BMJ Summaries 01/12/13

UK’s health spending per head fell in 2010 & 2011. Health spending per person in the United Kingdom fell by 2.5% in 2010 and by 1.1% in 2011, show annual figures published by the Organisation for Economic Cooperation and Development. The two years of decline in spending, adjusted for inflation and measured on a per capita basis, came after a decade in which health spending had risen by an average of 5.3% a year in the UK.

MPs challenge Serco over its trustworthiness to run public services. MPs have challenged the company at the centre of a GP out of hours service scandal over its trustworthiness to continue to provide the public service. In July the committee published a critical report into the service Serco provides in Cornwall in which it accused the company of bullying employees, providing a short staffed and substandard service, and manipulating data to hide the truth.

Patients’ rating of treatment tells you more about patients than hospitals, research concludes.Using patient reported outcome measures (PROMs) collected by the NHS in England since 2009, a team led by Andrew Street has found that most of the variation was accounted for by the types of patient treated rather than by the competence of the hospital treating them. PROMs assess the outcomes of treatments such as hip or knee replacement by asking patients a series of questions about their state of health before the operation and repeating the exercise three or six months afterwards, when they have had time to recover.

Campaign for real healthcare for real people. In their editorial Paul Hodgkin and Jeremy Taylor (who head up Patient Opinion and National Voices, respectively) cast a jaundiced eye over “the rhetorical lip service to the centrality of the patient.” Patient friendly platitudes now “abound in every official document,” meaning more or less whatever you want them to. Putting patients first has become “a pick and mix menu from which decision makers can select according to taste.”

More NHS trusts are on brink of deficit, as easy savings run out. Increasing numbers of NHS trusts could easily tip over into making losses from 2015, given the growing pressure on the health service and difficulty in making savings, MPs have been told. The Health Committee, holding a session for its inquiry into public expenditure on health and social care, asked witnesses their views on how the NHS was managing to meet the challenge placed on it to make £20bn (€24bn; $32bn) of efficiency savings by 2014-15.

Looking beyond “the house of care” for long term conditions. Spike Milligan once described the invention of a machine that did the work of two men. Unfortunately, it took three men to work it. As populations age, multimorbidity accrues, budgets tighten, and inequalities in health widen; patients, practitioners, and health systems cannot afford multiple services that provide fragmented care.

Patients will be involved in assessing CCGs, NHS England decides. Patients and members of the general public in England will have a role in judging the performance of clinical commissioning groups under a new system of regular assessment.
NHS England said that lay scrutiny would be part of a “transparent” new assurance process to ensure that commissioners of NHS services operated effectively and guaranteed safe, high quality care. Clinical commissioning groups will be assessed throughout the
year, with public and patient representatives having a role in quarterly assurance “meetings” to ensure openness

Three in four Americans want major changes to healthcare system, survey finds. Americans are more likely to forgo care because of cost, a new survey has found. The results show that Americans face higher out-of-pocket expenses and are more likely than residents of 10 other developed nations to report trouble paying their medical bills. About 40% of Americans polled, with and without insurance, reported that they had spent $1000 or more on healthcare, notncounting their premiums, in the past year, reflecting the high cost of US healthcare and the high deductibles and cost sharing required by many US health insurance plans. A fifth (18%) of Americans reported having “spent a lot of time on paperwork or disputes” concerning medical bills or insurance in 2013, and a third (28%) said that their insurance plan had denied payment for care or did not pay as much as expected.
The report said, “The United States also stood out in the 2012 survey of physicians in eleven countries for time-consuming insurance-related complexity. Fifty-four per cent of US primary care physicians said that the amount of time that they and their staff spent dealing with coverage restrictions was a ‘major problem.’”

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