The NHS secret is out. And local communities won't like it (The Guardian: 26 August 2016)
When Simon Stevens became NHS England’s chief executive in April 2014 he disavowed his predecessor David Nicholson’s radical centralisation of specialist hospital treatment into far fewer places.
Stevens also went further, using his first interview in the post to pledge to maintain local hospitals. Every NHS leader, and every MP, knows how attached the great British public is to the bricks and mortar of their local NHS. The last thing Stevens wanted was to face opposition by campaign groups, councillors and MPs to a particular A&E or maternity unit being downgraded or closed, and certainly not a wave of such protests in many parts of England simultaneously battling to save much-loved local services.
Yet that is the growing risk he now faces as a result of the 44 regional sustainability and transformation plans (STPs). The disclosure of controversial changes planned in north-west London, Leicestershire and the West Midlands – including entire hospitals being downgraded or closed – could easily result in England-wide protests.
NHS bosses say the plans are necessary for the sake of better care, modernisation and financial balance but an angry, disbelieving public is expected to fight tooth and nail against the loss of the local services.
The standoff over STPs has been coming for months and prefaces major political battles ahead which will involve unprecedented examination of the government’s record on and plans for the NHS. Are STPs part of an undeclared Tory plot to prepare the NHS for much greater privatisation after 2020? Or are they designed to move the health service from an illness treatment service to one that prevents ill-health in the first place? ...read more
NHS plans 'not just about closures', bosses insist (The Guardian: 26 August 2016)
NHS chiefs have said a planned programme of radical changes to meet increased demand and plug funding gaps does not only involve cuts, after opposition politicians and campaigners expressed alarm at the plans.
An investigation by the Guardian and the campaign group 38 Degrees showed a possible shortfall of about £20bn by 2020-21 if no action is taken, prompting NHS England to ask 44 local areas to submit a cost-cutting “sustainability and transformation plan” (STP).
The shadow health secretary, Diane Abbott, called the report “a damning indictment of this government’s underfunding and mismanagement of the NHS”, while Chris Hopson, chief executive of NHS Providers, which represents frontline NHS leaders, said a “glut” of hospital services could shut down.....read more
Stafford hospital suspends 'unsafe' children's A&E (The Guardian: 25 August 2016)
A Staffordshire hospital has suspended its A&E service for children after senior staff said it was “not currently clinically safe”.
The drastic measure, implemented at 10am on Thursday, came after County hospital in Stafford was found to have insufficient staff trained to the required level in resuscitation and life-support for children.
University Hospitals of North Midlands NHS trust advised parents not to bring their children to the hospital, and instead to take them to a GP or pharmacist in the case of minor illness or injury, or to call 999 in the event of an emergency.
It said any sick children brought to the hospital would be cared for by staff until a transfer to another hospital could be arranged....read more
Seven-day NHS: Labour demands inquiry as leak reveals crisis warning (The Guardian: 23 August 2016)
Labour is demanding an inquiry into revelations that senior civil servants fear the government’s push for a “truly seven-day NHS” may be derailed because it faces staffing and money problems.
Tom Watson, the party’s deputy leader, claimed that leaked Department of Health documents obtained by the Guardian and Channel Four News showed Jeremy Hunt had misled the public by pushing ahead with expanding the NHS in England despite his own mandarins’ concerns.
“Leaked secret papers show that junior doctors’ concerns were right. This warrants an inquiry. Hunt misled the public,” Watson tweeted in response to the disclosures, which have prompted renewed scrutiny of a policy that the Conservatives have pledged to deliver in full by 2020.
Senior Tories have responded to the publication of the department’s own risk assessment of the seven-day plan and other papers by making clear that they share the civil servants’ previously private worries....read more
Private provider beats trusts and GP federation to community contract (Nursing Times: 23 August 2016)
Virgin Care has been named preferred provider to provide adult community services in the South of England as part of an alliance contract, ahead of a bid from local trusts and a GP federation.
The decision was made on 10 August by Guildford and Waverley Clinical Commissioning Group.
The alliance contract involves Virgin Care in partnership with Royal Surrey County Hospital NHS Foundation Trust, Surrey and Borders Partnership NHS Foundation Trust, Age UK Surrey and Surrey County Council.
A joint bid for the contract was also made by local GP federation Procare, Sussex Community NHS Foundation Trust and again Royal Surrey County Hospital, but was subsequently rejected by the CCG....read more
Secret documents reveal official concerns over 'seven-day NHS' plans (The Guardian: 22 August 2016)
The health service has too few staff and too little money to deliver the government’s promised “truly seven-day NHS” on time and patients may not notice any difference even if it happens, leaked Department of Health documents reveal.
