Hospitals could join prisons in cycle of 'crisis, cash, repeat', says report (The Guardian: 28 February 2017)
Hospitals could join prisons and social care in a cycle of “crisis, cash, repeat” unless they receive better financial planning and reforms, a Whitehall report has warned.
Without improvements, public services are doomed to fail or breach spending controls, the report by the Institute for Government and the Chartered Institute of Public Finance and Accountancy (Cipfa) said.
The government’s austerity programme of delivering good services while cutting spending “ran out of steam” in 2015, according to an analysis of official figures. Both organisations are urging the chancellor to ensure any measures in the budget have sound evidence behind them.
The findings come as Philip Hammond comes under pressure to use an unexpected rise in tax receipts to aid public services in his first full budget next week.
Julian McCrae, the Institute for Government’s deputy director, said that unlike others, this report was not calling for more money but instead better organisation to shore up the public sector.
“As we’ve seen with prisons, social care and now potentially hospitals, the government risks getting into a cycle of crisis, cash, repeat,” he said. “This report is a call for better financial planning and reforms that are robust enough to survive public scrutiny.
“It is fundamental to increasing the effectiveness of these public services that ministers, officials and the public know how well government is performing and use this information to guide decisions.” ....read more
NHS staff ask 'least bad' patients to sleep in corridors amid hospital demand crisis (The Telegraph: 28 February 2017)
Patients are being asked to volunteer to sleep in corridors in order to free up spaces on overrun NHS wards, a new report reveals.
An anonymous survey of front-line doctors found staff are deliberately approaching the “least bad” patient in their ward to ask them to give up their bed.
The report on NHS performance in December and January by the Royal College of Physicians also reveals concerns that “panicking” managers desperate to get new patients into recently vacated beds are sidelining proper infection controls.
Patients groups said the document showed that quality hospital care has now become “a lottery” and that, despite a relatively mild winter, the NHS is “on course for catastrophe”.
Approximately 60,000 patients visited A&E a day in England in the last week of December, and early data indicates that a quarter had to wait for more than four hours to be seen, with many having to wait for up to 12 hours.
Emergency medicine consultants reported that their departments were so busy at the height of the winter period that patients were frequently treated in A&E waiting rooms, rather than in proper beds....read more
Government cutting beds across UK hospitals in NHS money saving measures (The Independent: 21 February 2017)
Hospitals will have to be closed and beds cut as part of a series of money-saving measures across the NHS in England.
A new report from The King's Fund think tank has warned that the number of hospital beds could destabilise services that were already "stretched to their limits" after the Winter.
Community services were also "feeling the strain" and could not currently cope with an increase in workload, it said.
Sustainability and transformation plans (STPs) have been put forward by NHS chiefs in 44 areas in England as part of a national programme to transform the health service and save money.
The included hospital closures and cuts to some specialist services such as accident and emergency and stroke care.
King's Fund Chief Executive, Chris Ham said that the NHS cannot “realistically” cut the number of beds when this winter had shown that they were needed.
But he added that also said it needs to throw its full weight behind the plans to stand a chance of pulling them off.
The cuts could include a 44 per cent reduction in inpatient bed days in south-west London and a cut in hospitals in north-west London from nine to five. Hospital beds in Dorset could also be from 1,810 to 1,570....read more
Health cuts most likely cause of major rise in mortality, study claims (The Guardian; 17 February 2017)
An unprecedented rise in mortality in England and Wales, where 30,000 excess deaths occurred in 2015, is likely to be linked to cuts to the NHS and social care, according to research which has drawn an angry response from the government.
The highly charged claim is made by researchers from the London School of Hygiene & Tropical Medicine, Oxford University and Blackburn with Darwen council, who say the increase in mortality took place against a backdrop of “severe cuts” to the NHS and social care, compromising their performance.
The Department of Health (DH) responded by accusing the authors of the paper and accompanying commentary, published in the Journal of the Royal Society of Medicine on Thursday, of bias.
The researchers ruled out other possible causes of the increase, including cold weather, flu and the relatively low effectiveness of the flu vaccine that year, noting that fatalities from the virus rose “but not exceptionally”.
After examination of NHS performance data for the period, which shows the service missing almost all its targets, they concluded: “The evidence points to a major failure of the health system, possibly exacerbated by failings in social care.”
