Wednesday, September 21, 2011

Commissioning groups 'concerned' about size and budgets

The following article is from the BBC news web site , its well worth a read , I am not 100% certain in my own mind that large scale GP commissioning groups will not just evolve in time into a sudo-PCt sort of organization .

Commissioning groups 'concerned' about size and budgets

By Jane Dreaper

Health correspondent, BBC News

A survey of the groups due to take over commissioning NHS care is highlighting fears about their size and budgets.

The questions were answered by 131 leaders, out of 253 new Clinical Commissioning Groups (CCGs).

A third said they felt under pressure to become larger, and two-thirds expressed fears that they might inherit debt.
The Department of Health said it expected parts of the NHS to work together to resolve any deficits.

The survey was organised by NHS Alliance and the National Association of Primary Care, which have joined forces to represent CCGs, who will take over buying and organising NHS services.

36% of GPs and other leaders who responded to the survey said they were under pressure from NHS managers to become bigger, so they could pass a viability test next month.

And 67% suspect they will have to deal with some legacy debt from former primary care trusts (PCTs) when the new system begins in England in April 2013.
Dr Michael Dixon, who heads the NHS Alliance, said: "Having a board with other clinical representatives and allowing for audit will be expensive.

"So the CCGs need to reach a critical mass in terms of size. But there's a risk of ending up recreating the old system of 150 primary care trusts.
'Double whammy'
"We're very concerned about the possibility of debts. My GP leaders don't want to be in the position of decommissioning services.

"It's been accepted that the CCGs shouldn't inherit deficits. But in practical terms, the squeeze on NHS finances is greater than people realise.

"Savings can be made in reducing referrals by GPs - but that won't achieve all the efficiencies that are needed.
"So there's concern not just about deficits but also the ongoing savings that are needed - and whether the CCGs will have sufficient budgets. It could be a double whammy."
Dr Dixon defended the idea of GPs taking a more active role in rationing treatment under the new system.

He said: "The NHS isn't some sort of soup kitchen where everyone can just pile in.
"GPs have always had to be responsible for the use of NHS resources, and to think about balancing them against the greater good.
"People are presenting this as a brave new world - but it's something we're doing anyway.
"Rationing is the duty of every patient, commissioner and manager - or we won't have a sustainable NHS."
No 'right' size
Dr Dixon said though that he agreed with the British Medical Association that GPs should not receive bonuses for saving money.

A Department of Health spokesman denied officials were being prescriptive about the size of CCGs.

He said: "There are widespread variations in the size and population coverage of PCTs and there is no single 'right' size."
"CCGs will not be responsible for PCT debt that arose before this current financial year.
"During 2011/12 and 2012/13, we expect PCT clusters, PCTs and developing CCGs to work together to resolve PCT deficits."

Saturday, September 10, 2011

Community and adult care Wiltshire Council

So in Wiltshire councils drive to cut costs one of four corporate directors is at risk , they are Sue Redmond, community and adult care, Caroline Godfrey, childrens’ services, Mark Boden, neighbourhood and planning and Carlton Brand, business and transformation.

Now as some of you might have noted I am not the greatest fan of Wiltshire Councils department of care services HOWEVER in this instants I feel in honor bound to leap to the defense of Mz Redman

The lady has in her short time in charge managed to bring stability to the department that was so shattered by the departure of Dr Ray Jones , once again Wiltshire council has under Mz Redman a care services to be proud of .

The cabinet of Wiltshire Council would in my humble opinion , be will advised to keep the lady in post .

6th Cambridge Workshop on Universal Access (UA) and Assistive Technology (AT)

6th Cambridge Workshop on Universal Access (UA) and Assistive Technology (AT)

Thursday, September 1, 2011

NHS Hospitals-To many to fund ?

The following article comes via the BBC web site , its a very balanced article about a very sensitive issue and one I think has been rather swept under the carpet .

Here in Wiltshire some years ago a consolidation of hospitals and treatment facilities took place which at the time were highly un popular but which I personally feel has lead to a far more effective care system in the county .

More hospitals need to close, says ex-NHS boss
By Nick Triggle
Health correspondent, BBC News

The closure of more hospitals is needed if the NHS is going to cope in the future, a former NHS boss says.

Lord Crisp, who was NHS chief executive in England from 2000 to 2006, said the Blair government should have been tougher when it had the chance.
He said there was now overcapacity in the hospital sector and said the same mistakes should not be made again.

Overhauling hospitals would free up funds for community services to deal with the ageing population, he added.

In an interview with the BBC News website, Lord Crisp said: "In the late 1990s waiting lists, A&E and standards in cardiac care were the big issues and we dealt with them.

"But the challenge now is dealing with the numbers of older people and those with long-term conditions. They need supporting in the community.

"That means a shift away from hospitals. There will be less need for large hospital outpatient departments and some services and whole hospitals will need to close or be merged with others."

Key moment

He said he could not put a figure on how many hospitals needed revamping, but added it could affect the whole spectrum of services provided.

His remarks come as ministers are considering the future of A&E, maternity services and children's units at three hospitals in north London.

Under the plans drawn up by the local NHS one hospital - Chase Farm - could lose its services.

Local campaigners have been fighting the proposals and a decision is expected in the coming weeks.

It is being seen as a key moment in the government's policy on hospital changes because, in opposition, the Tories promised to fight such closures.

Lord Crisp, who has written a book about his time at the helm of the NHS - 24 Hours to Save the NHS - which will be published later this month, said he did not know the full details of that case, but added it was important not to dodge difficult decisions.

He admitted the NHS under his stewardship in the Blair years should have scaled back on hospital services.

In particular, he admitted that the scale of hospital building projects probably went too far. More than 100 new hospitals or rebuilds were given the go-ahead.
He said: "By 2005 there was no hospital that was not thinking it was going to grow. We had major problems with very bad facilities, [but] perhaps we could have built smaller or consolidated on fewer sites.

"We missed that opportunity and this government needs to grasp that. We can't keep services going just because there is a nice building."
However, he said it was essential that any changes made were done to benefit patients and not just to save money, and that they should be carried out with proper consultation and engagement.

Lord Crisp's intervention comes after similar warnings by various experts. The King's Fund and NHS Confederation have both put the case for scaling back on hospital care in recent months.

Katherine Murphy, of the Patients Association, agreed the government should not be afraid of making difficult decisions.
She said: "What is the point of having brand new hospital buildings if there are not enough funds to treat people in them?"
But she also warned: "We must never forget that by merging services, there will be patients who may struggle to get to them because they are too far away."
A Department of Health spokeswoman said ministers agreed with the principle that more care should be moved into the community, but added changes must be made for the right reasons.

Labour said patients had benefited from the investment and reforms during its time in office.