A tough task ahead for the NHS in 2018/19

NHS Providers  | April 2018  | A tough task ahead for the NHS in 2018/19

Last year NHS Providers published Mission impossible? predicting that the task set for providers in 2017/18 was impossible to deliver. During the last year, trusts have treated more emergency patients than ever before. They are delivering 1.8% efficiency gains, which is nine times the UK whole economy average; and are on course to achieve more than £3bn in savings. 

Now NHS Providers have produced a new report, Tough Task: The NHS delivering for patients and staff in 2018/19, it is based on analysis of current data and survey data from trust leaders.   The report includes projected levels of demand and performance for next year,  forecasting that approximately 3.6 million emergency patients will not be treated within four hours and 560,000 patients needing elective care will not be seen within 18 weeks. It reports that the size of the task will add a significant extra burden onto an already hard pressed workforce.

road-3142580_1920Tough Task reveals widespread scepticism about the ability of the service to meet performance and financial targets in 2018/19.   It also reports a stark and worrying assessment of the challenges facing NHS trusts this coming financial year.
There is an emphasis on the tasks set out in the recent revised planning guidance: a long list of ‘must-dos’ for the NHS.  The report points to the lack of capacity in terms of beds and staff affecting hospitals, mental health, community and ambulance trusts, as health and social care services struggle to meet a steep and relentless rise in demand for treatment.

It raises concerns in three areas:

  • A & E
  • planned hospital treatment
  • Trust finances.

The authors conclude that patients’ experience of care is likely to decline below trusts’ and the NHS constitution’s acceptable standards (NHS Providers).

The interactive report can be accessed here  


The King’s Fund launches podcast

The King’s Fund | The NHS: are you satisfied with your health service?

The King’s Fund has announced the launch of a new monthly podcast series. It will focus on big ideas in health and care. Each month  experts from The King’s Fund and beyond will talk about the NHS, social care, and all things health policy and leadership.


The first episode is available now from The King’s Fund

The NHS are you satisfied with your care? 

Managing the hospital and social care interface: Interventions targeting older adults

The Nuffield Trust | March 2018  | Managing the hospital and social care interface: Interventions targeting older adults

This research report examines the relationship between the health and social care sectors, particularly the tensions between the two due to rising pressures on hospitals, when the think tank calls for increased collaboration between the two.

Managing the hospital
Image source: nuffieldtrust.org.uk

It explores the actions and strategies that providers and commissioners have put in place to improve the interface between secondary and social care, with a focus on what hospitals can do. With particular focus on:

• collaboration to prevent avoidable hospital admissions
• the interface between hospitals and social care providers when patients are
discharged from hospital
• the relationship between commissioners and social care providers
• wholescale organisational integration.



The report suggests increased

  • collaboration to prevent avoidable hospital admissions
  • the interface between hospitals and social care providers when patients are discharged from hospital
  • the relationship between commissioners and social care providers
  • wholescale organisational integration.

It uses seven case studies to support this and makes five recommendations for national policy-makers. In conjunction to this, the think tank makes  seven recommendations for hospital leaders, derived from discussion with hospitals, integrated care organisations and local authorities  throughout the course of this research.

These are:

  1. Think imaginatively about the workforce. We have already set out the recruitment and retention challenges facing the social care sector, and the way national policy needs to change to help address them. But there are also things that local providers can do.
  2. Do not make decisions about social care, without social care. Hospitals
    that make decisions about providing or commissioning social care
    without consulting their local authority or social care providers may risk
    destabilising the social care market.
  3. Think carefully about different types of integration. Organisational,
    service-level and patient-level integration all have their own strengths and
  4. Consider pooling budgets to facilitate progress. Most of our case studies
    benefited from a shared budget to initiate and sustain integration efforts.
    Some of this came from ‘vanguard’ funding, but most of the case study sites
    also drew on the Better Care Fund.
  5. Make sure that integrated teams have appropriate processes to support
    them. Where integrated teams work effectively, they have appropriate
    processual and managerial support. Shared governance and accountability
    processes mean that everyone is working to the same set of standards.
  6. Make sure that commissioners are on board. Collaboration and buy-in
    from all local commissioners and providers, including primary and
    community care, was a key factor in successful implementation for most of
    the case study sites.
  7. Collaborate with housing partners. There are good examples of
    collaboration with housing partners at the local level.

