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Thursday 28th May 2015

BBC News

  • Health bosses 'delay' Shrewsbury and Telford NHS plans.

    Plans to change some NHS services in Shropshire have been put back for a second time. Proposals to build a new hospital or switch services between those in Telford and Shrewsbury were delayed by the election. But now they are being delayed further to wait for government funding plans and to ensure options being discussed are realistic, health bosses said. Shropshire Clinical Commissioning Group (CCG) expected a 10-week delay. Shrewsbury and Telford Hospitals Trust has previously said it was unrealistic to keep two A& Es. The emergency departments at the Royal Shrewsbury Hospital and Telford's Princess Royal have struggled to hit waiting time targets over recent years.

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Messenger Newspapers

  • Funding cut to children's mental health services sparks row.

    A war of words has broken out between Trafford's Tory and Labour groups over the funding of mental health services for children. The Child and Adolescent Mental Health Services (CAMHS) is provided by Pennine Care NHS Trust for Trafford and a number of other areas - Bury, Oldham, Rochdale, Stockport and Tameside and Glossop. It provides care for children with a wide range of issues including eating disorders, depression, autism, suicidal feelings and learning disabilities. The Labour group hit out after cash-strapped Trafford - which needs to save £22.5m this year - cut its contribution to the services from £252,000 to £126,000. But the leader of Conservative-controlled Trafford Council, Cllr Sean Anstee, hit back - claiming services would not be affected.

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Yorkshire Post

  • NHS trust in £40m deficit forecast as crisis deepens.

    Hospital chiefs at Yorkshire’s biggest NHS trust are predicting a £40m deficit as the scale of the financial crisis facing the region’s health service mounts. Only three out of 15 NHS trusts running hospitals in the region are forecasting they will avoid deficits in 2015-16, with debts already expected to exceed £170m. The position, reflected around the country, is ramping up pressure on Chancellor George Osborne ahead of July’s Budget for an emergency NHS bail-out.

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Tuesday 26th May 2015

Daily Mirror

  • NHS vasectomies rationed as health service forced to make cuts.

    Free vasectomies are being rationed in some parts of the country, as the NHS is forced to cut costs. One commissioning group has told GP practices to cap the number of snips offered to patients. Each surgery in Basildon and Brentwood, in Essex, has been sent a letter assigning them a specific amount of vasectomies for the 2015/ 2016 financial year, ranging from 11 to one. Three surgeries are believed to have been told they can refer just one man a year for the procedure, which is a permanent method of contraception. The group has defended the decision, likely to be copied by other local health trusts. Earlier this month it was revealed that Basildon and Brentwood CCG had changed its funding for mental health services, forcing charity Mind to close its Valerie Lodge day centre.

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Health Service Journal

  • New NHS company reveals outcomes based targets.

    A new NHS owned company overseeing an £800m integrated older people’s services contract will have to hit outcomes based targets to secure up to 15% of its income. Keith Spencer, chief executive of UnitingCare Partnership, said the proportion of income based on achieving specified outcomes agreed with Cambridgeshire and Peterborough Clinical Commissioning Group would taper upwards over the five year deal. The company, a limited liability partnership, was established by Cambridgeshire and Peterborough, and Cambridge University Hospitals foundation trusts after they won a tender last October for the largest NHS outcomes based contract to date. It took over services on 1 April. Until now the outcomes based arrangements have been confidential. Mr Spencer told HSJ: “In years two and three around 10 per cent of the contract will be at risk and in years four and five it’s 15 per cent.” However, none of the company’s income this year will be based on hitting outcomes targets. He said 2015-16 would be a “bedding in year” to allow all parties to work through any practical issues with the new arrangements. The outcomes based framework the provider will be judged against is split into seven domains: patient experience; safe care; quality care; prevention; urgent care; long term care; and end of life care. Within these there are 62 indicators.UnitingCare faces a significant challenge to deliver the services within a tight spending envelope. A number of private providers, including Capita and Circle, withdrew from the tender process because of the steep efficiencies implied by the contract.

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Daily Telegraph

  • New NHS spending scandal: £3.3 billion wasted on agency doctors.

    NHS spending on temporary staff has risen by one third in a year, plunging the health service into “catastrophic” levels of debt. A record £3.3bn was spent on agency nurses and doctors in the last financial year — twice what had been planned. Regulators have revealed that in just one year, spending on temporary workers has risen by £800m, which is equal to the total NHS deficit across the country. NHS trusts are spending up to £3,200 for one doctor to cover a single shift, with payments of up to £2,200 for a nurse to work 12 hours. The sums mean trusts are paying rates equivalent to a salary of more than £700,000. A significant chunk of this is paid to the agencies providing the workers. Many NHS trusts have become entirely reliant on temporary workers. Between Christmas Eve and New Year’s Day more than half the shifts in some Accident and Emergency departments were worked by locum medics. The reports show that in total £3.3bn was spent on NHS temporary workers in 2014-15 – a rise of £793m on the £2.5bn spent in 2013-14. The 31% rise came as the NHS ran a deep deficit, going £822m into the red, compared with an overspend of £115m the previous year. The Royal College of Nursing said too few nurses were being trained in this country, forcing NHS trusts to pay inflated sums, to prevent dangerous levels of short-staffing.

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Monday 25th May 2015

Radical Soapbox

  • Taxpayers subsidising private pharmacies?

    It looks as though the UK Government is subsiding private healthcare companies by allowing them to claim back VAT. And this is possibly illegal under EU regulations. A VAT loophole has led to the absurdity of NHS hospitals closing down their own pharmacies and the private sector opening new pharmacies in their place1. This is happening because the private sector can claim back VAT paid on drugs, yet a NHS pharmacy cannot!! This financial chicanery is costing the British taxpayer a vast amount of money, which will increase as many more privately owned hospital pharmacies are planned. When asked about this loophole, Her Majesty’s Revenue and Customs (HMRC) said: “Although NHS pharmacies cannot recover VAT on drugs that they dispense on prescription, they are funded for that cost as part of their general funding for healthcare.” This is obfuscation of the highest degree. If we accept the HMRC statement to be correct, it confirms that the taxpayer is subsidising the private pharmacies. If this is not the case, then HMRC needs to make an unambiguous statement that the NHS has not been funded for the VAT on drugs that they dispense on prescription. This same loophole applies to Hospital at Home services provided by the private healthcare sector. BUPA used to openly advertise how they could undercut the NHS for using the expensive drugs, such as those needed for chemotherapy, purely because they can claim back VAT. However, when the Independent newspaper followed up Radical Soapbox’s information on BUPA and VAT, BUPA immediately removed the page from their website. Where the NHS buys drugs direct from the drug companies there is no cost to the taxpayer for VAT. The NHS is provided with the money to pay the VAT to the drug companies who, in turn, pay that VAT to the Government so the transactions are financially neutral. When the private pharmacies and Hospital at Home services buy the drugs they claim back the VAT and the transaction is no longer financially neutral.

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BMJ Blogs

  • David Wrigley: A seven day NHS?

    My seven point plan for Mr Cameron & Mr Hunt. The media have called this the “first major speech” in this brand new Conservative majority government. Prime Minister David Cameron, with five years of power ahead of him, decided to focus on the NHS, and, in particular, he focused on one particular aspect—seven day working. Trailed in the Tory manifesto and now offered to the nation it sounds appealing, but as is usually the case with many things Mr Cameron does, most of it doesn’t stand up to proper scrutiny. Here is my seven point plan for Mr Cameron’s seven day NHS: 1. Get the five days right first—If the government wants to make the NHS work safely and efficiently seven days a week, then it might be a good idea to get the five days of Monday to Friday working well beforehand. At the moment the NHS is in dire straits, struggling financially with medical, nursing, and allied staff leaving or retiring early in their droves. What was the adage Mr Cameron likes to use—fix the roof while the sun is shining ? Well, the sun isn’t shining much in the NHS, but you certainly need to fix the roof Mr Cameron and pretty sharpish.
    2. Sort social care out—The huge top down austerity driven cuts to local authorities has led to massive cuts to social care. This has led to social care being cut to the bone, and many older and vulnerable patients left alone or with haphazard 10 minute visits from zero hour contract care workers who have to dash from client to client in order to make any sort of living. If you want a seven day NHS, Mr Cameron, then you need to properly fund social care as these patients are increasingly unwell and needing more NHS care. And with inadequate community services for them, they languish in hospital beds, unable to be discharged safely to the community.

