NHS England has published new interim specialised commissioning service specifications, setting out the standards it expects providers to put in place in order to deliver high quality services. The specifications, which cover a range of services commissioned by NHS England, including cancer, kidney, rheumatology and vascular services, are available on individual Clinical Reference Group (CRG) websites and will be in place until October 1^st 2013. NHS England will continue to work with CRGs to develop specifications for 2013/14, to be published later this year.

Public Health England (PHE) has launched a new website which maps out premature deaths by local authority area in England. The Longer Lives website shows rates of under-75 deaths for cancer, stroke, and heart, lung and liver diseases, ranking different areas with a traffic light system. The figures show that there is wide geographical variation, with premature death rates from cancer ranging from 82.5 per 100,000 in Harrow, to 152 per 100,000 in Manchester. PHE expect the figures to be used by local authorities and Directors of Public Health to inform decision making and resource allocation.

NHS England has published its strategy for the future development of commissioning support services. The strategy sets out NHS England’s plans to ensure commissioning support provides innovative, value for money services and is responsive to Clinical Commissioning Group needs. It consists of three main elements:

• Enabling CCGs to exercise informed choice of how they source their commissioning support and from whom, including the launch of a new ’choice app’ for CCGs
• Building a strong cohort of excellent commissioning support providers, including investing in the development of CSUs, with the aim that they are autonomous by 2016
• Ensuring the establishment of efficient procurement mechanisms which enable fair and open competition.

NHS England has also published a procurement guide which explains how commissioners can change providers of commissioning support.

Monitor and NHS England have announced that under the new National Tariff for NHS services, which will be introduced in April next year, prices will remain close to current levels. Ahead of a formal consultation in the autumn, Monitor and NHS England are seeking views on their plans for the Tariff, which include proposals to set efficiency targets for providers of 3-4.5%.

The Health and Social Care Information Centre has published an updated version of the Innovation Scorecard. The Scorecard brings together data about the use of NICE recommended medicines and treatments to highlight variation between NHS organisations. While the Scorecard includes a number of new medicines, it does not cover any in-patent Sanofi medicines. In response to the publication, the ABPI has called for the next Scorecard, due to be published in September, to cover more new treatments.

Oncology

PHE has announced that it is setting up a new cancer database for England. The new service will contain detailed clinical information on all cancers diagnosed each year in England, based on monthly data collection from every acute NHS trust, as well as more than 11 million historical cancer records. PHE has stated that it will eventually track how each sub-type of cancer responds to treatment, which will help the development of personalised cancer medicines. This single cancer registry follows the completion of a five-year project to merge the eight cancer registries in England into a centrally managed network overseen by PHE.

New research published by Macmillan Cancer Support and the National Cancer Intelligence Network has found that there are currently around 400,000 people in England who have survived cancer between ten and 20 years after diagnosis. The findings show that a similar number of men and women survive the early years after diagnosis; however a gender gap develops between ten and 20 years, with almost twice as many women alive in this group.

Diabetes

A survey of more than 800 type 1 diabetics has found that 77% have never been offered the chance to participate in a study of the condition. The survey, published by JDRF, also found that 72% have never been told about medical research by their clinical team. They estimate that less than 3% of those living with type 1 diabetes are currently taking part in a trial.

The short stay was a bargain by booking through a local ferry company http://www.redfunnel.co.uk/ and the journey time around one hour across the Solent from Southampton to East Cowes was so much more pleasurable than a traditional airport experience.

VoyageMD stayed at a relatively new spa hotel http://www.lakesideparkhotel.com/ which, on the outside, bore an uncanny resemblance to an elderly care nursing home. The facilities were actually very good, the deal inexpensive but the front door staff were relatively disinterested – this may have been due to boredom as there were very few guests around. The bistro food was excellent especially the local seafood dishes – definitely worth a try.

