• The awards are open to registered charities that are at least three years old, working in a health related field in the UK, with a total annual income between £10,000 and £1 million.
• Nine winners receive £25,000 and an overall winner receives £35,000. Organisations that are highly commended or runners up receive £5,000 or £3,000.
• You do not need to present a new project. The awards are designed to recognise success and achievements for existing work.
• You decide how to use the award money.

Deadline

Closing date for applications: 5pm on 26th September 2008

Further Information

Guidelines and application form available at:

http://www.kingsfund.org.uk/gskimpactawards

ACADEMY OF MEDICAL ROYAL COLLEGES

ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH

THE ROYAL COLLEGE OF SURGEONS OF ENGLAND

ROYAL COLLEGE OF PHYSICIANS LONDON

KING'S FUND

BMA PRELIMINARY RESPONSE

ROYAL COLLEGE OF RADIOLOGISTS

UNITE

a red apple ........................

The Witch Doctor - Link to a random page

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Influentially, the most forward looking of the inquiries that he commissioned at the Treasury was a 20-year vision of the money needed in turning the publicly financed NHS into "a really good health service". A report issued by Derek Wanless, a former banker, recommended, in the first-instance, a significant 5-year boost in its funding and resources. In 2002, when Mr. Brown was at the Treasury, the proposals were approved, effectively sanctioning annual increments in the NHS budget of 10%. In real terms, after deducting inflationary pressures, this is worth around 7% growth, guaranteed as it was until the end of the last financial year 2007-08.

An examination of how that money has been spent and, specifically, what it has achieved, might seem a palpable starting point before any new policies are considered. Did that happen? Brown's preponderance and one of his first decisions since becoming Prime Minister was in asking Lord Darzai (a junior health minister) in formulating the way ahead over the next decade for the NHS. And, yet, awkwardly, the ‘Kings Fund' (a health policy think-tank) came up with the bright idea by commissioning Sir Derek in taking another look at the time. That examination casted back, rather than forward makes uncomfortable reading for the Prime Minister.

It is likely that only diehard opponents of the NHS would dispute advances made in recent years. But, genuine advances have been very real such as those patients needing operations, like cataract removals, who no longer have to wait as long as before, before being operated on. Many more doctors and nurses do now work in the NHS, compared to the situation that Labour inherited in 1997; hospitals have been empowered in purchasing and procuring expensive and innovative technologies such as MRI scanners. GP's appear to be prescribing more cholesterol-lowering statins that significantly reduces the risk of heart attacks and strokes.

Rationally speaking, though, given such vast sums of money the NHS has received, it would have been rather extraordinary if the NHS had not got better. The question, now, is whether it has improved enough given the amount of resources and funding it has received? Sir Derek's report highlights that the British taxpayer has received a return that is, 'poor value for money'.

The risk of throwing unlimited sums of money into the NHS was that much of it would be soaked-up in higher costs rather than producing more and better health care. In retrospect, this is exactly what did happen. For instance, Sir Derek's report finds that 43% of the extra funding given to the NHS since 2002 has gone directly in paying higher pay and prices. New contracts for doctors and a healthy boost in earnings for nursing and other NHS staff accounts for 90% of these higher costs.

One of the main objectives of the new contracts was in raising productivity. Sir Derek finds scant evidence of any such payoff. Rising unit costs betray a failure in making the efficiency gains, first envisaged, when the plans were originally set-out in a desire to regenerate the NHS.

Underpinning much of how the NHS has been regenerated is focussed around smarter use of information technology which, in essence, could and should help raise productivity as well as making patient-care safer. The government's push in a yearning to introduce electronic patient records, though, has clearly been dogged with delays and setbacks. Indeed, on a 10-year projection to 2013 expected to cost £12.4 billion, MPs on the health committee of the House of Commons collectively highlighted, "a worrying lack of progress on implementing local systems".

Since the start of this financial year, from April 2008, the real annual growth in NHS funding is expected to halve. The financial clamp-down, much needed after such vast sums having been poured into the NHS in recent years, should not really amount to a hindrance. The lessons of the past 5-years are that money alone cannot cure the ills of the NHS.

© Mark Dowe 2008: all rights protected

References:

• Guardian Editorial, 01 July 2008: "A promising prescription"

http://www.guardian.co.uk/commentisfree/2008/jul/01/nhs.health?commentpage=1&commentposted=1

• Allyson Pollock: "Farewell to a free NHS"

... Read the small print: Lord Darzi's report paves the way for Labour to charge for NHS care.

http://www.guardian.co.uk/commentisfree/2008/jul/01/nhs.health1

WILL POLYCLINICS DELIVER INTEGRATED CARE?

"For some health communities the development of polyclinic-type facilities could offer real opportunities to establish more integrated, patient-focused care, but only if considerable investment of time, effort and resources is put into their planning and development.

