Medical practice

New NHS planning guidance puts patient first

Many newspapers are reporting new planning guidance for the NHS released by the NHS Commissioning Board, which it says will "drive a revolution for patients…giving them greater control of their health."

It's a substantial document and different papers focus on different areas – BBC News focuses on the recommendation that the NHS provides services seven days a week, while The Guardian and The Daily Telegraph focus on the announcement that more surgical outcome data will be made available.

The new guidance is published by the NHS Commissioning Board, a new body set up as part of the government's NHS reform programme, which will oversee the spending of England's £95.6bn NHS budget from April 2013.

Among the many initiatives and changes it sets out, the following are likely to be seen as especially pertinent to NHS patients:

  • A move towards routine NHS care seven days a week – a change prompted by data that shows some hospitals have higher out-of-hours death rates than would normally be expected, and a concern that valuable facilities and services (scanners, operating theatres etc) should be made maximum use of at times that suit patients.
  • Much greater availability and use of clinical performance data. This will be used to drive quality improvements within the NHS and will also be made available on websites such as NHS Choices, so that patients can see clearly which NHS services are best and worst. The document says that even the performance of consultants will be published.
  • A greater focus on collecting patients' views on the care they receive. Patients are already able to rate and comment on NHS services via NHS Choices, and in future all hospitals will need to collect similar data in "real-time" (before patients leave hospital). This will also be made available for others to see and inform their choice of health provider.

Who produced the guidance?

'Everyone counts: Planning for Patients 2013/14' has been published by the NHS Commissioning Board, which will take on its full responsibilities from April 1 2013 and has the main aim of improving health outcomes for people in England.

In discussing the role of the NHS Commissioning Board (NHS CB), Sir David Nicholson, chief executive of the NHS and NHS CB, says: "At the heart of our approach is local control over decision making. We want to put power in the hands of clinicians who know their patients best. We want to give them money, information and tools to do the job. And we want the public to have the information they need to make choices and participate fully in the development of their health services."

In addition to the budget for clinical commissioning groups (CCGs), the NHS Commissioning Board will fund some services for the first time from April 2013, including:

  • specialised healthcare
  • primary care (general practice)
  • services for the military
  • prison and offender health

It puts the budget for these services at £25.4bn, a 2.6% increase for the same services for the 2012/13 period.

What recommendations did the guidance make?

The NHS Commissioning Board has provided five "offers" to NHS commissioners (those who fund services) to give them the guidance and evidence they need to produce better local health outcomes.

These are:

  • A move towards routine NHS care seven days a week. A forum led by the board's national medical director will report in autumn 2013 on ways to improve access to services seven days a week. The first stage of this review will focus on improving availability of diagnostic services, urgent and emergency care.
  • Greater transparency on doctors' performance and clinical outcomes, and more choice for patients.
  • Mechanisms to help patients give and use feedback, starting with a 'Friends and Family Test' that asks patients whether they would recommend a service to their loved ones. This will be introduced for all A&E and acute hospital inpatients from April 2013, and for maternity services from October 2013. Additionally, by 2015 all NHS patients should be able to give feedback on their care in "real-time".
  • Systematic collection of data on the performance of health and social care services to help those planning NHS care to monitor and drive up standards.
  • Ensuring high professional standards across care.

The guidance outlines that from 2013 it will be a requirement to publish clinical measures – including survival rates – from national audits for consultants (specialist medical doctors) across the following 10 medical and surgical specialties:

  • adult cardiac surgery – surgery to treat heart problems in adults, such as coronary heart bypass surgery or heart valve surgery
  • interventional cardiology – less invasive treatment most commonly used to widen blocked heart blood vessels (under X-ray imaging, a stent can be introduced via the artery in the leg and guided towards the heart)
  • vascular surgery – other types of surgery involving the blood vessels
  • upper gastrointestinal surgery – surgery of the stomach and intestines
  • colorectal surgery – surgery of the colon and/or rectum
  • orthopaedic surgery – surgery involving the bones, muscles and joints
  • bariatric surgery – weight-loss surgery
  • urological surgery – surgery involving the urinary tract (the kidneys, bladder or urethra)
  • head and neck surgery
  • thyroid and endocrine surgery – surgery to treat hormonal conditions, such as an underactive or overactive thyroid gland

The report says this data will allow comparisons to be made across hospitals by 2014/15 and help patients choose the best care for them. It is likely that the data will be made available on the NHS Choices website.

NHS Attribution