Category Archives: Commissioning

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions.

Kat Lay in the Times reports 15th June 2018: NHS (England) must use extra funds to fight cancer

Social Care is means tested, so why not health? More funds for cancer care is appropriate, but in Wales it could go on free prescriptions. If the people have a choice they will choose local, ahead of improved outcomes and travelling. As the population ages, and more people survive cancer, we will need more radiotherapy and oncology services. The shortage of Radiologists and Oncologists is so severe that the potential for improvement is threatened.

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The NHS will be expected to improve cancer survival rates and put a greater focus on maternity safety under a multimillion-pound funding package due to be announced within days.

Theresa May appeared poised to set plans to boost the NHS budget by more than 3 per cent after intensive meetings yesterday between No 10, the Treasury and the health team.

At a conference of health service managers in Manchester, Jeremy Hunt, the health secretary, said: “We need to make sure we unite the NHS and British people with a small set of bold ambitions as to how we want to transform our system. To get our cancer survival rate to the best in Europe; to transform our maternity safety so it is as good as Sweden; to truly integrate health and social care; to make sure we have waiting time standards for mental health that are as strong and powerful as the standard for physical health.”

He was still having “difficult” discussions with Mrs May and the Treasury over the precise details of a long-term funding plan, but an announcement is expected soon. NHS leaders say they need funding increases of 4 per cent a year, in line with assessments by think tanks. The Treasury is thought to be reluctant to provide that much.

Brexiteers want rises in health service spending to be funded by the so-called Brexit dividend — money available after Brexit that would have gone to the EU. They worry, however, that Philip Hammond, the chancellor, will suggest funding it through tax rises.

NHS sources fear that a “big picture” announcement could amount to a fudge because it will not spell out the exact funding increases on offer. That would mean health chiefs including Simon Stevens, chief executive of NHS England, waiting until November for the details.

There is also likely to be disappointment at a decision to keep social care funding, which is delivered through councils and is the subject of a forthcoming green paper, separate.

A report from the Institute for Public Policy Research, a left-wing think tank, has called for social care to be free of charge for people with substantial needs as part of a new long-term health funding settlement. Social care is currently means tested. Making it free would bring the care system into line with the NHS, where healthcare is free at the point of need.

Cancer patients given new drugs that won’t help them. GPs needed in oncology clinics…

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Rationed – Start of cheaper technique for breast cancer is delayed in UK despite adoption elsewhere. GP commissioners should be demanding intra-operative radiotherapy.

Cancer drugs fund is illogical. More money should be spent on radiology and radiotherapy.

Cancer chief quits amid radiotherapy shortfall

Artifical Intelligence is no threat to doctors, but it’s potential needs to be managed. A shortage of Radiologists is more bad news for the future.



NHS will help to find jobs for patients

Just because NHS England is going to do this, it does not mean the other 3 health services will do it. or that it will work. But it is good news, and the right way to think. The comment from the Times online which I have cut and pasted below summarises the “good news”. It will be interesting to see if the service lasts, and if the other Regions take it up.

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Kat Lay reports on the NHS England announcement 12th June in the Times: NHS will help to find jobs for patients

The NHS is to hire 300 employment coaches who will find patients jobs to keep them out of hospital.

Those in work tend to be in better health, visit their GP less and are less likely to need hospital treatment.

The specialists will help people with severe mental illness to seek work and hold down a job. They will offer assistance on CVs and interview techniques and are expected to work with 20,000 people by 2021. Pilot schemes running in Sussex, Bradford, Northampton and some London boroughs suggest that the coaches find work for at least a quarter of users. The scheme is being extended nationwide.

Claire Murdoch, NHS England national mental health director, said: “Tackling severe mental illness is not just about getting medication and treatment right but ensuring people can recover to live independently with their condition, including the reward and satisfaction of getting and keeping a job.”

NHS England is putting £10 million into the scheme over the next two years with further investment planned.