The primary focus should be on developing new pathways, technologies and ways of working rather than new buildings. Co-location alone is not sufficient to generate coworking between different teams and professionals. Investment in change management and strong clinical and managerial leadership will be required.

Commissioners will need to consider new ways of commissioning primary and community services. Services will need to be contracted on the basis of clear quality standards in order to ensure that the benefits of the new models of care are realised.

New approaches to assure the quality of out-of-hospital care and support professional development will be needed. There needs to be a much stronger framework for inspection and accreditation.

A major centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas. A hub-and-spoke model, where the polyclinic acts as a central resource base in a co-ordinated network of practices, is likely to be more appropriate to achieve the desired development of primary care services.

To maximise accessibility, choice of location is critical – polyclinics should ideally be developed in natural transport hubs. Where this is not possible, finding ways to integrate services more effectively within existing facilities or on existing sites would be preferable to developing a polyclinic in a less accessible location. Improved access by car cannot be assumed given restrictions on car parking imposed by local authorities on any new developments.

Substantial cost savings are unlikely to be made. Costs for some services may increase, unless hospitals can significantly reduce their unit costs and commissioners can manage demand. Scheduling of services will need to be carefully planned in order to ensure effective utilisation of building space and staff time. Developing polyclinics is likely to require transitional funding.

There are significant workforce implications that need to be thought through and addressed.

New developments should not simply be a response to a new national target, but a well thought-out element of a broader strategic plan that responds to local needs.

Any polyclinics developed should be subject to rigorous evaluation to help fill the current gaps in the evidence base."

Sounds as if those at King's Fund think the government have been a bit "gung ho" in their approach to polyclinics.

I wonder if they have reflected on why this might be so.

Eh, My Black Cat?

a red apple ........................

The Witch Doctor - Link to a random page

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  Paying the Price: The Cost of Mental Health Care in England to 2026, 30th May 2008, Kings Fund

Click on the Report Title for full-text access

This report from the King's Fund, the results of a year-long study into the costs of meeting the mental health needs of the nation over the next two decades, reveals that mental illness in England cost £50 billion in 2007.  Almost half, £22.5 billion represents money spent on direct NHS and social care services to support people with mental disorders. The rest, £26.1 billion, represents the estimated cost to the economy of earnings lost because of the thousands of people unable to work due to their mental illness.

Although it finds that the prevalence of most mental disorders, including schizophrenia, is likely to remain stable over the next 20 years, it predicts a huge increase in dementia - up by almost two-thirds (61 per cent) from 582,827 to 937,636 due to an ageing population.  As a result of this, and above inflation rises in health care costs, the bill for mental health services is expected to grow from £22.5 billion to £47 billion.

The report contains chapters on eight different specific disorders: depression, anxiety disorders, schizophrenic disorders, bipolar and related conditions, eating disorders, personality disorder, disorders affecting children and adolescents, and dementia.

A MAJOR ELECTION ISSSUE?

The Witch Doctor fancies that David Cameron and his advisors feel the time is politically right for them to address the polyclinic issue.

DAVID CAMERON - TODAY'S SPEECH ON PRIMARY CARE

The Humankind don't click much for some reason, so here are some extracts.

But click too, will you!

SHOULD THE GOVERNMENT EMULATE SURGEONS OR GPs?

....."For too long the NHS has been treated by Government like a surgeon treats a patient - laid out unconscious on the operating table, passively receiving major invasive surgery. Instead we should treat the NHS more like a walking, talking, conscious adult, in its right mind: in need of treatment, yes, but able to understand what's going on and, most importantly, able to take significant responsibility itself. In a word, we politicians need to treat the NHS as if we were its GP, not its surgeon...."

ABOUT ASSAULTS ON THE NHS

"It is genuinely impossible, looking back, to trace any coherent direction in the path of Labour's health policy over the last 10 years. The one constant has been a restless series of changes which, to the NHS itself, have felt like a series of frontal assaults. It all reflects Labour's seduction by management consultants.

It's said in the private sector that no-one ever got fired for hiring IBM. The same seems to go for the NHS. You see it in all the constant upheavals: the PCGs and the PCTs, the SHAs and the StHAs, the fiasco of the junior doctors system which replaced recruitment by human beings with recruitment by a computer, and an incompetent computer at that; the billions - literally billions - of pounds of public money wasted.

It's all the product of Labour's bureaucratic mindset, or what I call policy by PowerPoint: clever flowcharts and organograms which ignore the human relationships that are the most important aspect of healthcare."

ABOUT THE GP CONTRACT

"It is fundamentally dishonest for the Government to blame GPs for agreeing to a contract that ministers negotiated and urged GPs to accept. Nor is it GPs' fault that they are being paid far more than they or the Government intended - it's the Government's fault for miscalculating doctors' workload. And that's what happens when you organise the health service using top-down bureaucratic methods dressed up to look good on a PowerPoint presentation."

ABOUT PRIVATE PROVIDERS

"I often can't help thinking that Labour have been blinded by the private sector - not just management consultants but private providers too."