When the sun shines the Isle of Wight comes into its own and there is something for everyone. For this trip the itinerary included:

• The Garlic Farm http://www.thegarlicfarm.co.uk/
• Visits to the seaside (Sandown, Shanklin and Vetnor)
• A glorious walk around Luccombe – you need to be fit! http://www.isleofwightattractions.co.uk/LuccombeWalk.htm
• The best ever crab sandwiches at the Bonchurch Inn http://www.bonchurch-inn.co.uk/
• A long walk down to the coloured sands at the Needles http://www.theneedles.co.uk as the chairlift was not working
• Strolling around Yarmouth (this doesn’t take very long)

Eating authentic food from the Basques region of Spain in West Cowes http://amabi.co.uk/

Other pluses included little traffic congestion, wonderful scenery and views which change every few miles and how astonishingly easy it is to park your car – often for free! One must visit place of course is Osborne House, the family home of Queen Victoria http://www.english-heritage.org.uk/daysout/properties/osborne/.

Negatives were few but the rather old fashioned feel to the seaside areas might not be for everyone. VoyageMD did note the surprisingly high frequency of overweight and obesity (as well as tattoos!) but this may have been visitors to the island rather than locals.

So after 3 days and two nights on blisteringly hot June days on the Island, Voyage MD spent the final part of the holiday “glamping” in Mongolian Yurts near Sopley back on the mainland http://www.forestyurts.com/. This is camping without the pain (proper bed, hot showers, gas BBG, camp fire etc all provided) with the added bonus of fishing as the Yurts are right beside the local lake.

Now back at work and planning eh next trip which will be most likely the American Diabetes Association Meeting in Chicago  – VoyageMD may see some of you there..!

‘The Mandate’ is a document setting out the Government’s overall objectives for the NHS. It highlights those areas of health and care in which the Government expects to see improvements. The first Mandate was published in November 2012 and details a broad set of objectives which the NHS need to deliver on between 2013 and 2015 in order to help improve the quality of care.

The Mandate sets out five areas in which the Government expects the NHS to make particular progress, which correspond to the priorities set out by the Health Secretary, Jeremy Hunt, when he took office:

• Preventing premature deaths from the biggest killers.
• Supporting people with multiple long-term physical and mental health conditions, particularly by embracing opportunities created by technology and delivering a service that gives equal value to mental and physical health.
• Improving standards of care more broadly, not just through treatment, especially for older people and at the end of people’s lives.
•  Furthering economic growth, including supporting people with health conditions to remain in, or find, work.
• The diagnosis, treatment and care of people with dementia. The actual objectives outlined are aligned with the five domains of the NHS Outcomes Framework, but also include factors which impact on care outside of this, such as financial management, improving innovation, joint working and economic growth.

Key objectives include:

• To ensure people have access to the right treatment when they need it, including drugs and treatments recommended by NICE.
• To make measurable progress towards England becoming one of the most successful countries in Europe at preventing premature deaths by 2016.
• To make measurable progress towards making the NHS among the best in Europe at supporting people with on-going health problems to live healthily and independently.
• To continue to reduce avoidable harm and make measurable progress in embedding a culture of patient safety in the NHS including an improvement in the reporting of incidents.
• To inspire and help people to learn from the best by shining a light on variation and unacceptable practice.
• To make rapid progress in measuring and understanding how people really feel about the care they receive and taking action to address poor performance.
• To ensure good financial management and unprecedented improvements in value for money across the NHS, including ensuring the delivery of its contribution, and that of Clinical Commissioning Groups (CCGs), to the QIPP programme.

Why?

As part of the reforms to the Health Service in England, the Government has passed responsibility for the day-to-day running of the NHS to a new independent body, the NHS Commissioning Board (NHSCB).

The Mandate is now the main basis of Ministerial instruction to the NHS, which must be independent and clinically-led. It clearly sets out the strategic direction for the NHSCB and ensures it is democratically accountable. It cannot be changed in the course of the year without the agreement of the NHSCB, other than in exceptional circumstances, including a general election. The Mandate is therefore intended to set a long term agenda and provide the NHS with much greater stability to plan ahead and innovate. In addition to this, the Government believes the Mandate will also enable them to:

• Set out their priorities clearly and concisely so they are transparent and can be easily understood.
• Give the NHSCB the operational freedom to decide how best to deliver on their outlined objectives.
• Hold the NHSCB to account for the money it spends and the outcomes it achieves.
• Drive forward an outcomes based approach with greater emphasis on putting patients at the heart of the NHS.
• Embed the principle of local autonomy and innovation, as well as empower patients, service users and carers.