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HSJ

  • Updated: NHS provider sector reports £822m deficit.

    NHS providers have reported a deficit of £822m for 2014-15, with foundation trusts ending the year in the red for first time ever. HSJ analysis suggests that without bailouts the net deficit was closer to £1bn. Figures released by Monitor this afternoon showed FTs finished the financial year with a combined deficit of £349m, compared to a planned shortfall of just £10m. Meanwhile, the NHS Trust Development Authority reported a combined deficit of £473m for non-foundation trusts, which was £65m worse than planned. However, the underlying position of the sector was even worse, as TDA papers make clear that the deficits of 15 NHS trusts were reduced or removed by the payment of “provider deficit funding”. The TDA has declined to say how much these bailouts were worth overall. However, HSJ analysis of trust board papers has found that 10 of the recipient providers received sums totalling £122m. If the five recipients that have not reported details of their bailouts received similar amounts, this would suggest the net deficit for the provider sector overall was closer to £1bn. Both national authorities said the overspending had been driven by unplanned growth in demand for hospital services, particularly in urgent and emergency care; increased use of agency and contract staff; and a failure to deliver planned efficiency savings. Monitor’s figures said 77 FTs out of 152 finished the year in deficit, more than two thirds of which were acute trusts. A record breaking number of emergency inpatients, representing an increase about 5 per cent on 2013-14, led to massive overspending on agency workers. Trusts have also warned the regulator it will be even tougher to balance the books in 2015-16. Monitor chief executive David Bennett said: “The last financial year was exceptionally challenging for the FT sector, and it is clear the current one is following the same pattern. The sector can no longer afford to operate on a business as usual basis, and we all need to redouble our efforts to deliver substantial efficiency gains in order to ensure patients get the services they need. “This will no doubt involve some significant changes to the way people work at some institutions, but as the regulator we believe there is scope for more to be done at a number of levels without compromising patient care. Monitor is therefore stepping up its efforts to provide practical help and support to FTs that are struggling both financially and operationally.” The TDA said 59 non-FTs reported a break even or surplus position, reaching a combined surplus of £141m. However, the remaining 40 non-FTs reported a combined deficit of £614m.

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The Telegraph

  • NHS spending: how temporary staff keep the health service going.

    Ballooning levels of spending on agency nurses and doctors mean NHS trusts are paying the equivalent of £750,000 a year just to fill one post. Hospitals have spent £3,200 for one doctor to cover a single shift, with payments of up to £2,200 for a nurse to work 12 hours. A new report by NHS regulators reveals an £822 ?million deficit across the NHS, which can be blamed entirely on spiralling spending on temporary workers. During the last financial year, the health service spent a record £3.3 ? billion on agency staff. It was a rise of 31 per cent in one year, with spending at more than twice the levels planned. The reliance on agency staff follows growing concern about shortages of NHS staff, particularly nurses and Accident & Emergency doctors. That came in the wake of the Mid Staffs scandal, where hundreds of patients died amid shortages of nurses, with just two to care for 40 patients in some parts of the hospital. Experts say the new figures show “catastrophic” levels of deficit, which is directly harming patient care. The reports from regulators show lengthening waiting times, and rising numbers of hospitals missing targets to start treatment for cancer patients within two months. Hospital managers say that, faced with a choice between leaving wards dangerously under-staffed or spending exorbitant sums on agency staff, they are forced into the latter. But some have questioned the system which allows the market to dictate sky-high rates, with no effective caps on what the NHS will pay. This winter, United Lincolnshire Hospitals NHS Trust paid £3,257 for one doctor to work a shift of 12 hours, and remain on call to work for 12 hours. The sum is equivalent to an annual salary of £765,395 or £16,285 a week. Meanwhile, Shrewsbury and Telford Hospital NHS Trust paid the record sum of £2,200 to hire one nurse to work 12 hours – equal to a weekly wage of £11,000 or an annual salary of £517,000. A large chunk of the payments are taken by the agencies who hire them.

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The Guardian

  • NHS needs emergency cash boost or care could suffer, ministers told.

    Ministers are under pressure to give the NHS an emergency cash injection after official figures showed hospitals overspent by £1bn last year. NHS providers of care in England – hospitals as well as mental health, ambulance and community services – ended 2014-15 with £821.6m in deficit. That was more than seven times higher than the previous year’s £107m shortfall. Rising demand for care, a soaring bill for agency staff and the need to make billions of pounds of efficiency savings contributed to the serious financial downturn and led to warnings that this could soon damage patient care. Biggest NHS trust is failing on safety and quality of care, says watchdog “Plugging the growing black hole in NHS finances must now be an urgent priority for the government. There is a real prospect of deficits snowballing and, unless the government finds extra money, an accelerating decline in NHS performance and a deterioration in patient care”, said Richard Murray, director of policy at the King’s Fund. Ministers will have to decide whether to give the NHS more money, possibly in the 8 July budget, or try to restore financial discipline by, for example, ordering a clampdown on agency staff. Any reduction in the number of staff on duty could jeopardise the safety and quality of patient care. NHS sources say Jeremy Hunt, the health secretary, is deeply frustrated that hospitals’ finances and performance against waiting time targets have worsened despite him giving them well over £1bn since 2013 to cope with winter pressures and cut the waiting list for planned treatment. “We know the NHS is busier than ever and trusts are facing challenges. However, we expect them to show tight financial grip and live within their means,” said a Department of Health spokesman.

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Friday 22nd May 2015

Pulse

  • GPs say no to offering top-up payments for private primary care.

    GPs gave a resounding ‘no’ to offering NHS patients the option to pay extra ‘top-up’ payments for private services at their annual BMA conference. The LMCs conference overwhelmingly voted against a motion put by Gloucestershire LMC, which called for general practice to be allowed to offer both private and NHS treatments - and for the GPC to include this in contract negotiations. The motion stated: ‘Conference believes patient care would be improved were practices to be allowed to offer ‘top-up’ private services to their NHS patients and requests that the GPC include this in their contract negotiations’. Putting the motion, Dr Jethro Hubbard argued the move would level the playing field between GPs and other providers like foundation trusts. However, Dr Jackie Applebee from Tower Hamlets LMC said offering top-up payments would be a ‘slippery slope’ to the introduction of a wider fee-paying system - and questioned how patients would benefit.

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BBC News

  • Bedfordshire NHS healthcare group deficit hits £43.2m.

    An organisation in Bedfordshire responsible for NHS-funded healthcare has revealed a deficit of £43.2m. Bedfordshire Clinical Commissioning Group (CCG) wrongly believed it had been running with a small surplus since it was founded in April 2013. The CCG, which looks after the health needs of 441,000 people and has a budget of £444m, blamed rising demand and poor management information.
    New senior leadership has been brought in to tackle the deficit.

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Colchester Gazette

  • Hospital trust chairman Alan Rose supports Save Our Cancer Surgery campaign.

    The new chairman of the board of Colchester Hospital University NHS Foundation Trust Alan Rose has supported centralising urology cancer surgery in Colchester. Mr Rose said: "We would look to work in collaboration with other trusts to provide the best possible service."

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Yorkshire Post

  • NHS trust dealt blow after losing £190m contract.