Coaches are urged to build relationships with employers to gain access to the “hidden” labour market of jobs that are never advertised. The specialists, whose support is not time-limited, then act as a link between a patient, their employer and their medical team.

A Centre for Mental Health review calculated that the scheme saved £6,000 per client over 18 months.

Far from being a waste of money this is long overdue. So often adolescents with special needs are let down by CAHMS and then as they mature, adult social services. What they need is an opportunity to contribute to society as they are able and in return receive both a fair wage and a sense of worth. At the moment all they hear is “limited resources”.

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Whay are patients like me denied a new cancer drug? You know the answer – rationing…

Sean O’Neill knows the answer to his question. But he thought, before he was ill, that he never would need to ask this question. After all, politicians deny rationing, and only restriction, priorities, and exclusions. We need not ration at the low volume high cost end (as much) if we charge for the low cost high volume end.

Why are patients like me denied a new cancer drug?

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The cancer cure stories have been coming thick and fast over the past month. We’ve had the “biggest breakthrough since chemotherapy”, a woman cured of breast cancer with an injection of her own cells, a hormone pill that will “liberate thousands of women” from chemotherapy and the notion that artificial intelligence will beat the disease.

After Tessa Jowell’s death from brain cancer last month, Theresa May found a magic money tree to give more patients access to experimental treatments. And Simon Stevens, chief executive of NHS England, was moved to declare that an early diagnosis blood test had placed us “on the cusp of a new era of personalised medicine that will dramatically transform care for cancer”.

Mr Stevens’s lofty words are wedged firmly in my craw, impossible to swallow. I have a cancer, chronic lymphocytic leukaemia, that is already striding into a new era in which doctors feel chemotherapy is largely unnecessary and dangerously counterproductive.

There is a groundbreaking drug available, a once-a-day pill, which stops the growth of cancerous cells without blasting the bone marrow. It’s a drug that allows most patients to get back to a full life — enjoying time with their families, going to work, paying their taxes.

This is no pie-in-the-sky experiment: it’s here now. The National Institute for Health and Care Excellence (Nice) says this drug, ibrutinib, is “innovative and effective” and should be “routinely available” for patients (like me) who have relapsed after a previous course of chemotherapy.

But Mr Stevens is denying us ibrutinib. His bureaucrats overruled Nice and issued doctors with a checklist restricting the prescription of the drug. Instead, Mr Stevens thinks I should endure another six months of debilitating chemotherapy, this time including a drug called bendamustine, derived from mustard gas by East German scientists in the 1960s. So much for a new era.

True to form for Whitehall, Mr Stevens’s communications officers refuse to answer questions about who overruled Nice, why or what other drugs are being restricted like this. Jeremy Hunt, the health secretary, should surely intervene. The health department says the NHS “is legally required to fund” Nice-approved treatments.

If Mr Hunt, who has received dozens of letters from MPs about this issue, has not already called in Mr Stevens to ask him why NHS England appears to be breaking the law by secretly curtailing access to approved drugs, now is the moment.

Sean O’Neill is chief reporter

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The cost of technology is exceeding our ability to pay.

Commissioners and Trust Board directors find themselves in an impossible position. Their political masters will not allow use of the word “rationing”, and yet they are expected to keep up with new treatments, and make them available to all. We rarely hear any “exit interviews” but the resignation of Bob Kerslake following the demoting of KGT to “special measures” should tell the politicians what the professionals already know: the health services are founded on financial sand. The edifice is falling.

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Chris Smyth reports 6th June in the Times: Discount deal opens up new cancer treatment but 

Of course there are numerous other treatments, and much money has been invested to get a return!

Hundreds of lung cancer patients will receive a cutting-edge immunotherapy drug on the NHS after health chiefs boasted of beating down prices.

The deal was the first test of a controversial policy that allows NHS England to restrict or delay medicines that will cost taxpayers more than £20 million a year, even if deemed cost-effective.

Officials said the threat of such measures had been enough to persuade the drugmaker, MSD, to agree a confidential discount. Pembrolizumab costs £84,000 per patient at full price and to get below the threshold would have to be reduced to a fraction of that. About 1,800 patients a year will now be eligible.