ABOUT THE WORST OF BOTH WORLDS

"Indeed, the Government has spent 10 years oscillating between the rhetoric of local decision making on one hand and their instinct for central control on the other."

ABOUT THE ROLE OF THE GP

"And there is a good health rationale for GP budget-holding too: what's called the continuity of care. The family doctor service is the way to ensure that - even though the patients may see many specialists - there is always one doctor in charge: the doctor closest to the patient. This is especially important when it comes to preventative action or the management of chronic conditions, which require significant patient involvement."

ABOUT POLYCLINICS

"Now they are trying to abolish the family doctor service. Communities which have lost their Post Office, their local shops, their local police station, are going to lose their doctor. So the Conservative Party will fight Labour's plans to close GP surgeries. We pledge to save the family doctor service from Gordon Brown's NHS cuts."

ABOUT MODERNISATION

"A truly modern health service would enhance the small local GP surgery, not abolish it."

ABOUT GP'S PETITION

"I want us to establish now the consensus we need for a primary care led health service in the future."

ABOUT THE FUTURE

"So we will formally make the NHS independent of Government control. And then last - the conclusion of these reforms - a transformation of the Department of Health itself. From the national manager of primary and acute care, to the agency responsible for public health."

Well, My Black Cat, the NHS is going to become a major election issue.

Mr Brown would do well to realise that every voter in the land uses the NHS, works in the NHS, or has a close relative who uses or works in the NHS.

Everyone!

Elections can be won or lost on the NHS!

And sooner or later, this government's spin that is demeaning the medical profession, so that voters are blinded to the multinationals waiting in the wings, will turn sour.

On that we agree, My Black Cat.

a red apple ........................

The Witch Doctor - Link to a random page

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LINK TO MISSING PERSONS WEBSITE

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However, the publication also states that the lack of a systematic approach to ensuring safety across maternity services is creating unnecessary risks. It reports that there is an insufficient focus on maternity services and safety by trust boards; staff are overburdened with too many separate and complex guidelines; tension between obstetricians and midwives is leading to problems with team working & communication; and, often, there are an inadequate numbers of staff with the right skills on duty.

The inquiry calls for a range of practical improvements and identifies the key factors in improving safety as: stronger governance at board level, better team & multidisciplinary working, more training in safety, including training on the labour ward, and good management of staffing levels & skill mix.

Well if those who hold the purse strings, and ultimately decide staffing levels are not responsible for the service being safe, who is it down to? They have answered it by highlighting the pressures on staff. The pressures are there due to the neglect by senior managers. However, I don't believe that they should carry all the blame, the DoH and Government are just as much, if not more, responsible. It is they who keep throwing initiatives out, promising the public this level of care, that access to services but at the same time the budgets are not increased sufficiently for the facilities and staff to be provided, in fact monies are effectively cut by the Trusts in an effort to stay within the Government decided budget. The report actually states that the 'boards that oversee NHS Trusts have insufficient focus on maternity services' and I believe that this is true, as long as mortality and morbidity remain low they are not prodded into taking action but the report does 'call the the Trusts into action' as it goes on to advise that 'we could do better for mothers and their babies'.

I have blogged so much about the hand-to-mouth provision of care within the service. The obstetricians and midwives struggle to ensure that the service is 'safe' and on the whole we do well but women do not only want a service that is safe, they want the service that government, books and the media has lead them to expect. It is this that causes the majority of moans we read about on a regular basis, difficulty seeing a midwife when they want to, not only when it is scheduled; lack of attention from staff when they are in labour, on the wards or back home. Not enough help with breastfeeding, having to wait for painkillers and worse. On labour ward it would be lovely to provide one-to-one care but if there are more women than midwives that can never happen and attention will always be paramount for the high-risk cases. On the ward the problem is that if the ward is half full of women who have just had a major operation, C-Section, the staff are going to be more concerned about their post-operative recovery, that is a safety issue, the others demands on their attention, though hugely important, are not life-threatening.

So lets hear it for the staff on the ground because although they are under resourced they are still providing a safe service.

The report concludes that the overwhelming majority of births in England are safe, despite growing pressures on maternity services. However, it suggests that the lack of a systematic approach to ensuring safety across maternity services is creating unnecessary risks and calls for a range of practical improvements.

The NCT welcomes the report and agrees that more steps can and should be taken to improve the safety of maternity services.  As part of improving safety, it is important to prevent complications from developing by providing care which keeps as many births as normal as possible.

To achieve this, all women should have supportive, one to one midwifery care throughout labour and the NCT supports the recommendations made to increase investment in staffing. More midwives are needed in the service to help keep labour and birth normal.

It is vital that increased midwifery staffing levels are also managed effectively to make maximum use of available resources. Midwives should be well supported by administrative and maternity support staff so they are able to focus on providing care and not on basic administrative or housekeeping tasks. Midwives and obstetricians must be led and managed to form a cohesive well functioning team.