Charity nurses warn of ‘postcode lottery’ in specialist children's care (Nursing Times: 23 May 2016)

Expert children’s nurses have highlighted wide variations in services and standards for children with complex health needs as the ground-breaking charity nursing scheme celebrates its 10th anniversary.

Services provided by its nurses have made a dramatic difference to families including reducing distressing emergency hospital admissions and cutting lengthy stays in hospital.

However, nurses and managers involved in the scheme warn that many children with complex health conditions still face a “postcode lottery” when it comes to getting all-round support. Problems include reductions in children’s community nursing teams, huge variation in the types of services available and a lack of emotional support and training for parents caring for seriously ill children....read more

 

Mental health support 'denied to children' (BBC News: 28 May 2016)

More than a quarter of children referred to mental health services in England in 2015 - including some who had attempted suicide - received no help, a report says.

A review by the Children's Commissioner also found that 13% with life-threatening conditions were not allowed specialist support.

She said the system was "playing Russian roulette" with their health.

NHS England said it was "clearly the case" that services need to expand.

The commissioner obtained data from 48 of England's 60 child and adolescent mental health service trusts, and discovered 28% of child referrals were denied specialist treatment - mostly on the grounds that their illness was not serious enough.

This group included children who had attempted serious self-harm and those with psychosis and anorexia nervosa.

It also found that those who secured treatment faced lengthy delays, with an average waiting time of more than 100 days....read more

 
 
GPs like me can't help mental health patients in 10 minutes – it's cruel (The Guardian: 16 May 2016)
 
The word compassion in all Latin derived languages combines the prefix, with (com) and the root, to bear or suffering (passio). For a doctor and all health professionals this is a given prerequisite. We suffer with our patients. It is the essential penance we shoulder in return for the wondrous joy of helping those in need.

I am a GP, and as such I act as one of the gatekeepers to the health service. People of any age and problem can walk through our door. Wherever possible we either treat or reassure. If not then we direct the patient to another NHS service for help.

In general practice we see a large number of patients in need. Few people more so than those struggling with mental health problems. There are 10 times more people suffering with major depression compared to 1945. It is utterly heartbreaking to see a depressed person who is struggling, only to reply to them: “Sorry, but the counselling you need is at least a six-week wait”. To this patient, six weeks is 42 days (and nights), 1,008 hours, 60,480 minutes or 3.63 million seconds.

These seconds are not ordinary seconds. Life feels like constantly walking in oversized wellies through knee-high wet mud. It is backbreaking, emotionally draining, gloomy and painful. As their GP, I have to condemn my patient to at least 3.63 million seconds of further torture without hope. I feel so helpless and cruel....read more

 

NHS mental health funding is still lagging behind, says report (The Guardian: 9 May 2016)
 

Government pledges to put more money into mental health are being broken because the NHS is not passing the money on to the NHS trusts that treat patients, a new report has revealed.

Care for people who need psychological help will suffer unless a chasm is bridged between ministerial promises and cash reaching the frontline, campaigners warn.

The disparity also threatens to undermine the historic change in 2012 that compelled the NHS in England to give physical and mental health equal priority or “parity of esteem”. Although mental ill-health accounts for 28% of the total burden of disease, it gets just 13% of the NHS’s budget.

New research undertaken by NHS Providers and the Healthcare Financial Management Association, revealed on Monday, found that only half of the 32 mental health trusts they spoke to – 55% of the total – had received a real-terms increase in their budgets in 2015-16. And only 25% said they expected NHS clinical commissioning groups (CCGs) to increase the value of their contracts for 2016-17, even though the 209 CCGs have seen an average 3.4% rise in their budgets this year....read more

 

Mental health services must get the funding they need - Saffron Cordery (The Guardian: 9 May 2016)

The phrase “parity of esteem” when used to describe the treatment of mental health services in the NHS is rightly being put under the microscope. It has been widely used to communicate a commitment to improving quality, broadening access to services and boosting funding. However, recently it has become clear that there is a gap between this intention and the reality on the ground.