Confidential internal DH papers drawn up for Jeremy Hunt and other ministers in late July show that senior civil servants trying to deliver what was a totemic Conservative pledge in last year’s general election have uncovered 13 major “risks” to it.
While Hunt has been insisting that the NHS reorganise around seven-day working, the documents show civil servants listing a string of dangers in implementing the plan – as summarised by a secret “risk register” of the controversial proposal that has prompted a bitter industrial dispute with junior doctors.
The biggest danger, the officials said, is “workforce overload” – a lack of available GPs, hospital consultants and other health professionals “meaning the full service cannot be delivered”, they say in documents that have been obtained by the Guardian and Channel 4 News.....read more
NHS crisis plan to cancel operations and appointments as winter draws in (The Telegraph: 21 August 2016)
Hospitals are to cancel thousands of operations and appointments in a desperate bid to stop the NHS "buckling" this winter, under Government plans.
Health officials are drawing up contingency measures to attempt to safeguard emergency care by diverting senior doctors from operating theatres into wards and Accident & Emergency departments as winter sets in.
The national plan, detailed in evidence to the Commons health select committee, comes amid concern that the NHS is already in the grip of the worst bed-blocking crisis on record.
Last night, Britain’s most senior A&E doctor said hospitals were under such strain that a bad outbreak of flu this winter would be enough to leave services “poleaxed”....read more
Nurse shortage puts children's mental health plan ‘at risk’ (Nursing Times: 19 August 2016)
A government mental health strategy is at risk because most children and young people’s mental health trusts have nurse recruitment difficulties, suggests an independent report.
Experts evaluated whether children and young people’s mental health care had improved since the publication in March 2015 of the government strategy Future in Mind.
The strategy, backed by £1.4bn over five years, aimed to modernise the way children and young people’s mental health services operated and tackle the current treatment gap.
The vision was to move towards a system focused on prevention and early-intervention, where specialist services were integrated with wider health and care support.
The Education Policy Institute think-tank set up a commission in December, which was chaired by Liberal Democrat MP and former health minister Norman Lamb, to assess the progress of the strategy during its first year....read more
GPs told to refer patients to private sector in bid to cut local trust’s waiting times (Pulse: 19 August 2016)
GPs in Hertfordshire have been told to refer patients to private hospitals in a bid to control soaring waiting times at the local NHS trust, Pulse has learned.
NHS Herts Valley CCG has told GPs to refrain from referring patients to West Hertfordshire NHS Trust (WHHT) for non-urgent appointments wherever possible, and has particularly encouraged GPs to not refer for certain specialties, including cardiology, ENT, urology, pain, and general surgery.
Instead GPs have been told to refer patients to alternative hospitals, including local private providers, while the Trust is in the process transferring existing referrals to the private hospitals. The referrals will be funded by the NHS.
This is in a bid to cut waiting times at the trust, which has failed to meet national 18-week referral to treatment targets....read more
NHS success in tackling health inequality varies hugely across England (The Guardian: 20 August 2016)
The social divide in hospital admissions – which means far more poor people end up in hospital for preventable conditions than richer people – varies dramatically across England, researchers have found.
Data compiled by the University of York for NHS England revealed that the performance of a clinical commissioning group (CCG) in tackling the social divide in these preventable hospital admissions is not always linked to how rich or poor the CCG’s patient population is.
Liverpool clinical commissioning group, which appears on the worst performers list, and Tower Hamlets and Portsmouth CCGs, which appear on the best performers list, each serve some of the most deprived neighbourhoods in the country.
At the wealthy end of the scale, South Cheshire performs badly on inequalities, while East Surrey CCG performs well, appearing in the top 10....read more
Virgin Care preferred bidder for £69m community services contract (HSJ: 19 August 2016)
The seven year contract – with an option to extend for a further three years – is being jointly commissioned by Bath and North East Somerset Clinical Commissioning Group and Bath and North East Somerset Council.
It covers over 200 services currently delivered by more than 60 organisations including: health visiting; speech and language therapy; diabetes nurses; district nurses; the falls prevention team; the independent living service; physiotherapy and reablement services; and palliative care nurses.
Virgin Care was chosen ahead of a consortium led by the social enterprise Sirona Care and Health, which included Avon and Wiltshire Mental Health Partnership Trust, Royal United Hospitals Bath Foundation Trust, Dorothy House Hospice Care, and the GP organisation Bath and North East Somerset Enhanced Medical Services.
