The PCT Procurement Guide supports NHS commissioners in deciding whether and how to procure health services through formal tendering and market-testing exercises. The Guide sets out the policy and regulatory context for procurement, and issues to consider when developing a procurement strategy. The Guide should be read in conjunction with the Principles and rules for Cooperation and Competition, published as Annex D of the 2008/9 Operating Framework, and the Framework for Managing Choice Cooperation and Competition

The Framework for Managing Choice Cooperation and Competition supports SHAs and PCTs in understanding the roles, responsibilities, values and behaviours required for the effective management of choice and competition within the NHS. The Framework is the outcome of a series of workshops and seminars with senior SHA and PCT leaders. The Framework should be read in conjunction with the
Principles and rules for Cooperation and Competition (Annex D of the 2008/9 Operating Framework) and the PCT Procurement Guide (published 16 May 2008). Additionally, the Framework signals a further series of tools and guidance for system managers to be released throughout the year.

Delivering the National Programme for IT in the NHS is proving to be an enormous challenge. All elements of the Programme are advancing and some are complete, but the original timescales for the electronic Care Records Service, one of the central elements of the Programme, turned out to be unachievable, raised unrealistic expectations and put confidence in the Programme at risk.

• Executive Summary

• The National Programme for IT in the NHS: Progress since 2006: Report by the Comptroller and Auditor General: HC 484-I Session 2007-2008: Volume 1

• The National Programme for IT in the NHS: Progress since 2006: Report by the Comptroller and Auditor General: HC 484-I Session 2007-2008: Volume 2

The progress report on the Programme by the National Audit Office concludes that the original vision remains intact and still appears feasible. However, it is likely to take until 2014-15 before every NHS Trust in England has fully deployed the care records systems, four years later than planned. In the North, Midlands and East area, the software has taken much longer to develop than planned, so some Trusts have had to take an interim system. Completing the development of the system and introducing it in this area are significant challenges still to be addressed.

The year 2007/2008 - NHS Chief Executive’s annual report is NHS Chief Executive David Nicholson’s second annual report looks at the progress made across the NHS in the last 12 months, and the challenges for the year ahead. In addition to his annual report, David Nicholson has published a Framework for choice, cooperation and competition and a PCT procurement guide for health services.

Public perceptions of privacy and dignity in hospitals is research, conducted by Ipsos MORI, involved 2,000 interviews with members of the public across the country. It was designed to explore perceptions towards privacy and dignity in hospitals, with particular emphasis on the importance of single-sex accommodation. Key findings are that cleanliness and staff attitudes are the most important factors for patients to feel they are treated with privacy and dignity in hospital.

The NHS Next Stage Review has been led locally by clinicians in each NHS region. Seventy-four local clinical working groups, made up of some 2000 clinicians, have been looking at the clinical evidence and engaging with their local communities. They have developed improved models of care for their regions to ensure that the NHS is up to date with the latest clinical developments and is able to meet changing needs and expectations.

NHS Next Stage Review Leading Local Change sets the context for these local visions and the principles which will guide their implementation.

Changing for the Better provides best practice guidance on provide clear guidance for patients, the public and NHS staff on the processes underpinning changes to acute NHS services arising from the NHS Next Stage Review.

The Common core principles to support self care have been developed by Skills for Health and Skills for Care with key stakeholders, including service users and carers, to develop a set of common core principles to support self care. The principles capture best practice in order to enable service reform and encourage choice, control, independence and participation of those using health and social services.

New statistics from the NHS Information Centre

• Expenditure on health
• NHS stop smoking statistics
• Hospital outpatient statistics
• Diagnostic waiting times

The devolution of increased power to local NHS bodies and front-line professionals,has resulted in calls to ensure that those who take on increased responsibility are held to account. There is no clarity on how this may be achieved or the extent people want more control over how their primary care trust (PCT) spends its money.

The main political parties im to end the ‘democratic deficit’ and ensure local people have increased input on the delivery of local health care, and this will be a central theme of Professor Lord Darzi’s review of the NHS. The King’s Fund report, Should Primary Care Trusts Be Made More Locally Accountable?, makes a thorough assessment of the various options for making PCTs more accountable to their local communities.

It states that if the aim of involving the public is to give more democratic validity to the health service, systematic changes – such as giving local councillors control over PCT budgets, or electing PCT board members – would be appropriate.

However, improving the quality of services is the target, then an incremental approach would be better.  Targeted initiatives – such as citizens’ juries or enhanced Public Patient Involvement Forums – focusing on specific PCT functions may prove to be a more successful route to accountability.