Our report, Funding Mental Health at Local Level: Unpicking the Variation, published in partnership with the Healthcare Financial Management Association, shows just that, and it makes for difficult reading. Despite a number of funding boosts, it is clear that the necessary investment just isn’t reaching frontline mental health services. Our survey found that only half of mental health trusts received a real-term increase last year, despite the fact that the commissioners who fund them were required to increase their investment in line with their overall financial allocation.

Particularly concerning is the finding that NHS England is not necessarily leading by example. It is responsible for setting the rules and for holding local commissioners to account for their spending plans, yet its own specialised commissioning teams are not consistently meeting parity of esteem commitments towards mental health services, with only a third of trusts receiving a real-terms increase in 2015–16.

The situation does not look like it will improve this year either. Although we are still concluding the contracting round for 2016–17, providers were even less positive about receiving additional investment, with only a quarter confident that they would see a real-term increase...(read more)

 

GPs like me can't help mental health patients in 10 minutes – it's cruel (The Guardian: 16 May 2016)
 

The word compassion in all Latin derived languages combines the prefix, with (com) and the root, to bear or suffering (passio). For a doctor and all health professionals this is a given prerequisite. We suffer with our patients. It is the essential penance we shoulder in return for the wondrous joy of helping those in need.

I am a GP, and as such I act as one of the gatekeepers to the health service. People of any age and problem can walk through our door. Wherever possible we either treat or reassure. If not then we direct the patient to another NHS service for help.

In general practice we see a large number of patients in need. Few people more so than those struggling with mental health problems. There are 10 times more people suffering with major depression compared to 1945. It is utterly heartbreaking to see a depressed person who is struggling, only to reply to them: “Sorry, but the counselling you need is at least a six-week wait”. To this patient, six weeks is 42 days (and nights), 1,008 hours, 60,480 minutes or 3.63 million seconds.

These seconds are not ordinary seconds. Life feels like constantly walking in oversized wellies through knee-high wet mud. It is backbreaking, emotionally draining, gloomy and painful. As their GP, I have to condemn my patient to at least 3.63 million seconds of further torture without hope. I feel so helpless and cruel....read more

 

Penalties for under-resourced doctor concerns (BMA News: 16 May 2016)

GP practices rated outstanding or good by the CQC (Care Quality Commission) have benefited from more funding than those deemed inadequate or requiring improvement, the BMA can reveal.

A report released today highlights the pattern between practices with higher average funding per patient and better inspection ratings — raising concerns that under-resourced doctors are being penalised.

The report calls for fairer funding across the country and appeals to the Government and NHS England to ensure all practices are given at least the same funding as the average practice rated outstanding.

‘This analysis shows there is a clear link between the amount of funding a GP practice receives and the rating it is allocated by the CQC,’ BMA GPs committee chair Chaand Nagpaul says.

‘Despite this, the CQC takes no account of resources available to a GP practice when it grades its care, even if this leads to GPs and their staff being publically shamed with an “inadequate” or “needs improvement” rating.’...read more

 

'Red risks' identified for 111 provider switch (HSJ: 11 May 2016)

NHS 111 and GP out of hours services in east Kent are to be run by one organisation – but there are already fears about the transition to the new provider.

Primecare, which is owned by Allied Healthcare, will provide an integrated service from October, including a care navigator service to help more complex patients remain at home. The current providers are South East Coast Ambulance Service Foundation Trust for 111 and social enterprise IC24 for out of hours GP services.

The four east Kent CCGs say Primecare will initially run the combined service for three years, with an option to extend for another two. It said Primecare came top in a rigorous evaluation by patients and commissioners, who looked at safety, quality, service delivery and overall cost effectiveness.

