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Star ratings show NHS improving against tougher targets

Almost a quarter of NHS trusts in England, including a third of acute trusts, failed to achieve financial balance for the year, according to the NHS watchdog's latest star ratings.

But the Healthcare Commission's annual performance ratings for NHS trusts - the last in their current format, also show how primary care, mental health and ambulance trusts have all generally improved over the past few years.

The commission's latest ratings, which cover the financial year 2004-05,

found that 138 out of 590 trusts failed the key target on financial management to break even by the end of the year, resulting in a total overspend of almost £500 million.

Performance was assessed across a range of areas: waiting times, access to GPs, financial management, patient care and death rates. The assessment showed improvements had been made in reducing MRSA and death rates for cancer, stroke and heart disease.

There was also a drop in the number of acute hospitals with three stars, reflecting the difficulties in meeting the indicator relating to financial performance and the tougher targets for waiting times in A&E.

This is the final year the commission will rate performance using the current star ratings system. Next year trusts are subject to a new annual health check, which aims to give a more comprehensive picture of NHS performance.

A code of conduct for Payment by Results

Chairs and non-executive directors' views are sought for a consultation on a code of conduct for healthcare organisation operating Payment by Results (PbR).

The code has been drafted by a working party, NHS organisations, independent providers and the Department of Health. It aims to support high-quality patient care by promoting positive and collaborative relationships between healthcare organisations.

Under PbR, providers are paid for each patient they treat, according to a national price list. This new financial system is designed to provide a fair and transparent basis for funding healthcare. It will facilitate patient choice and reward efficiency, with successful providers able to reinvest surpluses to improve services for patients. Providers whose services are currently above average cost will need to make cost savings between now and 2008-2009 when the system takes full effect.

The new code emphasises the importance of collaboration, efficiency and transparency on the part of healthcare organisations. It also includes specific rules for how PbR should be operated in practice. These cover a number of areas: setting the tariff, patient choice, referrals and treatment thresholds and payments.

The code of conduct will apply to all organisations involved in PbR, including the Department of Health and all organisations commissioning and providing care for NHS patients. Non-NHS providers will adopt the code as part of their accreditation process.

More GPs to tackle inequalities in health services

A wave of new GP practices and NHS Walk-in Centres are set to open next year in some of the towns and cities with the poorest access to primary care services.

Health secretary Patricia Hewitt announced there will be two schemes in London and one each in Liverpool, Lancashire, Plymouth and Yorkshire. They will include new 'breakfast' and 'tea-time' surgeries with practices open from as early as 7am and as late as 10pm.

Six PCTs will open a total of three new NHS Walk-in Centres, two new GP practices and one nurse-led practice. They will also be able to employ additional GPs, nurse practitioners and healthcare assistants.

The Department of Health will provide PCTs with tailor-made practical support, including technical advice on procurement, resources to enable clinicians to develop proposals, business planning skills, legal advice and support for communication and consultation.

Similar schemes could also be set up in 15 other areas where there are similar problems with GP numbers.

Day surgery report praises progress

The Department of Health has reaffirmed its commitment to increasing the efficiency of NHS day surgery after a report praised improvements in patient care and increased choice.

The Healthcare Commission's report on 313 day surgery units in England found that the vast majority of patients (91 per cent) are being given a choice of dates for their operation.

More patients are also being given personalised appointments to avoid unnecessary waiting, while almost all now receive appropriate written information about their surgery beforehand. But the commission also said there is scope for units to do much more for patients using the capacity already available. Nearly half (45 per cent) of the theatre time allocated for day surgery is not being used because of cancelled operations, late starts and excessive delays between operations.

At least 74,000 more patients every year could have day surgery if the least efficient units started learning from the best examples.

NHS workforce numbers up

A new batch of statistics on workforce levels across the NHS shows a general improvement in the number of staff.

The statistics are as follows:

Workforce vacancy survey

Workforce vacancy survey

Figures show the three-month vacancy rates for the main staff groups dropped in the first quarter of this year.

The biggest fall was for consultants, with the vacancy rate down from 4.4 per cent in March 2004 to 3.3 per cent this year.

Allied health professionals were close behind, with the 4.3 per cent rate going down to 3.4 per cent. The rate for qualified nurses also fell from 2.6 per cent last year to just 1.9 per cent.

Qualified scientific, therapeutic and technical staff vacancy rates went down to 2.2 per cent from 2.6 per cent a year ago.

GPs and consultants workforce

GPs and consultants workforce

The number of consultants and GPs in England continued to increase during the first quarter of 2005.

An increase of around one per cent pushed the number of consultants to 31,210 by the end of March, up by 347 from December.

The increase was similar for GPs, with an extra 396 practitioners increasing the total to 32,194.

GP practices vacancy survey

GP practices vacancy survey

A survey of 2,000 randomly selected GP practices in England showed the estimated three-month GP vacancy rate in England is 2.4 per cent.

That drops to around one per cent in rural areas, while urban areas have a vacancy rate of 4.2 per cent. Practice nurse vacancies in England are much lower, running at less than one per 100,000 patients.

Speedier scans for patients as choice is announced for diagnostics

Thousands of patients facing long waits for diagnostic tests such as MRI and CT scans in their local hospital will be offered an alternative to help reduce waiting lists, the Government has announced.

The choice of scans programme, to begin in November, will use spare capacity within the NHS and independent contractors.

Under the scheme, patients waiting longer than 20 weeks for scans would be offered the services of another hospital.

By April 2006, this will be extended to patients waiting longer than 16 weeks for the overwhelming majority of imaging scans, with the maximum wait falling to 20 weeks.

Health secretary Patricia Hewitt said the new scheme would address the problem of hidden waiting lists and the 'bottleneck' of patient waiting times for scans and diagnostic tests.

