Tag Archives: Finance

Right care: wrong answers

Dropkin, G. Journal of Public Health, https://doi.org/10.1093/pubmed/fdx136

Published: 03 November 2017

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Background

NHS RightCare is an NHS England programme describing itself as ‘a proven approach that delivers better patient outcomes’. It identifies opportunities for savings and quality improvements, comparing each Clinical Commissioning Group (CCG) with the ‘Best 5’ of a fixed set of ‘Similar 10’ CCGs chosen using equally weighted demographic and deprivation indicators. This article tests whether these indicators are sufficient and equal weighting is appropriate, and evaluates significance.

Methods

Robust public data on lung, colorectal, and breast cancer mortality is modelled using the indicators and incidence. Peers chosen using the preferred models are compared with the Similar 10. Confidence intervals are obtained for comparator group averages. RightCare significance is simulated.

Results

Preferred models have unequally weighted covariates. Incidence is the strongest predictor of lung cancer mortality. The ‘Similar 10’ are inappropriate comparators. RightCare significance ignores variability of comparator outcomes, causing 12% Type I errors. Whilst RightCare shows 1842 annual avoidable lung cancer deaths in 80 CCGs, only 168 deaths in 8 CCGs appear exceptional using appropriate peers and CIs.

Conclusion

CCGs cannot expect to match the average performance of the RightCare ‘Best 5’. Until the methodology is examined with data of known quality, claims that RightCare is a ‘proven approach’ are unsubstantiated.

 

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Current, future and avoidable costs of stroke in the UK – Societal costs of stroke in the next 20 years and potential returns from increased spending on research

By The Stroke Association (2017)

This report estimates that the current cost of stroke to the UK is £26 billion every year, a threefold increase from the previous estimated cost of £9 billion. The figures also predict that a growing and ageing population, increasing numbers of stroke survivors, and rising care costs are crucial factors behind the increasing financial burden of stroke over the next 20 years.

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Big cuts planned to public health budgets

by The King’s Fund (2017)

Central government cuts have forced councils to reduce planned spending on vital public health services such as sexual health clinics and reducing harm from smoking, alcohol and drugs by £85 million, according to new analysis by The King’s Fund.

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Click here to view the King’s Fund analysis

NHS needs £9.5bn to transform

By BMA  (2017)

This analysis of the 44 STPs in England estimates that £9.5bn of capital funding is required to create the infrastructure to deliver the plans. The BMA sent out a series of FOI requests and have compiled information for each STP area on the financial needs required to implement the plans in each area. 

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Extended hours in primary care linked to reductions in minor A&E attendances

By National Institute for Health Research (2016)

This briefing summarises the findings of a study that found that practices that offered additional appointments showed a reduction in the number of their patients attending emergency departments for minor conditions but that there was no overall reduction in emergency visits. Costs were reduced for emergency departments but by less than the cost of the additional appointments. These findings suggest additional appointments may help reduce minor A&E visits but may be more costly overall.

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Debt and health: a briefing

By The Picker Institute (2015)

This briefing focuses on the relationship between debt and health including the health related consequences of debt, the impact it can have on individual mental health and recommendations for implication prevention.

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Assessing the impacts of alcohol policies

By OECD Health Working Papers (2015)

This working paper assesses alcohol policies in three countries: Canada, the Czech Republic and Germany. The results show that brief interventions in primary care, typically targeting high-risk drinkers, and tax increases, which affect all drinkers, have the potential to generate large health gains. The impacts of regulation and enforcement policies as well as other health care interventions are more dependent on the setting and mode of implementation, while school-based programmes show less promise. Alcohol policies have the potential to prevent alcohol-related disabilities and injuries in hundreds of thousands of working-age people in the countries examined, with major potential gains in their productivity. Most alcohol policies are estimated to cut health care expenditures to the extent that their implementation costs would be more than offset. Health care interventions and enforcement of drinking-and-driving restrictions are more expensive policies, but they still have very favourable cost-effectiveness profiles.

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