GPs reject merger ‘driven by NHS England’ | HSJ Local | Health Service Journal

  • GP members have rejected proposals for six-way merger of clinical commissioning groups in Staffordshire
  • LMC had warned benefits of merger were “speculative” and claimed NHSE had driven proposals

GPs have voted against proposals to merge six clinical commissioning groups in Staffordshire, after being told the plans were “driven by NHS England”, HSJ has learned.

The CCGs’ shared management team outlined the intention to merge last year, but various concerns have been raised among the GP members.

The outcome of the vote is due to be formally announced after an extraordinary meeting this evening, but HSJ understands members in a clear majority of the CCGs have voted against the proposals.

The CCGs, which share an accountable officer and several other senior posts, declined to comment on the vote ahead of the meeting, and it is not clear whether they will now pursue the plans.

As reported in the Healthcare Leader, prior to the vote Paul Scott, chair of the North Staffordshire Local Medical Committee, advised his members to reject the merger.

He wrote in an email, seen by HSJ: “Much has been made of the potential benefits of having a single CCG in Staffordshire, yet few if any of these arguments hold true or are at best speculative.


Source: GPs reject merger ‘driven by NHS England’ | HSJ Local | Health Service Journal

Care homes: coming out of the shadows?

Original post from The King’s Fund

‘……………By Richard Humphries  Assistant Director, Policy

In Untold stories Alan Bennett draws on the experiences of his mother, who had dementia, to capture his unease that ‘something is not right around care homes for older people’. He wrote ‘a home is not a home but neither is it a hospital nor yet a hotel. What do we call the old people who live (and die) there… residents? Patients? Inmates? No word really suits. And who looks after them? Nurses? Not really since very few of them are qualified. As Mam pointed out early in her residency: “They’re not nurses these. Most of them are just lasses”.’

Ten years on, these persisting ambiguities were reflected, albeit in less inimitable prose, at our recent conference on the role of care homes in delivering integrated care. David Oliver has described elsewhere why care homes are hugely important to the prospects for our health and social care system – their places outnumber hospital beds by about three to one. So it was not surprising that the event attracted an enthusiastic and engaged audience of more than 200 people, many drawn from the care home sector. The diverse range of presentations and case studies will no doubt elicit different reactions and views. I was struck by three strong themes that emerged.

The first is the transformation in the level of acuity and complexity of the needs that most care homes for older people now face. Dementia, frailty and complex co-morbidity are now the norm among people in care homes. Yet the way their care is commissioned, organised, delivered and funded has not kept pace. One example is the difficulty of ensuring residents can receive good health care – aimed at essential needs such as podiatry, continence and good primary care management of long-term health conditions. ‘The NHS does not stop at the door of the care home’, Andrea Sutcliffe, the Care Quality Commission’s Chief Inspector of Social Care, reminded us.

The second theme is workforce recruitment and retention. A big worry is the growing difficulty of recruiting qualified nurses from a limited pool with stiff competition from hospitals that offer higher status, esteem and career opportunities. The ability of providers to pay little more than the national minimum wage for mainstream care staff also acts as a huge brake on career progression and opportunities to improve the quality of care.

The third theme that stood out is there is much good practice to celebrate, as Professor Julienne Meyer pointed out to much applause. The conference heard many examples of innovation in areas such as reablement, supporting nursing in care homes, and housing-based models of care. NHS England’s programme of vanguard sites for developing enhanced health in care homes excited great interest, though it is pause for thought that this was the first time many attendees had heard about it.

All of these issues were brought into sharp focus in the final panel discussion involving people who are at the coalface of residential care, directly managing or owning care homes. What was top of their wish lists for good joined-up care? They wanted care homes to be accorded the same respect and esteem as other valued public services such as hospitals; to have more staff to respond properly to the growing needs of residents; to be able to pay staff more than the minimum wage; and to have better access to quality – adding services such as physiotherapy.

That none of these ‘asks’ seems unreasonable reflects how long care homes have operated in the shadows of public and political awareness, with policy attention focused on reactions to service failure rather than the promotion of good care.

Historically, care homes have received but a fraction of the time and resources bestowed on other parts of the health and care system. Many, but not all, of the sector’s woes are fuelled by under-funding, of which low staff pay is one symptom. The NHS’s £30 billion funding shortfall has created much noise, but the sound of silence surrounds the deeper funding malaise in social care. And though the NHS five year forward viewvanguard programme is a welcome starting point to treating care homes as part of the whole system of care, a much more ambitious programme will be required to reflect the scale and diversity of the care home sector.Care England and the National Care Forum have each offered a clear prospectus for improvement and reform. If our event is any guide, care homes are eager for change. But what about everyone else?

Acute hospitals and integrated care

Original post from The King’s Fund

‘………..From hospitals to health systems

A core part of the vision in the NHS five year forward view is a fundamentally different role for acute hospitals. Hospitals in England and elsewhere face significant challenges as a result of rising demand and the changing needs of the population, and they will not be able to meet these challenges by continuing to work alone. Instead, acute trust leaders need to embrace a system-wide perspective and work increasingly closely with primary care, community services, social care and others.

In some areas of the country this change is already well under way, with hospital leaders taking a shared responsibility for leadership of a local system. This report describes lessons from five case studies where acute hospitals are working collaboratively with local partners to build integrated models of care – three of these sites have since been chosen as vanguards by NHS England. The report assesses the achievements made so far, distils the lessons learnt for other local health economies, and makes recommendations for national policy-makers.

Key findings

  • The successes seen in the case study sites have only been achieved after several years of sustained effort, with a particular emphasis on building the necessary relationships and trust.
  • Whole-system governance structures involving acute hospital providers and other local partners can support the development and rapid implementation of integrated models of care, drawing on resources and expertise from across the local health system.
  • A major challenge identified was engaging primary care within these shared governance structures. In cases where progress had been made, acute hospital leaders had invested considerable time and energy in building relationships with general practice.
  • There was some evidence that integration of acute and community services within a single organisation can facilitate the implementation of integrated care models, but many of the same benefits can also be achieved through successful partnership working.
  • Hospital leaders in the study believed that integrated service models would help to manage growing demand within existing bed capacity, rather than achieving any significant reduction in bed numbers.

Policy implications

  • Acute sector leaders should be encouraged and supported to take a leadership role in their local health systems, working with local partners to develop more integrated models of care, and taking greater responsibility for prevention and public health.
  • Supporting actions at various levels are needed: including a regulatory model with greater emphasis on whole-system performance; a nuanced approach to competition that does not create barriers to constructive dialogue and partnership working between commissioners and providers; and more flexible contracting models for general practice.
  • There is a need for realism regarding the pace of implementation of new models of care. Even in local health economies where integrated working is well advanced, the current situation is a long way from the vision described in the NHS five year forward view.
Acute hospitals and integrated care - From hospitals to health systems | by Chris Naylor, Hugh Alderwick, Matthew Honeyman

Print copy: £10.00 | Buy

No. of pages: 92

ISBN: 978 1 909029 47 7…………’