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Health Policy Today - Monday 16th June

Tom Smith on today’s health policy debate.
The big story of the day is the Healthcare Commission’s warning that NHS trusts have 10 months to get on track with the management of hospital acquired infections or face the consequences of being labelled a failing trust.  The weekend’s papers continued to debate polyclinics, making the grounds for disagreement between the government and doctors more clear.  Both the FT and the Sunday Times reported that the Government is set to rewrite its rules on allowing co-payments in the NHS.

NHS trusts warned to clean up their act by the Healthcare Commission

Questions will be asked about the competence of the government after it was revealed no improvement has been made in dealing with hospital acquired infections.  Last year 1 in 4 trusts failed to meet minimum standards and this year the same proportion are failing – 103 from 391 say that have not them.
Last year’s Annual Health Check was published 6 weeks or so into Brown’s premiership.  In response he promised that hospitals would be ordered to undergo a ‘deep clean‘.   For the Independent, while Gordon Brown’s announcement sounded good, ‘there was a problem: there was no clinical evidence to suggest this was where effort ought to be directed‘.  It was human behaviour – and hand washing routines – that were problematic, not necessarily dirty wards.  But despite the evidence, ‚‘the Prime Minister ploughed on anyway because the idea of a deep clean was deemed a way of communicating to the typical voter how seriously he was taking the problem“.  
The poor results will be embarrassing to the government and is likely to lead in extra pressure being exerted on managers – of the kind we two weeks ago with announcements that Foundation Trusts or even private management could take over failing hospitals.
The survey from the Healthcare Commission is the first part of the organisation’s work in collecting information with which to publish this year’s Annual Health Check.  The Healthcare Commission say that despite huge political and public pressure on hospitals to protect patients...many NHS trusts are failing to put necessary measures in place.  The Commission warn that if hospitals continue to miss standards then they could face closure: NHS trusts have 10 months to meet the target and the Commission’s report is described as “a wake up call“.

The polyclinic debate is beginning to settle – on a mixed model of primary care

After a fraught couple of weeks there are signs that the polyclinic argument may begin to settle.  The Sunday Times summed up the debate in calmer terms.  They use two patients to illustrate that different groups want different things from the Health Service.  
Against polyclinics, is a woman who used to be part of a large clinic, where she saw different doctors on each visit.  She blames this lack of continuity for their failing to refer her for a potential brain tumour, which was eventually diagnosed after she’d paid privately for an MRI scan.  For polyclinics is a father of two who works full-time, as does his wife.  He says a large centre that is open for longer is exactly what he needs.  According to the Sunday Times, their opposing views show that the country is divided on the issue.
In the previous week, the Sunday Times commissioning a poll from ICM.  It shows a real mix of views – 36% for polyclinics, 42% against and 22% undecided or unsure.
The answer seems to be that there should be a mix of services available, so those who value access can gain it quickly while those who prefer continuity can see the same doctor (perhaps waiting longer).  Beneath the story, readers are invited to comment.  One GP asks why, even in a polyclinic, a patient cannot see a doctor of their choice.  He sees no contradiction between the models.

Ken Clarke: ‘I believe in a free NHS, but this will be hard to defend‘

The BBC’s Politics Show (East Midlands edition) had devoted a section of Sunday’s programme to the 60th anniversary of the NHS, which featured a long interview with Nottingham MP and former health secretary, Ken Clarke, talking about his battles with the BMA and his attitude to the NHS.
Clarke says he “fervently” believes in an NHS funded from general taxation, that is free to its users.  He warns, however, that future health secretaries may have to “wade through political blood” to keep these principles in tact.

Insurance scheme launched that will pay for expensive drugs in order for the NHS to administer

An article in Saturday’s Daily Mail reported the first insurance scheme that is designed to pay for the most expensive drugs.  ‘The policy is unique in that it gives patients access to a legal helpline and free legal advice if they face being penalised by having NHS treatment withdrawn as a result‘.
The Western Provident-Association will offer policies from between £15 and £24 per month.  The cancer drugs option will cost £4.20 per month on top.  The Association clearly believes that the government is legally wrong to disallow patients from NHS care if they seek private treatment for their illness, as Chief executive Julian Stainton explains

A spokesperson for the Department of Health clarified its position.  Patients are free to take treatments not available on the NHS.  But “the additional treatment may make involve some associated care which cannot be provided separately“.  In these cases, the patient must be treated privately for the whole of that package of care“.

Government to change rules on co-payments

It seems like the government has been giving a lot of thought to its position and over the weekend both the Financial Times and the Sunday Times – which has been playing a leading role in the debate, reported that the government is likely to change its rules.  
The Sunday Times said the government had been ‘forced’ to rethink the issue, a move which the FT says was signalled as Downing Street said there was “no single solution“ to the issue and said “it was right that the concerns people have expressed are given consideration“.
The FT said the government’s move will be ‘partly addressed‘ by the Darzi review to be published in a few weeks.