The rationale for the contract is to integrate the disparate services. Virgin Care will act as a “prime provider”, directly delivering and coordinating services, but with the option to subcontract to other providers where appropriate....read more
Virgin Care bags major £700m health and care co-ordination deal (National Health Executive: 19 August 2016)
Virgin Care has been chosen as the preferred bidder to co-ordinate over 200 health and care services in Bath and North East Somerset as part of a major £700m contract.
According to NHS Bath and North East Somerset CCG, the deal is intended to strengthen health and care co-ordination in the region after several complaints from people who claim to “have difficulty finding their way” around the system.
The contract is worth £69.2m a year and will run for seven years, with the option to extend for a further three years, which the CCG and the local council say is in line with their current spending on community services....read more
Hospital doctors ‘miss signs of illness’ because of chronic staff shortages (The Guardian: 20 August 2016)
“Dangerous” medical understaffing in hospitals is so rife that signs of illness are being missed, blood tests delayed and newly qualified doctors left in charge of up to 100 patients.
Chronic shortages of medics are also leading to those with little experience of some types of illness taking responsibility for wards full of medically needy patients, or with complex issues, whose conditions they know little about and do not feel qualified to give proper care to, including in intensive care and stroke and surgical units.
A survey of UK doctors, the results of which have been given to the Observer, reveals widespread concern that gaps in rotas were risking patients’ safety. Doctors said they were left stressed and in tears at being “pressurised” by managers to work more shifts to help hospitals cope with rising demand and said their relationships with patients were suffering.
One trainee surgeon said shortages meant a colleague in his first year of training was the only doctor in charge of more than 100 surgical patients overnight....read more
Cuts to health visitors could have ‘irredeemable’ effects on obesity and mental health (National Health Executive: 17 August 2016)
Leaders from major healthcare organisations have come together to call on the government to halt deep cuts to health visitor posts in order to keep other problems, such as childhood obesity and mental ill health, from escalating further.
In a joint letter to the Times – signed by the CEOs of 11 health bodies, such as the Royal College of Nursing (RCN), Unite, the Royal College of GPs, the RCPCH, the NSPCC and the National Children’s Bureau – professionals said cuts to the Health Visitor Implementation Programme is deteriorating public health.
The government’s Health Visitor Implementation Plan invested enough funds to train more than 4,000 health visitors, a job that plays a “vital and unique” role to prevent ill health and promote healthy lifestyles to children.
But five years on, posts are being cut harshly throughout England, with the latest workforce figures showing numbers have been falling since the beginning of the year – including a significant drop of 433 posts just between March and April.
According to the RCN, anecdotal evidence suggests this drop is “just the start of a significant reduction” in the number of these services due to ongoing cuts to local authority public health budgets.
In the letter, the 11 signatories argued the loss of health visitor posts could have “irredeemable consequences” for children and families, while “stunting the progress of several key government priorities”, from obesity and mental health issues in children and adults to promoting social inclusion....read more
Doctor shortage may see maternity unit downgraded (HSJ: 16 August 2016)
A shortage of doctors may lead to an Oxfordshire maternity unit being downgraded next month.
Oxford University Hospitals Foundation Trust, which runs Horton General Hospital, has scheduled an extraordinary meeting of its board of directors on 31 August to decide whether to downgrade the unit to midwife led only.
The trust has faced an ongoing recruitment crisis at Horton’s maternity unit, having held three recruitment rounds for the middle grade obstetric posts since the start of the financial year. It warns that from the end of September, six out of the eight required doctor’s posts may still be vacant.....read more
CCG consults on closing four hospitals (Pulse: 16 August 2016)
NHS South Devon and Torbay CCG are consulting on closing four local hospitals in order to increase 'community-based care'.
The proposals, aim to swap 'resources from bed-based hospital care to community-based care' by reducing the number of hospital beds, and therefore closing Ashburton, Bovey Tracey, Dartmouth and Paignton hospitals.
The CCG says that that this will allow 'investment in community-based services including community nurses, physiotherapists occupational therapists and social care staff to support people in their own homes.'...read more
New 'dementia atlas' reveals disparity in care across England (The Guardian: 16 August 2016)
People with dementia are being let down by local services across the country, according to new government data that critics say has revealed a postcode lottery in care for the chronic and degenerative brain disease.
An interactive “dementia atlas”, published online on Tuesday by the Department of Health, shows that standards of care vary widely in different areas, with services failing to reach almost half the patients for check-ups even once a year in one area....read more
NHS problems only going to get worse, says Patients Association (The Guardian: 16 August 2016)
Problems within the NHS are only going to get worse, the Patients Association has warned, after a study showed that tens of thousands of people are being forced to wait more than 18 weeks for routine surgery.