The efficacy of Communities of practice

Communities of practice (CoPs) often develop organically through shared interests or are created as a means of sharing best practice, disseminating knowledge and experiences as well as developing professionally or personally. According to the RAND Corporation the impact of CoPs can be difficult to quantify and there is incomplete evidence about the value they add. For CoPs to support current ambitions to transform UK health and social care a deeper understanding of their operation and consequences was required. For this reason a scoping review was undertaken, it had two primary research questions:

  1. How do the CoPs operate and how can their work be explored in more depth?
  2. How, when and why can the knowledge generated within CoPs lead to improved work?startup-594090_1920

The review intended to gather data to determine the best approach to a full-scale evaluation of CoPs, as well as to provide immediate evidence to help the CoPs improve their effectiveness.

Some of the CoPs covered in this review include medicines safety; maternity; duty of candour; medicines optimisation; sepsis; acute deterioration; and delirium. CoPs members include NHS non-medical and medical staff from a range of professional groups, and academics. (RAND Corporation)
Key findings

If the knowledge necessary to resolve or explore  a problem is in the CoP there is the opportunity for change, but if this is not the case then the CoP must be adapted or modified to engage senior leadership, change national mandates or work with commissioners.

The report identified a number of future evaluation questions along with associated subsidiary questions. The key overarching questions are:

  • (How) is the momentum towards transformation sustained and what are the wider dependencies that are needed for this to happen?
  • (How) is progress and value-added measured?
  • (How) is the rhythm of learning sustained?
  • (How) are cultures and principles nurtured and sustained? (RAND Corporation)

The eBook can be read online  here

Alternatively it can be downloaded from the RAND website


NHS spending during the last 70 years (The Nuffield Trust)

The Nuffield Trust  | March 2018  | 70 years of NHS spending

A new post on the Nuffield Trust’s blog considers how NHS spending has changed over time.  While speding was an estimated £460 million in the 1950s,  a figure that is dwarfed by current spending of  and projections of £158.4 billion by 2020.


NHS spending
Image source: nuffieldtrust.org.uk

After the figures are adjusted for inflation, by 2020 NHS spending looks to be around 10 times that of 1950.  John Appleby, writing on the think tank’s blog, considers after more than a decade of decreasing spending as a share of gross domestic product (GDP) what it will take to reverse this trend?

He comments that returning to spending of 7.6% of GDP over the next three years would require a real increase in funding of £15.1 billion – £11.4 billion more than current plans – and equivalent to an average annual real increase of 3.3%, rather than the 0.8% currently planned. Such growth is not out of line with the history of NHS spending – indeed, somewhat below the 4% or so per year long run average.

(The Nuffield Trust)
The full post can be read here 


New data protection legislation affecting all NHS organisations

The General Data Protection Regulation (GDPR) is set to replace the existing Data Protection Act on 25 May 2018. It will require all organisations, which process personal data – including CCGs, to meet higher data protection standards.

Some of the new requirements of GDPR will be appointing a data protection officer, the ability to demonstrate that you are complying with the new law and higher penalties for those not following the rules.

The Information Commissioners Office has produced a package of tools and resources to help you get ready. These resources include:

Image source: ico.org.uk/

Further information can be found on the Information Commissioner’s Office’s website.

NHS workforce statistics

NHS DigitalMarch 2018 | NHS Workforce Statistics, December 2017

Provisional workforce statistics have been published in a report by NHS Digital. The data have been extracted and validated from the NHS’s HR and Payroll system.  This report shows provisional monthly numbers of NHS Hospital and Community Health Service (HCHS) staff groups working in Trusts and CCGs in England.  They include hospital doctors and non- medical staff and are available as headcount and full-time equivalents.


In December 2017

  • The headcount was 1,198,238 in December 2017. This is 4,568 (0.4 per cent) less than the previous month (1,202,806) and 20,869 (1.8 per cent) more than in December 2016 (1,177,369).
  • The full time equivalent (FTE) total was 1,057,900 in December 2017. This is 4,001 (0.4 per cent) less than the previous month (1,061,902) and 18,835 (1.8 per cent) more than in December 2016 (1,039,065).
  • Professionally qualified staff make up over half (54.2 per cent) of the HCHS workforce (based on FTE).


NHS Sickness absence rates for November 2017 are accessible here

NHS Staff Earnings Estimates December 2017 can be found here