Pembrolizumab is one of new class of medicines that boost the body’s own natural defences against cancer. It is used in cancers of the lung, stomach, head and neck, skin and bladder and is being tested in other types such as prostate cancer.….

On the same day Kat Lay reported: Targeting cancer’s genes prolongs life

Treating cancers based on their genes, rather than where they occur in the body, increases a patient’s chance of surviving for a decade six-fold, a study has found.

Data presented at the American Society for Clinical Oncology (Asco) meeting in Chicago showed that 15 per cent of patients given drugs that targeted specific genetic mutations in their tumours survived for three years, compared with 7 per cent of patients who had standard unmatched therapy.

Six per cent of the matched group survived for ten years compared with 1 per cent of the unmatched group.

“All patients should have access to next-generation sequencing and I believe in the next few years we are going to see this approach dramatically improving outcomes,” Apostolia Tsimberidou, who led the research, said. “We need to know what is really causing these diseases so we can treat them properly.”

Researchers from the University of Texas looked at more than 3,000 patients with cancers including breast, lung, gynaecological and stomach tumours. After using a technique called next-generation sequencing, which tested between 20 and 50 genes simultaneously to determine exactly which molecular abnormalities were present in the tumours, they found that 1,307 had at least one genetic change. Some 711 of those patients received drugs matched to the biology of the tumour, for example blocking the function of the mutated or altered gene, sometimes alongside chemotherapy. A further 596 received a drug that was not matched to their tumour’s biology, usually because a matched treatment was not available to that patient at the time.

Those studied had advanced cancer that standard care had failed to halt, with some having tried 16 therapies. While overall survival in the study was small because the patients involved were very ill to start with, Professor Tsimberidou said that the results would probably be even more striking had the technique been used earlier.

In the NHS, many cancer patients receive genetic testing of some type, but next-generation sequencing has yet to be adopted widely. The cost can vary but has declined rapidly in recent years, with some versions costing about £300.

Professor Tsimberidou said that one patient in her clinic had had glioblastoma — the aggressive brain cancer that killed Tessa Jowell, the former cabinet minister, last month — diagnosed in 2011 but was still alive thanks to personalised treatments.

Catherine Diefenbach, an Asco expert, said: “We’ve just scratched the surface. Now with faster and more robust genetic tests we can help even more patients by treating the cancer based on its genetic makeup rather than solely on its location in the body.”


High Tech advances hit NHS funding. A proper debate wont happen however.

The state is not able to keep up with the advance of technology. This means we HAVE to ration care. It’s just a choice of rationing covertly and differently by post code/region, or doing  it overtly. Our cowardly political masters know this, but refuse to speak out. The media thinks health is too complex for a sustained debate that their readers will appreciate. So, in a media led society,  it won’t happen.

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Nye Bevan did not foresee, and your leader neglects, the effects of medical advances on both NHS funding requirements and patient demand (“Higher tax is not the only solution to an ailing NHS”, Editorial, last week).

New investigations and treatments create “wants”, which change to “needs” as they become familiar. Such advances have been dramatic and are often expensive: if they extend life beyond what was previously possible, patients survive to require more clinical management for longer. Thus the costs are not limited to the treatments themselves, but to the longevity they facilitate.

No country, whatever its healthcare model, can provide the funding that could potentially be absorbed as technology advances. We have to recognise this and use funding wisely. A mature debate is long overdue.
Dr Vernon Needham, provost, Wessex Faculty, Royal College of General Practitioners

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Red-tape waste
Your editorial is correct. Huge sums are being wasted through the present complex system of commissioning healthcare. The internal market process has been estimated to consume 14% of the total NHS budget and has not been shown to improve outcomes.