How?

The NHSCB is legally bound to pursue the objectives set out in the Mandate and it must report annually on its progress. The Government will publish a yearly assessment of the Board’s performance, which will include feedback from CCGs, local councils, patients and other stakeholders. It is not yet clear exactly what action the Government will take if the NHSCB is judged to be failing to deliver on the objectives.

The Mandate states that in order to fulfil its objectives, the NHSCB should give local commissioners, providers and health and wellbeing boards the autonomy to deliver better health outcomes in their areas. To support the achievement of the objectives on a local level, the NHSCB will use mechanisms and incentive schemes such as the CCG Outcomes Indicator Set (formerly the Commissioning Outcomes Framework), QIPP, Commissioning for Quality and Innovation (CQUIN), and the Quality Outcomes Framework (QOF) to drive and measure improvements in performance. The NHSCB’s overall progress in delivering better health outcomes will be measured using the key performance indicators set out in the NHS Outcomes Framework.

The first Mandate will run from April 2013 to the end of March 2015, though the Government intends for subsequent Mandates to be updated annually. The objectives included in future Mandates will be debated in Parliament in order to ensure democratic legitimacy for the work of the NHSCB.

• 40% of respondents said that NHS leadership is poor or very poor
• 73% said that quality of care is not given enough priority
• 40% said time and resources are the biggest obstacle to improving care
• 27.5% said the culture in the NHS is the biggest obstacle to improving care

 
Community Pharmacy
 
A survey of 122 pharmacies conducted by Which? has found that 43% of its mystery shoppers were given unsatisfactory advice by pharmacy staff. The survey also found:
 

• Advice given in the scenario of a customer requesting a medicine which could react with their other prescriptions was rated unsatisfactory in 71% of cases
• Independent pharmacies were rated worse than leading chains and supermarkets
• Counter assistants were significantly more likely to give poor advice than pharmacists

The Royal Pharmaceutical Society (RPS) has published research which indicates that only 49% of patients are aware of the side-effects of a medicine before they start taking it. In response to the figures, the RPS has called for more tailored advice to be provided by pharmacists to patients to address their lack of knowledge about medicines. Other findings include:

• 44% said they check how a medicine might react with their other prescriptions
• 42% said they read the patient information leaflet included in the pack
• 10% check for interactions between a medicine and any herbal remedy they are taking

 
Resignations
 
NHS England has announced that Sir David Nicholson will retire as the organisation’s Chief Executive in March 2014. Sir David has worked in the NHS for 35 years and has led it as Chief Executive for almost seven years, during which time he oversaw the implementation of the Government’s reforms and the structural transition to NHS England. No announcement has been made regarding his successor.

As a practicing doctor VoyageMD has had to deal with acute medical emergencies outside of his normal work environment. These have included being first attender at a nasty road traffic accident, helping a tourist with a suspected stroke whilst travelling on Eurostar and many years ago attending to an elderly Russian lady with chest pain shortly into an extremely long flight from Moscow to the United States.

The experience can be very scary due to (a) being the only person at the scene with any medical knowledge, (b) having no access to medical equipment and (c) being called upon to deal with a problem that you may not have come across for many years. Despite these, as far as VoyageMD is aware, all of the unfortunate individuals lived to tell the tale!
Statistically speaking with almost 3 billion people flying around the globe every year there is a reasonable chance that you may come across a medical “incident” at 30, 000 feet. The good news from a recently published review of this subject is that very often there actually is a doctor (48%) or other clinician (nurse 20%) on board who can help the stricken passenger (N Eng J Med May 30th 2013).

