FINANCE

Healthy Balance. A review of public health performance and spending (11th March 2010)
This briefing, from the Audit Commission, estimates that £21 billion of NHS funds has been allocated in 2009/10 on the basis of health inequalities. Despite the health of the nation improving overall, health inequalities has proved a stubborn area to address.

It highlights some of the variation in success among different localities, particularly for teenage pregnancies. Despite the sums of money allocated, it is not always clear how much has been spent on improving health inequalities and what the impact has been. It is hard to see an obvious link between spending and improvement, or get any clear view of value for money.

Briefing

Statements on Internal Control (SICs) 2009/10: disclosures guidance (published 1st February 2010 new to website 4th March 2010)
Clarification on how and where organisations should make disclosures or qualifications on their Statement on Internal Control (SIC) about risk management and review processes being in place for the full year, gaps in assurance frameworks, NHS Pension Scheme compliance and significant control issues for 2008/09.
Information

NHS

General Election - Guidance (11th March 2010)
Two letters have been produced to provide chief executives with information on handling the General Election period, once it starts. It includes links to previous guidance and advice.
Letter for Arms Length Bodies
Letter for NHS Trust AND PCT

The handbook to the NHS Constitution for England (8th March 2010)
This Handbook is designed to give NHS staff and patients all the information they need about the NHS Constitution for England. It outlines the roles we all have to play in protecting and developing the NHS and will help you understand our rights, pledges, values and responsibilities.
Document

Getting the most out of PROMs. Putting health outcomes at the heart of NHS decision-making (11th March 2010)
More than 100 years ago Florence Nightingale suggested a health-related outcome measure for her patients: relieved, unrelieved and dead. Despite the developments in medical technology since then, attempts to measure the positive outcomes of health care have been slow in coming. An important step forward was made in 2009 when the English NHS began collecting patient-reported outcome measures (PROMs) for four elective procedures.

The aim of this report, from the Kings Fund, is to provoke and encourage thinking about the wide range of ways in which PROMs data can be used to inform decisions. It draws on Bupa’s example to discuss how providers can use PROMs data to improve clinical performance. It also offers practical advice for commissioners in using PROMs data to assess value for money and decide how to purchase health care systems.
Report

Rising to the challenge: health priorities for government and the NHS (11th March 2010)
The document sets out what the NHS Confederation see as the major priorities facing the NHS, what they think NHS leaders can do now to help develop the system and enhance patient care, and what a new government will need to do post-election to facilitate this and create the necessary conditions for progress.
Document

The NHS Constitution for England (8th March 2010)
This Constitution establishes the principles and values of the NHS in England. It sets out rights to which patients, public and staff are entitled, and pledges which the NHS is committed to achieve, together with responsibilities which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively. All NHS bodies and private and third sector providers supplying NHS services are required by law to take account of this Constitution in their decisions and actions.
Document

Guidance on the attribution of NHS non-commercial Research costs, Support costs and treatment costs (ReSeT Guidance) (15th March 2010)
This document clarifies the distinction between the three categories of costs associated with non-commercial research studies: Research Costs, NHS Support Costs and Treatment Costs. It is supported by two annexes – Annex A provides an exemplar set of common activities that have been attributed to the three specific cost categories and Annex B provides a list of Frequently Asked Questions (FAQs). The first section of the FAQs relates to FAQs that are generic across the United Kingdom and the second section to country specific questions. These Annexes will be updated on a regular basis and users need to ensure that they have the latest version (please refer to individual Health Department websites for their country specific FAQs).
Document

PRIMARY CARE TRUSTS

Easements to quality and outcomes framework (QOF): patient experience indicators 7 and 8 (24th February 2010)
Dear colleague letter which provides advice for PCTs on calculating the easements to the thresholds for Quality and Outcomes Framework (QOF) indicators PE7 and PE8 contained in the Directions on the swine flu (H1N1) vaccination agreement for clinical priority groups.
Letter

Monitoring use of money to implement End of Life Care Strategy - PCTs (25th February 2010)

Templates to monitor how the additional money provided to help implement the End of Life Care Strategy in 2009/10 is being invested have been issued to SHA and PCT Directors of Finance.

Templates

STRATEGIC HEALTH AUTHORITY

Monitoring use of money to implement End of Life Strategy - SHA's (25th February 2010)

Templates to monitor how the additional money provided to help implement the End of Life Care Strategy in 2009/10 is being invested have been issued to SHA and PCT Directors of Finance.

