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A Brighton GP surgery is under threat despite providing excellent services and strong links to the local community. This decision flies in the face of the proven 'social value' being delivered and potentially puts patients at risk. The reasons are presented in this excellent article which exposes the continued 'race to the bottom' due to an apparently unnecessary tendering exercise, a decision made behind closed doors and a failure to consult. Quote from Polly Toynbee's article in the Guardian: "Here’s the puzzle. Andrew Lansley’s calamitous system that opened the NHS to “any willing provider” to compete for contracts was supposedly swept away in 2022, replaced with ICBs that strove for cooperation across all NHS and social services in England. Yet some ICBs still apply the old competitive impulse to NHS services, even though they now have an obligation to ensure that tenders help to reduce inequalities."

This guidance offers high-level information to assist those adopting ambient scribing products that feature Generative Artificial Intelligence (AI), for use across health and care settings in England. These products are sometimes referred to as ambient scribes or AI scribes and include advanced ambient voice technologies (AVTs) used for clinical or patient documentation and workflow support. The guidance is intended for settings aiming to implement a specific product or function of an existing product. 

The Health and Social Care Secretary's statement to the House of Commons on plans to abolish NHS England.

In this Health Services Journal article, Alastair McLellan looks at the financial planning challenges facing Daniel Elkeles as he takes up the position of Chair of NHS England. The article suggest that NHS Providers should prioritise making the challenges facing trusts clear to the Government and NHS England. It also suggests the need for a patient approach to ensure that all parties understand the implications of financial agreements that are made.

This report from the All Party Parliamentary Group (APPG) on Eating Disorders highlights the urgent need for a national strategy to address the growing eating disorder crisis in the UK. It is based on evidence given by people with eating disorders, carers, healthcare professionals, managers and academics, alongside information obtained from Freedom of Information requests and data analysis. You can find out more about this report in this blog by Hope Virgo, author and Secretariat of the APPG. The report reveals that: people face significant barriers to accessing treatment. healthcare providers are insufficiently trained. care pathways are fragmented. there is a lack of standardised data around eating disorders. there is a postcode lottery in service provision. patients are at times being discharged from services with dangerously low BMIs. The report makes five recommendations that call on the Government to: develop a national strategy for eating disorders. provide additional funding for eating disorder services This funding should address the demand for both adult and children’s services. launch a confidential inquiry into all eating disorder deaths. increase research funding for eating disorders: The aim is to enhance treatment outcomes and ultimately discover a cure for eating disorders. ensure non-executive director oversight for adult and children's eating disorder services. This oversight and accountability should be implemented in all NHS Trusts and Health Boards in the UK.

The Covid-19 pandemic, which rapidly escalated into a global crisis that impacted millions of lives and disrupted economies around the world, was a wake-up call for the management of infectious disease outbreaks. Dr Stella Chungong and Dr Landry Ndriko Mayigane work for the Health Security Preparedness Department in the World Health Organization’s Health Emergencies Programme. In this article, they encourage countries to implement early action reviews (EARs) of disease outbreaks. EARs help countries assess their vigilance, planning and responsiveness, and could help countries be better prepared during outbreaks.  The guidelines detail three time-based metrics, named 7-1-7, which offer a simple, structured approach to outbreak management: 7 Days to Detect, which measures how quickly the country can detect a suspected disease outbreak, with the aim being detection within 7 days. 1 Day to Notify, which measures the time taken to notify relevant public health authorities and stakeholders, with the aim being notification within 1 day. This goal is not new; it is consistent with the International Health Regulations (2005) that require countries to notify the relevant authorities within 24 hours of detecting a disease outbreak. 7 Days to Respond measures how quickly the country can establish a response to the outbreak, the aim being the instigation of effective response actions within 7 days.

