Andy Mayer: A longer working life means a healthier life – policymakers should take note

By Andy Mayer of the Age Endeavour Fellowship

There is compelling evidence in a new report, Work Longer, Live Healthier: The relationship between economic activity, health and government policy, from the Institute of Economic Affairs and Age Endeavour Fellowship, that Sir Alex Ferguson may have more than one reason to regret his decision to stand down from Manchester United at a youthful 71 years of age.

Although he will feel good for a few months, in the long-term the impact on his health from not spending each Saturday shouting referees into favourable decisions will be negative. The same will be true for most of us – particularly if we choose early retirement.

For example, the research finds that the employment rate for men aged between 55-59 fell from over 90% to under 70% between 1968 and the late 1990s. From 80% to 50% for those between 60-64, and 30% to 15% for those between 65-69. This whilst both life expectancy and healthy life expectancy were rising.

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Nick Seddon of Reform: The NHS Bill should not be dropped - it is only the start of the reforms we need to make

Nick Seddon is Deputy Director of the independent think tank Reform.

Tim Montgomerie’s idea that scrapping the enfeebled Health Bill and sacking Andrew Lansley will make the problem go away is simply wrong. The three Cabinet Ministers he cites are equally wrong. Today’s task is to pass the Bill. This will clear the way so that the Government can get on with tomorrow’s job – the pressing task of delivering a lot more for a lot less.

The problems with the NHS were identified by the last Labour government. It burns money like no other public service, has poor levels of productivity, and quality is extremely patchy. Scandal follows scandal – whether it’s elderly care, children’s care, hospital care or home care. According to credit rating agency Standard & Poor’s, at least 20 hospitals are in such a bad way they will need “extraordinary support” (i.e. lots of money) from Government. This sum could balloon into billions (indeed, a £5 billion overspend, according to a former Special Advisor to Tony Blair, Professor Paul Corrigan, in a report for us last year) in coming years. This is both a short term and a long term problem. For the sake of the health of the people – and the Government’s deficit reduction plan – reform of the NHS is necessity, not a choice, Bill or no Bill.

David Cameron has repeatedly declared that he wants the NHS to look much like it is today. Actually, we should want it to look unrecognisably better. This cannot be a branding exercise. Nor is it legislation that counts. It is delivery that matters now. The only hope for any Government is to radically improve the service.

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Thomas Cawston of Reform Think Tank: NHS reform is a necessity but the Coalition chose the wrong reforms

David Cameron famously claimed his three priorities for Government could be summed in three letters: N-H-S. However, the Coalition could never have neutralised the NHS as a political issue. As today’s Health Select Committee report rightly points out, improving value for money without reducing the quality of care is one of key public policy challenges of this Parliament. Meeting this challenge demands reform. The report equivocally states that making the NHS more efficient means “making fundamental changes to the way care is delivered. As Stephen Dorrell stated this morning “changing not the way the system is managed, but the system itself”.
 
The key message of the report is that efficiency savings are not happening fast enough and being made in the wrong way. The report expressed concerns that savings are being made “through ‘salami-slicing’ existing processes instead of rethinking and redesigning services”. The report also suggested that short term thinking rather than long term planning would make it harder for the NHS to become sustainable. Many have already argued that the Government is falling behind. According to the Department of Health’s own figures the NHS fell short of its forecast savings for the first half of the year. The evidence on the ground is of NHS organisations falling behind, yet the Secretary of State remains in denial. Speaking on the Today programme Andrew Lansley claimed to be “on track” and denied claims that we efficiency savings were turning into cuts.
 
However, with the Health and Social Care Bill on the final leg of its difficult journey through Parliament, today’s report has been seen as another call that the Government should drop its reforms. Last week the Royal College of Nursing joined the list of those arguing that the Government must focus on efficiency and announced outright opposition to the Health Bill. Certainly, reorganising the management of the NHS has distracted NHS leaders. However, the cuts to services have been caused by the failure to reform the system. The Government’s reforms did not focus on value for money, or on creating the competition and diversity that are needed to drive improvement. Instead, under the guise of empowering local clinicians, the Government has rearranged the management in a system that is now more centralised than before.
 
While Tim Montgomerie is right to note that the Government has brought its NHS problems on itself, reforming the NHS was always going to be the challenge that the Coalition would need to grasp. The rises in health spending under the last Government was becoming unsustainable and delivering value for money was essential. Reform was necessity not a choice. The Government’s problems did not start through failing to communicate unnecessary reforms, but with choosing the wrong reforms.

2020health says that for healthcare competition to be real, there has to be a chance of failure

By Paul Goodman
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Julia Manning, Chief Executive of 2020health, (and ConservativeHome contributor) is telling it as she sees it on the Government's health bill, in a submission published today.