However, a report to the CCG boards last month on the mobilisation of the new contract has five “red rated” risks including the risks related to this being Primecare’s first 111 contract, staff not transferring across from current operators and a new call centre not being ready in time. Even after planned mitigation, the risk around the new call centre remains at red....read more

 

Deep South: Kernow’s troubles continue (HSJ: 11 May 2016)

There are a number of organisations in the South West beset with difficulties, financial and otherwise. But Kernow Clinical Commissioning Group, along with Southern Health Foundation Trust, probably ranks among the most troubled.

The CCG’s problems first came to light in December when it revealed that it was not – as it had previously reported – forecasting half a million pound surplus, but a £14m deficit for 2015-16.

The shortfall ended up even worse than that – according to the latest information from the CCG, it finished with a £17.4m deficit (it actually overspent by £21.4m but was able to improve its position slightly because of a £4m surplus the previous year)....read more

 

16,000 patient practice on short-term contract as six APMS providers pull out (Pulse: 5 May 2016)

A 16,000 patient practice has been left on a short-term interim contract after six of the seven APMS providers invited by NHS England to tender for the contract pulled out saying it was unviable.

The partners at The Mandeville Practice in Aylesbury, Buckingham handed back their contract last year after being unable to replace a recently retired senior partner, and finding locum costs unsustainable.

Since April, the practice has been run by local APMS provider Practice U Surgeries Ltd, on an 18-month contract.

Former partner Dr Gill Beck says it has been left with ‘no security for its future’, adding that commissioners were now getting to grips with how the practice can be run long-term without destabilising adjacent practices.

Local GP leaders said the practice that was no longer viable under the traditional funding model and which would become a ‘poisoned chalice’ if recruitment problems continued.

Speaking on the current state of general practice at the BMA’s Special Representative Meeting (SRM) this week, Dr Beck told delegates: ‘Within 18 months of my retirement from that practice, my partners handed in their contract.

‘Seven private companies came round to look at this, to see if they would take it over. Six withdrew saying it was financially unviable. My practice has gone to a one-year contract with a private organisation with no security for its future.’..read more

NHS spend on private ambulances trebles in four years (BBC News: 26 May 2016)

NHS spending on private ambulances for 999 calls in England has trebled in four years, BBC research has found.

Ambulance trusts paid private companies and voluntary organisations £68.7m to attend emergency calls in 2015-6, compared to £22.1m in 2011-2. They respond to all types of calls.

NHS England said 999 calls for ambulances rose 4.5% last year.

Unions attacked "creeping privatisation" and called for more money for staff recruitment.

The ambulance service in England took 861,000 emergency phone calls in March 2016 - which equates to 27,800 a day - compared to 22,400 calls a day in March 2015, a rise of 24%.

Contractors include private firms and charities such as St John Ambulance and the British Red Cross....read more

 

Ambulance delays linked to 35 deaths in past five years (The Guardian: 23 May 2016)

Thirty-five patients have died in the past five years after delays of up to six hours in an ambulance reaching them and mistakes by 999 call handlers and ambulance crew, coroners have warned.

The deaths – which include a nine-month-old baby, two other children, a student nurse, a mother-to-be and an 87-year-old woman with dementia – have exposed how NHS ambulance services, faced with sometimes chronic shortages of vehicles and staff, are struggling to cope with demand.

Coroners in England and Wales have issued official warnings called prevention of future deaths notices highlighting problems with lack of resources, an inability to respond quickly enough to 999 calls and poor care that have caused, contributed to or been involved in the 35 deaths, inquiries by the Guardian have shown.

In five of the cases the patient would or might have lived if either the ambulance had got there sooner or the attending crew had provided better treatment, coroners said....read more

Trust reports dozens of 12 hour trolley waits in single month (HSJ: 16 May 2016)

Around 70 emergency patients waited more than 12 hours to be admitted at an acute trust in Greater Manchester in a single month. Official data, published by NHS England last week, said there were 137 “trolley waits” of at least 12 hours at Pennine Acute Hospitals Trust in March.

However, the trust said a new internal system had skewed the figures, so the true number of 12 hour breaches was about 70.