Templates

Priority review of long term conditions care planning and PSA target (4th March 2010)

Letter to Strategic Health Authorities on information needed to report to the Prime Minister's Delivery Unit on progress against the commitment, made in High Quality Care for All, to offer everyone with a long term condition a personalised care plan.

Information

FINANCE

NHS reference costs 2009/10: collection guidance (17th February 2010)
This document outlines the mandatory requirements for the 2009-2010 reference costs collection. It updates and supersedes previous costing guidance. It should be read in conjunction with the latest version of the NHS costing manual.
Document

NHS Costing Manual 2009-2010 (17th February 2010)
This manual sets out the principles and practice of costing to be applied in the NHS. It is not just designed to support the production of the National Schedule of Reference Costs, and through this, the national tariff, but should also be used in developing and monitoring service and financial frameworks, as well as developments in and the monitoring and implementation of National Service Frameworks.
Manual

NHS

Clarification of Complaints Regulations 2009 (28th January 2010)
New regulations for handling NHS and adult social care complaints came into effect on 1 April 2009 - however, some local provider websites are still referencing the 2004 regulations. Additionally, clarification has been provided on the legislative position around complaints being handled by PALS, and cases where legal proceedings are being taken.
Document

NHS reference costs 2008-09 (28th January 2010)
These documents provide details of how, and on what, almost £48 billion of NHS expenditure was used in the 2008-09 financial year.

As in previous years, the main purpose is to provide a basis for comparison within (and outside) the NHS between organisations, and down to the level of individual treatments.
Documents

NHS reference costs 2008-2009: Appendix DBRC Organisation Specific Reference Cost Data (28th January 2010)
This page contains the reference costs 2008-09 organisation level data that underpins the national averages. To reduce file sizes these have been zipped and are in csv format, a guidance sheet demonstrating how to upload these files into Microsoft Access is also supplied. This method of publication replaces the data DVD publication used in previous years.
Document

PRIMARY CARE TRUSTS

PCT Value for money profiles (15th January 2010)
The new primary care trust (PCT) value for money (VfM) profiles are available as an interactive web tool.

The tool provides comparative information about a selected PCT's performance in managing costs and delivering outputs (activities) and outcomes (health improvements for local people). It also tracks performance over time to see whether improvements are being achieved in line with priorities and how the trend in performance compares to others.
Tool

Practice-based commissioning budget guidance for 2010/11 (14th January 2010)
PCTs are responsible for ensuring that practices receive an indicative budget that reflects the needs of their population as accurately as possible. This allows a practice to access a 'fair share' of the resources available to the whole of the PCT for its patients. The Department has updated the toolkit that can be used to determine weighted capitation indicative budgets at practice level. This is part of our ongoing commitment to refine the methodology and improve accuracy.
Toolkit

GP Extended Opening Hours (7th January 2010)
PCTs are to continue to progress extended opening hours in GP practices, particularly for patients of practices who are not offering this service. The current DES rolls forward in 2010/11 and PCTs are asked to submit plans saying how they will make full use of the resources available for extended opening.
Document

PAYMENT BY RESULTS

Payment by Results 2010-11 road test package (17th December 2009)
The road test exercise provides an opportunity for the service to get used to the new tariff, and supports the planning process. The main focus of the road test this year is to gather comments on the draft guidance, which has been substantially revised and expanded.
Documents

PRIMARY CARE TRUSTS

Use of Resources Good Practice and Case Studies (17th December 2009)
To help auditors and audited bodies identify good practice, the Audit Commission have published some case studies from the 2008/09 auditors' use of resources work.
Case Studies

An overview of the new arrangements under Park IX of the Drug Tariff for the provision of stoma and urology appliances, and related services in primary care (22nd December 2009)
The Department of Health have published guidance on the new arrangements, as announced in April 2009 following the Part IX Review for the NHS supply of certain appliances in primary care require changes to the NHS Pharmaceutical Service Regulations, Directions and amendments to the Drug Tariff.