The risk of a medical emergency on board an aircraft is apparently 1 for every 604 flights with the most common problems being syncope (fainting or collapsing), respiratory symptoms or nausea and vomiting. The good news is that a doctor was available to volunteer help at around 50% of the events and the aircraft had to be diverted only 7% of the time. At the end of the flight around a quarter of the “patients” were sent to the local emergency room (ER) where 9% had to be admitted and only a tiny number (0.3%) died.

Although diabetes-related problems were uncommon – around 2% of all emergencies on board, 8% of aircraft had to be diverted and a quarter of individuals had to be sent to the ER on landing. Although having 50% dextrose (glucose) is a US Federal Aviation Administration requirement, being able to test for glucose or ketones seems to be dependent on the whim of individual airlines.

The bottom line:

• Medical emergencies during a flight, although rare when considered on a per-passenger basis, occur daily.
• During an event there is almost a 50:50 chance that a doctor or other clinician will be on the same flight.
• Most medial events during a flight can be dealt with without the aircraft having to be diverted.

Finally, although the on-board emergency medical kit covers most eventualities, there does need to be consistency across ALL airlines when it comes to dealing with diabetes-related emergencies including access to blood glucose monitoring on all flights.

NHS England (formerly known as the NHS Commissioning Board) is an independent national organisation responsible for the day-to-day running of the NHS. As the body tasked with ensuring the NHS delivers better outcomes for patients, it also provides leadership for the new system and is accountable for the delivery of improvements against the objectives set out in the NHS Mandate.

As well as overall leadership, NHS England will be directly responsible for approximately £25bn worth of commissioning to cover specialised services, primary care and military and prison services. It will also be accountable for Clinical Commissioning Groups (CCGs) who will have responsibility for commissioning a further £65bn of healthcare across England. NHS England will performance-manage all 211 CCGs to ensure they are financially stable and achieving the outcomes required of them.

NHS England is led by the incumbent Chief Executive of the NHS, Sir David Nicholson. He heads a team of seven National Directors:

• Medical Director – Professor Sir Bruce Keogh
• Chief Nursing Officer – Jane Cummings
• Director of Policy – Bill McCarthy
• Director for Patients and Information – Tim Kelsey
• Director of Commissioning Development – Dame Barbara Hakin
• Chief Financial Officer – Paul Baumann
• Director of Human Resources – Jo-Anne Wass

Alongside the National Directors, several Non-Executive Directors sit on the board. They are tasked with providing expertise and advice from outside the NHS and represent a number of different industries, such as finance, retail and the voluntary and public sectors.

NHS England employs 3,500 staff across several bodies:

National office: Based in Leeds, they employ 800 people.
Commissioning Regions: 4 regions based in North, Midlands & East, South and London, employing 200 people.
Local Area Teams (LATs): 27 LATs responsible for commissioning primary care services, including pharmacy services; assessing CCG performance; managing primary care contracts; and managing NHS England’s local relationships. In addition, 10 of the 27 will be responsible for specialised commissioning. They are managed by the Commissioning Regions and there are an estimated 8 CCGs per LAT on average.

Why?
The creation of an ‘NHS Commissioning Board’ was first proposed in the Government White Paper, Equity and Excellence: Liberating the NHS, published in July 2010. This laid the foundations for a national body, now known as ‘NHS England’, to assume those functions held by PCTs which could not be provided by CCGs such as primary care commissioning. The White Paper also set out the statutory position of NHS England as a function independent from the Department of Health (DH) in order to limit the powers of Government Ministers in day-to-day decisions about the NHS.

In the Government’s original plans, CCGs would have been responsible for spending the vast majority of the commissioning budget; however, the number of services defined as specialised has since increased. The decision to transfer a number of specialised services previously under the remit of PCTs, such as chemotherapy, to NHS England was taken to eliminate variation in standards of care and access to treatment.