The rise in deaths from 2014 to 529,655 in 2015 was the biggest in percentage terms in almost 50 years and the mortality rate was the highest since 2008. The excess deaths were largely among older people who are most dependent on health and social care, the authors said....read more
Smokers trying to quit hit by postcode lottery as GPs ration help (The Guardian: 19 February 2017)
Smokers in England wanting to quit face a postcode lottery as cash-strapped councils and GPs restrict access to services that can help them.
The revelation has alarmed health experts and charities who claim that lives are being put at risk as a result of the fragmented provision.
Evidence obtained under the Freedom of Information Act shows that an increasing number of clinical commissioning groups – the 200 or so organisations that deliver NHS services in England – have been instructing GPs to stop providing the services. Many of the groups argue that it is no longer their responsibility.
In 2012, local authorities were made responsible for improving public health and given £2.8bn of ring-fenced grants to pay for it. But, as the grants have been pared back, councils have pulled their funding for stop smoking services.
This has led to a rationing of treatments – such as nicotine replacement therapies, bupropion (brand name Zyban) or varenicline (Champix) – in many areas. When used in conjunction with counselling, studies suggest the chances of a smoker quitting can be substantial.
Almost a quarter of a million people stopped smoking in the 12 months to April 2015 as a result of using the services, a quit rate of 51%. The services are said to have a high success rate in helping smokers in poorer communities stop.
“We are increasingly concerned that cuts in council spending, NHS cost pressures and a lack of joined-up thinking by central government are combining to block progress on cutting smoking, still the No 1 public health challenge facing the country,” said Deborah Arnott, chief executive of Action on Smoking and Health (Ash)....read more
Fears of 'two-tier NHS' as GPs allow fee-paying patients to jump the queue (The Guardian: 8 February 2017)
Family doctors in Bournemouth have set up the first private GP service at which people who pay up to £145 a time will be seen faster and get longer appointments than their NHS patients.
The creation of the clinic has prompted fears that other GPs will follow suit and that NHS patients will become “second-class citizens” as general practice increasingly becomes a two-tier health service.
The three doctors running the Dorset Private GP service are offering “the unhurried, thorough, personal care we believe is best for patients” – at a price. Patients pay £40 for a 10-minute phone consultation, £80 for a 20-minute face-to-face appointment and £145 for 40 minutes with a GP.
“With the NHS sometimes struggling to offer a quality service now is the time to choose a private doctor,” according to the website for the trio’s venture. They offer times that suit patients and the chance to see the same GP at each visit, benefits that few NHS patients are offered any more because of the heavy and growing pressures on family doctor surgeries.
Those who pay receive their appointment at the same Poole Road Medical Centre in Bournemouth where the GPs see the NHS patients on their practice list. However, private patients in effect jump the queue to be seen as they can get appointments on the day, whereas ordinary patients can wait up to four weeks for an appointment lasting just seven minutes.
GPs are barred under the terms of their contract from offering private medical services to patients on their practice list. However, the Dorset Private GP service is not breaking any rules because it is only offering the service to other people....read more
NHS Health Check: A&E waits for January 'worst ever' (BBC News: 9 February 2017)
Record numbers of patients spent more than four hours in accident and emergency units in England in January, figures leaked to the BBC suggest.
During a difficult winter for the NHS, January appears to be the worst performing month in the past 13 years.
The figures also suggest record numbers of people waited longer than 12 hours for a hospital bed once seen in A&E.
The BMA said the prime minister could no longer "bury her head in the sand" over increasing pressure in the NHS.
And it accused the government of failing to grasp the seriousness of the situation.
But a spokesman from the Department of Health said the vast majority of patients were seen and treated quickly, and busy periods in hospitals were supported by an extra £400 million of funding....read more
NHS cash crisis in Kent halts non-urgent surgery until April (The Guardian: 2 February 2017)
An NHS body has run so short of money that it has banned patients in its area from having non-urgent surgery for up to 102 days in an unprecedented move that doctors have condemned as unfair and damaging.
Around 1,700 patients will be affected by West Kent clinical commissioning group’s (CCG) attempt to save £3.2m by delaying non-urgent operations from 20 December last year until the new financial year starts in April.
The CCG has introduced what the Royal College of Surgeons says is the longest ban in health service history on patients undergoing surgery to relieve pain, immobility, disability and other problems. The 1,700 patients include those waiting to have a new hip or knee fitted.