The new regulations will come into effect on 1st April 2010 and a transitional period of nine months from 1 April 2010 gives pharmacies and appliance contractors sufficient time to ensure they are able to comply with the new terms of service by 31 December 2010.
Guidance

Out of hours training for GP registrars (17th December 2009)
Letter to PCTs Chief Executives regarding their responsibility to commission increased GP Out of Hours training.
Letter

FINANCE

The Quarter: quarter 2, 2009/10 (8th December 2009)
David Flory has released his second quarterly report of 2009/10, which details NHS finance and operational performance. It shows that the NHS has built on a strong start to 2009/10 by sustaining delivery on key priorities such as reducing waiting times and healthcare associated infections (HCAIs), increasing access to primary care and maintaining good financial health. However, there are still a few organisations struggling to balance their finances and attention will be focused on these. Against a background of good overall operational performance, there also remain some organisations still not delivering standards on a consistent basis. Such deficiencies in performance need to be addressed locally.
Report

MENTAL HEALTH

New Horizons: a shared vision for mental health (7th December 2009)
New Horizons is a cross-government programme of action with the twin aims to:

• improve the mental health and well-being of the population
• improve the quality and accessibility of services for people with poor mental health.

New Horizons sets out an intention across a wide range of agencies to move towards a society where people understand that their mental well-being is as important as their physical health if they are to live their lives to the full. It describes some of the factors that affect well-being and some everyday strategies for preserving and boosting it. It also sets out the benefits, including economic benefits, of doing so.
Guidance

Working our way to better mental health: a framework for action (7th December 2009)
The Government has launched the first ever national mental health and employment strategy.

The framework is designed to:

• Improve well-being at work for everyone, and
• Deliver significantly better employment results for people with mental health conditions, supporting them into work, helping them to stay in work and assisting them to return to work more quickly after sickness absences.

Framework

Realising ambitions: Better employment support for people with a mental health condition (7th December 2009)
This report sets out the reviewers’ vision for change to ensure the Government can better help more people with mental health conditions who are workless into sustained employment.

It sets out a number of recommendations for Government. These fall in to three broad groups:

• increasing capacity and dispelling myths within existing structures so they are better able to meet the needs of people with a mental health condition
• “model of more support”: implementing Individual Placement and Support (IPS) in a Great Britain context
• establishing effective systems for monitoring outcomes and driving change.

Report

Work, Recovery and Inclusion: Employment support for people in contact with secondary mental health services (7th December 2009)
Work, Recovery and Inclusion is a new government delivery strategy that sets out a series of actions that will help meet the aspirations of people in contact with secondary mental health services who want to work. It is deliberately challenging and aspirational and aims to bring about significant changes in outcomes.

The strategy looks to a future where people who are in contact with secondary mental health services are helped to get jobs, where they are equally valued for their contributions to the workplace, and where having a mental health condition is not seen as a barrier to work.
Strategy

Mental health clinical costing standards 2009/10 (4th December 2009)
Best practice guidance for organisations using and implementing Patient Level Costing and Information Systems (PLICS) in a mental health setting.
Guidance

Revision of Preventing Suicide: A toolkit for mental health services (25th November 2009)
The National Patient Safety Agency (NPSA) has launched a revision of "Preventing Suicide: A toolkit for mental health service". The toolkit was originally published in 2003 and has been amended to reflect recent policy changes and has had input from key stakeholders, service users, carers and experts.
Toolkit

At a glance 18: Personalisation briefing: implications for community mental health services (November 2009)
This briefing, from Social Care Institute for Excellence, examines the implications of the personalisation agenda for practitioners and managers in community mental health services.
Briefing (Web Page)
Briefing (PDF)

FINANCE

More for less: Are productivity and efficiency improving in the NHS? (12th November 2009)
This analytical briefing looks at how NHS money has been spent, whether primary care trusts have been successful in keeping more patients out of hospital, and whether hospitals have become more efficient. It highlights that the NHS is treating more patients at lower cost and trusts are starting to meet the challenges of the future. It suggests NHS trusts are increasing productivity and reducing unit costs. But overall, there is no sign yet that primary care trusts have been successful in moving care from hospitals closer to patients' homes.
Summary
Full Report

Auditors' Local Evaluation (ALE) 2009/10 (11th November 2009)
The supporting documentation for the Auditors' Local Evaluation (ALE) 2009/10 is now available from the Audit Commission website. This includes the overview and the key lines of enquiry (KLOE) and guidance.
Documents

FINANCE

Means to an end. Joint financing across health and social care (29th October 2009)
This report reviews the joint financing and integrated care arrangements between NHS bodies and councils with adult social care responsibilities. It builds on our previous publication, Clarifying joint financing arrangements, that explained the practical implications and legislative framework for joint financing.

It considers how these arrangements are used, focusing on learning disability, mental health and older people - areas where service users most often need health and social care.