The National education and competence framework for advanced critical care practitioners describes:

• the role of an advanced critical care practitioner
• how the role should function within the critical care team
• the benefits of introducing the role in clinical practice
• a national framework of education and competence

More than one in four adults admitted to hospitals, care homes or mental health units are suffering from malnutrition, the Nutrition Screening Survey and Audit of Adults on Admission to Hospitals, Care Homes and Mental Health Units has found. Women and the elderly were at greatest risk, says the report from the British Association for Parenteral and Enteral Nutrition (Bapen). More than 11,000 patients were screened for signs of being under-fed and 28 per cent were found to be malnourished.

It recommends:

• Screening should be undertaken in all institutions and repeated at interval according to care setting, using accurate and reliable instruments
• Results of screening should be included in care plans.
• Nutrition advice and nutrition support teams should be routinely available.
• Strategies to detect, prevent, and treat malnutrition should be in place in all care settings, including the community, where most malnutrition originates.

The Secretary of State has made two sets of Directions, both in respect of Local Involvement Networks (LINks). The first set of directions are to LINks themselves, setting out their duties when it comes to providing annual reports to the Secretary of State. The second set are to commissioners of health and social care services (primary care trusts, NHS trusts in England, strategic health authorities, and local authorities). These set out the requirements they need to include in their future contracts with independent providers. A briefing has been produced by the DH for providers of independent services about this second set of Directions.

The Pharmacy in England: building on strengths - delivering the future white paper sets out a vision for building on the strengths of pharmacy, using that capacity and capability to deliver further improvements in pharmaceutical services over the coming years as part of an overall strategy to ensure safe, effective, fairer and more personalised patient care.

It includes the Government’s response to the Review of NHS pharmaceutical contractual arrangements conducted by Anne Galbraith, former chair of the Prescription Pricing Authority, which the Government commissioned in 2007 (published below). It also considers as appropriate views put forward by the All Party Pharmacy Group’s report The Future of Pharmacy (published in 2007) and considers the complementary but important work of dispensing doctors and appliance contractors.

Patients will be able to choose where they are treated from any provider meeting Healthcare Commission standards from 1 April, but Free Choice at the Point of Referral a King’s Fund’s briefing on the latest official data finds the policy has some way to go before it is likely to drive improvements in the quality of hospital services.

One of the ambitions of free choice is to create incentives for hospitals to drive up quality standards as they compete for patients, but official data shows that:

• use of ‘Choose and Book’ — the computer system designed to facilitate choice — whilst increasing still falls short of the government’s target, with only 50 per cent of referrals from GP to hospital being made using the system
• although increasing numbers of patients say they remember being offered a choice of hospital by their GP since the policy began in 2006, the proportion is still only 45 per cent
• of those 45 per cent, only 27 per cent said their GP gave them a booklet containing comparative information on hospital performance to help them make a decision.

The Report of the Office of Health Economics Commission on NHS Outcomes, Performance and Productivity identifies that the collection and use of outcomes measures in the NHS is both practical and essential.   In order to do so effectively the report makes the following recommendations:

• Measurement of patient outcomes and use of that information to drive better commissioning of services should be made an explicit element of the Government’s vision of “world class commissioning”.

• Mortality and survival data should be collated and published for all condition/treatment areas at the same time as collection of other outcomes data is initiated. Data on casemix must be collected, so that the crude mortality/survival data can be adjusted for the casemix treated. Confidence intervals should be estimated and reported to permit comparisons to be made over time and between providers.

• For elective surgery, condition-specific measures should be collected beforeand after surgery simultaneously with the generic EQ-5D for all NHS patients undergoing common procedures.

• Measurement of mental health outcomes in secondary care should be reinvigorated with collection of HoNOS data being incentivised in addition to mental health providers being reminded of its mandatory nature as part of the Mental Health Minimum Data Set. Routine collection at annual intervals of the CORE-OM measure for all patients receiving community based mental health services be piloted in a range of NHS Trusts at the earliest practical opportunity in 2008/09.

• Research is required to identify a generic measure of health related quality of life that is suitable for application to mental health patients as well as recipients of other kinds of health care.

• The practicality and value of collecting and using measures of outcomes for COPD patients should be piloted by a range of commissioners and their secondary and primary care providers, commencing in 2008/09. The preferred disease specific measure is either the Chronic Respiratory Disease Questionnaire (CRDQ) or the St George’s Respiratory Questionnaire (SGRQ).

• For colorectal cancer patients, mortality data (1 year and 5 years after diagnosis) should continue to be monitored and assessed as an important but partial measure of health service productivity in this disease area given its relatively high rate of mortality. But at the same time instigation in 2008/09 of pilot programmes of routine use of the EORTC QLQ-CR38 instrument to measure outcomes in colorectal cancer patients simultaneously with the EQ-5D or an SF- series generic measure should be undertaken.