    A Yorkshire NHS trust has been dealt a hammer blow after losing a £190 million contract to provide key services in the region. Leeds and York Partnership NHS Foundation Trust has run mental health and learning disability services in the Vale of York and some specialist services in North Yorkshire since 2012. But it has not been selected as the preferred provider of a new five-year contract tendered by bosses at NHS Vale of York Clinical Commissioning Group (CCG) to run services from October. Trust bosses are challenging the decision which comes in the wake of a critical report into NHS mental health provision in the York area by the Care Quality Commission (CQC). No details of the winner are being released by the CCG which last night said it could not comment until the end of an official “standstill” period.

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Guardian

  • Biggest NHS trust is failing on safety and quality of care, says watchdog.

    Inspectors have criticised the NHS’s largest hospital trust after finding it is seriously understaffed, focuses too little on safety and has cancelled operations on numerous occasions because there were too few beds. The Care Quality Commission has found a series of failings in the safety and quality of care being provided at Barts health trust in London, where major problems – including a deficit approaching £100m – have led to the recent departure of its two main bosses. But inspectors also found many areas of good or outstanding practice, including patients’ outcomes at both hospitals being at or above the national average across most medical and surgical specialties.

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Thursday 21st May 2015

Chartered Society of Physiotherapy

  • Community services contract returns to the NHS from private sector.

    Physios providing community services in Suffolk will become NHS staff again in the autumn, following the announcement of a deal to replace a private provider with a consortium of NHS bodies.West Suffolk NHS Trust, Ipswich Hospital NHS Trust, and Norfolk Community Health and Care NHS Trust have jointly been awarded preferred bidder status to run community health services in Suffolk from 1 October. The services were previously provided by private firm Serco, but after announcing a £13.7 million loss on the contract last year, the firm announced it would not bid again for the services when the contract was due to end in October.

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Guardian

  • We cannot stand by and watch general practice slide into permanent decline.

    Dr Kailash Chand writes: The UK election saw a focus on general practice that was unlike any previous campaign in modern times. Sadly all the parties were unified in their failure to acknowledge the crisis facing GP services, which have become an under-resourced, over-stretched shell of their former self, struggling to keep pace with patient demand despite the efforts of their staff. This mismatch between reality and politicians’ promises is a real threat to patient services in the years ahead. The problems facing GP practices are all around us. A foundation trust in Derbyshire has been made “emergency caretaker” of three GP practices facing recruitment and financial problems, as two others in the area face closure. There are now 7,962 GP practices in England – one in 20 has disappeared since 2010. The rate of loss of local surgeries has speeded up – 79 closed and 55 opened in 2010 but in 2013, 126 closed and only 13 opened. There has been a five-fold rise in the number of GP surgeries approaching senior NHS managers for advice about shutting their doors or merging with nearby practices. Meanwhile, a recent British Medical Association (BMA) survey of more than 15,000 GPs found that 93% feel their workload was negatively affecting patient care, while a third were considering leaving the profession as a result in next five years.The Royal College of General Practice last year warned that more than 1,000 GPs will be leaving the profession each year by 2022. I could, of course, go on with more figures to illustrate what GPs on the ground are telling me: they are having to work hard on shrinking resources just to keep up with the pace of expectations from patients. This is why the prime minister’s announcement this week of seven-day services is being met with cynicism by many in the NHS. GPs will tell you that they are perplexed as to how they are supposed to provide this service when they can’t even provide enough appointments during a standard working day. The promise of thousands of new GPs not only ignores the fact that the pressures of being a GP are putting medical graduates off joining the profession, but also that it takes a good eight to 10 years to train. The new government needs a reality check and needs to understand that what GP services need is a long-term, stable plan that gets them back on an even keel. This means better funding and a sensible recruitment plan, and also a wide-ranging look at how we can support new services in general practice and release the experience and potential that GPs and patients have to shape services locally.

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Tuesday 19th May 2015

East Angolia

  • Suffolk’s community healthcare back in NHS hands after Serco’s three-year control.

    Suffolk’s two biggest hospitals, West Suffolk NHS Foundation Trust and Ipswich Hospital NHS Trust, and Norfolk Community Health and Care NHS Trust have been confirmed as the preferred bidder to deliver NHS community health services in the county. The contract will be held by West Suffolk Hospital and patients will “continue to receive the same safe, high quality services” by the “same staff in the same locations”, said the NHS Ipswich and East Suffolk and NHS West Suffolk clinical commissioning groups, who awarded the contracts. Community healthcare services provide vital help to around 650,000 people in Suffolk, such as community nursing, specialist nursing, community hospitals, speech and language therapy, dental services and specialist children’s services. Serco, the private company currently running Suffolk Community Healthcare, announced earlier this year it was withdrawing from the service after making losses of £13.7 million on the contract in 2014. Serco was awarded the £140 million, three-year contract in 2012. The CCGs had been critical of the company’s failure to meet response targets in its early stages, but said that, overall, they were satisfied with the service, which had improved. It will continue with the contract until the new provider takes over on October 1. Nick Hulme, chief executive of the Ipswich Hospital NHS Trust, said: “Today’s news brings a new era to the way in which we can provide seamless care in the hospital and in the community. “We are breaking new ground in the way we have worked with our partners in putting together our proposal and would like to thank them and the many members of our community who have helped shape our bid. We look forward to closer working with our GP, social care colleagues and community staff whose contribution is key to the success of this venture." Earlier this month, UNISON regional organiser Jeff Keighley questioned how the new contract can succeed. With CCGs operating on restricted budgets, he raised doubts any increase to the £140m would be possible. And without extra funding, he claims the bidders will be unable to operate without making losses like Serco’s or significant cuts to jobs and services.

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Huffington Post

  • Why the Government's Plans for the NHS Spell Disaster.

    Monday brought the first announcements on the NHS from David Cameron and Jeremy Hunt since the election - although as John Humphrys rightly pointed out in his interview with Mr Hunt, they have been doing the job for five years already. Greeted with trepidation by NHS staff, the announcements outlined some key policies. Consequently I am disillusioned, sad and angry, in equal measures. Jeremy Hunt confirmed to NHS primary care staff that he has no understanding of modern general practice. His solution to finding the staff and resources to allow for seven-day opening was that GPs should stop doing blood tests. I hate to burst your bubble Mr Hunt, but for any practice to have survived the last five years, the GPs certainly aren't sat taking bloods. You may wish to look up the following roles - practice nurse, advanced nurse practitioner, minor illness nurse, healthcare assistant, phlebotomist, dispenser, pharmacist, practice manager, business manager, PA, administrator, secretary, receptionist. All of these and more are part of modern general practice. They are a skilled team, who work together to ensure that only those patients with complex illnesses and significant needs are seen by the GPs. We don't take bloods. We don't do routine asthma or diabetes reviews. We rarely see coughs and colds, rashes or urine infections. What our excellent nursing colleagues aren't able to deal with - the patients with heart disease, kidney failure, depression and cancer, who are on 20+ drugs - is what we are seeing; in-between dealing with doing a large amount of telephone triage and consultations, which comes from the lack of appointments due to not having enough doctors. Some of us offer e-mail or Skype, but these take no less time than traditional consultations, and sometimes longer. We see those hospital letters that require clinical input, because the trained admin staff and PAs have filtered out all they can. The practice dispensers and pharmacists have checked the discharge letters. These have already been coded and entered on the computer system.

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The Guardian

  • David Cameron’s promise of a ‘seven-day NHS’ is rooted in ignorance, not evidence.