The report's recommendations and examples of notable practice aim to help national and local bodies better understand the options available, how to use them and to achieve better outcomes for service users.
Report

CHILDREN'S SERVICES

Children's trusts: A briefing paper on improving financial management (23rd October 2009)
Jointly produced by the Audit Commission and CIPFA, 'Children's trusts' provides practical guidance on improving financial management in children's trusts. The document supports the Audit Commissions national report 'Are we there yet?', presenting the findings of research into the progress local councils and their partners are making in developing children's trusts.
Paper

FINANCE

Auditors' Local Evaluation and Use of Resources 2008/09 (1st October 2009)

Each year, the Audit Commission assesses how well NHS trusts and primary care trusts manage their resources and deliver value for money. For 2008/09, these assessments have been based on the Auditors' Local Evaluation (ALE) for NHS trusts and Use of Resources (UoR) for primary care trusts. We have published a national report outlining the scores and how they should be viewed in the context of the overall financial performance of the NHS in 2008/09, which is one of a continued improvement in financial stability. NHS foundation trusts are assessed by Monitor.

Auditors make assessments in a number of themes using key lines of enquiry. There are five themes for ALE and three themes for UoR:
ALE

• financial reporting
• financial management
• financial standing
• internal control
• value for money

UoR

• managing finances
• governing the business
• managing resources

Report

WORLD HEALTH

Disparities in health expenditure across Organisation for Economic Co-operation and Development (OECD) countries: Why does the United States spend so much more than other countries? (30th September 2009)
The United States spent 16% of its national income (GDP) on health in 2007, which is by far, the highest share in the OECD and more than seven percentage points higher than the average of 8.9% in OECD countries. This presentation was given by Mark Pearson, Head of OECD Health Division, to the U.S Senate Special Committee on Aging.
Document

Health: Improving Policy Coherence for Development (Policy Brief) (7th October 2009)
The cost of treating disease is vastly greater than the cost of controlling or preventing disease. In a time of global recession, the disparity in health outcomes between developed and developing countries will most likely widen. The rapid expansion in trade, foreign investment and international travel mean that infectious diseases can have adverse effects not only on health but also on economic growth and security.
Brief

FINANCE

The current and future state of NHS Finances. Results of an independent survey of Finance Directors in PCTs conducted by KPMG and Dr Foster Intelligence (published 30 July 2009 new to website 17th September 2009)
The overwhelming majority of PCT finance directors (84%) say they are not well enough prepared to identify substantial efficiency savings within the NHS, a survey by KPMG and Dr. Foster Intelligence has found.

The NHS has embarked on a self declared efficiency agenda and aims to identify savings between £15 and 20 billion over the next three years. However, the survey among PCT finance directors seems to suggest that most of them are not ready to take on the challenge. The survey also reveals that almost half of all finance directors feel that NHS frontline staff is aware of the efficiency challenge but limited in their understanding of its impact on budgets.
Report

Auditors' Local Evaluation (ALE) 2007/08 (24th September 2009)
The summary results for NHS trusts and primary care trusts are now available from the Auditors' Local Evaluation 2007/08 briefing.
Results

The Statement of Financial Entitlements (Amendment) (No. 5) Directions 2009 (25th September 2009)
The Statement of Financial Entitlements (Amendment) (No. 5) Directions 2009 were signed on 22nd September 2009 and come into force on the 1st October 2009. These amending directions make three changes to the dispensing provisions in the General Medical Services Statement of Financial Entitlements (SFE) published in April 2005.
Directions

FINANCE

The Quarter: quarter 1, 2009/10 (10th September 2009)

David Flory’s first quarterly report of 2009/10 on NHS finance and service performance, shows that the NHS has started 2009/10 well, building on last year’s success.

The latest data on the reduction of healthcare associated infections (HCAIs) show that the risk of infection with MRSA bacteraemia or C. difficile is at its lowest for five years. Most hospitals are already achieving the 2010 target levels for reducing C. difficile infections by 30 percent against the 2007/08 baseline, having achieved a national reduction of 35 percent over the last financial year. The NHS has sustained operational standards on 18 weeks and has improved access to primary care services by further increasing the number of GP practices offering extended opening hours.
Report

NHS

Does improving quality save money? (1st September 2009)
This report, from The Health Foundation, reviews the evidence of whether improving quality can also save money for health service providers. It explores the cost saving potential of initiatives to improve quality and the barriers to success.
Report

FINANCE

2007-08 National Survey of Investment in Adult Mental Health services (23rd July 2009)
This is the seventh annual report presenting the results of the finance mapping exercise carried out as part of the autumn review process. It provides details of the level of investment in adult mental health services in England for 2007/08 and compares it with the reported results in the five previous years.
Report