To deliver value for money over the medium to long term, a government needs to turn its objectives into outcomes in a way that delivers the best value for every pound of taxpayers’ money while managing its fiscal position. It needs to: plan and prioritise its spending (and other activities) to address those objectives. monitor and manage both costs and value delivered. evaluate the results. adjust as necessary. report to Parliament on how it has used taxpayers’ money. This report by the National Audit Office aims to provide useful insights as officials and ministers are making changes to the planning and spending framework. It will also be useful to Parliamentarians and stakeholders seeking to scrutinise government spending and delivery.

In 2016, Lord Carter’s report Operational productivity and performance in English NHS acute hospitals highlighted the potential to save £1.275 billion by enhancing estate efficiency across the NHS in England. This report looks at estate costs and performance in 2022/23 compared to those observed by Lord Carter in 2014/15. It is based on NHS trusts’ annual Estates Returns Information Collection (ERIC) submissions. Report highlights: Over the past 9 years, the cost of occupancy – the total expenses associated with occupying and operating buildings – across NHS secondary care has fallen by £0.24 billion, from £12.2 billion in 2014/15 to £11.9 billion in 2022/23 (in 2022/23 values). The number of patients using these facilities each year has increased by 13.8 million, from 123.9 million in 2014/15 to 137.7 million in 2022/23. The non-clinical occupied floor area has dropped from 44% to 33% of the total estate, below Lord Carter’s 35% target. With the integration of new technologies and modern working methods, trusts are aiming to further reduce non-clinical space to below 30%. The amount of floor area used for each patient attendance has decreased by 7% in the same period, contributing to the lower overall occupancy costs. Under-utilised occupied floor area has dropped to 1.9% from 4.4% in 2014/15. More than 1,850 energy efficiency schemes have been implemented since 2018/19. 81 new combined heat and power (CHP) units have been installed and 47% of the estate is now using LED lighting. Estates and facilities management teams have reduced the ongoing cost of their services by 17% (£2.24 billion or £16 per attendance).

The UK is the “sick man” of Europe at the moment—on almost every health indicator including life expectancy, healthy life expectancy, obesity rates and healthcare capacity—we lag behind our peers. Recent data from the Office for National Statistics shows the substantial impact this is having on our national prosperity. The number of people who cannot work primarily because of long-term illness reached a record nearly 2.6 million. In this article for The Guardian, Professor Dame Sally Davies, former chief medical officer for England, argues that this is not the first time the UK has lagged behind on health outcomes and faced the associated economic harm. During the 19th-century Industrial Revolution and the 20th-century post-war period, Britain faced health crises that, like today’s, also undermined labour supply, economic participation and growth. She highlights that in both of these instances, national leaders implemented bold new public health strategies on both health and economic grounds and asks the question, 'Why is the Government not taking a more comprehensive policy approach to tackling the serious health issues we face in 2023?'

This is the report of a review into how the executive leadership of the NHS could be better supported and empowered to ensure the best possible service is delivered for patients. Sir Ron Kerr was commissioned by the Department of Health and Social Care (DHSC) to conduct the review, which focused on three issues in particular: The expectations and support available for leaders - particularly those in challenging organisations and systems The scope for further alignment of performance management expectations at the organisational and system level The options for reducing the administrative burden placed on executive leaders The report describes the methodology of the review, outlines its findings and makes a number of recommendations around these issues.

When many people think about NHS services they often think about clinical staff, such as doctors or nurses, and how they deliver care and interact with patients and families. However, in the context of patient safety, there is often more to see ‘behind-the-scenes’ in non-patient facing services. These services may be less visible, but they play a vital part in ensuring patient safety. Understanding the importance of these services, and how they are crucial to the ability of the NHS to operate effectively, is often underestimated. In this blog for the Healthcare Safety Investigation Branch (HSIB), National Investigators Russ Evans and Craig Hadley highlight how 'behind-the-scenes' services are crucial to help the NHS operate effectively and safely.