    David Cameron’s promise of a “seven-day NHS” is curious. The NHS is already available seven days and nights a week. Out-of-hours GP services cover evenings and weekends, A& E departments are always open, and inpatients are treated around the clock at weekends (with consultants on call), as on any other day. What seems implied is not new services at night and at the weekends, but better services. Yet the prime minister was not specific about what he has in mind, and any improvements will have costs. GPs, the government again suggests, should open their surgeries at weekends, and consultants should do more work at weekends. But GP practices can already earn extra funding for providing “enhanced services” on weekday evenings or at weekends. What this has shown is that demand for access at these times varies considerably, according to the demographics of the populations concerned; some GPs think that if you assess demand carefully, almost all of it can be met within normal weekday hours. This suggests that a blanket policy would waste resources: what would be helpful would be for NHS England to offer to assist every practice to work out the best way for it to meet the local demand. The case for shifting some senior hospital medical staff hours from weekdays to weekends is also problematic, and the evidence that Cameron cited to justify it is disputed. Hospital admissions at weekends are different – they rarely come from outpatient clinics, which are held on weekdays: most are emergency admissions and tend to be more serious. But it is not entirely clear that outcomes are worse for such patients than for comparably ill patients admitted on weekdays. Supposing that the evidence did suggest that rearranging consultants’ hours in order to spread them over a seven-day week would be beneficial, the implications of such a shift would be immense. Consultants work with teams; it would affect every level of clinical staff, and the staff of all the diagnostic and other technical services that support surgical and non-surgical care; it could even lead to a fall in the quality of care overall.

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Monday 18th May 2015

Ekklesia

  • The prevailing fiction of our times is that the private sector is better at running things than the public sector.

    This has been the ideology we’ve lived under since Margaret Thatcher. And despite evidence to the contrary, politicians in Labour, Conservatives and the Liberal Democrats all seem wedded to it. But what’s the truth of the matter ? The example of British Rail is a salutary one. Back in 1993 when it was taken out of public hands, the argument was that this would make it more efficient and accountable. However, the reverse appears to be true. Rather than providing transparency the system is riddled with ‘backstairs lobbying’ and "manipulation of the terms of public debate by well resourced private interest".Furthermore the complexities of managing the different franchises and the infrastructure of the network means railway services are now subsidised more heavily than they were under British Rail. Meanwhile a study by Corporate Watch suggests that privatised utilities cost the taxpayer more than public ones. No wonder public polling suggests nationalisation of utilities would be popular. As a former local authority manager, I’ve seen first hand the problems that privatisation brings. I’m not a statist ideologue. I believe many services are better delivered on the ground by the voluntary sector, and I’ve come across good social care providers who work for profit. But, now we've reached a situation where big international companies such as G4S, and Capita can bid for essential human services, despite their poor reputations, I believe it's time to call a halt. By the early 2000’s things were beginning to look different. Changes in EU rules about procurement of contracts meant we were obliged to offer new opportunities under competitive tender. Suddenly, we were asking providers to apply for a job. By the time I arrived in Oxfordshire in 2006, tendering was being applied to organisations who had existing contracts. This required the development of new procurement systems and teams. The idea behind procurement is that by having a competitive tendering process the most effective provider wins. Whilst I think this is a valid argument if you are purchasing equipment and stationery, it is less effective when funding human services. A procurement team costs money, but a procurement process costs even more. An opportunity has to be advertised which requires procurement and contract staff spending hours producing information about the services and devising how the procurement will work. When the advertisement is up, potential bidders are invited to ask questions which have to be painstakingly answered. Neither does procurement always yield the best results. I’ve known successful organisations fail to be shortlisted because they filled the PQQ out wrong. Providers valued by service users and their families can lose a contract because the person presenting their case gave a poor showing.

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SpinWatch

  • NHS: The foxes have control.

    ‘The whole point of our NHS reforms,’ David Cameron said, is ‘to put the power in the hands of local doctors, so that they make decisions based on what is good for their local area.’ That is tosh. Yes, most of the NHS budget was handed to GPs, who are now – phase 2 – handing it over to private corporations. It is private firms who will determine how and where the NHS budget will be spent (through a process known in NHS speak as commissioning). Everything from deciding which hospitals stay open, which services are still available on the NHS, and who provides these services, the NHS or the private sector. As the Observer reveals this morning, the list of approved suppliers bidding for this work – the planning and buying of care – has just quietly been released. The list is dominated by management consultancies, outsourcing giant, Capita, and US health insurer, UnitedHealth, the previous employer of NHS CEO, Simon Stevens. Last year, Spinwatch uncovered how UnitedHealth’s lobbyist, Chris Exeter, chaired a discreet forum, the Commissioning Support Industry Group, giving these firms regular privileged access to senior NHS officials overseeing the creation of this new market in ‘commissioning services’. Capita was another member of the group, as were KPMG, PwC, EY (formerly Ernst & Young) and McKinsey. There are nine consortia set up to ‘supply’ local health purchasing decisions. UnitedHealth, Capita, KPMG and PwC are now approved suppliers to two thirds of them. McKinsey and EY are suppliers to half of them. These companies (and others) will supply GP commissioners with key services that have until now been done by the NHS for the NHS: planning services; managing relationships and contracts with healthcare providers, like hospitals; and crucially deciding what the NHS will look like in the future – what NHS England calls ‘transformation and service redesign’.

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The Guardian

  • Hospitals are cancelling the largest number of operations for 10 years, according to new official figures, prompting warnings that the NHS is under “extreme pressure”.

    A total of 20,464 planned surgeries were cancelled at the last minute for non-clinical reasons in January, February and March in England. That was the most since the first three months of 2005, when 21,500 surgeries had to be called off. And it was up from the 17,868 cancellations seen in the same quarter of 2014: a rise of almost 15%. The figures published on Friday led to warnings that patients affected suffered anxiety or distress as a result. Call-offs happen because beds set aside for patients having elective – or planned – surgery are needed for other cases, often ones that have recently come in as emergencies. They can also be the result of nurses and doctors being needed elsewhere in the hospital. Plymouth Hospitals NHS trust cancelled 648 operations – the most of any trust – and Hull and East Yorkshire Hospitals NHS Trust was second-worst, with 526 cancellations. A few trusts cancelled none. Patients whose surgery is cancelled at the last minute are meant to have their rearranged operation within 28 days. But the latest NHS England figures show that more and more people are having to wait longer than that. Almost one in 10 such patients in the first quarter of this year – 1,787 (8.7%) in all – did not then receive their treatment within the supposed maximum time. That was the highest figure since January-March 2006, when 1,959 had to wait longer than 28 days. “Care is in effect being rationed. The NHS is being forced to choose between which patients to treat now and which patients must wait longer for treatment”, said Dr Mark Porter, the head of the British Medical Association. Porter said: “Behind each cancelled operation is an anxious patient left waiting longer for treatment, with some patients experiencing more than one cancellation. These figures lay bare the extreme pressure across the system.” Dr Peter Carter, general secretary of the Royal College of Nursing, said: “Operations are critical in restoring patients to health and it is extremely concerning that patients are having to wait this long for treatment. These figures reflect the perilous state of affairs in overstretched acute services.” Budget cuts had led to serious understaffing across the NHS, so it was no surprise that cancelled operations were reaching such heights, he added. Andrew Gwynne, Labour’s health spokesman, said government policies had left hospitals unable to cope with a surge in demand for care. “These figures are another sign of how the NHS has gone downhill. David Cameron … caused this crisis by making it harder to see a GP and taking social care support away from hundreds of thousands of people.”

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Friday 15th May 2015

A Better NHS

  • In 2008, Professor Don Berwick wrote in the British Medical Journal, Reinvest in general practice and primary care—These, not hospital care, are the soul of a proper, community oriented, health preserving care system.

    General practice is the jewel in the crown of the NHS. Save it. Build it. His advice was ignored. The NHS has an unprecedented funding-gap of this governement’s own making and it has no credible plan to fill it. General Practice is in a parlous state one in three training posts and one in six vacancies unfilled while older GPs are retiring early and younger ones are emigrating or choosing to work part-time. The loss of MPIG could force dozens of practices to close. The consequence is that the remaining GPs cannot cope. Something has to give. What GPs want, according to the recent BMA survey is more time with patients, with 80% ranking continuity of care as essential. They said they needed more core funding, longer consultation times and a reduction in bureaucracy. GPs are attempting to practice relationship-based, patient-centred care in an increasingly performance and guideline-centred NHS. This is in the interests of neither GPs nor patients. In 1992, Julian Tudor Hart asked rhetorically, “can contexts for clinical decision-making be structured so that doctors’ interests coincide with those of patients individually and society collectively ? He knew that the solution would “require revolutionary changes in the way care is conceived, organised and resourced.” GPs are still reeling from the last revolutionary re-disorganisation that was the 2012 NHS Act and there is very little appetite for radical change. Having said that, British General Practice has been, in large part because of its independent contractor status, favoured by 82% of BMA respondents, incredibly innovative and new models of federating and networking are actively growing. The vast majority of GPs, despite their political differences, are deeply committed to their patients and still find great satisfaction in spending time with their patients. Our future resilience depends on the quality of this time.