How?
The DH issues the ‘Mandate’ which sets out those areas in which the Government expects NHS England to deliver improvement over a set period; the current Mandate is in place until 2015. NHS England’s progress in delivering the Mandate will be measured through a wide range of indicators set out in the NHS Outcomes Framework, which is agreed by NHS England with the DH. To reflect the move from disease-specific quality measurements to a focus on outcomes across broader areas, the framework sets out high-level national outcomes across five domains. For each domain, there are a small number of overarching indicators followed by a number of specific improvement areas.

There are National Leads for each of the five domains who are tasked with coordinating and leading NHS England’s work to improve outcomes in that domain. The National Leads are supported by 21 National Clinical Directors, who provide expert advice and research on specific conditions and diseases across the domains.

The five domains and their National Leads, who report to the Medical Director, are:

• Preventing people from dying prematurely (Professor Sir Mike Richards)
• Enhancing quality of life for people with long-term conditions (Dr Martin McShane)
• Helping people to recover from episodes of ill Health or following injury (Professor Keith
• Willet)
• Ensuring that people have a positive experience of care (Neal Churchill)
• Treating and caring for people in a safe environment and protecting them from avoidable
• harm (Dr Mike Durkin)

To help achieve the required outcomes, NHS England will use tools such as the CCG Outcome Indicator Set (formerly known as the Commissioning Outcomes Framework) and NICE Quality Standards to ensure outcomes are being achieved at the local level by CCGs. CCGs will be incentivised to do this through payment mechanisms such as the Quality and Outcomes Framework (QOF) and Commissioning for Quality and Innovation (CQUIN).
 
The Government will publish a yearly assessment of NHS England’s performance in delivering the Mandate. Progress will be measured using the key performance indicators set out in the NHS Outcomes Framework and the process will include feedback from CCGs, local councils, patients and other stakeholders. However, it is not yet clear exactly what action the Government will take if the NHS England is judged to be failing to deliver on its objectives.

Although many of us buy travel insurance in case of a cancelled flight or lost bag, by far and away the most important reason is to make sure you are covered in the event of an unforeseen illness. This is especially true if you are travelling to the United States where the cost of a hospital admission without insurance can be enormous running into many hundreds of thousands of dollars if not more.

So you would think that insurance companies would be smart enough to ask the right questions of would-be travellers to make sure that the premium being charged reflects the risk of becoming unwell whilst abroad?

Obviously not all medical events during a trip are predictable but for diabetes it is possible to think about potential risks related to the diabetes itself and also the treatment, especially for insulin users.

As a practicing doctor one of the major difficulties for many people with diabetes is the effort required to avoid hypoglycaemia (low blood glucose levels). Travelling long-distances across time zones adds to the risk of hypoglycaemia and that is one of the reasons why we have created VoyageMD.com.  Given how common the problem of hypoglycaemia is you would have thought assessing hypoglycaemia risk would be part of the process used by travel insurance companies to work out the cost of insurance. It isn’t!

So to prepare you for buying travel insurance here are some of the questions you will be asked. In the UK the questions are more or less standard across the industry.

For the question “how many admissions have you had” it is not clear whether being brought to the Accident & Emergency Department after a severe hypo but discharged the same day counts but it looks like you have to have been admitted formally i.e. 24 hours

The list of “medical conditions” you can choose from does require very in depth knowledge of all medical aspects of your diabetes so best to check with your diabetes team:

For other medical conditions the criteria for declaring are:

That is about it! It seems odd that Travel Insurance companies who are asking you to pay quite a lot of money up front to covert the potential risk of you falling ill abroad seem to be unsure of which questions to ask! For instance they seem uninterested in:

• Whether your diabetes is well controlled or not
• Whether you do any self-monitoring of blood glucose levels
• Whether you recognise low blood glucose levels at a time when you can correct them

They also seem to lump all diabetes-related complications together in terms of calculating insurance premiums.

The bottom line – VoyageMD suspects that the companies assume the worst and end up charging far more. People working hard at keeping their diabetes under control should not be penalised.

VoyageMD is more than happy to work with the Travel Insurance Industry so that people living with diabetes are charged a rate that reflects their personal risk by asking the right questions. For most people living with diabetes this should result in lower and more sensible travel insurance premiums.