About 200 clinical commissioning groups (CCGs), each with its own infrastructure, have to negotiate with multiple providers. Recent changes were meant to reduce bureaucracy, but my experience on the governing body of a CCG leads me to believe the opposite has happened. The system is divisive and wasteful.
Professor Robert Elkeles, Northwood, London

A bus-load of cash awaits
It shouldn’t be difficult to find more funds for the NHS. As those of us who followed the EU referendum can attest, Boris Johnson and Michael Gove know where to find an extra £350m a week.
Stephen Ball, Littleborough, Greater Manchester

Alan Milburn thinks the penny has dropped…. Money alone will solve nothing for the UKs health services.

We cannot expect a former health Secretary to admit we need to ration health care, but this is the nearest we will get. NHSreality does not think the penny has dropped with a majority of the politicians as yet. ….. One of the signs of inefficiency is readmission rates, which are rising fast. There may well not be a bed for YOU when you need one… Rationing is happening but we are all denying it, and as it is covert, Commissioners get away with it where they can.

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Alan Milburn opines in te Times 1st June 2018: The government can gift the NHS time as well as money

The penny has dropped. The Prime Minister has come to realise that the NHS — indeed the wider care system — needs more money. An announcement, perhaps to coincide with the 70th birthday of the NHS in July, is apparently imminent.

It has become obvious to government that demand and supply are out of kilter. Hospital admissions have risen by one third in a decade but resources have failed to keep pace with NHS funding rising at less than half the rate of the 4 per cent historic average.

The arguments are now raging in Whitehall about how much the NHS needs to be sustainable. History seems like a good guide — 4 per cent is surely the minimum needed.

But here I have a health warning for the government. Increasing the volume of cash is only one leg of the three-legged stool on which a stable NHS needs to sit. The second leg is visibility over-resourcing.

The NHS needs long-term line of sight — 5 to 10 years — over resources so that it can plan with certainty to transform local services so they meet future demographic and disease challenges.

It will take time to change services so that they are less fragmented and more integrated, less dependent on hospital care and more more community-based, less focussed purely on treatment and more on prevention. The government can gift it time as well as money.

Thirdly, reforms must accompany resources. People working in the health service know that the current structures are no longer fit for purpose. Structural reforms since 2010 have led to unprecedented confusion and uncertainty.

The reforms were intended to introduce more competition but the thrust of The Five Year Forward View — the NHS’s reform plan — is about encouraging greater collaboration, not least between health and social care.

Today the NHS is in an organisational no-man’s land. In particular there is a misalignment between the ambition of creating integrated, place-based and outcome-led care and the operation of the current financial system. Money talks in the NHS. Not just the volume of money but how it is used, deployed and how it moves around the system. I know that from my experience as Health Secretary in the Blair government.

When we put record resources into the NHS, at first hospital activity levels stalled and waiting times continued to rise. One of the key things that changed that was the introduction of incentives on hospitals to increase activity and reduce waiting.

The more they did, the more resources they got. That change led to unprecedented reductions in the times patients had to wait for an operation. But today, although reducing wait times remains important, the biggest priority for the NHS is to tackle chronic diseases like diabetes and improve population health outcomes. That needs a different set of financial incentives.

The current financial system is caught in a time warp and needs to catch up. Without reform there is a risk that that the government simply won’t get the most bang for the buck out of the new resources it intends to invest in the NHS. That would mean too many of the extra resources would be wasted.

What is more, if left unreformed, the financial system will be a stumbling block to the service transformation that is so desperately needed. According to a new report drawn up by PwC with the help of the Healthcare Finance Management Association, 76 per cent of NHS finance professionals feel the current funding structures in the NHS are not fit for purpose.

I agree. To make sure that the extra resources are put to the best use, reforms are needed. Health and social care budgets need to be brought together at a local level. How providers get paid should be changed to reward improvements in health outcomes rather than increases in the number of people treated — so helping the drive towards prevention rather than activity.

Channeling NHS resources through local systems rather than single institutions would speed care integration. And banning capital to revenue transfers — which have robbed the NHS of billions of desperately needed infrastructure spending in recent years — would provide more investment in out-of-hospital care. These changes would put extra resources to work for the benefit of patients.