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The Independent

  • Private healthcare companies accused of using tax relief to undercut the NHS.

    Private healthcare companies have been accused of getting unfair tax relief when competing with the NHS to provide treatments such as chemotherapy for patients at home. NHS Trusts are increasingly trying to treat patients in their own homes, rather than making them travel to hospitals. The service is often provided by private companies working under contract to the NHS, rather than directly by NHS nurses and carers. The government argues that private firms may be able to do this cheaper than the NHS. But it has now emerged that the competition appears skewed because, while private firms can recover the 20 per cent VAT they incur on purchasing drugs, the NHS cannot. That means the private provider’s service can appear many thousands of pounds cheaper than NHS provision when bidding for contracts. The accusations will give fresh fuel to critics who claim there is an inherent bias in government policy towards favouring privatisation of large swathes of the health service. The difference VAT makes can be substantial, as a document on Bupa’s website entitled “Economic Attractiveness: home chemotherapy” illustrates. This shows Bupa saves £244 for each infusion of Herceptin due to its “nil” VAT status. As the Bupa document says, after other overheads, “for a cohort of 50 patients an annual saving of £187,000 can be made”. HMRC said: “The NHS trust will incur VAT on the cost of buying the drugs which it cannot reclaim, but the NHS is funded for their irrecoverable VAT under Government funding arrangements.” But the Bupa document makes no mention of that, highlighting instead its £244 VAT saving. Meanwhile, some NHS sources say the VAT shortfall is not fully made up by the Government.

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Thursday 14th May 2015

The RT

  • ‘Slow death of the NHS’: RT asks what a Tory govt means for the health service.

    With a majority Conservative government in power, fresh questions are being raised over the future of Britain’s most beloved institution. RT asks: can the Tories be trusted with the NHS ? Two days before polling day Labour leader Ed Miliband urged voters to “rescue the NHS,” warning it faced “savage cuts” and a “financial time bomb.” A week later, while Miliband is taking a long overdue holiday in Ibiza, Tory minister Jeremy Hunt is assuming responsibility for Britain’s Department of Health for the second time. Labour’s manifesto included key pledges on the health service, such as injecting an extra £2.5 billion in funding to pay for 20,000 more nurses, 3,000 midwives and 8,000 GPs. Miliband also promised to repeal the controversial Health and Social Care Act – which further opened the door to privatization – and cap the amount of profit private companies can make from the NHS at 5 percent. The National Health Service (NHS) was a key talking point of the general election campaign and Labour were keen to portray the Tories as a party that would wreak havoc on the institution, which former Tory Chancellor Nigel Lawson famously said was the “closest thing the English have to a religion.” With the Conservatives now in power, RT has approached leading voices in the debate around healthcare to find out what the next five years have in store for the National Health Service.

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The Conversation

  • Four critical NHS issues that could keep Jeremy Hunt awake at night.

    The NHS has faced numerous struggles in its 66-year history, from the financial crisis of the late 1980s, which prompted the Thatcher Review and led to the introduction of the NHS internal market in 1991, to the more recent Lansley reforms and the debacle of the 2012 Health and Social Care Act. But surely none will compare with the challenges over the next five years. These include: More reconfiguration of services. In a health system funded out of general taxation, it is important that politicians are held accountable to the public for the £115 billion NHS budget. Promises or pledges of up to £8 billion (equivalent to a funding increase of 1.1% a year) have been in response to a £30 billion shortfall by 2020, identified by NHS England in 2014. The “missing” £22 billion is supposed to come from productivity improvements and cost savings. Further devolution of health budgets: Developments on the ground have often been moving ahead of the political debate. For example, NHS England’s Five Year Forward View, published in autumn 2014, presented new models for the future organisation of primary and secondary care services, which have been broadly accepted. Also, proposals to integrate health and social care in Manchester, announced rather hastily earlier this year, have prompted much debate elsewhere in the country. Competition vs integration: The use of competition and the private sector in NHS service provision has long been contentious. The latest model of NHS commissioning – the Clinical Commissioning Groups (CCGs), a product of the 2012 act – sought to put GPs in charge of the majority of the NHS budget on the assumption that they were best placed to know the needs of their patients. However, only a minority of GPs were involved in CCG decision-making, and this clinical engagement seems to be waning. With challenging decisions ahead, the weak public accountability of CCGs may become exposed.

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HSJ

  • Major teaching hospital's deficit could double.

    One of England’s biggest and most prestigious teaching hospital trusts has predicted a large deficit for 2014-15, with indications it will almost double in this financial year. King’s College Hospital Foundation Trust, which has a turnover of £892m, reported to its most recent board meeting that at the end of March it had a deficit for 2014-15 of £47.4m. This is a £19.4m deterioration on the previous year-end prediction. However, the trust’s full year, audited position has not yet been reported. King’s is the latest large teaching hospitals trust to indicate it would be recording a deficit for the last financial year. Barts Health Trust declared it was predicting a year-end deficit of £93m and Leeds Teaching Hospitals Trust is expecting a deficit of £52m. King’s chief executive Tim Smart resigned last month and senior civil servant Lord Kerslake was appointed as chair in April. Lord Kerslake has ordered a board governance review that will report back next month. The trust’s financial position could well worsen over the next 11 months, a trust document indicates. Minutes of a meeting of the trust’s finance and performance committee meeting in January, published last week, show PwC consultants told the King’s senior management team that the “size of the underlying financial challenge pre-[cost improvement programmes] and non-recurrent funds [in 2015-16] is circa £112m”.

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Tuesday 12th May 2015

The Conversation

  • Uncertainties over the NHS will continue amid further Tory cuts to local government.

    Gone are the weeks of fog that were predicted to follow the 2015 general election. Instead the principal contours of the political landscape that lie before us for the next five years are much clearer. But when it comes to the NHS, there are more uncertainties than certainties. A major uncertainty must be over how far the government, unfettered by coalition partners, will further hollow out the NHS through the outsourcing of services to the private sector. The fear is that the NHS progressively becomes a brand on the façade while myriad private provide back-room functions to support clinical commissioning groups and frontline health and community services. Regardless of whether using public funds in this way is efficient and in the public interest, it is inconceivable that the new government, propped up by powerful donors, lobbyists and business interests who stand to do well from lucrative NHS contracts – what the Social Market Foundation termed “institutional corruption” – will not move swiftly down this road. Indeed, getting the controversial Transatlantic Trade and Investment Partnership Treaty (TTIP) ratified at the earliest opportunity will be a priority. Critics consider the TTIP will hasten the privatisation of public services like the NHS and further open them up to large American health companies, like United Health, where Simon Stevens, NHS Chief Executive, was former president of its global health division.

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BBC News

  • The NHS: What we weren't told during the election.

