….. The past few months have witnessed the most intense and prolonged criticism of England’s National Health Service (NHS) in its 65-year history. Some critics have suggested that the NHS faces a crisis that can be resolved only by altering the fundamental principle on which it was founded ….
….. Never before has the NHS had to cope with no increase in funding for a sustained period. With rising demand, the NHS is required to improve its productivity at an unprecedented rate of 4% per year. The government is convinced that to achieve this improvement, two fundamental changes are needed…..
…… The first concerns the local commissioning organizations …..
…… Prolonged financial stringency and a reorganization were challenging enough without a high-profile report suggesting that NHS hospitals may not be safe….
…… For the NHS to survive in its present form, it will need to overcome four formidable challenges. The first is financial constraint. Although the government claims to be maintaining funding in real terms, high rates of inflation in health care plus some financial maneuvers, such as withholding from the NHS any funds in its budget that it hasn’t spent, mean there has been an actual funding reduction of almost 1% per year since 2011. Of greater concern is that social services have undergone a substantial cut of about 7% per year since 2011, which is resulting in more emergency admissions to hospitals and delays in discharges……
…… The second challenge is that the NHS may face opposition to its attempts to improve productivity. During the first 2 years of austerity, improvement was achieved mostly by freezing (or even reducing) staff pay, a policy that will not be sustainable. Similarly, driving down prices paid to suppliers for consumables cannot be extended indefinitely…..
….. The third challenge is a lack of managerial capacity, stemming largely from the government’s imposition of a reorganization that had little support from key staff members. This problem has been exacerbated by widespread criticism of managers, in the wake of the Francis Report, by members of the public, the media, and politicians…..
…… Finally, there is concern that the way the NHS has been reorganized will impede attempts to achieve greater integration of services across health care and with social services — integration that is essential to achieving efficient, high-quality care…..
…… So, will the NHS survive these challenges? …….
…… Although some of the challenges in England are unique, the underlying problem of meeting rising demand for care with steady or diminishing resources is faced by many countries. Just as we can learn from other health care systems, our experiences over the next few years in redesigning the organization and delivery of services will undoubtedly provide lessons for others…..
“For those of us on the front line of MSer care we are seeing the impact of these changes already. The complexity of the changes are bewildering to say the least, and to pin down people to take responsibility for making life and death decisions about changing MS treatments has been a roller coaster ride for me. In England we are not allowed to switch MSers on natalizumab to fingolimod who are at high risk of developing PML because NICE has not given fingolimod the green light for this indication. It doesn’t matter if one, two or three people develop PML and die from this complication. NICE has ruled and that’s it. What has happened to good old fashioned pragmatic clinical decision making?”
Multiple Sclerosis Research: Private prescriptions within the NHS
15 May 2013
“Our post on ‘Topping-up the NHS with private prescribing’ has generated a healthy debate. In response to a query yesterday I thought I would highlight an example of private prescribing within the NHS in relation to the …
Topping-up the NHS with private prescribing – Multiple Sclerosis …
13 May 2013
Topping-up the NHS with private prescribing. “At the MS Frontiers meeting, last week, one of the MSers dropped a bombshell in a trial meeting we had. He believes that if MSers want access to new and expensive DMTs and …
Multiple Sclerosis Research: Off-label prescribing
16 Dec 2012
Hence the frustration of Maurice Saatchi at the unwillingness of his wife’s oncologists to prescribe experimental drugs for his wife and his push for a private members bill. ” ‘Doctors are too scared of getting sued to make any …
ABN Debate: Brenner vs. Giovannoni on treating active MS
24 May 2013
“I also threw in a curved ball by getting Dr B in the case to prescribe more active DMTs using a private prescription under the NHS; please note this was a fictitious scenario, but quite possible in the ‘new NHS’. The socialists in …
Multiple Sclerosis Research: Is the NHS over?
17 May 2013
“The following are the preliminary results of the survey we have been running in response to the private prescriptions debate that has been raging on the blog. If you have missed out I would urge you to read the two posts …