01.02.15
Under pressure
Source: National Health Executive Jan/Feb 2015
There is no one cause that explains the difficult winter the NHS is experiencing, which is a much wider problem than just A&E. As explained in our news pages and elsewhere this edition, various areas of the health service feel they are in crisis and under insurmountable pressure – general practice, midwifery, mental health and others.
The Better Care Fund may help to reduce some of the pressures on emergency departments, but the evidence so far suggests the help will be marginal rather than truly transformative. Under the revised conditions issued last year (after unhappiness at senior ministerial and civil servant level with local areas’ original submitted proposals), the target is a 3.5% cut in emergency admissions compared to 2014 levels. Local health and care leaders do not think this feasible, and the changes made to the core purpose of the Fund last summer lost some of the goodwill and support of the local government and social care sectors, as the Department of Health tried to do more to placate the angry secondary care sector.
The National Audit Office says the savings potential of the bids remain questionable and optimistic – but with the plans becoming reality as of April 2015, it will not be long until we find out.
One model we may see less of in the future is outsourcing of entire hospitals. What has happened at Hinchingbrooke has become a proxy for wider political debates in the media, with some trying to link its failures in the Care Quality Commission inspection with its privatised management, while others say it was a troubled hospital to begin with and that Circle had a big ship to turn around. More on Hinchingbrooke on pages 15, 24 and 61.
Elsewhere in this edition, we have some forthright views from Lord Darzi on funding for cancer drugs and treatment and the necessity of innovation, plus a brace of articles on the potential role of volunteers in reducing emergency admissions and assisting with integrated care agendas.
NHE’s David Stevenson reports on Cambridge University Hospital’s implementation of the Epic eHospital system, which has had to cope with the full force of winter demand in its first months in action, and also writes on conflicts of interest management at CCGs (see page 50).
As I was writing this, NHS England announced the details of its incentive scheme to encourage more doctors to go into general practice – something urgently needed, as Dr Michael Dixon of the NHS Alliance spells out on page 21. General practice has an image problem among young doctors (although some of its perceived drawbacks are a matter of perception rather than reality), but clearly something needs to happen.
Interestingly, the A&E crisis has seen similar claims of recruitment problems for emergency medicine too, though the statistics there can be read in a number of ways.
With 100 days to go until the general election, and the NHS one of the biggest issues of all, it’s bound to be an interesting few months.
Adam Hewitt
Editor