Bon Voyage

The Government has come together with several national health and care organisations to publish plans setting out actions to implement integrated care across the NHS and social care system. ‘Integrated care and support: our shared commitment’ brings together 14 partners, including the Department of Health (DH), NHS England, The Local Government Association, NICE, Public Health England and CQC. It outlines how local areas can use existing structures such as Health and Wellbeing Boards to better integrate care across local authorities, the NHS, education, housing services, public health and other care and support providers. The plans, which intend to make joined up health and care the norm by 2018 include:

• Projects supporting integrated care in every part of the country by 2015
• An agreed definition of good integrated care and support
• ’Pioneer’ areas appointed around the country by September 2013 to demonstrate innovative approaches to integrated care
• A commitment to develop new ways of measuring people’s experience of integrated care and support by the end of 2013

The Health Secretary, Jeremy Hunt, has announced a new £260m fund to help hospitals replace paper based systems for patient notes and prescriptions. The fund, which is part of DH’s ambition for a ‘paperless’ NHS by 2018, will be primarily used to increase electronic prescribing, which sends doctors’ prescriptions directly to pharmacies to reduce errors and improve patient safety.

The Government has published its Care and Support Bill. The Bill introduces a number of reforms to the social care system, including new rights for carers, a national eligibility threshold for care and support and a cap on the costs that people will have to pay for care. The Bill also includes legislation as part of the Government’s response to the Francis Inquiry into care failings at Mid Staffordshire. These include the introduction of Ofsted-style ratings for hospitals and care homes and new powers for the Care Quality Commission (CQC) to put trusts into special administration over quality failures.

NHS

Monitor and NHS England have announced plans to reform the way hospitals are paid for carrying out treatments. They have published a joint discussion paper seeking views on changes to the ‘Payment by Results’ system, which has been criticised for not being patient focused and for acting as a barrier to delivering integrated care.

NICE

At NICE’s annual Conference this week, Minister for Health, Earl Howe announced that the Institute will work with Public Health England to develop new Quality Standards as part of a Public Health Quality Standards programme. Topics that have been referred so far include strategies to prevent obesity in adults and children. Earl Howe also announced that over the next five years NICE will develop single integrated Quality Standards which will cover the NHS, social care and public health.

Industry

The National Institute for Health Research (NIHR) Clinical Research Network, which provides a range of services to help researchers from industry to complete clinical studies in the NHS, has launched a new service package for industry. The service includes the provision of early feedback on study deliverability, including expert clinical guidance to support a decision to place a study in the UK and a service identifying all sites with the expertise to deliver a particular study. Other features include:

• A single online ‘Industry Application Gateway’ for all industry studies
• A streamlined, faster process for applications
• A central ‘Industry Information Centre’ to provide information and advice to help companies use the service effectively

The NIHR has published research showing that less than 20% of people would feel confident about asking their doctor or medical specialist about taking part in a research study. In response to the figures, the NIHR has launched a campaign called “it’s OK to ask”, aimed at empowering patients to ask their doctor about clinical research, and whether it’s right for them.

Oncology

A survey commissioned by Macmillan Cancer Support has found that 10,000 of the 170,000 cancer patients in hospital in England have reported being given the wrong drugs in the last year. The survey also found that many patients had experienced some degree of poor care, including 37% who said their hospital room or area was not always kept clean and tidy. According to the survey, 7% felt like dropping out of treatment early because of the way hospital staff dealt with them. Other findings include:

• 11% had received important news about their treatment in an open ward or room
• 30% of those who need extra food had not received it
• 10% had been woken up over night by cleaners
• 15% had to wait half an hour for their water to be refilled

Diabetes

New research by Cardiff University has found that the number of people under 40 with type 2 diabetes in the UK has more than doubled in the past 20 years. The study’s authors attribute the increase to factors including obesity, diet and family history and state that “an earlier age of onset will result in poorer quality of life, place an increasing burden on healthcare resources and may lead to premature death”.