This would still be the most for a single trust in England, followed by Great Western Hospitals Foundation Trust with 49 breaches. Pennine Acute reported 39 breaches in February and 21 in January.  There have been serious performance problems at the trust this year, with the Care Quality Commission understood to have raised concerns about emergency services following an inspection in February. Its full findings are due to be published later this year.

HSJ asked the trust if any of the 12 hour breaches had led to patient safety incidents or harm, but this question went unanswered in its response....read more

 

Last-minute hospital operation cancellations at 15-year high (The Guardian: 13 May 2016)

The number of hospital operations cancelled at the last minute because of a lack of staff or beds has risen to its highest in 15 years, new NHS figures show.

A total of 74,086 patients in England suffered the frustration of their procedure being postponed at the 11th hour during 2015-16 for what the NHS calls “non-clinical reasons”.

Experts warned that the data was another sign that standards are slipping as the health service comes under increasingly heavy pressure. The 74,086 is the biggest total since 2001-02 when 81,743 patients experienced the same delay at the last moment. That was 2,604 (4%) up on the 71,482 such cancellations seen during the previous year.

“These are not just statistics, these are people’s lives and delayed operations can impede a patient’s quality of life”, said Katherine Murphy, chief executive of the Patients Association....read more

 

Rise in urgent operations being cancelled (HSJ: 11 May 2016)

Two trusts cancelled urgent operations at least twice for more than 20 patients, official statistics show.

HSJ analysis of NHS England data has found that Countess of Chester Hospital Foundation Trust and North Bristol Trust were forced to cancel urgent procedures 37 and 21 times respectively in 2015-16.

There were 3,716 urgent operations cancelled in 2015-16

The data for last year shows East Sussex Healthcare Trust cancelled urgent operations twice or more 13 times, but the trust said it submitted incorrect data to NHS England and this actually only happened six times.

The total number of urgent operations cancelled in 2015-16 was 3,716, up from 3,559 in 2014-15 and 3,055 in 2013-14.

The figures show 134 multiple cancellations of urgent operations in 2015-16, with more than half of them at East Sussex, Countess of Chester and North Bristol....read more

 

Revealed: London NHS chiefs to axe enough beds to fill a hospital in battle to plug £1bn black hole (London Evening Standard: 10 May 2016)

Enough beds to fill an entire hospital could be shut under new plans to plug a massive black hole in the finances of London’s NHS, the Evening Standard can reveal.

Health chiefs want to axe “500 acute beds” across north-west London after claiming that 30 per cent of patients in hospital do not need to be treated there. Instead, care is to be provided in the “least acute setting appropriate”, either at home or in a community or GP clinic, to prevent a £1 billion overspend in health and social care in five years.

The plans today sparked concern from patient groups with the belief that they were quietly submitted while attention was focused on the mayoral elections.

Graham Hawkes, chief executive of Healthwatch Hillingdon, said it backed the aim of delivering better care to an ageing population but feared the impact of closing 500 beds.

“We understand that this will not just be general hospital beds, but include reductions in beds for treating acute mental health patients,” he said....read more

 

Threat of public health nurse cuts now becoming a reality (Nursing Times: 3 May 2016)

Council cuts to budgets for health visiting and school nursing services that are putting jobs at risk threaten to “unravel” recent national efforts to boost the workforce, it has been warned.

Local authorities took over the responsibility from the NHS for commissioning for services for all 0 to 19 year-olds in October. But since then the government has announced a string of cuts to the public health funding it provides to local councils.

Last summer, it announced £200m public health in-year cuts for 2015-16, which it later confirmed would be applied evenly as a 6.2% reduction for each council.

Earlier this year, the Department of Health announced it would decrease local council public health grants by £77m in 2016-17, with additional reductions expected the year after.

Nursing Times has now learnt of several regions where authorities are cutting or reviewing the budgets for health visiting and school nursing, which are paid for out of the public health grant.