Acute trusts, NHS Foundation Trusts and independent healthcare providers, working for the NHS to NHS principles, standards and prices will be eligible to provide diagnostic scans for these patients.

Healthcare watchdog publishes annual report

NHS trusts must involve patients and the public in the design of their services, according to a new report.

The annual State of Healthcare report 2005, published by the Healthcare Commission, highlighted a number of lessons for healthcare organisations and regulatory bodies.

The report, which looked across all types of healthcare, focused on the patient experience this year. It said very long waiting lists were a thing of the past and that new ways of providing services, such as NHS Direct and NHS Walk-in Centres, were improving access to services.

It also praised improvements in a broad range of NHS health services, including cancer and heart services.

The report also highlighted a number of lessons for healthcare organisations and regulatory bodies. In particular, it emphasised the need to involve patients and the public in the design of services, improve information for patients at all stages of their care and spread good practice.

Improving Care for Older People conference

This conference examined the key practical issues involved in improving services and care delivery for older people.

Among the key issues for non-executive directors was the development of multi-disciplinary and nurse-led teams to treat older people.

A key presentation was given by Dianne Lewis, a nurse consultant for older people at Calderdale and Huddersfield NHS Trust. She said there were useful lessons in the way that the trust had planned, established and maintained a nurse-led clinic.

National director for older people's services, Professor Ian Philp, spoke about the National Service Framework for Older People, while professor of social work at King's College London, Jill Manthorpe, highlighted the role of older people's champions.

Better mental health for older people

A new online publication outlining a vision of how health and social care services should work together to secure better services for older people has been published.

Securing better mental health for older adults represents the first time national directors have joined forces across mental health and older people's services to secure improved service delivery for older people with mental health needs.

The document is a precursor to a service development guide which will be launched by care services minister Liam Byrne this autumn.

Telecare guidelines aim to help older people

New guidelines on the use of new technology in healthcare could improve the quality of life for older people and reduce the number of unnecessary hospital admissions.

The guidance, published by care services minister Liam Byrne, outlines how to use the £80 million announced a year ago for innovative healthcare services, especially telecare.

Telecare, which is mainly used to support older people, can range from a simple basic community alarm service to sophisticated devices for detecting or monitoring for falls, fire and gas which trigger a warning to a response centre.

Falls are the leading cause of death from injury in people over the age of 75, and more than one third of people aged over 65 suffer a fall each year.

The £80m will be allocated over two years from April 2006 as part of the preventative technologies grant.

Funding for sexual health services

An extra £15 million of funding to help transform sexual health services across England has been announced by public health minister Caroline Flint.

The funding will be made available immediately for use over the next year, enabling sexual health clinics to improve their buildings, expand services, increase capacity and reduce waiting times.

The funding is in addition to the £130m already committed for genito-urinary medicine services in the Choosing Health White Paper.

CMO calls for tobacco clampdown

The dangers posed by cheap tobacco and tobacco smuggling were the major issues addressed in the chief medical officer's latest annual report.

Professor Sir Liam Donaldson's report highlighted the need for tighter controls on the movement of tobacco across international borders.

He also highlighted four additional areas of health for action: influencing public sector food purchasing to improve health, establishing more consistent standards of care for treating chronic obstructive pulmonary disease (COPD), achieving faster compliance with patient safety alerts and combating the increased prevalence of the congenital abdominal illness gastroschisis.

NHS dentistry services update

The General Dental Services contractual arrangements have been published by the Department of Health and will be introduced by April 2006.

They will enable PCTs to commission local dental services to reflect local needs and pay dentists for an overall level of care, rather than for each of the individual treatments they carry out.

PCTs will have a duty to maintain the devolved allocations earmarked for dentistry. They can use the money to develop more integrated primary dental care arrangements.

Trusts will also be able to prioritise local dental services and draw on their wider resources following the Government's investment in the NHS to deploy additional funding. These safeguards and flexibilities do not exist under the present system.

Proposals to abolish the current payment system for dental work and replace it with a three-band system, which states clearly how much a treatment will cost, have also been published. The Department of Health is running a 12-week consultation on the plans, which ends on 30 September.

The Government is also on track to recruit 1,000 new dentists into the NHS by October. Responding to the House of Commons' public accounts committee report, health minister Rosie Winterton said an extra £368 million was being invested in NHS dentistry and student places were increasing by 25 per cent.

Report urges ambulance service reform

NHS ambulances services are to undergo fundamental changes to improve the speed, quality and breadth of care services after a wide-ranging review of operations.

It represents a shift in the role of the service to become a mobile healthcare system, delivering a more personalised service to patients. Key recommendations in Taking Healthcare to the Patient: Transforming NHS Ambulance Services include:

  • a reduction in the number of ambulance trusts to increase efficiency after the report found larger organisations were more efficient than smaller ones
  • a uniform way for trusts to measure response times to the most urgent, category A, calls and the abolition of targets for response times to less urgent, category B, cases.

The report also proposed new roles and better career development for ambulance staff, new ways of improving financial efficiency and a broadening in the range of clinical services available, including supporting primary care teams.

Report NHS fraud on freephone line

A new phone line has been set up for the confidential reporting of suspected NHS fraud free of charge.

Examples of suspected fraud include:

  • wrongful claiming of exemption from pharmaceutical, dental or optical fees
  • submission of false timesheets
  • altering of prescriptions
  • use of aliases to obtain controlled drugs
  • creation of ghost patients
  • any other fraudulent activity in the NHS.

The number for the NHS Fraud and Corruption Reporting Line is 0800 028 40 60.

The NHS Counter Fraud Service, part of the NHS Counter Fraud and Security Management Service, is visiting NHS bodies across England and Wales during October to raise awareness of the existence of fraud and corruption in the health service.

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