The government’s long term workforce plan, developed by NHS England, was finally published on 30 June, having first been promised more than five years ago by the then secretary of state for health and current chancellor, Jeremy Hunt. The plan is a welcome and necessary step towards solving the workforce challenges that have vexed the health service, although it is more of a jigsaw puzzle than a masterplan. The overall picture of a future NHS workforce with many more staff, increasingly working in more diverse multidisciplinary teams, and with greater support from technology, is encouraging but several pieces are missing from the vision and roadmap for its delivery, writes William L Palmer and Rebecca Rosen in this BMJ Editorial.

The presentation was held following the inaugural William Rathbone X Lecture, given by Professor Alison Leary, who spoke on the highly topical subject, ‘Thinking differently about nursing workforce challenges.’ The presentation can be watched from The Queen's Nursing Institute website.

The first comprehensive workforce plan for the NHS, putting staffing on a sustainable footing and improving patient care. It focuses on retaining existing talent and making the best use of new technology alongside the biggest recruitment drive in health service history. Train – Grow the workforce By significantly expanding domestic education, training and recruitment, we will have more healthcare professionals working in the NHS. This will include more doctors and nurses alongside an expansion in a range of other professions, including more staff working in new roles. This Plan sets out the path to: Double the number of medical school training places, taking the total number of places up to 15,000 a year by 2031/32, with more medical school places in areas with the greatest shortages, to level up training and help address geographical inequity. To support this ambition, we will increase the number of medical school places by a third, to 10,000 a year by 2028/29. The first new medical school places will be available from September 2025. Increase the number of GP training places by 50% to 6,000 by 2031/32. We will work towards this ambition by increasing the number of GP specialty training places to 5,000 a year by 2027/28. The first 500 new places will be available from September 2025. Increase adult nursing training places by 92%, taking the total number of places to nearly 38,000 by 2031/32. To support this ambition, we will increase training places to nearly 28,000 in 2028/29. This forms part of our ambition to increase the number of nursing and midwifery training places to around 58,000 by 2031/32. We will work towards achieving this by increasing places to over 44,000 by 2028/29, with 20% of registered nurses qualifying through apprenticeship routes compared to just 9% now. Provide 22% of all training for clinical staff through apprenticeship routes by 2031/32, up from just 7% today. To support this ambition, we will reach 16% by 2028/29. This will ensure we train enough staff in the right roles. Apprenticeships will help widen access to opportunities for people from all backgrounds and in underserved areas to join the NHS. Introduce medical degree apprenticeships, with pilots running in 2024/25, so that by 2031/32, 2,000 medical students will train via this route. We will work towards this ambition by growing medical degree apprenticeships to more than 850 by 2028/29. Expand dentistry training places by 40% so that there are over 1,100 places by 2031/32. To support this ambition, we will expand places by 24% by 2028/29, taking the overall number that year to 1,000 places. Train more NHS staff domestically. This will mean that we can reduce reliance on international recruitment and agency staff. In 15 years’ time, we expect around 9– 10.5% of our workforce to be recruited from overseas, compared to nearly a quarter now. Retain – Embed the right culture and improve retention By improving culture, leadership and wellbeing, we will ensure up to 130,000 fewer staff leave the NHS over the next 15 years. We will: Continue to build on what we know works and implement the actions from the NHS People Plan to ensure the NHS People Promise becomes a reality for all staff by rolling out the interventions that have proven to be successful already. For example, ensuring staff can work flexibly, have access to health and wellbeing support, and work in a team that is well led. Implement plans to improve flexible opportunities for prospective retirees and deliver the actions needed to modernise the NHS Pension Scheme, building on changes announced by the government in the Spring Budget 2023 to pension tax arrangements, which came into effect in April 2023. From autumn, recently retired consultant doctors will have a new option to offer their availability to trusts across England, to support delivery of outpatient care, through the NHS Emeritus Doctor Scheme. Commit to ongoing national funding for continuing professional development for nurses, midwives and allied health professionals, so NHS staff are supported to meet