    The NHS was one of the major topics of the election campaign. Politicians were falling over themselves to talk about it and promise more. More money, more nurses and more doctors. And if that wasn't enough, the Conservatives were pledging more opening: they plan to ensure the NHS becomes a seven-day service. But despite all this talk, there was also a lot that wasn't mentioned too.
    The state of social care was perhaps one of the most obvious issues. Councils and those working with elderly people have long been arguing that the cuts to local government have meant that essential services, like help in the home, that keep people living independently, are being squeezed. But while the Tories, Labour and Liberal Democrats all committed to extra money for the NHS, there was little in the way of guarantees for social care despite the close relationship between the two. The other thing that seems to have been forgotten by the politicians is that the need for extra money was just one part of the jigsaw. Where was the vision for this during the election ? Did anyone spell out what they were going to stop, ration or restrict ? You will be hard-pressed to find information about any of that even given the acres of coverage the 2015 election generated. More than one person has told me this is on a par with the lack of detail about the £12bn of welfare cuts the Tories were heavily criticised for during the campaign. But it wasn't just the long-term picture that remained a little hazy, there was also radio silence on a more pressing immediate issue - hospital deficits. When asked how many more staff they would need over the next five years, a significant number of trusts told Health Education England last year that they wanted fewer. And this brings us nicely on to the next point: the workforce. There was a lot of talk about extra staff. GPs, nurses and midwives, but this ignores the fact that it takes years - 10 for a GP - to get them trained. Taken together, these three issues - working together with social care, money and staffing - present a major obstacle. This is, perhaps, the biggest unspoken truth. If the NHS is going to remain sustainable, it will probably have to undergo the most significant transformation in its history. It's just that the politicians haven't and won't be selling it as such.

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Monday 11th May 2015

Pulse

  • GPs face cap on number of vasectomy referrals.

    GPs have been told they can only refer a limited number of patients to undergo vasectomy under plans to cut referral costs, Pulse can reveal. Practices in Basildon and Brentwood CCG have been told they face a cap on how many GP referrals for vasectomy they can make in 2015/ 16, with three practices told they can refer just one patient each this year. In a leaked letter, the CCG said it had made the decision after reviewing past ‘activity and spend’ on vasectomy services. But GP leaders said the move was ridiculous and the CCG should consider reversing the plan.

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GP Online

  • Viewpoint: Dr Kailash Chand: NHS needs rebuilding not a shopping list of new policies.

    BMA deputy chairman Dr Kailash Chand writes: We don’t have to worry any more about the promises of opposition parties. However, the Conservatives who promised £8bn have not detailed how they will raise the money or how much will arrive in each year to keep the NHS functioning. And a further promise of a 24-7 services, does matter. Seven day working, guaranteed shorter access times, and more GPs and nurses—have been described by Mark Porter, the BMA’s chairman, as outlandish and unachievable. Staff morale in many parts of the service is at rock bottom because of real-terms pay cuts and the relentless workload. Many GPs are retiring early, and new recruits are thin on the ground. Funding of the NHS has dropped to only 7% of our national GDP – a level not seen since 2008. The proposed £12bn austerity savings, suggest larger reductions in local authority social care and related budgets. This could have both direct and indirect effects on the NHS. Healthcare needs extra funding for NHS and social care for 2015-/ 6 and the rest of the next parliament. What is needed from this government is to provide the NHS funding to the EU or OECD average, based on share of GDP; restore accountability through the health secretary to provide a universal health service; and to stop the damaging and relentless drive towards a health market. The BMA is calling for an open and honest debate about the NHS. We need to rebuild the NHS in next five years, rather than a shopping list of new policies.

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Huffington Post

  • A Call To Arms for NHS Staff.

    So the results are in. The NHS now knows what the programme for the next five years is going to include. These are the Conservative manifesto highlights to look forward to, on top of finding £22billion pounds of efficiency savings, which has already been described as looking "increasingly unlikely" by the King's Fund, we have to:
    1) Provide a 7/ 7 service - I can't be the only one scratching their head at this. We do this already. It's called your GP 8am-6.30pm, and the GP out of hours service overnight and at weekends. They do keep forgetting to mention this.
    2) You will able to see a GP 8-8pm 7 days a week - given that pilots for this have just ended because of underuse, and because they did not alter A& E attendance rates, this is simply expanding the service and not reducing pressure already there. There aren't predicted to be enough "new" doctors to cover five day opening until at least 2025.
    3) Right to access a specific named GP - this is already the case for some groups of patients and is an entirely paper exercise. You will have a named GP allocated to you. You may never see them, or may much prefer to see someone else. But the box is ticked so the government can say you have one. Like it or not.
    4) Same day appointments for over 75s who need them - the devil is in the detail - "who need them". Granted most over 75s do have considerable health needs, but that doesn't always mean they clinically need to be seen on the same day.
    5) Care Quality Commission (CQC) ratings for all hospitals, care homes and GP surgeries - The CQC is the equivalent of OFSTED inspections for schools, but for healthcare providers. Getting a rating involves an inspection, and preparing for a CQC inspection is a BREEZE! It is in no way time consuming and onerous; it definitely does not take doctors away from seeing patients, or practice managers from ensuring the business is running smoothly. The British Medical Association (BMA) is the union of doctors. The RCGP is the Royal College of General Practitioners - it oversees the curriculum and training of GPs. Both have tried repeatedly in the last parliament to engage with the government about the problems with the structure of the NHS since the introduction of the Health and Social Care Act in 2012. About the chronic underfunding of the NHS, the collapse of frontline general practice, the crisis in recruitment of doctors into the roles of GPs and A& E doctors. While small concessions have been achieved, both groups have failed to have a significant impact on the government's agenda. I am just a regular doctor. I don't pretend to understand the complexities of Whitehall wrangling. So here's my suggestion to the BMA and the RCGP - stop. Stop trying to make the politicians understand. They don't care what we have to say, they aren't willing to listen and will push through their own agenda now they have a majority and a "democratic mandate". They want an American-style model driven by consumerism and the vocal wants of those who are in least need. Give up. Turn around, and instead of facing the politicians, face us. Face the doctors, nurses and staff. Focus on us. Put all your energy into uniting us, pulling us together, getting a single, determined voice from the NHS.

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Friday 8th May 2015

Touch Stone

  • New evidence nails the “no NHS privatisation” lie.

    The government habitually dismiss accusations of NHS privatisation. However a new analysis of NHS contracts produced by the NHS Support Federation shows how they will have to confront reality. Ministers say that very little NHS money goes to private companies (6% is the figure often given). However since the changes were brought in for the NHS in April 2013, private companies have been winning large contracts to plan and deliver NHS work and their involvement with the NHS has grown dramatically. In April 2014-15 alone private companies won awards totalling over £3.5 billion, five times higher than the figure in the previous year (April 2013-14). Not only have the government’s changes to the NHS increased the use of private companies, but they have increased significantly the use of the market to plan and deliver care. Over the last year, (April 2014–15) £9.6 billion worth of NHS contract awards were made through the process of competitive tendering, up from £1.2 billion in the year before the NHS changes (April 2012-13) and just £291 million in the year after the last election (April 2010-11). Since April 2013 over £21 billion worth of opportunities to plan and deliver NHS care have been advertised, that’s over 1000 contracts up for grabs covering every aspect of the patient journey.

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HSJ

  • Vanguard sites will not access full £200m transformation fund.

    Some of the £200m transformation fund to support the development of new care models will be spent on projects not connected with NHS England’s ‘vanguard’ sites, HSJ has learned. The fund was allocated to the NHS by chancellor George Osborne in last year’s autumn statement, as part of a “down payment” to implement the NHS Five Year Forward View. NHS England’s Forward View Into Action planning guidance document, published in December, promised “a £200m would-be investment in new care models”. When it identified the 29 vanguard sites developing new care models in March, the authority said the project would be “backed by a £200m transformation fund”. HSJ understands that NHS England has now committed the funding to a number of projects, but not all of it will be spent implementing the new care models, while some will go to schemes unconnected to the forward view. Some of the £200m will be used to support NHS England’s “transforming care” scheme, which began nearly two years before the forward view was published. The initiative, established in response to the Winterbourne View scandal, is designed to improve services for people with autism and learning disabilities.

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Hospital Doctors

  • NHS reform added to growing inequality in life expectancy.