Its headline recommendations are as follows:

• Don’t hamper competition
• Admit choice has its limits
• Don’t undermine NICE
• Put safety ahead of sentimentality – allow failure
• Merge CQC and Monitor and stop self-assessment
• Introduce payment-by-results for patients
• Increase chances for co-payments

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New Reform reports show the potential benefits and favourable public attitudes towards for-profit delivery in public services

By Matthew Barrett

The Reform think-tank today launched a new report highlighting cases of successful private sector involvement in public services. These include:

• The Valencia region in Spain, where 20% of health services are provided by private sector organisations, who have to deliver at a cost 25% lower than the public sector.
• In Germany, a third of hospitals are run by for-profit organisations and a further third by not-for-profit organisations. All hospitals are accessible to German citizens through the national programme.
• In Britain, private sector companies have operated prisons for some years. In 2010, an independent evaluation of HMP Doncaster, operated by Serco, found that “the prison is considered to be leading the way in terms of the rehabilitation revolution”.
• A number of failing Local Education Authorities have been run by for-profit companies since 1999. Cambridge Education @ Islington became the education partner of the London Borough of Islington in 2000. By last year, the borough's GCSE results have nearly caught up with the national average, having once being among the worst.
• Other Local Education Authorities have given contracts to for-profit companies to help them improve schools. In 2008, for example, Northamptonshire County Council agreed a three-year contract with the for-profit company EdisonLearning to improve seventeen primary schools and four secondary schools in the council's remit. In the first two years of the contract, the proportion of 15-year-olds achieving five good GCSEs increased from 24.8% to 33.3%.

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2020Health: At least £3.3 billion of taxpayer’s money is not being spent on genuine healthcare needs

Matthew Barrett

A new report by 2020health's Chief Executive, Julia Manning, is entitled "Stealing the NHS: How careless is the NHS being with our tax money?", and is based on the findings of a survey of 357 NHS Trusts including hospitals and Primary Care Trusts.

• 3 NHS Trusts had, in one or more of the past 3 years, undertaken NO fraud investigations – the most was 90 in one year
• Only half of Foundation Trusts (and all Hospitals have been told they have to become Foundation Trusts) responded to the survey – compared to 87% of PCTs
• The current regulations only ask about the activity reporting process, not any outcomes, e.g. how much money has gone missing or how they have reduced fraud

249 Trusts (out of 357) in all responded, the breakdown of which is:

• Response rate from NHS Foundation Trusts: 49.6%, 47.7% of these withheld some or all information
• Response rate from Acute Hospital Trusts: 87%, 52.2% of these withheld some or all information
• Response rate from Primary Care Trusts: 78.5%, 47.9% of these withheld some or all information 

The report recommends NHS Trusts are more transparent about counter-fraud activity and spending, that reporting requirements are changed to provide clear and accurate information about fraud losses and what preventative measures are in place, and to fine NHS Trusts who do not publish information about their counter-fraud outcomes.

Julia Manning said:

"We were shocked at the complacency of some NHS Trusts. They seem to have forgotten that it is our tax money that they are responsible for and that we have a right to know that it's being spent on healthcare. Others Trusts were obviously taking scrutiny of their spending very seriously. At a time when the NHS is being asked to save £4bn a year it’s incredible to think that so much money is being stolen while patients are being denied new drugs."

Ross Carroll, Mike Hewitson and Stuart Carroll: Don’t forget pharmacists Mr. Lansley – your “new NHS” needs them

Ross Carroll is a member of the Bow Group Health Policy Committee and a public policy manager.  Mike Hewitson is a member of the Bow Group Health Policy Committee and a qualified pharmacist and community pharmacist contractor. Stuart Carroll is a senior health economist and chairman of the Bow Group Health Committee. Here they summarise the research paper they have written for the Bow Group looking at the role of enhanced pharmacy services in the “new NHS”, which is published today and can be downloaded from the Bow Group website.

Despite the Coalition Government’s pledge to ring-fence the healthcare budget, the NHS is facing sustained financial retrenchment and increased user demand.  Against the backdrop of the UK’s parlous public finances, it is vital all aspects of healthcare are examined to assess where increased value and quality can be delivered with greater cost-effectiveness.  This is especially critical since Andrew Lansley has rightfully placed patient health outcomes at the heart of Government reforms; a pressing imperative given rising public health challenges and an aging population predisposed to long-term conditions (LTCs).

The conclusions drawn from our research paper show that Enhanced Pharmacy Services, which include smoking cessation, sexual health and weight loss programmes, are an under-utilised resource that can deliver innovative, cost-effective services to patients in a highly accessible manner.  Moreover, such services can help the NHS achieve its Quality, Innovation, Productivity and Prevention (QIPP) objectives.