Wales

The Welsh Government has published the Welsh Health Survey, which covers a range of health-related issues, including health status, lifestyle and health behaviours, and use of health services. The survey found that 59% of adults were classified as overweight or obese. Since the survey started in 2003/04, there has been a 2% increase in the number of adults reporting being treated for diabetes, with 7% now reportedly being treated for diabetes.

The Queen attended Parliament for the annual state opening of the new legislative session. During the ceremony she delivered a speech setting out the Government’s agenda for the next year, which includes plans for legislation in the following areas:

• Immigration – restricting recent migrants’ access to benefits, hospital services and some housing allocations
• Pensions – introducing a flat rate pension
• Social care – implementing a cap on social care costs
• Intellectual property – simplifying patent and design protection laws, including adopting a single patent application valid for all EU countries

NHS

The Department of Health (DH) has published a guide to the NHS in England. The guide sets out the different roles of the organisations in the new system and how they work together. It also explains how the NHS safeguards and empowers patients, uses information and research to improve health outcomes and provides education and training.
NHS England has published details of the interim process it will use to assess Clinical Commissioning Groups’ (CCGs) performance. CCGs will be rated four times a year on the delivery of their agreed strategic plan, which includes standards set out in the NHS Constitution, such as limits on waiting times, and improvement against the indicators set out in the NHS Outcomes Framework. They will also be assessed annually on their organisational capability, with a particular focus on their relationships with the public and key stakeholders, and their capacity to assure quality. Where a CCG is judged to be seriously failing NHS England will intervene, taking actions such as replacing the group’s leaders. A final version of the process will be published in the autumn.
NHS England has launched a series of new dedicated webpages for each of the 74 Clinical Reference Groups (CRGs) which support its specialised commissioning responsibilities. CRGs are made up of clinicians, commissioners, public health experts and patients and carers and are responsible for providing NHS England with clinical advice regarding these directly commissioned services. The pages set out the membership of the CRGs, the products they are developing, such as service specifications, and other documents relating to their activities.

Policy

2020health has published a report warning that the Government’s plans to introduce value-based
pricing (VBP) for new drugs from next year are flawed. The report states that valuing drugs is “not a science capable of precision or consensus conclusions” and that VBP was likely to become a “drug rationing system”. It recommends that companies should be allowed to continue setting prices, while capping total profits or sales, and lowering the price of their older drugs to offset higher prices for new ones. Other findings include:

• The pricing of medicines would become politicised, with patients used as “political pawns”
• VBP cannot easily be applied to the most important medical breakthroughs

Industry

The ABPI published a document setting out the pharmaceutical industry’s contribution to patients, the NHS and the economy. ‘Delivering value to the UK’ states that the commercial environment is becoming increasingly challenging for industry and warns that the benefits the sector provides shouldn’t be underestimated as it comes under increased pressure to cut costs. Contributions identified in the document include:

• Generating a trade surplus of £5bn per year
• Investing £13.3m per day on R&D
• Directly employing 68,000 people
• Developing one sixth of the world’s most popular prescription medicines
• Contributing towards the steady rise in life expectancy over the last century
• Reducing mortality across a wide range of diseases, including doubling five-year survival rates for colorectal cancer

Community Pharmacy

DH has published guidance to support local authorities and Health and Wellbeing Boards (HWBs) to interpret and implement their new duty to develop and update pharmaceutical needs assessments (PNAs). Each HWB will need to publish a PNA by April 2015, setting out their area’s needs for pharmaceutical services and identifying any gaps in provision that need to be filled by commissioners.

Oncology

A survey of Scottish oncologists and haematologists has found that more than a third know of patients who have moved from Scotland to England to receive treatment. The survey also found that half of those questioned believed restricted access to treatment had lowered the standard of care available in Scotland compared to the rest of Europe.

Appointments

Nick Seddon has been appointed as Health and Social Care Adviser to the Prime Minister, David Cameron. Mr Seddon was previously Deputy Director of the think tank Reform and Head of Communications at Circle, an independent health provider.