Due to proposed workforce cuts and reconfigurations, it has been claimed these services could in the future be run at “dangerous” and “unsustainable” levels....read more 

 

Staff shortages cited as factor in delayed discharge (Nursing Times: 26 May 2016)

Workforce capacity issues in health and social care organisations are making it difficult to discharge older patients from hospital effectively, a report has warned.

Across the health and social care system, providers and commissioners said that staff recruitment and retention were a significant cause of delays, according to the National Audit Office report.

It warned that vacancy rates for nursing and home care staff were up to 14-15% in some regions, and fewer than half of hospitals felt they had sufficient staff trained in the care of older patients.

Efforts to speed up discharge was also being inhibited by health and social care organisations not sharing patient information effectively, despite a statutory duty to do so.

While hospitals were financially incentivised to reduce discharge delays, there was nothing similar to encourage community providers and councils to speed up receipt of patients, added the report titled Discharging older patients from hospital...read more

Economists claim there will be a 6% drop in student numbers after bursary scrapped (Nursing Times: 25 May 2016)

Economists have estimated that demand for healthcare courses will drop by at least 6% following the removal of bursaries next year, leading to thousands fewer nurses being trained in 2017.

They also predicted that universities would lose at least £57m next year, largely due to smaller student intakes, under the new arrangements that will see nursing, midwifery and allied health professional students in England having to take out loans to fund their tuition fees and living costs.

Meanwhile, the report – titled The Impact of the 2015 Comprehensive Spending Review on Higher Education Fees and Funding Arrangements in Subjects Allied to Medicine – estimated the government would fail to make the vast majority of savings it expects from the move because a large proportion of student loans would have to be written off.

According to the analysis, carried out by consultants London Economics for Unison and the National Union of Students, the cost to healthcare students to study at university would increase by 71% under the government reforms....read more

 

Why has the NHS deficit ballooned? One word: understaffing (The Guardian: 20 May 2016)

Why are NHS finances in such a mess? The biggest reason is staffing – or, to be more precise, understaffing. The NHS in England is struggling with a serious and growing lack of personnel, especially nurses and some specialist doctors. This is forcing hospital trusts to spend unprecedented amounts of money on locums, especially those supplied by employment agencies, many of which charge what have been described by the NHS England chief executive, Simon Stevens, and the health secretary, Jeremy Hunt, as “rip-off” rates.

The mark-ups these agencies charge takes money away from frontline care. Barts health trust in London – the largest in the NHS – spent about £80m on agency staff in 2015-16, roughly £30m of which was profit for the agencies.

The sharp increase in the bill for agency staff mirrors almost exactly the dramatic decline in the health service’s finances. These personnel cost the NHS £2.5bn in 2013-14, rising to £3.3bn in 2014-15. The bill for 2015-16 was expected to hit £4bn, but new caps on trusts’ agency staff spending, introduced by Hunt last year, brought that down to £3.7bn – a saving of £300m, but still astronomical. There has also been a crackdown on the use of management consultants.

Most trusts have hired extra staff, and increasingly rely on agency workers to fill rotas and wards to standards recommended by Robert Francis’s official report into the Mid Staffordshire hospital scandal,which identified a lack of nurses as a key reason for inadequate care at the trust.

However, Francis’s report was published amid the longest period of austerity in the 67-year history of the NHS, with its 1% annual real-terms budget increases far below the 4% year-on-year rise it had been used to....read more

 

'Almost half' of junior doctors 'will quit the NHS' if contract is imposed (Pulse: 17 May 2016)

Almost half of junior doctors plan to quit the NHS if health secretary Jeremy Hunt’s threatened contract imposition goes ahead, a survey has found.

The survey, launched by a GP trainee and attracting thousands of responses, was designed to gauge the opinions from doctors and medical students about the junior doctor contract row.

The GPC also reacted to findings, branding them ‘very worrying’ and with ’potentially serious ramifications’.