• Collection of data about the wider benefits from health services by addition of questions on patients’ experience of care to the patient questionnaires used to measure health outcomes. Aspects covered should include: access, care co-ordination, autonomy, choice, communication, confidentiality, dignity, quality of amenities and support for carers.Further research is needed into the relative values of the wider benefits referred to in recommendation 8 and by compassion with health outcomes.This should be commissioned during the course of 2008/9.

• Information on wider benefits is already collected in national patient surveys. Building on its ‘customer experience information’ project, the Department of Health should work with its counterparts in Northern Ireland, Scotland and Wales on a UK-wide stock-take of patient surveys in process and planned, and then use this as the basis for discussion with all the interested parties how to co-ordinate those surveys in future.

• After a short period of research to identify the most practical way of collecting such data, including working days lost, measurement of productivity effects should be commenced for patients being treated for mental health problems, diseases of the nervous system and diseases of the musculo-skeletal system should be identified.

• Modification of existing national surveys of a sample of the general population should be investigated as one way of collecting at a general level data relevant to the wider societal impacts of health care interventions, including impacts on carers.

• Health care professional bodies, including the Royal Colleges, should explicitly and actively support the collection and use by their members of patient outcome measures, including the provision of training in their collection and use for both existing and new clinicians.

• Training in understanding and using outcome measures should be provided to NHS commissioner and provider managers.

• Investment should be made in IT and appropriately trained staff to enable user-friendly information collection, collation and analysis of outcome measures.

• The NHS should, commencing as early as possible in 2008/09, pilot, monitor and evaluate explicit incentives to collect, collate, analyse, feedback and use patient outcome measures. Initially at least this would not be extended to rewarding providers for the measured levels of outcomes achieved, although that could be considered once experience with use of outcomes measures has accumulated.

• There should be an expectation that within 5 years (i.e. by the end of 2012/13) routine measures of patient outcomes comprising the impact of an NHS intervention in terms of patient survival, quality of life, and experience of care, are collected for the majority of NHS activity. Within 10 years it should be the exception rather than the rule to find an area of NHS activity that is not assessed and actively managed according to the outcomes achieved.

• The NHS should work with the ONS Centre for the Measurement of Government Activity to ensure that the health outcomes data used by the NHS can also used by ONS in its periodic assessments of NHS productivity and, subsequently, in the National Accounts.

Trends in children and young people’s care - Emergency admission statistics 1996-2006 for children and young people aged 0 -19 years over the period 1996/97 to 2006/07,  including information on trends for:

• different age groups
• selected consultant specialties most likely to be involved in the care of children and young people
• emergency admission methods
• length of stay in hospital

Extensively discussed in the mass media Choice at referral: guidance framework for 2008/9  provides best practice guidance and information for referrers, providers and commissioners on how the roll-out of free choice in elective care in 2008/9 will operate.  It is supplemented by the Impact of Free Choice policy in Choose and Book R4.0.

The Bercow Review of services for Children and Young People (0–19) with Speech, Language and Communication Needs - Interim Report ( Executive Summary) identifies 5 key themes:

• Communication is crucial – communication is at the core of all social interaction.  Communication is a key life skill. Communication is a fundamental human right. For some children and young people, acquiring the ability to communicate is a difficult and ongoing challenge. Just as the nature and severity of their needs will vary, so will the type and extent of the help required to address them.
• Early identification and intervention are essential in order to avoid poor outcomes for children and young people – in addressing delay and disorders, the most important facts we know are the value of early intervention and the danger of its absence. If a child receives the right help early on, he or she has a better chance of tackling problems, communicating adequately and making progress. If a child does not benefit from early intervention, there are multiple risks – of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects and, in some cases, of a descent into criminality.
• A continuum of services, designed around the family, is needed – universal, targeted and specialist services are required to meet the range of needs and, as the Government envisages in its recent Children’s Plan, children, young people and their families must be at their heart.
• Joint working is critical – in planning, commissioning and delivering universal, targeted and specialist provision, it is critical that health services and children’s services, including schools, work together in support of children and young people with SLCN. No single agency can deliver any one of the five Every Child Matters outcomes for children and young people by working in isolation. Separate silos produce misunderstandings, cause divisions and can be bewildering or infuriating to parents for whose children services are delayed or denied as a result.
• The current system is characterised by high variability and a lack of equity – the current system is routinely described by families as a “postcode lottery”, particularly in the context of their access to speech and language therapy (SLT).

Public and patient involvement in the NHS from the BMA looks at the concept of public and patient involvement. It has a focus on the new mechanisms that are designed to ensure local communities more say in commissioning services.

It concludes there is a real risk of the having the opposite effect. To increase the involvement of ordinary people in their health service, more effective fora for expressing their views are required. Suggestions on how this may be achieved are developed in this report.