Commissioning of specialised services

The National Audit Office has published The commissioning of specialised services in the NHS. The report reveals that spending on specialised services has increased at a much greater rate than other parts of the NHS.

The report highlights that although NHS England took responsibility for commissioning these services three years ago, it still does not have an agreed overarching service strategy, consistent information from all providers on costs, access to services and outcomes or how efficiently services are being delivered. The report finds that a number of factors are creating financial pressures for specialised services including the increasing volume of effective but expensive new drugs, and increasing demand for these services.

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NIH Study Finds Factors That May Influence Influenza Vaccine Effectiveness

Infection Control Today. Published online: 19 April 2016.
Image source: R. Dourmashkin, Wellcome Images // CC BY-NC-ND 4.0

Image shows Influenza B (Li) virus particles.

The long-held approach to predicting seasonal influenza vaccine effectiveness may need to be revisited, new research suggests. Currently, seasonal flu vaccines are designed to induce high levels of protective antibodies against hemagglutinin (HA), a protein found on the surface of the influenza virus that enables the virus to enter a human cell and initiate infection. New research conducted by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, found that higher levels of antibody against a different flu surface protein–neuraminidase (NA)–were the better predictor of protection against flu infection and its unpleasant side effects. Neuraminidase, which is not currently the main target antigen in traditional flu vaccines, enables newly formed flu viruses to exit the host cell and cause further viral replication in the body.

The findings, from a clinical trial in which healthy volunteers were willingly exposed to naturally occurring 2009 H1N1 influenza type A virus, appear online today in the open-access journal mBio.

Read the full commentary here

Improving access to mental health services

The National Audit Office has published Mental health services: preparations for improving access. This report looks at the preparations the Department of Health, NHS England and other arm’s-length bodies are making for improving access to mental health services. It is the first output in what we expect to be a long-term programme of work on mental health in the coming years, covering both the health system’s progress in improving support for people with mental health problems and how mental health issues are tackled more widely across government.

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Related link: NHS Clinical Commissioners

Investment in General Practice

NHS England announces multi-billion plan designed to improve patient care and access, and invest in new ways of providing primary care.

NHS England has published General practice: forward view. The plan sets out details of increased levels of investment in primary care, with an extra £2.4 billion a year for general practice services by 2020/21.  The plan also contains specific, practical and funded steps to strengthen workforce, drive efficiencies in workload, modernise infrastructure and technology, and redesign in the way primary care is offered to patients.

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Commissioning better cancer services

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NHS England has published guidance to support commissioners and strategic clinical networks to ensure every person affected by cancer will have access to a recovery package and follow-up pathways by 2020, as set out in the cancer strategy.

The guidance includes checklists for developing service specifications, practical examples and templates to use and adapt locally.

Full reference: Implementing the Cancer Taskforce Recommendations: Commissioning person centred care for people affected by cancer

Effectiveness of multidisciplinary team case management: difference-in-differences analysis

Stokes, J. et al. BMJ Open. 2016. 6:e010468

Objectives: To evaluate a multidisciplinary team (MDT) case management intervention, at the individual (direct effects of intervention) and practice levels (potential spillover effects).

Design: Difference-in-differences design with multiple intervention start dates, analysing hospital admissions data. In secondary analyses, we stratified individual-level results by risk score.

Setting: Single clinical commissioning group (CCG) in the UK’s National Health Service (NHS).

Participants: At the individual level, we matched 2049 intervention patients using propensity scoring one-to-one with control patients. At the practice level, 30 practices were compared using a natural experiment through staged implementation.

Intervention: Practice Integrated Care Teams (PICTs), using MDT case management of high-risk patients together with a summary record of care versus usual care.

Direct and indirect outcome measures: Primary measures of intervention effects were accident and emergency (A&E) visits; inpatient non-elective stays, 30-day re-admissions; inpatient elective stays; outpatient visits; and admissions for ambulatory care sensitive conditions. Secondary measures included inpatient length of stay; total cost of secondary care services; and patient satisfaction (at the practice level only).

Results: At the individual level, we found slight, clinically trivial increases in inpatient non-elective admissions (+0.01 admissions per patient per month; 95% CI 0.00 to 0.01. Effect size (ES): 0.02) and 30-day re-admissions (+0.00; 0.00 to 0.01. ES: 0.03). We found no indication that highest risk patients benefitted more from the intervention. At the practice level, we found a small decrease in inpatient non-elective admissions (−0.63 admissions per 1000 patients per month; −1.17 to −0.09. ES: −0.24). However, this result did not withstand a robustness check; the estimate may have absorbed some differences in underlying practice trends.

Conclusions: The intervention does not meet its primary aim, and the clinical significance and cost-effectiveness of these small practice-level effects is debatable. There is an ongoing need to develop effective ways to reduce unnecessary attendances in secondary care for the high-risk population.

Read the full article here

End of life care commissioning toolkit

05 April 2016 – NHS England

Providing high quality end of life care that is truly centred around the needs of the individual and their loved ones is an important outcome to aim for.  Given the complexity of ensuring all the patient’s needs are met, wherever possible, requires all the agencies to work together.

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Image source: NHSIQ

The ‘Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020’, stresses how we must all work together to find new ways of delivering better care to make a difference.  The role of commissioners in collaborative working continues to be fundamental in making progress in end of life care.

The toolkit is aimed at being a useful resource which is complimentary to the overall national strategic direction, whilst aiming  to support commissioners ‘commission high quality end of life care’ and to be complimentary to their local Sustainable Transformation Plans.

View the full toolkit here

View the full commentary here