    There are rising inequalities in life expectancy, research suggests, with the gap between the top and bottom 1% of life expectancies in local authority districts of England and Wales increasing by around 0.9 of a year for men and 1.1 years for women. Moreover, the research shows that the inequalities (gaps) between the top and bottom 1% of life expectancies of English and Welsh local authority districts are expected to continue to rise steadily, from 6.1 years in 2012 to 8.3 years in 2030 in men, and from 5.6 years to 8.3 years in women. The inequalities are set against rising national life expectancy. By 2030, life expectancy in England and Wales is expected to reach 85.7 years for men and 87.6 years for women - closing the gap between male and female life expectancy from 6.0 years in 1981 to just 1.9 years by 2030. The Lancet study suggests that between 1981 and 2012, national life expectancy in England and Wales increased by 8.2 years in men (to 79.5 years) and 6.0 years in women (to 83.3 years). “Our national forecasts of life expectancy in 2030 are higher than official figures from the Office for National Statistics, by 2.4 years for men and 1.0 years for women, meaning that pensions will have larger pay-outs than planned, and health and social services will have to serve an even older population than currently planned,” says senior author Professor Majid Ezzati from Imperial College London, UK. ”The discrepancies found between our estimates and earlier figures are likely to be because previous estimates have extrapolated from past trends in death rates, an approach that may underestimate gains in life expectancy.”

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Pulse

  • Private APMS provider has three practices put in special measures by CQC.

    A private APMS provider in the north-west of England has had three of its practices deemed inadequate by the CQC, with a further practice rated as needing improvement. The GP-led private company SSP Health had its Seaforth Village Surgery, Hightown Surgery and Kensington Park Surgery put into special measures following inspections in March and April. Local GP leaders said problems stemmed from the competitively tendered contracts for the practices being unviable in the first place. However, SSP Health said it is in the process of contesting the CQC’s reports of inadequacies at the practices. The provider has had two other practices inspected so far, both of which were given a ‘good’ rating. The three practices are among only 28 to be given a rating of inadequate across the whole of England so far. In the inspection reports, the CQC said that its practices: Put patients ‘at risk of harm because systems and processes were not in place to keep them safe’ (Seaforth); Failed to report safety incidents (Seaforth); Did not have adequte leadership (Seaforth & Hightown); Failed to put in place systems to promote patient safety were not embedded at practice level (Hightown); Was ‘not caring towards patients’ (Hightown); Failed to carry out ‘sufficiently thorough’ reviews and investigations, while ‘lessons learnt were not communicated widely enough to support improvement’ (Kensington Park).

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  • GP seven-day pilot schemes being abandoned in blow to Conservatives' access drive.

    A CCG has cancelled a seven-day GP access pilot after it failed to reduce pressure on local A& E services, while others are considering cancelling theirs, Pulse has learned, casting further doubt on the Conservatives’ flagship scheme to create a seven-day GP service. NHS Canterbury and Coastal CCG found that its scheme, which saw GPs opening from 9am to 1pm on Saturdays and Sundays from November to April, failed to help local A& Es meet the four-hour target over the period. Local GP leaders across the country are also reporting that commissioners are considering cancelling other schemes, including one which is costing £70 per appointment. The Conservatives have pledged to roll out seven-day GP access to all patients across England by 2020, and the Prime Minister’s Challenge Fund has recently allocated £100 million to a second wave of seven-day GP pilots. The Government has said that this is partly to allow patients to see their GP outside working hours, but it has also claimed it will reduce pressures on A& E. But GP leaders have said that commissioners’ doubts about the schemes demonstrate that seven-day access is not having the intended effects and was instead wasting NHS resources and worsening the GP workforce crisis. The NHS Canterbury and Coastal CCG scheme, which was funded via CCG urgent care resilience funds, was aimed to ‘to help reduce pressure on busy A& E departments across East Kent’ as 40% of patients who attend A& E in the area ‘could appropriately be seen by a GP’, according to the CCG. Dr Gaurav Gupta, a vice chair of Kent LMC whose practice hosted one of the weekend access points, told Pulse the CCG was hoping to prove that it was cost effective to continue beyond the pilot by reducing pressure on urgent care services.

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Thursday 7th May 2015

Daily Telegraph

  • Unethical NHS doctors drive up waiting times to attract private patients.

    NHS doctors may be deliberately driving up waiting times to attract more private patients, a top heart consultant has claimed. John Dean, a consultant cardiologist at Royal Devon and Exeter NHS Foundation Trust Hospital, said it was unethical for doctors to practice both privately and for the health service and they should give up one or the other. He claims that there is a ‘perverse incentive’ for doctors to increase NHS waiting times so that patients will decide to go private to jump the queue, a practice he described as ‘the greedy preying on the needy.’ It is why, he says, there is little private work for cancer specialists, because the waiting times are too short to allow doctors to game the system.Previously Sir Bruce Keogh, the government’s medical director has warned in the past that NHS doctors are trying to get people to go to their own private practices rather than use the NHS for free.

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BBC News

  • Private work has negative impact on NHS, expert says.

    Private practice may "prey on the needy" and doctors should question whether they can morally juggle it with NHS work, an expert argues in the BMJ. Dr John Dean, who quit private medicine, describes it as "largely a con" in his opinion, as it does not necessarily lead to better care. He believes it has a negative impact on the NHS - taking staff away from wards. But the British Medical Association says there should be no conflict of interest between private and NHS work. Dr Dean, who works at the Royal Devon and Exeter NHS Foundation Trust Hospital, says he initially took up private practice to help put his children through private education and renovate his house. But, according to the article, he grew increasingly uncomfortable with his career choice as it proved difficult to keep his private and NHS work separate. "No matter how high I set my own moral and ethical standards, I could not escape the fact that I was involved in a business for which the conduct of some involved was so venal it bordered on criminal - the greedy preying on the needy," he says. And from a patient's point of view, "the whole business is largely a con", he says. While patients think they are getting higher quality medicine, in his view, the main advantage is jumping the NHS queue. He warns: "Private hospitals are like five-star hotels but for the most part they are no place to be if you are really sick." In his report he suggests privately-funded care could have a wider negative impact on the NHS. Since a senior doctor cannot be in two places at once, time spent in the private sector "deprives the NHS of a valuable resource," Dr Dean says. He says perhaps medics who choose to undertake private practice should not be allowed to do any more NHS work. But commenting on the article, a spokesperson for the doctors' union, the British Medical Association (BMA), said: "There should be no conflict of interest between NHS and private work and this principle is contained in consultants' employment contracts. Consultants who want to do private work must first offer to do extra work for the NHS, ensuring NHS work is the priority."

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Guardian

  • NHS 'like sick patient in early-stage terminal decline', former boss says.

    The NHS is like a very sick patient who is in “early-stage terminal decline” because lack of money has left it unable to cope with the growing demand for care, the service’s former boss and leading doctors have warned. Sir David Nicholson, who ran the NHS in England until last year, is among the signatories of a letter to the Guardian that says the health service needs higher levels of investment than any of the three main political parties have pledged in the run-up to the election. Their dramatic intervention comes just hours before the end of an election campaign in which the future of the NHS, in particular how much money it should get to help it close the forecast £30bn gap in its finances, has been one of the key issues. The NHS in England’s share of gross domestic product has fallen to 7%, its lowest level since before the global downturn began in 2008, the 10 signatories say. As a result, they add: “Our health service is now exhibiting the symptoms of a very ill patient, and it is our firmly held belief that a different course of treatment is needed if we are to reverse early-stage terminal decline.” They also blame “savage cuts in social care” for hospitals struggling to cope with the growing number of patients needing treatment and lengthening waits to see a GP. They challenged the next government to increase NHS spending until it reaches the average of countries belonging to the Organisation for Economic Co-operation and Development, which is currently 9.3%. The UK spends about 9.3% of GDP on healthcare, but only if private healthcare is included. About one in 10 Britons has private health insurance.

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Yorkshire Post

  • Election campaign ‘did not tackle NHS issue’.

