos (Draft) Bill scrutinises proposals set out within the Government’s 'Human Tissue and Embryos (Draft) Bill (Cm. 7087)'.

After scrutinising the Draft Bill, the Committee challenge a number of aspects of the Government’s approach.

NICE: slow publication of guidance criticised

This Report, 'National Institute for Health and Clinical Excellence’ (HC 27), looks at the role of National Institute for Health and Clinical Excellence (NICE), how the organisation works, changes made since its establishment and the new challenges it faces.

NHS Electronic Patient Records reviewed

One of the main aims of the 10-year National Programme for Information Technology in England is implementing Electronic Patient Records (EPR). The NHS Care Records Service creates two separate EPR systems: a national Summary Care Record, containing basic information, and local Detailed Care Records, containing more comprehensive clinical information.

This Report ‘The Electronic Patient Record’ (HC 422-I) examines the implementation of the scheme.

Committee recommends cohesion between health and social care services to cut costs

As health and social care services require significant improvement, interaction between both sectors is encouraged in an increasingly challenging fiscal climate.

In ‘Public Expenditure’ (HC 512), the Health Committee finds that settlements planned in the October Spending Review will create a highly challenging context for the delivery of health and social care services over the next four years.

White paper details response to Government development plan for NHS

'Liberating the NHS: Legislative Framework and Next Steps’ (Cm. 7993) documents how the NHS reform programme, set out in a White Paper published in July 2010, will be implemented by the Government.

The Department of Health (DH) describes how the Government will legislate for and implement its reforms set out in the White Paper 'Equity and Excellence: Liberating the NHS’ (Cm.7881), drawing on the insights and experience contributed by those who responded to the consultation.