Today the NHS has reached an inflection point. Without change, it will not be sustainable as a universal service providing care according to need regardless of the ability to pay. The promise of more government investment is welcome. but it must be accompanied by reforms.

There is a huge opportunity to better optimise resources, better empower patients and better improve health outcomes. Change is always hard in the NHS but there is a big prize on offer — not just to sustain the system, but to transform it.

Alan Milburn is chairman of the PwC Health Industries Oversight Board and a former health secretary

Chris Smyth reports 1st June: Millions return to hospital after only a month

Is NHS rationing a possibility? – BBC News

Sarah Page reports for West Susses County Times 1st June: Vital eye surgery rationed across the county despite calls for rationing to stop


There is advantage in enhancing choice by enlarging trusts. And it will improve outcomes… Good news for Devon: bad news for Wales.

Apart from economies of scale, and reducing overhead, there is advantage in enhancing choice by enlarging trusts. And it will improve outcomes…

Hywel Dda and ABMU trusts in West Wales need to merge. The politics of Wales may prevent this but in England there is a utilitarian precedent in Devon. Exeter and Barnstable trusts are combining. Good news for Devon: bad news for Wales if the option is not taken.

Sarah Howells for the North Devon Gazette reports that “North Devon MP welcomes move to share health care bosses with Exeter”.

North Devon’s MP has said a new collaboration between Exeter and North Devon’s healthcare trusts could increase the services available in Barnstaple.

Peter Heaton-Jones released a statement reacting to the news Northern Devon Healthcare Trust (NDHT) and Royal Devon and Exeter (RD&E) will be working in collaboration.

If agreed by both trust boards, Exeter’s chief executive and chairman will take over the running of NDHT as well.

Mr Heaton-Jones said: “Last week I met the acting chief executive of the Northern Devon Healthcare Trust, Andy Ibbs, and the board chairman, Roger French, to discuss these new arrangements.

“I sought and received assurances that the collaboration has a single purpose: to ensure that all acute services can continue to be delivered in Barnstaple.

“Last year, the NHS England review concluded rightly that all services should be retained at the NDDH, but set the challenge of doing so in a sustainable way.

“This new arrangement does just that, and means we can share resources and expertise to our long-term advantage.

“In fact, I have been told that some procedures currently not available in Barnstaple may be able to be delivered here in future as a result of this collaboration..

“The local community is passionate about our hospital, and I will soon be meeting the new chief executive to hear more about the collaboration and how it will safeguard the future delivery of services in Barnstaple.”

Hospital campaigners have welcomed the move, and a spokesman for Save Our Hospital Services said the group hoped the new management would ensure the retention of acute services in North Devon.

As part of the draft agreement, a senior management team will be based at both North Devon and Exeter hospitals, and an appraisal will look into a long-term solution.

However, Devon County Councillor Brian Greenslade, said he felt the move could cause concern for those already worries about a loss of services in North Devon.

He said: “For the people of North Devon the critical thing is to protect the delivery of acute services provided in the NDDH.

“This is my key objective and where I will focus my scrutiny attention.

“I will also be probing to see whether this proposed collaboration gives the opportunity to repatriate some acute services from the RDE to Barnstaple.

“I also believe with the increasing population in North Devon there is a case now to look at growing the facilities at the NDDH.

“We have been very lucky to have such a good hospital in North Devon with such dedicated staff.

“Let us remember that had it not been for former MP Jeremy Thorpe and the 50,000 signature he presented to Parliament, we probably would have not had this facility in our community.”

Jennifer Howells, regional director South West for NHS Improvement and NHS England, said the two trusts were ‘determined to do the right thing’ for the community.

She added: “Working with the RD&E through this agreement, and with ongoing support from NHS Improvement, I am confident that NDHT will have the best possible support to make the necessary, sustainable improvements that will enable them to provide the quality of services patients expect from the NHS.”

Swansea should combine with Hywel Dda, This option is not in the Trusts gift, but is political. And the opportunity afforded by restructuring may be lost if choice and specialist access is not improved…