Tag Archives: health

Social care reform – the next great health debate?

Amid the furore surrounding the Government’s legislation on NHS reform, the wheels have slowly been turning on reform in the social care sector.

At last week’s seminar on the future of social care held at The Care Show in London, the chief executive of the English Community Care Association, Martin Green, said that engaging with government policy makers had never been more important. Peter Hay, President of the Association of Directors of Adult Social Services, and a member of the Department of Health’s listening exercise, NHS Future Forum echoed that sentiment.

It is no wonder that leading figures in social care are urging organisations and the wider public to engage. Social care is under huge strain and faces potentially huge changes in policy, particularly on funding and care home regulation.

The Dilnot Commission on the funding of social care has reported and its findings are being digested within the Department of Health. Local authority funding of social care was already being squeezed, but following the Budget, this is now being done with thumbscrews.

The sorry saga of the collapse of Southern Cross, in part a consequence of reduced local authority funding, has tainted politicians’ perceptions of care home providers. It has also prompted the House of Commons Health Select Committee to widen its inquiry into social care to examine the regulation of care homes in addition to future funding and personalisation. It will look into how to protect against the consequences of operators going bust, and we can expect some very public grilling of care home providers over the coming months.

The DoH published a discussion paper last week on the regulation of the social care market. It examines issues surrounding the risk of financial failure of large care home operators.

There is no guarantee that every care home will always remain open. Nor is the DoH looking to protect care home businesses. There will be no “moral hazard” of the sort that surrounds banks. If a care home operator becomes unviable as a business, it will ultimately be allowed to fail.

What the DH is groping for is a system that will help prevent failures like that of Southern Cross and allow for the orderly transition of care homes to new operators. It is looking for feedback on suggestions such as tougher regulation, more rigorous financial checks, or requiring operators to post bonds to cover for financial failure.

This is just to scratch the surface; the options for reform could reach into every aspect of social care and there is no shortage of contentious issues. Just when the Government gets its NHS reforms enacted (or ditched?), it will set itself up for another round of reform, policy proposals and, no doubt some heavy-duty controversy along the way.

There will be some serious policy boxing over the coming months, with round one commencing with publication of the social care White Paper next spring. Anyone with an interest in the future of social care should answer the calls to engage. Let’s just hope that the ring is big enough to hold us all.

Manifesto makes a point

The Labour, Conservative and Liberal Democrat manifestos will be published next week. These will provide an invaluable resource for insomniacs and political anoraks around the country, as well as giving us an insight into the likely policy priorities of the next Government.

Manifestos are necessarily limited in what they cover, with the infamous exception of Labour’s 1983 offering, “the longest suicide note in history”. They are usually confined to broad policy statements and worded with enough ambiguity to allow future ministers a liberal interpretation of what exactly are their commitments.

But elections also provide an opportunity for outside interests to enter the policy debate. That’s why the run-up to the General Election has seen various businesses and campaign organisations put forward their own manifestos, visions and policy demands.

One valuable contribution comes from vaccine manufacturer, Sanofi Pasteur MSD’s manifesto, Putting vaccines at the heart of health care. It calls for a full-scale review of vaccination policy to give it a more central role in the provision of health care.

In his first speech as Health Secretary in June 2009, Andy Burnham said that prevention is a “long-term insurance policy against spending challenges”. The focus, however, has been on attempting to change life-style choices. No one is arguing against this, but if policy makers want to enhance prevention, then greater importance should be given to vaccination, which is a far more effective means of preventing ill-health than relying on people to change their eating and drinking habits.

Vaccination can prevent more than 20 infectious diseases and has helped eradicate smallpox. Only the provision of safe water has done more than vaccines to reduce mortality. But too often it is seen as something that is only for children. The NHS Choices website lists 17 vaccines (including next stage doses and boosters) that are offered routinely to “everyone” in the UK. Yet only two, flu and pneumonia, are for adults.

Our immune systems decline with age, which leads to more frequent and more severe infections. And with the over-60s population predicted to increase by 160% between 1999 and 2050, increasing infections in the older population will increase the burden on the NHS.

That’s why Sanofi’s manifesto echoes the calls of European health academics for a “life course” approach to vaccination. Vaccination programmes should start from 50 years of age, before age-related decline in the immune system begins. The recent approval by the Joint Committee on Vaccination and Immunisation for a shingles vaccine to be available on the NHS, albeit from the age of 70, is a start. This could help reduce the incidence of this debilitating disease by half, and thereby save the NHS care costs.

Judging by the three-way bun-fight between Andy Burnham and his Conservative and Lib Dem shadows, Andrew Lansley and Norman Lamb on Newsnight yesterday, the election campaign is unlikely to see serious debate on the future of health policy.

Officials and health professionals will read Sanofi’s manifesto with care but will politicians get the point about vaccination? Perhaps when the election is over, they will read other people’s manifestos.

NHS first, patients second

Yesterday was an inauspicious day for Virgin Group to renter the primary healthcare market. It bought a 75 per cent stake in Assura, the medical services group that forms collaborative joint venture partnerships with NHS GP practices to provide primary care, urgent care and outpatient services, diagnostics and day-case procedures in the community. On the same day the Department of Health ordered primary care trusts across the east of England to suspend procurement for community services.

The unstated intention of the DoH is to halt the independent investigation by the department’s Co-operation and Competition Panel into the legality of Health Secretary, Andy Burnham’s, policy that NHS bodies should be the “preferred providers” of health services before it ruled against his policy.

This is bad news for outside providers, who will see their market shrink. But it is also bad news for patients, as it will reduce choice and leave them with no option but to use an NHS provider, even if they get a poor service from it.