Out of 4,500 replies via kwiksurveys.com in April, 46% of eligible respondents said they would leave the NHS this summer if the contract goes ahead, with 28% saying they would work abroad in countries like Australia and New Zealand; 15% pledging to leave medicine and change career and 3% vowing to leave to work in private healthcare....read more

 

Plan to train NHS nurses to cover for doctors sparks alarm (The Guardian: 17 May 2016)

A plan to train nurses to stand in for doctors as a way to tackle the hospital staffing crisis has caused alarm among doctors and patient groups.

A report by the Nuffield Trust, commissioned by NHS Employers, recommends giving extra training to nurses and other support staff to give them “advance practice roles” or “physician associate” status.

It says this will provide a relatively quick solution to the current shortage of doctors and help ease the workload of more qualified medics.

Junior doctors have said the idea is dangerous while the Patients Association said it should be regarded as a quick fix to plug the NHS’s workforce gap.

The report claims that retraining staff “could provide a cost-effective and rapid solution to mitigating some of the pressures on more senior staff”.

The report envisages a new tier of medical staff between doctors and nurses. “Physician associate represent a new cadre of staff with the potential to address a number of workforce challenges,” it says.

The Patients Association said such proposals should not be seen as a cheaper alternative to hiring highly qualified staff.

Junior doctors, who are involved in a dispute with the government over a new contract, said the plans would put patients’ lives at risk....read more

 

Seven-day NHS plans fail to address staffing needs, say MPs (The Guardian: 11 May 2016)

There has been “no coherent attempt” to assess how many staff will be needed to ensure that a seven-day NHS can function, parliament’s spending watchdog has found. 

A report by the public accounts committee says the Department of Health (DH) has not yet worked out if the current supply of staff can adequately meet demand in the health service in England.

“National bodies need to get a better grip on the supply of clinical staff in order to address current and future workforce pressures,” it concludes.

The report will be seized upon by critics of the health secretary, Jeremy Hunt, whose long-running dispute with junior doctors is based on claims that there needs to be more staff working on weekends to ensure patient safety.

MPs add that the DH has failed to assess the staffing implications of the Tories’ pledge for a seven-day NHS....read more

 

Hunt: staff shortage due to excessive 'optimism' (BMA: 10 May 2016)

Health secretary Jeremy Hunt has admitted successive governments — including his own — have failed to train enough staff to satisfy the needs of the NHS.

Speaking during health questions in Commons, Mr Hunt blamed the rocketing NHS agency bill, which drained the service of £3bn last year, on an ‘optimistic’ view of how few staff could safely manage a ward.

Mr Hunt (pictured) claimed to be taking action to decrease the vast costs — suggesting the agency cap implemented by the Government last year, which gives hospitals a defined limit on spending with agencies, would save £1bn a year.

Answering a question put to the house, which asked what the Government’s plans were to reduce agency spending, the health secretary said: ‘We’ve taken tough measures to control unsustainable spending on agency staff. Agency spending is now falling.’

Mr Hunt was pushed to respond further by Southport Liberal Democrat MP John Pugh, who said: ‘I don’t share his [Mr Hunt’s] optimism.

‘The real problem is the shortage of permanent staff.’...read more

 

Trust blames 'bad behaviour' of neighbouring providers for staff shortage (HSJ: 4 May 2016)

A financially stricken foundation trust has blamed “bad behaviour” of neighbouring trusts breaking agency spending caps for its staff shortages.

Doncaster and Bassetlaw FT has been forced to suspend inpatient admissions and transfer patients to other hospitals.

In a board briefing last week, chief executive Mike Pinkerton warned the lack of locum agency staff to fill rotas “now poses an escalating continuity of services risk” to the trust. He has complained directly to local trusts and NHS Improvement over the issue.

Papers show staffing became a particular problem in the trust’s Doncaster and Worksop emergency departments following the agency caps being brought down again in February, with staff leaving to “surrounding trusts as a result of them breaking cap rates”....read more

 

90% of GP trainees to shun full-time clinical work (Pulse: 5 May 2016)

Only one in ten GP trainees expect to be doing full-time clinical work in five years’ time, a major report from the King’s Fund think-tank has revealed.