It is the latest example of cash-strapped CCGs implementing controversial restrictions on patients’ access to treatment which doctors have agreed they need. It follows a series of rows over the growing number of England’s 209 CCGs rationing care, including to smokers and those who are obese.
West Kent CCG has decided to suspend non-urgent surgery to help ensure that it does not bust its £616m annual budget. It pays for and supervises the care received by 463,000 people in Maidstone, Tunbridge Wells and surrounding areas.....read more
NHS spending per person will be cut next year, ministers confirm (The Independent: 28 January 2017)
The Government will cut the National Health Service’s budget per person in real terms next year, ministers have admitted in official figures for the first time.
Numbers released by ministers show NHS England will face a sharp reduction of 0.6 per cent in real terms of per head in the financial year 2018-19.
The numbers corroborate claims by NHS chief Simon Stevens earlier this month that “in 2018-19, real-terms NHS spending per person in England is going to go down”.
The figures also fly in the face of the Government’s public insistence that it is investing more in the health service, with Jeremy Hunt and Theresa May repeating the mantra of an extra £10bn for the NHS.
That claim was debunked by the cross-party Health Committee in the summer, whose chair, Tory MP Sarah Wollaston, said the number was both “incorrect” and “risks giving a false impression that the NHS is awash with cash”.
The Liberal Democrats said the figures show Tory claims of investment were “disingenuous” while Labour said the Government should use the March budget to close the black hole opening up in the health service’s finances....read more
How the ‘humanitarian’ crisis in the NHS is paving the way for private healthcare (The Independent: 13 January 2017)
t has been a calamitous winter inside the NHS. Last week, three people tragically died at Worcestershire Royal hospital with a women dying of a heart attack after waiting for 35 hours on a trolley. A similar picture has developed across the country with patients on trolleys due to lack of beds, many hospital trusts on red alert and ambulances missing targets for life-threatening emergencies. The British Red Cross declared a humanitarian crisis in the NHS.
The return of the Red Cross to Europe, over the last few years, for the first time since the Second World War is a terrible indicator of the toll austerity is taking. Wall-to-wall coverage and acres of column inches have generally failed to examine the root causes. Health journalists and correspondents seem perfectly content to recycle the crisis mantra. This is extremely convenient for the government and vested interests. What is missing from this picture is that the NHS crisis is manufactured by deliberate policies of cuts and privatisation.
The NHS will have endured an unprecedented nearly £40bn in cuts by 2020. Prime Minister Theresa May’s response – notably in last Sunday’s interview with Sophy Ridge on Sky News – has been to downplay the crisis. Hunt followed suit and his statement to the Commons on Monday was a typical masterclass in deflecting the blame. The initial response in the government playbook was to change the subject to mental health. Hunt also raised the possibility of axing the 4-hour A&E waiting target....read more
LMCs stepping up plans for GPs to do more private work by end of this year (Pulse: 24 January 2017)
GPs leaders in England are pushing ahead with plans to develop new structures that will enable GPs to carry out more private work in a bid to increase GP funding, Pulse has learnt.
The chair of Oxfordshire LMC told Pulse that they have been in discussions with LMCs across England about implementing new structures by the end of the year that will allow GPs to charge fees for carrying out non-contractual work.
Current rules prevent GPs from charging their own patients for care, but Oxfordshire LMC chair Dr Prit Buttar said they have developed models using third-party companies that would ’allow practices to take on what they want’.
The LMC said last year it was developing a ‘Plan B’ to take GPs out of the NHS, following the lead of Northern Ireland, where the GPC is set to vote on collecting practice resignations later this month.
It was, in part, a response to the UK GPC abandoning plans to ballot practices on mass resignation from the NHS, after receiving reassurances from NHS England that it was willing to consider the GPC’s proposals to alleviate pressures on GPs.
Dr Buttar told Pulse that the plans for GPs to provide more private services at the expense of NHS work have moved forward, and he expected to have a model for alternative working in place by the end of 2017....read more
Seventh practice in under two years set to close in English city (Pulse: 18 January 2017)
Yet another GP practice has closed in Brighton, bringing the total number of closures up to seven in less than two years, covering more than 30,000 patients.
Some 2,300 patients have been left with instructions to temporarily rely on a local walk-in centre after the GP principal at single-handed Lewes Road Surgery handed back their contract.