As a special adviser in the Department of Health, I was involved in discussions on Labour’s manifesto for the 2005 election. The final version, on which the Government was elected, committed the NHS to use new providers from the independent and voluntary sectors to provide health services. The purpose for doing so was to add capacity, promote innovation and to drive competition, or “contestability”, within the NHS. The ultimate goal, of course, was to improve the quality of patients’ healthcare.

Burnham’s speech last year to the King’s Fund, in which he stated that the NHS should be the preferred provider of health services, sent a signal that opportunities for the private and voluntary sectors were being closed down. NHS officials in one east of England primary care trust were not slow to get the message and abruptly excluded private and voluntary organisations from tenders.

A final determination of the legality of this move will come after the 2010 election. This is just as well for the Government since the motivation behind it is clearly political. Burnham’s move is designed to appease unions, like the BMA and Unison, who have never been wholly reconciled to the involvement of the private sector in the provision of NHS services. It also helps position him slightly to the left for any future Labour leadership election.

Labour’s manifesto for the 2010 election will not be as welcoming of alternative providers, but there will still be scope for them to provide NHS services. It is clear though, that the independent and voluntary sectors still have a lot of persuading to do to overcome resistance from within the NHS. This will be the case even under a sympathetic Conservative administration.

A determined campaign by private and voluntary providers will need to begin the moment the election campaign finishes.

Needled by vial hysteria

I gave blood today: my personal contribution to the NHS. I had no Hancock-like fears about donating the full pint. The NHS’s blood transfusion service ran a smooth operation and I was a grateful recipient of my free cup of tea and biscuits.

We give blood not because we necessarily expect to need a transfusion in the future, but because we want to make an individual contribution to the nation’s health service. By contrast, we have ourselves or our children vaccinated because we want protection from infectious diseases. There is still a wider societal benefit: the higher the rate of vaccination, the lower the pool of people at risk of infection who, in turn, could pass on their infection to others.

This principle of vaccination protecting not just the individual but wider society was severely undermined by the campaign against the MMR vaccine by the now-disgraced Dr Andrew Wakefield and some of the more cynical and hysterical sections of the media. This week, a panel of the General Medical Council (GMC) found him guilty of “dishonesty and misleading conduct” in pursuing his claim of a link between the MMR vaccine and autism.

As a result of his campaign, public confidence in the MMR jab was severely damaged and vaccination rates fell dramatically. This led to an upturn in the incidence of measles, a disease that can be fatal. Thanks to a national MMR vaccine catch-up campaign launched in 2008, coverage is going up again. But in the years 2006 and 2007, there were 1,726 confirmed cases of measles in England and Wales – more than the previous ten years put together. There was one death from acute measles in England in 2006 and another in 2008, while between 1992 and 2006 there were none.

The whole sorry saga around the MMR vaccine shows how seriously the Government and the vaccine industry need to take the issue of public confidence. Apart from the provision of safe water, no other health intervention has done more than vaccination to reduce mortality. Scaremongering campaigns such as the one on MMR, show that it is possible to whip up fears about its efficacy.

I know from my time as a special adviser in the Department of Health how much effort ministers and the Chief Medical Officer had to make to rebut frenzied media coverage generated by Dr Wakefield’s campaign. They didn’t do this simply to avoid unpleasant newspaper headlines, but to protect public health.

There is no shortage of Government initiatives to support the pharmaceutical and, by extension, the vaccine manufacturing industry. But after this week’s GMC verdict, it is perhaps time for it to consider what more needs to be done to strengthen public confidence in the benefits of vaccination and give it a more central place in the provision of healthcare. That way, we can increase our immunity against both preventable diseases and alarmist media campaigns.

Bashing the booze again

Sorry about this. I hadn’t meant to return so quickly to the alcohol debate, but the “news” published today by the British Medical Journal that alcohol advertisers are targeting 15-16 year olds deserves a response.

The nub of the story is that in reviewing alcohol industry marketing documents submitted to the House of Commons Health Select Committee, some health academics, led by Professor Gerard Hastings of Stirling University’s Institute for Social Marketing (the Health Committee’s special adviser) “discovered” that alcohol producers were conducting market research on 15 and 16 year olds. The researchers say that this was used to “guide campaign development and deployment” for alcohol marketing among young people. That is certainly the spin picked up by the media. The Guardian lapped it up: Alcohol industry is ‘targeting young people’, it declared.

But is that what the alcohol industry is really doing? The Portman Group code on Naming, Packaging and Promotion of Alcoholic Drinks seeks to ensure that drinks are marketed in a socially-responsible way and to an adult audience only. Not only is the industry committed not to targeting marketing, advertising, branding or promotions at under-18s, but in advertising it is also committed not to using images of people who are or who appear to be under 25.

The Portman Group has been highly effective in ensuring that the way drinks are named, packaged and promoted is responsible. In 2008 (its most recent report) it randomly sampled 485 alcohol drinks packages and assessed them against the code. Of these, they had reservations against the packaging of 32 products. Producers of most of these drinks immediately volunteered to change their marketing. In just ten cases the producer opted to defend their marketing to the Independent Complaints Panel, and of these just two products were ultimately found in breach of the Code.

So if the industry is so responsible and assiduous in its adherence to the Portman Group Code, why does it conduct market research among 15 and 16 year olds? Well, if you are committed NOT to marketing drinks to the under-18s, it seems only sensible and responsible that you find out what it is that appeals to them so that you can avoid doing it! In order to design advertising and marketing for over-18s, it has to know what would also appeal to under-18s and avoid it. Frankly, I would be more worried if they weren’t doing market research among under-18s.

But this common sense point is lost on the puritanical researchers and the hypocritical media, because it doesn’t serve their purpose of making the alcohol industry the whipping boy for the year. Expect to see a lot more booze bashing as the year unfolds.