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.

Project: London is a clinic of Medecins Du Monde (UK) which aims to support migrants that need help accessing healthcare.  It has just  published its second annual report the Project: London report and recommendations 2007: Improving access to healthcare for the community’s most vulnerable.

The report finds no evidence of health tourism, with patients had been in the UK for an average of 3 years before accessing care from Project: London. Migrants are no more likely to have expensive, complicated medical needs than anyone else. It also identifies difficulties for pregnant women in accessing proper care. Although they were entitled, nearly 70% of the women had no access to care, a situation which puts both mother and child in jeopardy, and must be addressed as a matter of urgency.

Proposed changes to NHS access for migrants are unlikely to be cost effective because:

• Lack of GP access means no chance of preventing diseases
• Lack of GP access means no chance of early and affordable treatment of diseases – including those which are contagious
• Lack of GP access is likely to lead to increased pressure on already burdened A&E department.

The Heatwave Plan for England 2008 is published today on a day of blazing sunshine, so that should put paid to a summer in the UK. Its purpose is to enhance resilience in the event of a heatwave. It is an important component of overall emergency planning; and will become increasingly relevant in adapting to the impact of climate change.

Related documents:

Advice for health and social care professionals offers advice for individuals, or teams, engaged in primary care or social services, or for home care providers both on caring for people most at risk during a heatwave, and on organising others who provide care.

Heatwave: supporting vulnerable people before and during a heatwave - advice for care home managers and staff where people are especially at risk during a heatwave. The effects of heat occur rapidly, and to be effective, preparatory action has to be taken before the beginning of June. This factsheet details necessary preparations.

Heatwave: a guide to looking after yourself and others during hot weather providing useful information and advice on the hazards of a heatwave, how to recognise the symptoms of heat exhaustion and heat stroke, and how to deal with the effects of too much heat.

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.

Making the connections: using healthcare professionals to deliver organisational improvements aims to help the NHS understand how Non-Medical Prescribing can help to deliver services, the Department of Health commissioned Primary Care Contracting to produce 6 Nurse Prescribing and 6 Pharmacist Prescribing case studies.  Many nurse and pharmacist independent prescribers manage their own caseloads including in dedicated clinics - helping patients to manage long-term conditions’ or by treating one-off episodes of care in GP Practices or in Walk-in Centres and in Accident and Emergency Departments.

The debate about organisational models for community provider services has been ongoing since 2005. One model being examined is that of a community foundation trust (CFT), allowing community service providers to acquire the same freedoms as acute and mental health foundation trusts.

Towards autonomy from the NHS Confederation draws on the experiences of eight CFT pilots and looks at what other organisations can learn from them. The pilot CFTs have had different experiences but some common themes emerge, most importantly the potential to bring benefits for patients.

Individual Budgets and the interface with health: a discussion paper was commissioned by CSIP as a stand alone piece of work to capture the issues and learning from the Individual Budgets pilot regarding the interface between Individual Budgets and Health. A “think tank” session was organised with key stakeholders from the Cabinet Office, Department of Health, In Control and Individual Budget pilot sites to discuss these emerging issues and any relevant activity.

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 Report on the National Patient Choice Survey, England - November 2007 and provisional headline results for January 2008 gives the final results of around 78,000 responses to the tenth national patient choice survey commissioned to assess the implementation of choice at PCT level.  The series of surveys, conducted by Ipsos MORI on behalf of the Department, monitor patient awareness of choice and recall of having been offered a choice of hospital for their first outpatient appointment.  They were designed to provide a national overview of choice and summary results at PCT level, with a revised format from November 2007 incorporating new questions.

The main findings of the November survey are:

• The percentage of patients recalling being offered a choice of hospital for their first outpatient appointment was 44% in November, compared with 45% in September and 48% in the March 2007 survey.
• 41% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 39% in September and 29% in the May/June 2006 survey.
• 61% of patients who were aware of choice recalled being offered choice, whereas 32% of those not aware of choice recalled being offered it, compared with 64% and 32% respectively in the September survey.

Results of new questions introduced for the November survey are:

• 65% of patients were able to go to the hospital they wanted, with a further 25% having no preference and 7% unable to go where they wanted.
• 40% of patients discussed which hospital they might go to with their GP.
• Half the patients (50%) who were offered choice said they used the GP as a source of information to choose their hospital, with a third (33%) saying they used their own experience or that of friends and family.
• 39% of patients booked their first hospital appointment when the hospital contacted them following a letter from the GP.  30% telephoned an appointments line, 19% were booked on screen by the GP or other practice staff and 3% used the internet.
• 78% of patients were satisfied with how long they had to wait from the time their GP referred them to when they saw the hospital.
• For the first time, hospital cleanliness and low infection rates were selected more often (by 76% of patients) than location or transport considerations as an important factor when choosing a hospital.

Provisional headline findings of the January 2008 survey are:

• 46% of patients recalled being offered a choice of hospital for their first outpatient appointment, compared with 44% in the November survey.
• 42% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 41% in November.
• 68% of patients were able to go to the hospital they wanted, with a further 22% having no preference and 7% unable to go where they wanted.

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.

This document provides information and guidance to NHS organisations on the Healthcare Travel Costs Scheme (HTCS), which replaces the current Hospital Travel Costs Scheme.The main differences between the HTCS and its predecessor are:

• subject to a limited exception, patients referred by a doctor or dentist for non-primary care services under the National Health Service Act 2006 (including treatments or tests which would traditionally have been carried out in the hospital setting but are now provided elsewhere) are now eligible to have their travel expenses to receive such services paid for under the scheme, where they meet the eligibility criteria

• road and toll charges may now be reimbursed through the scheme

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

Code of practice for promotion of NHS services sets out rules around promotional material issued by providers of NHS services to ensure that: the information patients receive is not misleading, inaccurate, unfair or offensive, that the brand and reputation of the NHS is protected, and that expenditure on promotional activity is not excessive.

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.