The Government’s response has been to fully accept the report’s suggestions, as many tie in with the general programme of reforms set out in the Health and Social Care Bill. However, much like many of the proposals we saw outlined in the Bill and put into practice over the past year, other groups have been less enthusiastic. For example, Dr Clare Gerada, chair of the RCGP, has voiced concerns at the lack of evidence base for public health proposals, and that questioning patients at every opportunity may even be detrimental to the patient/physician relationship.

This is the first report of what will likely be many throughout 2012 both supporting reform and condemning it in equal measure. But what changes within the NHS can be expected in the coming year? Here are a few points that the Virgo HEALTH team will be looking out for…

First and foremost, the Health and Social Care Bill will receive Royal Assent, with most proposals likely to be still intact. Even so, there are lingering questions over Andrew Lansley’s position within the Cabinet. Will he continue to serve as Secretary of State into 2013? In all likelihood, yes – but nothing is certain.
As the Government progresses with the reforms throughout 2012, we will see the further dismantlement of current NHS structures and consolidation of new bodies such as the NHS Commissioning Board and Clinical Commissioning Groups in their place. However, there will continue to be plenty of debate over the composition and size of these groups, and the role traditional commissioners from PCT and SHA backgrounds can play in them. 2012 should therefore provide more answers as to the future these managers have within the new NHS.

The DH published figures at the end of December confirming that it was on track to deliver the savings required for the year 2011/12 as set out in the Budget, recording savings of £2.5 billion in the first 6 months of the efficiency challenge. Many argue that the easy cuts have been already been made, and that the NHS will be facing an increasingly difficult challenge to try and find further savings. We will see whether the figure of £6 billion for the year is achieved in the summer, and towards the end of the year, whether it is still on track to hit its final target.

Finally, ‘no decision about me, without me’ as an underpinning principle behind the reforms will begin to come to the fore. Can we expect to see patients taking more interest in their care, as more choice is provided, and information becomes available? Andrew Lansley has stated this week that ‘blacklisting’ of NHS drugs needs to be ended to stop the current ‘postcode lottery’, but also to avoid the threat of legal action from patients who know their rights.

We are sure you will be following developments in the NHS like us, during a year which will undoubtedly be crucial for the success of the reforms and economic future of the NHS.

A major tenant of the Health and Social Care Bill, which is still slowly working its way through Parliament, is to decentralise the decision-making process. However the guidance recently circulated to Primary Care Trusts indicates that a number of functions originally earmarked for local clinical commissioning groups will now be handed back to regional subsidiaries of the newly formed NHS Commissioning Board.

The leaked document suggests that four key functions for the smooth running of commissioning (business intelligence such as collecting or organising data, major clinical procurement, back office functions such as IT, human resources and finance, and communications services) are best done ‘at scale’ and highlights that considerable savings would be achieved by delivering these. Not only that, but these functions are also stated to be ‘at risk of becoming unsustainable if not centralised’ – a sentiment arguably at opposite ends of the spectrum to the original aims of the Bill!

The most interesting aspect of this argument is the concept of ‘at scale’. Andrew Lansley was understood to want to promote local and patient-centric decision-making by elevating GPs to powerful budgetholders, as well as scrap the existing system of PCTs and SHAs that were branding as ‘too bureaucratic’. Perhaps this guidance is a sign that practical considerations are catching up with policymakers at the Department of Health, as large organisations in any sector will tell you that it is often inappropriate and inefficient to devolve responsibility for all services to a local level.

We’ll be watching closely to see how commissioning functions will eventually be divided between clinical commissioning groups and regional arms of the NHS Commissioning Board. As the latest plans appear to suggest approximately ten outposts will be established across the country, perhaps we will never be able to escape the ‘bureaucratic structure’ of centralised bodies in an efficient and well run health service?

Interestingly, the use of txt spk (text speak) is spreading beyond the realms of the mobile phone and the instant message with authors such as Martin Amis and Will Self experimenting with the language in their work. Clearly, the need to communicate in fewer than 160 characters (or 140 if you consider Twitter) requires a certain amount of imagination and inventiveness. However, it also means that punctuation goes out of the window, no doubt sending Lynne Truss and members of The Queen’s English Society into a grammar meltdown. Txt spk has now been employed on countless occasions to help engage the younger generation. For example, author Michael Baum has adapted Shakespeare and Dickens to make the work of these writers more accessible to children. Of course, there is always the risk that appropriating language in this way might backfire. It seems likely that children will find txt spk less appealing if they know their parents are using it.

Unsurprisingly, the NHS has jumped on the bandwagon and applied some of these principles to its social marketing.

Recent public health campaigns covering a variety of topics, including teenage pregnancy, cervical screening and breastfeeding have adopted a less formal, more light-hearted approach
than those rolled out in the past and have been more successful as a result. This is because the people behind them understand that young people, the target demographic in all of these cases, are more receptive to this approach. Take the NHS Lancashire Be A Star breastfeeding campaign for example, which achieved national news coverage simply for being so ‘in tune’ with its audience.

