Proposed changes to the NHS

'Everyone counts: Planning for patients 2013/2014' is the title of a document published by the NHS Commissioning Board yesterday outlining the incentives that will be used to improve NHS services from April 2013, the first year of the new NHS, where improvement will be driven by clinical commissioners.

The document includes a clear set of outcomes against which to measure such improvements and outlines five offers:

1. Move towards a seven-day a week working for routine NHS services
2. Greater transparency and choice for patients
3. More patient participation 
4. Better data to support the drive to improve services
5. Higher standards and safer care

I will now look at points one and two in more detail as these points in particular featured in the news over the weekend.

The idea of a seven day service follows research which suggests patients are more likely to die if they are admitted to hospital over the weekend. In fact the study showed that patients in England were 16% more likely to die if they were admitted on a Sunday rather than mid-week. 

Staffing - in particular the absence of senior doctors - has been highlighted as a key reason for this.

Although such a scheme would be ideal and may be successful there are obvious obstacles that must be overcome, for example a reluctance to work on the weekend due to family commitments. What incentives or schemes could there be to try and overcome this reluctance? Bearing in mind the NHS is trying to save money whenever possible so lucrative salaries are probably not the answer... Not only are there obstacles but solutions that work for one speciality may not work for another! 

Secondly the greater transparency and choice for patients, for example the provision of surgeons' data. Such data on heart surgeons is already available but the aim is to enable access to data belonging to a number of other specialities for example vascular and orthopaedic surgeons. 

As well as enhancing patient choice the data would allow surgeons to compare "performance" and consequently this might lead to competition and an incentive or pressure to improve performance. 

The primary concern amongst surgeons and other medical professionals with releasing this data is that it may give a misleading impression and may be misinterpreted. For example surgeons performing more difficult, high risk, complex surgery may look to be performing worse and labelled as "bad" surgeons when in fact they are the best surgeons but the nature of their work is extremely high risk.

To conclude Sir David Nicholson, the chief executive of the NHS Commissioning Board said the following about the proposed changes: “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 the 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.”