their full potential. Support the health and wellbeing of the NHS workforce and, working with local leaders, ensure integrated occupational health and wellbeing services are in place for all staff. Explore measures with the government such as a tie-in period to encourage dentists to spend a minimum proportion of their time delivering NHS care in the years following graduation. Support NHS staff to make use of the change announced in the Spring Budget 2023 that extended childcare support to working parents over the next three years, to help staff to stay in work. Reform – Working and training differently Working differently means enabling innovative ways of working with new roles as part of multidisciplinary teams so that staff can spend more time with patients. It changes how services are delivered, including by harnessing digital and technological innovations. Training will be reformed to support education expansion. It will: Focus on expanding enhanced, advanced and associate roles to offer modernised careers, with a stronger emphasis on the generalist and core skills needed to care for patients with multimorbidity, frailty or mental health needs. This includes setting out the path to grow the proportion of staff in these newer roles from around 1% to 5% by the end of the Plan by: Ensuring that more than 6,300 clinicians start advanced practice pathways each year by 2031/32. We will support this ambition by having at least 3,000 clinicians start on advanced practice pathways in both 2023/24 and 2024/25, with this increasing to 5,000 by 2028/29. We will increase training places for nursing associates (NAs) to 10,500 by 2031/32. We will work towards this by training 5,000 NAs in both 2023/24 and 2024/25, increasing to 7,000 a year by 2028/29. By 2036/37, there will be over 64,000 nursing associates working in the NHS, compared to 4,600 today. o Increasing physician associate (PA) training places to over 1,500 by 2031/32. In support of this, around 1,300 physician associates (PAs) will be trained per year from 2023/24, increasing to over 1,400 a year in 2027/28 and 2028/29, establishing a workforce of 10,000 PAs by 2036/37. Grow the number and proportion of NHS staff working in mental health, primary and community care to enable the service ambition to deliver more preventative and proactive care across the NHS. This Plan sets out an ambition to grow these roles 73% by 2036/37. Work with professions to embrace technological innovations, such as artificial intelligence and robotic assisted surgery. NHS England will convene an expert group to identify advanced technology that can be used most effectively in the NHS, building on the findings of the Topol Review. Expand existing programmes to demonstrate the benefits of generalist approaches to education and training and ensure that, at core stages of their training, doctors have access to development that broadens their generalist and core skills. Work with partners to ensure new roles are appropriately regulated to ensure they can use their full scope of practice, and are freeing up the time of other clinicians as much as possible – for example, by bringing anaesthesia and physician associates in scope of General Medical Council (GMC) registration by the end of 2024 with the potential to give them prescribing rights in the future. Support experienced doctors to work in general practice under the supervision of a fully qualified GP. We will also ensure that all foundation doctors can have at least one four-month placement in general practice, with full coverage by 2030/31. Work with regulators and others to take advantage of EU exit freedoms and capitalise on technological innovation to explore how nursing and medical students can gain the skills, knowledge and experience they need to practise safely and competently in the NHS in less time. Doctors and nurses would still have to meet the high standards and outcomes defined by their regulator. • Support medical schools to move from five or six-year degree programmes to four-year degree programmes that meet the same established standards set by the GMC, and pilot a medical internship programme which will shorten undergraduate training time, to bring people into the workforce more efficiently so that in future students undertaking shorter medical degrees make up a substantial proportion of the overall number of medical students. The Plan is based on an ambitious labour productivity assumption of up to 2% (at a range of 1.5–2%). This ambition requires continued effort to achieve operational excellence, reducing the administrative burden through technological advancement and better infrastructure, care delivered in more efficient and appropriate settings (closer to home and avoiding costly admissions), and using a broader range of skilled professionals, upskilling and retaining our staff. These opportunities to boost labour productivity will require continued and sustained investment in the NHS infrastructure, a significant increase in funding for technology and innovation, and delivery of the broader proposals in this Plan.