A report entitled Feeling the Wait found that hospital trusts across England each cancelled an average of 753 operations on the day in 2015. Equipment shortages, a lack of beds and scheduling errors were the main reasons given to patients in such cases, the authors said.
The total number of procedures cancelled by individual trusts ranged from eight to 3,269.
The report said: “We have grown increasingly concerned at the waits patients are facing for surgery and the amount of patients who have had their operation cancelled on the day.
“There is a significant psychological burden on patients waiting to be given a date for surgery and for patients whose surgery has been cancelled (often on the day the surgery was due to take place).”
The study highlighted substantial increases in the number of patients waiting longer than 18 weeks for routine operations....read more
Hospital A&E wards 'in crisis over shortage of emergency doctors' (The Guardian: 10 August 2016)
Hospital accident and emergency wards are in crisis as the supply of doctors fails to keep pace with demand for them in A&E departments according to medics’ representatives.
The warning from the Royal College of Emergency Medicine came as an A&E in the east Midlands announced it may have to temporarily close its doors at night owing to a national shortage of emergency doctors.
United Lincolnshire hospitals NHS trust (ULHT) said that a “crisis point” had been reached and patients’ lives could be put at risk if action was not taken at Grantham and District hospital.
Management at ULHT said they were looking to reduce A&E hours because the department was facing a severe shortage of doctors.
The trust, which runs the A&E, as well as two others in the region, said that it had been seriously affected by a “national shortage of appropriately trained doctors to work in A&Es”, adding: “We have reached a crisis point and we may put patients at risk if we don’t act.”...read more
Crisis-hit hospital trust may close Grantham A&E at night (BBC News: 10 August 2016)
Hospital bosses could shut an accident and emergency department at night in order to combat a staffing crisis.
United Lincolnshire Hospitals NHS Trust said it is considering slashing opening hours at Grantham and District Hospital due to a severe shortage of doctors.
It said closing the Grantham A&E rather than the departments at Lincoln County Hospital or Pilgrim Hospital in Boston was the "safest option".
A spokesman for the trust said failing to act "may put patients at risk".
The Royal College for Emergency Medicine (RCEM) said news of the potential closure was "disappointing, yet unsurprising"....read more
Hundreds of adult nurse training places expected to be left unfilled (Nursing Times:5 August 2016)
Universities have recruited “significantly less” numbers of students to adult nurse training places than was planned in recent months, which is expected to leave almost 300 course places empty by the end of the year, the national workforce planning body has said.
In addition, problems with filling district nursing and health visiting courses have also continued....read more
16 CCGs launch integrated NHS 111 and urgent care services (HSJ: 3 August 2016)
Sixteen West Midlands clinical commissioning groups are set to mobilise a new integrated NHS 111, GP out of hours and urgent care service across a population of 4.6 million after awarding a set of contracts worth up to £172m.
In March 2016, Sandwell and West Birmingham CCG, on behalf of the 16 CCGs, launched a procurement process for an integrated NHS 111 and out of hours GP services contract. Tender documents revealed the deal was worth between £86.4m and £172.1m, from July 2016 to July 2022. The CCGs have refused reveal the new combined contract value.
Care UK has been chosen to deliver NHS 111 and “clinical hub” services. Four providers have won new contracts for out of hours services in Birmingham South Central, Herefordshire, Sandwell and West Birmingham, and Rugby. The remaining areas have adapted existing out of hours contracts.
The deal is made up of two main elements: a single NHS 111 service for the entire patch, plus individual out of hours contracts for each CCG. An overarching alliance contract links the 111 service to out of hours, with the intention of making the services more integrated than they are at present.
The first element is intended to provide a single point of access through 111 services bringing together urgent care, GP out of hours services, ambulance services and social care. The alliance agreement between providers will allow for closer working between 111, out of hours and urgent care providers....read more
PrEP rationing is symptomatic of NHS bid to cut costs, at all costs (The Guardian: 2 August 2016)
NHS England’s setback in the high court over its attempt to get one set of cash-strapped public bodies (local councils) to foot the £10m-£20m a year bill for PrEP treatment rather than another – itself – is the latest manifestation of the health service’s increasing efforts to reduce the number of treatments it pays for, or the number of patients who receive them, or both.
Gradually, and largely unacknowledged, the NHS is rationing access to more and more types of care in order to try to balance its books, even when doing so includes treatments – such as PrEP, with its 90% success rate – that are proven to work but deemed prohibitively expensive in the midst of its decade-long funding squeeze.
Doctors, patients and health charities routinely insist that lives will be lost as a result, but still the process rolls on, affecting different groups of patients every time a decision is made....read more