It follows four practices in the city closing last year, while two more closed in 2015 - with one GP partner telling Pulse it was 'like a bereavement'.
Local leaders said that it is creating further pressure in an area that already has 'significant capacity problems'.
NHS England said in a letter to patients that Lewes Road Surgery principal Dr Amrut Shah was 'stepping down with immediate effect' following 'discussions over Christmas'.
It further admitted that it was likely patients may have to register elsewhere by the end of this month to 'guarantee' their 'ongoing care'....read more
More than 7,000 nurses could face axe under secret NHS plans (The Telegraph: 16 January 2017)
More than 7,000 nurse posts could be axed from NHS hospitals across the country despite a mounting Accident & Emergency crisis, new plans reveal.
Every area has been ordered to draw up meaures to save £22bn and reorganise health services in order to meet rising demand from an ageing population.
But new documents suggest that the proposals could result in the loss of more than 17,000 staff by 2020 - including 7,300 nurses and midwives.
Last night senior nurses said the implications for safety were “truly frightening” with widespread shortages of staff already in overstretched hospitals.
The forecasts, seen by Health Service Journal, also reveal that the plans rely on a dramatic reversal in trends which have seen casualty units under unprecedented pressure.
While A&E attendances across England have risen by 4.5 per cent and emergency admissions by 3.5 per cent in the past 12 months, the plans rely on a 4.2 per cent fall in attendances, and a 0.8 per cent drop in admissions.
Health authorities across England have been ordered to draw up 44 “sustainability and transformation plans” (STPs) to tackle rising pressures on the health service.
The controversial measures will see swingeing bed cuts in many parts of the country, and widespread closures of Accident & Emergency departments....read more
Hospitals across UK cancelling 'urgent' cancer operations as NHS winter crisis worsens (The Independent: 15 January 2017)
Hospitals across the UK are cancelling "urgent" cancer operations as the NHS winter crisis worsens.
Some patients have reportedly been told with just a day's notice that their surgery has been postponed, with a leading surgeon saying it was "extremely worrying" that hospitals had resorted to the decisions.
Cancer operations have previously held a protected status but the demand for beds and lack of social care capacity has encroached on that.
Clare Marx, president of the Royal College of Surgeons, told The Observer: "Feedback from our members suggests that since the start of January, a large number of hospitals across the UK are now cancelling cancer surgery. This will be extremely worrying to patients and their families.
"It is heartbreaking for a surgeon to have to explain to a patient who has cancer that their operation has had to be cancelled as there are no beds available. It is increasingly clear that no part of the system and no patient is immune from the pressure the NHS is experiencing."...read more
Theresa May urged to get a grip on NHS as winter crisis spirals (The Guardian: 7 January 2017)
Theresa May is under intense pressure to announce an emergency NHS rescue plan to parliament – amid a chorus of warnings that hospitals and GP services across England have finally reached breaking point.
Labour and the Liberal Democrats are demanding the prime minister, or Jeremy Hunt, the health secretary, appear before MPs on Monday – when parliament returns from the Christmas break – as doctors and medical organisations said the winter crisis was reminiscent of the chaos that engulfed the service in the dark days of the 1990s. Former Tory health minister and practising NHS doctor Dan Poulter said it was essential that ministers disclosed the extent of the problems, because there was an urgent need to focus minds and build momentum behind the search for a cross-party solution.
In a further sign of spiralling pressures on health and social care services, the president of the Society for Acute Medicine, Dr Mark Holland, called on May to convene a special version of Cobra, the committee that is summoned only in national emergencies.
While Department of Health sources said that they understood the concerns, they said ministers had addressed the problems by announcing more funding for social care and the NHS. They also said the NHS was equipped to deal with winter pressures that they said were no more serious than last year. The demands for a plan of action and statement to parliament came after the British Red Cross, which has been providing help to dozens of overstretched hospitals, said the situation affecting the NHS in England was a “humanitarian crisis”....read more
Ambulance workers say new cost-cutting measure risks lives (The Guardian: 8 January 2017)
Paramedics have accused their own NHS ambulance service of endangering lives in a bid to save money by cutting a system under which they abandon meal breaks to respond to patients with life-threatening conditions.