For example, it is estimated annually that 57 million GP consultations concern minor ailments, which in large could be dealt with at a pharmacy.  The average cost of a pharmacy consultation (£17.75) versus an average GP consultation (£32) is £14.25 less expensive.  If all patients with minor ailments received pharmacy consultations, then over £812 million could potentially be saved from the NHS budget equating to over 4% of the Government’s pledged £20 billion efficiency savings target. 

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Civitas warns against Lansley's NHS reorganisation plans

Health Secretary Andrew Lansley was on BBC1 this morning discussing his plan to transfer control of NHS purchasing to GPs. Mr Lansley said that because of Labour's increased NHS spending, Britain now spends European quantities of money without achieving European standards of treatment. It is time, he said, to sweep away Labour's bureaucracy and targets and trust the clinicians who care for us with the NHS' budget. He is planning a £1bn cull of bureaucrats and diversion of that money to the frontline.

The Civitas think tank has warned, however, that Mr Lansley's reorganisation plans could "set the NHS back three years". 

Analysing the impact of the last reconfiguration of commissioning on performance, Civitas worries that it took three years for merged Primary Care Trusts to achieve levels of performance comparable with the pre-merger period.

James Gubb, Director of the health unit at Civitas, said:

"The NHS is facing the most difficult financial times in its history. Now is not the time for ripping up internal structures yet again on scant evidence base, but for focusing minds on the task ahead and really getting behind the difficult decisions PCTs, as commissioners, will have to make."

Civitas also worries that fundholding may have worked under the last Tory government when it was voluntary but may be less effective as a compulsory measure:

"GP fundholders were self-selected volunteers for the programme, tending to be well-organised practices in middle-class areas, enthusiastic about taking on commissioning budgets. There is no evidence to draw on to support GPs across the country taking on commissioning as consortia, as is proposed by the government."  

Gubb points to the Mid Staffordshire hospital crisis where 1,200 people died unnecessarily. He quotes the Frances Inquiry's warning about the dangers of reorganisation, causing a "lack of capacity and organisational memory".

A PDF of Mr Gubb's full report.

'How to save the NHS £12bn in one year without stopping a single operation'

The 2020Health think tank is launching a report - Cutting the costs without cancelling the Services - which outlines ways to save the NHS £12bn in one year.

2020Health is led by Julia Manning, a member of the Tory candidates list, and enjoys close links to Andrew Lansley, the Health secretary. Commenting on the report - written jointly with Gail Beer and Emma Hill - Ms Manning states:

“The NHS can deliver £12 billion in savings over the next year which can be re-invested in new technology and elderly care... There is no need for health trusts to make rash decisions, cancelling operations or axing doctors which will permanently affect clinical outcomes for patients. These savings can be made ahead of the longer term changes that will save money such as reconfiguration of services, reducing practice variation, reducing low-level demand and opening up more competition.”

The following economies are among some of those suggested:

• Merging emergency services administration – SAVE £14.4m
• Investing to improve staff’s health and wellbeing, reduce sickness absence and so cut agency worker’s costs – SAVE £555m
• Forcing mergers of pathology labs to save duplication – SAVE £880m
• 5% across the board pay cut for all NHS staff for just one year – SAVE £1.8bn
• Withholding hospital payments for hospital acquired infections – SAVE £150m
• Slashing management spend - SAVE £1.5bn
• Enhancing NHS counter fraud measures, encouraging trusts to see fraud as a business risk - SAVE £1bn
• Halting any new building plans - SAVE £800 million
• Making NHS IT fit for purpose - SAVE £2bn
• Reducing dependency on prescriptions and medicines waste – SAVE £1.6bn

ASI report lists £16bn of non-bank privatisation opportunities

A new Adam Smith Institute report recommends 3% annual cuts in every departmental budget for the life of the parliament. Such cuts would reduce spending by £91 billion by 2015. The report by Nigel Hawkins is titled The Party is Over - A Blueprint for Fiscal Stability. Mr Hawkins, a City economist, backs George Osborne's decision to cut early but questions the decision to ringfence the NHS. It argues that the NHS budget should be cut by 2% every year with a focus on:

• Reducing payroll costs outside nursing;
• Managing hospital bed occupation more effectively;
• Creating greater efficiencies within PCTs;
• Cutting the annual drugs bill;
• Regaining control of the disastrous NHS IT project; and
• Scaling back the hospital-building programme.

Hawkins recommends that Secretaries of State unable to deliver 3% annual cuts should be fired.

The report - PDF here - also identified candidates for privatisation. Hawkins estimates that George Osborne can gather £16bn from non-bank privatisations including £3.8bn from the Royal Mail and £48.5bn from sale of the nationalised banks.

Click on table to enlarge.