Similarly, Primary Care Trusts across the West Midlands ran a three-year disease awareness campaign to improve cervical screening rates among 25-39 year old women. The success of the campaign, which resulted in a 16 per cent increase in the uptake of screening in the target group within the first three months, was attributed to its “eye-catching and colourful humour” and the fact that it acknowledged that having a smear test isn’t the greatest of experiences, hence the pants.

Then there’s NHS Leicester City’s video Teenage Kicks. The short which was filmed on a mobile phone and used actors to show a teenage girl giving birth on a school playing field, received thousands of hits after it was posted on video-sharing sites, including YouTube and Kontraband.

Thanks to a change in tack, these and other campaigns are helping to raise awareness of the issues and, more importantly, altering behaviour.

And with most complaints against doctors centring on communication rather than clinical shortcomings, is it also time for the medical profession to rethink the way it interacts with the general public?

Despite the fact that all medical students now receive formal communications training, doctors continue to be criticised for their bedside manner (or, more accurately, lack of) and while the situation is undoubtedly improving, there are still areas for development. For example, although The National Cancer Patient Experience Survey conducted across England during the first three months of 2010 showed that 81 per cent of patients said they got understandable answers to important questions all or most of the time from doctors, only 66 per cent of patients were given easy-to-understand written information about the type of cancer they had. Even though it’s acknowledged that the level of comprehension will depend on the education of the patient, guidelines recommend that jargon and three-letter acronyms should be avoided and silence should be welcomed, especially when breaking bad news.

While the medical profession is considered cutting edge when it comes to its use of social media and digital technology, is there a risk of more straightforward communications principles getting left behind?

For example, while employing abbreviations such as WYP (what’s your problem?) and IMO (in my opinion) might work with the under 25s, it is unlikely to resonate with the over 75s. At the end of the day, doctors are medical specialists not language specialists and so it seems unreasonable to expect them to keep up-to-speed with all the latest linguistic trends on top of everything else. Surely, all we really need is for them to be factual but sympathetic and refrain from using technical language or terms with ambiguous meanings. In other words, KISS (keep it simple, stupid), the classic media training guidance!

Only once the committee stage is complete will we have a better idea of the timetable for change and the key policies that the Coalition Government are prioritising (it could be that some changes are sacrificed or rescheduled if pilot schemes are requested).

In other policy news, the new Royal College of General Practitioners survey suggests over 50% of GPs disagree that the proposed model of GP commissioning would create a patient-led NHS and more than 70% disagree- or strongly-disagree that the concept of ‘Any Willing Provider’ would either achieve a patient-led NHS, or improve healthcare outcomes.

While Dr Sarah Wollaston as MP for Totnes  is in the rare position of also being able to vote on the Bill, most GPs of course don’t have that option. Let’s hope that Andrew Lansley hasn’t forgotten that his reforms will not only need to be passed by the Houses of Parliament but also face the final hurdle of being implemented by this as yet unconvinced GP audience.

Political scientist Robert Dahl’s famous definition of power ‘A has power over B to the extent that he can get B to do something that B would not otherwise do’ could perhaps be re-written with Mr Lansley’s particular predicament in mind: ‘A secretary of state for health has power over the NHS to the extent that he can get his White Paper passed in an Act of Parliament and that legislation implemented by healthcare professionals and managers’.

While we’ll have to wait until later in the parliamentary calendar to see how Lansley fares, with outspoken opposition from prominent figures further down the HSJ100 such as number 11 Clare Gerada over the weekend, his claim on pole position looks decidedly uncertain.

Quite how NICE will work alongside GP consortia remains to be seen, and there are obvious challenges not least when it comes to the consistency of prescribing habits throughout the UK. For the media, and for that matter the public, NICE was a clear target for criticism, often viewed by frustrated and angry patients as bureaucrats putting barriers in the way of patients receiving the treatment they feel they rightly deserve. GPs are likely to be similarly unpopular if they are viewed as blocking access to treatments (especially those that are available in other areas.)

The reforms are due to come into place no later than 2014, although as Richard Barker, director general of the Association of the British Pharmaceutical Industry (ABPI) noted yesterday, it is quite possible that a number of prescribers will begin to deviate from NICE guidance since clinicians know it will soon become redundant. However, if NICE continues to play a highly influential role, but GPs shoulder the weight of controversial cost-effectiveness decisions, patients could feel confused by what they can and cannot access. In all this, convincing patients that they come first and bureaucrats come last will be no small challenge.

Regional variation could still exist if cost-effectiveness decisions are made by GP consortia, so the move does not signal an end to talk of ‘postcode lotteries’. While there is much detail to be filled in here before making any such speculation, healthcare communications programmes will be guided by value judgements and access to drugs in the same way they have done based on NICE guidance.

The #nhssm Twitter discussion has many more useful cases of social media use in the NHS, with hospital comms teams, healthcare professionals, and ‘e-patients’ all using technology to share best practice and promote useful tools and ideas. It’s still early days, but the future of the NHS is ‘social’ if not anything else.

This is the start of a big conversation that has significant implications on the NHS and public health. We’ll be following closely, and recommend others to do so and get involved too…