Crews at the South East Coast ambulance service (Secamb), which covers a huge swath of south-east England, were told that they would no longer be paid overtime for abandoning their breaks to respond to some 999 calls including emergencies involving strokes, seizures and breathing problems. The instruction came as it emerged that medical staff across the UK faced an unprecedented demand on emergency resources last week.
Frontline staff with Secamb have complained to the Guardian about the controversial change of policy as pressure mounted on the government to respond to the growing crisis engulfing NHS emergency departments.
Paramedics have warned that patient safety and lives could be put at risk because it will lengthen the service’s response times, which its boss recently admitted were already poor.
Ambulance crews will no longer be paid the £25 they receive each time they interrupt the single – and unpaid – 30-minute meal break they get during their 12-hour shift in order to answer a Red 2 call, which can involve someone with chest pains or car crash casualties.
The Patients Association said the policy was short-sighted and the welfare of patients should never be sacrificed in a quest for savings. It comes as NHS governance grew into a major political issue in the wake of three patient deaths at Worcestershire Royal hospital last week.
On Sunday, Theresa May rejected the British Red Cross’s claim that hospitals and ambulance services were under such pressure that it constitutes a “humanitarian crisis”. The prime minister made clear she would not be producing an NHS rescue plan....read more
NHS spends millions on private companies that block GP referrals, investigation finds (The Independent: 4 January 2017)
The NHS is spending millions on private companies that stop GPs referring patients to hospitals, an investigation has revealed.
Controversial "referral management centres" are supposed to cut costs and improve the quality of GP referrals – but three quarters of NHS bodies that told the British Medical Journal (BMJ) they used the schemes could not say whether they had saved money overall.
The centres can block or redirect GP referrals for procedures such as hip and knee replacements, treatment for allergies and cataract surgery to manage outpatient activity at local hospitals.
At least £57m has been paid out to them since April 2013, according to the 69 per cent of Clinical Commissioning Groups (CCGs) using the schemes which gave details of their operating costs.
Doctors expressed concern that paying third parties to screen GP referrals – around a third of which are run by private companies – was of questionable effectiveness.
“[CCGs] are leaping at these schemes without any clear evidence of benefit and that they’re just hopeful that it might reduce their costs,” Dr Richard Vautrey told the journal....read more
NHS could face its worst January as it struggles with festive backlog, warns doctor (The Guardian: 2 January 2017)
The NHS is facing “potentially the worst January” ever as it struggles to deal with the backlog of patients occupying beds over Christmas, a leading doctor has warned.
Dr Mark Holland, president of the Society for Acute Medicine (SAM), said hospitals had already seen large numbers of elderly patients over the festive period and that the health service was on the brink of a major crisis.
Holland, who is based in Manchester, said hospitals were operating under a “false sense of security” as elective procedures dipped during the Christmas period with those beds becoming available for emergency patients.
Once routine operations start up regularly this week, hospitals must make these allocated beds available again. A bout of flu, the winter vomiting virus, or even a cold snap, could prove the tipping point, he warned....read more
Jeremy Hunt accused of compromising weekday hospital care (The Guardian: 2 January 2017)
The health secretary, Jeremy Hunt, has been accused of compromising the care patients receive during the week by not taking forward his pledge to hire more junior doctors to help deliver a seven-day NHS.
The Liberal Democrats’ health spokesman, Norman Lamb, said that with juniors now having to work more at weekends, already under-staffed hospitals had fewer medics on duty on weekdays.
He said Hunt had done little to make good on the hiring pledge he made in parliament during the year-long dispute over junior doctors’ contracts.
“My fear is that unless you can guarantee that there will be more junior doctors employed, imposing a change which involves more hours being worked at weekends will inevitably reduce the numbers of hours worked during weekdays when the pressure is at its greatest,” Lamb said. “This could result in real safety concerns.”
In a letter to Lamb, Hunt failed to provide any detail of how many more junior medics would be trained and employed this year or any other year before the end of this parliament in 2020.
He has previously acknowledged the potential for too few doctors being on duty between Monday and Friday as a result of the new contract he imposed in October on all 54,000 junior doctors working in the NHS in England.
Hunt told Lamb that it was up to hospital trusts to expand their junior doctor workforce, raising doubt that his previous assurance would be acted on.
Nor did the letter provide any detail on how many extra trainee medics would join the NHS this year, despite Hunt having told Lamb in the House of Commons on 5 September that he would give him a number.....read more