This report assesses why NHS hospitals are failing to deliver higher activity despite higher spending on the service and higher levels of staffing over the last couple of years. It argues that politicians need to urgently focus on capital investment, staff retention and boosting management capacity, and sets out key questions for policy makers to address if they want to solve the NHS crisis. The NHS has been on a longer-term negative trajectory: most of the challenges identified in the report existed before the pandemic and have been exacerbated since.

The King's Fund compared the healthcare systems in different countries by doing three things: Reviewed the research literature and assessed previous attempts to rank and compare health care systems. Interviewed academic experts in international health care policy and experts who had extensive knowledge of the UK, German and Singaporean healthcare systems. Analysed the latest quantitative performance data for the UK health care system and the health systems of 18 higher-income peer countries.  They analysed data in three main domains:  the context the health system operates in (eg, the health status and behaviours of the population)  the resources a health system has (eg, levels of staffing, equipment and health care spending)  how well the health care systems uses its resources and what it achieves as a result (eg, measures of efficiency in delivering services, quality of care, financial protection from the costs of ill health, and health care outcomes).  Key points: The analysis found the UK healthcare system has fewer key resources than its peers. It performs relatively well on some measures of efficiency but waiting times for common procedures were ‘middle-of-the-pack’ before the Covid-19 pandemic and have deteriorated sharply since. The UK performs well on protecting people from some of the financial costs of ill health, but lags behind its peers on important healthcare outcomes, including life expectancy and deaths. The latter could have been avoided through timely and effective healthcare, and public health and preventive services. There is little evidence that one particular ‘type’ of health care system or model of health care funding produces systematically better results than another. Countries predominantly try to achieve better health outcomes by improving their existing model of healthcare, rather than by adopting a radically different model.

This stocktake by NHS Confederation highlights insights from medicines optimisation forums on the experience of ICS medicines optimisation so far: the opportunities that exist, the barriers experienced, the support that is needed, and what the vision for medicines optimisation could achieve. Recommendations System leadership. ICS leaders, including but not limited to chief pharmacists, should ensure that medicines optimisation teams are mainstream in projects and service redesigns from the start, so downstream effects and preventative impact of medicinal interventions, alongside social prescribing, can be considered and ensure best value. Establish the right governance. ICS should consider establishing a clear board-level medicines lead, supported by appropriate system-wide committees and sub-committees, which help to provide multi-disciplinary expertise to drive transformation across each system. Governance arrangements should ensure a better balance with medicines optimisation teams between time spent on operational and transformational activity. Build one medicines optimisation team. Alongside developing pharmacy workforce plans that develop innovative and rotational roles, ICBs should consider how they can build awareness of medicines optimisation right across the system including into social care, providing training where necessary. Harness digital and data. Use shared care records to enable access to medicines information for relevant healthcare professionals across care pathways. Meanwhile, use system-wide data to assess incidence of avoidable harm, specifically inappropriate sodium valproate prescribing, as well as medicines expenditure, to establish an initial baseline in each system to measure success and improvement going forward. Shared learning and self-improvement. ICSs should be supported to share learning about their respective progress transforming medicines optimisation to drive a process of peer learning and self-improvement. This could include learning on how different systems are delivering improvement in risk assurance; data analytics; digital interoperability; pharmacy workforce planning; development of rotational and cross-sector roles; and integrating medicinal and social prescribing.

The NHS in England’s annual budget is £161 billion. Yet across the sector there is huge cause for concern, including the still-growing backlog, workforce issues, the state of the estate and the relentless demand on primary care. In this blog, ex-NHS strategic health authority chief executive Mike Farrar and Health Policy Insight editor Andy Cowper look at how these issues can be tackled to provide an NHS that meets the needs of the population. They cover the following subjects: Politics, policy and prevention System working and pivoting to prevention - how to shift resources Building a compelling case for change Moving towards less top-down-ism Being clear about what an ICS is for Culture change and mindsets shifts Resourcing change