The report – Understanding pressures in general practice – also claims that the crisis in general practice has been ‘invisible’ for policy-makers due to failure by the DH and NHS England to collect data.

Its analysis of 30 million patient contacts from 177 practices found that the number of consultations since 2010/11 had grown by 15%, echoing a recent study published in the Lancet.

GP leaders said that the lack of data on general practice had led ‘many to turn a blind eye to the ever-worsening crisis’ in the profession.

The report comes two weeks after NHS England released its ‘General Practice Forward View’, which committed to devoting more than 10% of the NHS budget into general practice.

The King’s Fund welcomed NHS England’s proposed measures, but warned that general practice was in a crisis.

It pointed to an increase in demand and a reduction in funding, as well as a recruitment crisis.

And it warned that the recruitment crisis could get worse, as a survey of 318 trainees revealed they were shunning a full-time career in general practice – and not only because of family commitments....read more

16,000 patient practice on short-term contract as six APMS providers pull out (Pulse: 5 May 2016)

A 16,000 patient practice has been left on a short-term interim contract after six of the seven APMS providers invited by NHS England to tender for the contract pulled out saying it was unviable.

The partners at The Mandeville Practice in Aylesbury, Buckingham handed back their contract last year after being unable to replace a recently retired senior partner, and finding locum costs unsustainable.

Since April, the practice has been run by local APMS provider Practice U Surgeries Ltd, on an 18-month contract.

Former partner Dr Gill Beck says it has been left with ‘no security for its future’, adding that commissioners were now getting to grips with how the practice can be run long-term without destabilising adjacent practices.

Local GP leaders said the practice that was no longer viable under the traditional funding model and which would become a ‘poisoned chalice’ if recruitment problems continued.

Speaking on the current state of general practice at the BMA’s Special Representative Meeting (SRM) this week, Dr Beck told delegates: ‘Within 18 months of my retirement from that practice, my partners handed in their contract.

‘Seven private companies came round to look at this, to see if they would take it over. Six withdrew saying it was financially unviable. My practice has gone to a one-year contract with a private organisation with no security for its future.’..read more

Out of hours provider to go into administration (HSJ: 13 May 2016)

An out of hours provider has been forced to end provision of services across the East Midlands after it announced it intends to file for administration.

Central Nottinghamshire Clinical Services said on Thursday it will stop its services in Leicester, Leicestershire, Rutland and north Nottinghamshire. It transferred them to other providers on Friday.

CNCS has stopped running out of hours services at King’s Mill Hospital

The news comes against the backdrop of pressure on general practice and out of hours services across the country. HSJ has been told that services in Leicester, Leicestershire and Rutland have moved to Derbyshire Health United, the out of hours provider for North Derbyshire, South Derbyshire, Hardwick and Erewash clinical commissioning groups.

Nottingham Emergency Medicine Service has taken over running out of hours services at King’s Mill and Newark hospitals in Nottinghamshire.

Care home support services, also provided by CNCS, have been transferred to Nottinghamshire Healthcare Trust....read more

 

GPC demands practices be compensated for 'systematic failure' of support services (Pulse: 11 May 2016)

The GPC has told NHS managers that every practice should be compensated for the significant extra workload they have had to take on as a result of the ‘systematic failure’ stemming from the handover of primary care support services to the private provider Capita. 

The GPC sent a letter to NHS England most senior management to highlight the ‘serious and systemic failure’ of the relaunched primary care support service, for which it is ’ultimately responsible’.

Capita has said that they have introduced new procedures in a bid to alleviate the problems for practices.

Pulse has written extensively about the problems with Primary Care Support England, which has seen practices accumulating piles of uncollected patient recordsmissing payments, and left without vital practice supplies.

The GPC has raised these issues with Capita, but the letter states that interim solutions have heaped more workload and costs on practices and things have not improved ‘despite reassurances’ made weeks ago....read more

 

'Meltdown' of £330m outsource contract disrupts primary care (HSJ: 11 May 2016)

Vital primary care support services are in “meltdown” after NHS England contracted them out to Capita last year, prompting anger among providers toward the contractor and the national body.

The outsourcing giant took over primary care support in September following a competitive tender. The contract is worth £330m over seven years.

Capita’s bid depended on saving £21m a year, driven by centralising administration and technology functions.

However, there have been reports of the service getting dramatically worse since the beginning of 2016 as the old localised service centres have been closed and transferred to Capita’s new centres.

HSJ has heard GPs, community pharmacists and optometrists have all been affected. 

Chaand Nagpaul, chair of the British Medical Association’s GP committee, has written to NHS England to highlight “a multitude of serious complaints” from GPs. These have focused on Capita’s failure to supply essential supplies such as syringes and prescription forms, and to deal effectively with paper records moving between practices.

Dr Nagpaul said Capita “appears to have been considerably underprepared”. The poor service has increased practice workload and cost practices money, he said. He called for practices to be compensated.

He told HSJ: “This is a salutary lesson… it is another example of how the idea of outsourcing appears attractive in offering more for less, but that is based on a very simplistic view of how the NHS functions. The NHS has been very efficient and effective. The NHS functions on organisational memory, and you cannot just take a service over and run it better.”

Bob Morley, executive secretary of Birmingham Local Medical Committee, said there had been some instances of practices not being able to release paper records because couriers, subcontracted by Capita, had arrived without appropriate identification. He also said some practices had not been paid properly.

The situation was an “almighty mess”, he said...read more

 

Is private equity really fit to run care homes? - Graham Ruddick (The Guardian: 4 May 2016)

These are crucial weeks for England’s care home industry. Homes across the country face a cash crisis, and they are about to find out whether the pressure on them is going to ease.

Since George Osborne announced in the autumn statement last year that councils could increase council tax by an extra 2% to pay for social care, care home operators have been eagerly anticipating a rise in the fees they receive from local authorities. The tax increases took effect from April, so the extra money for councils should start flowing to care homes imminently.

Well over 90% of local authorities have chosen to enforce the 2% tax hike. The extra cash is crucial for care homes. The chancellor introduced the “precept”, as it has been described, after warnings from leaders in the care home industry that homes could close because they were running out of cash.

Care homes are being squeezed by a fall in the fees that cash-strapped councils pay for residents, and a rise in staff costs. This squeeze has become more pronounced due to the introduction of the “national living wage”, meaning care homes have to pay all staff over the age of 25 at least £7.20 per hour.

Care home operators made a clear argument to the chancellor – if you want us to increase the amount we pay staff, then you have to help us fund it. This is why councils can increase council tax.

The funding issues for care homes are clear. The number of beds in care homes in the UK fell by 3,000 last year, the first decline for a decade according to research by industry analysts LaingBuisson. In addition, private residents now pay 40% more on average than publicly funded residents for like-for-like services, which critics claim is because care homes are trying to make up the shortfall from state-backed residents. There is also evidence that the quality of care in homes is deteriorating. The Care Quality Commission has found a third of Britain’s 18,000 care homes require improvement and 7% are “inadequate”.

The pressure on the industry was underlined last week when Four Seasons, the biggest care home operator, published its financial results. It has 440 homes, 18,500 residents, and 31,000 staff. It is a behemoth in the care home world. However, its results showed a £264m annual pre-tax loss for 2015.

Four Seasons is at the centre of the storm in the care industry. Not only is it feeling the squeeze from rising costs and falling fees, but it has been in private equity ownership for a decade, which has left it lumbered with interest payments of more than £50m every year and debts of more than £500m.

The situation brings back shocking memories of the collapse of Southern Cross, then Britain’s biggest care home group, five years ago. S&P, the credit ratings agency, warned last year that Four Seasons was going to run out of cash. It begs the question – is private equity really fit to run a care home?...read more

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