    Politicians have failed to address the real issues facing the NHS during the General Election campaign, One Medical Group boss Rachel Beverley-Stevenson has said. Workforce supply and service demand are two of the most pressing concerns in the health service, but have not been tackled by any political party, Ms Beverley-Stevenson said. Independent healthcare provider One Medical Group operates GP surgeries and urgent care centres, as well as running a portfolio of NHS clinical premises. Ms Beverley-Stevenson told The Yorkshire Post that care providers would be “disappointed” by the debate surrounding the NHS during the election campaign. She said: “Most people within care will be disappointed that the real issues aren’t being tackled by any of them.” She said: “Workforce is a massive challenge and it’s been very disappointing in this election campaign that nobody has really talked about that. What they have said is, ‘we’ll fund 8,000 new doctors and so many new nurses’. Well where are these people ? It takes 10 years to train a GP and a number of years to train a really good nurse. There are not great big drawers of them, plus there’s not the money to train them.” As well as lower numbers of trainees coming through, a reliance on sessional staff is compounding the problem, she said. “We’ve created a market over the last few years where it’s much more attractive to GPs and nurses to be a locum worker,” she said. “Unless the government stops that by capping rates, I can’t see how they’re ever going to solve this workforce crisis.” The rates paid for locum and bank staff are sometimes double the rate of staff workers, which is also hitting budgets, she said. Ms Beverley-Stevenson also highlighted the battle against rising demand, as many patients access the wrong services. “Thirty per cent of patients, as a minimum, are not going to the right place for their care,” she said. In terms of spending commitments, many healthcare providers are of the view that “none of the numbers are big enough”. Since its launch in 2004, One Medical Group has grown its portfolio to 14 premises and 16 primary care centres. Its turnover has risen to more than £10m.

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Tuesday 5th May 2015

Guardian

  • My plea to the next health secretary: don't restructure the NHS again.

    GP Hamed Khan writes: “Organisation, re-organisation and re-disorganisation” is what the Kings Fund once described as the disease of the NHS. Every new government has a new health minister, who has his own ideas of revolutionising and fixing the NHS. This is despite various objective independent surveys showing that it remains the best and most efficient health system in the world. Lord Darzi was keen on polyclinics, an idea recycled from the 1970’s Soviet Union, while Andrew Lansley’s health and social care bill shifted responsibility for allocating the NHS budget to GPs. As we wait to see what the next health secretary conjures up, I remember the effect of the last restructuring. When the health and social care bill was being passed through parliament, I was finishing my GP training and on the verge of starting life as a fully qualified GP. There was almost universal opposition to the bill, and huge anxiety about the potential implications for us in our day-to-day jobs. In some practices, senior GPs were having to spend time away from the practices working with the shadow clinical commissioning groups (CCGs) that were being prepared to take on the role that primary care trusts previously had. This increased their workload substantially. Some practices hired locums to ease this pressure, while others had to stretch resources. At the same time there was a feeling among practices that it was important to have their GPs involved in the local commissioning group boards, to give them access and representation. As the health bill started getting more coverage in the media, patient perception also started to change. Some thought that GPs now had the keys to the NHS budget and hence had infinite access to resources enabling us to refer patients anywhere for anything. Others believed that we were reducing prescriptions as this would save us money, which we personally pocketed. It was the so-called efficiency savings of £20bn ordered by the government that tied our hands when it came to prescribing and referring patients. The wisdom of implementing the ”efficiency savings” and the biggest ever restructuring of the NHS simultaneously was lost on us. One of the more interesting consequences was the change in the dynamic between hospital doctors and GPs. Suddenly GPs were seen as the ultimate power brokers within the NHS, with decisive control and influence. Four years down the line, morale has hit an all-time low. There is a massive recruitment crisis, with a third of GP training places remaining unfilled, compounded by a retention crisis, with swathes of GPs either emigrating to Australia and Canada or taking early retirement. As I write this article a survey has been released which shows that the number of GPs who feel that the health reforms have damaged patient care is more than double the number who feel it has improved things. As we wait for the election, Labour has pledged to repeal the Health and Social Care Act, which is likely to lead to another round of organisation, re-organisation and re-disorganisation, and the chaos that inevitably follows. The Royal College of GPs ardently opposed the Conservative health bill, but is against any further top-down reorganisation. Most GPs I know agree with this stance, and are tired of reorganisations that worsen patient care and distract us from seeing patients. The NHS is facing unprecedented difficulties and an existential crisis, and what we need is stability. At a recent dinner party one of my non-medical friends remarked that there should be a 10-year moratorium on all restructuring by politicians. Whoever offers this would definitely get my vote.

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Express and Star

  • 200 face jobs axe at Sandwell hospital trust in bid to save £16m.

    More than 200 jobs face being axed at Sandwell’s hospital trust during the next 12 months to slash more than £16m from the wage bill. It’s the next phase of wider plans by Sandwell and West Birmingham Hospitals Trust to cut around 1,400 posts over five years. Bosses are looking to scrap 205 ‘whole time equivalent’ positions by March 2016 – but say around 260 workers are expected to be affected by the move. A consultation is under way and it’s hoped that a ‘significant’ number of the posts can be cut by redeploying staff or not recruiting to vacant roles. The hospital trust, which runs Sandwell Hospital and City Hospital, has already redeployed 150 workers to other roles since first announcing its wider plans last year.

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Nursing Times

  • Do election pledges on nursing and the NHS stand up to scrutiny?

    Nicola Merrifield writes: As predicted, the NHS has been a key battleground in the 2015 election and most parties have spied an opportunity to garner support by making promises on boosting the nursing workforce. Labour has the most expansive plans, with a manifesto pledge to ensure 20,000 more nurses over the next five years, along with 3,000 extra midwives and 5,000 more care workers. It has also committed to more training places – an extra 10,000 nurses above current levels by 2020, starting with 1,000 extra on courses starting this year. Meanwhile, perhaps more surprisingly, the UK Independence Party has promised the same number of nurses and midwives as Labour, but all of the others – barring the Greens – have committed in some shape or form to increasing nurse numbers. However, no party provides detailed information on what strategies will be required to achieve their workforce goals, for example extra training places, return to practice schemes, retention of existing employees or overseas recruitment. Professor James Buchan, a nursing workforce expert from Edinburgh’s Queen Margaret University, noted that the next government faced the “big challenge” of ensuring a rapid increase in nursing numbers in the short term. “It’s all very well and worthy to commit to increasing the nursing workforce, but we have to recognise that our options in the short term are relatively limited,” he said. “What we actually need is not random pre-election promises, but a commitment to sustained workforce planning,” he added. He also pointed out that pledges to rapidly increase the community nursing workforce were particularly problematic. “That is not an area of the workforce that lends itself easily to international recruitment, because not many others countries train nurses to function effectively in those community services compared to acute hospitals, which are easier to recruit from,” he said. Some parties have also targeted the growing unrest among nurses about pay freezes and a failure of wages to keep pace with inflation in recent years. Around 70% of NHS provider budgets are spent on staff pay. But the Nuffield Trust’s director of healthcare systems, Candace Imison, warned that while pledges to increase wages would be welcome to nurses, pay awards would have a “huge influence” on what could be achieved elsewhere within the NHS budget. She agreed that real terms pay cuts were not sustainable in future, as the recovering economy gave nurses increasing options to work elsewhere. But she noted that wage increases across the NHS would be a far greater financial challenge than any of the party proposals to increase the nursing workforce. Ms Imison said she did not believe any party had pledged sufficient money to both pay NHS staff better wages and improve staffing levels, in light of the £22bn efficiency savings the health service was required to make by 2020. “The maths isn’t possible,” she said. “You cannot grow the workforce, pay them more and live within a constrained budget. Something has to give.” According to NHS England bosses, the health service will need £8bn extra funding every year by 2020 – combined with the efficiency savings – to tackle the £30bn annual deficit that is expected to appear over the next five years as demand grows. All of the parties have agreed to meet or go beyond this funding requirement by 2020, apart from Labour and Plaid Cymru. Instead, Labour has promised an extra £2.5bn from a “Time to Care” fund, paid for by a so-called mansion tax, while claiming that an estimated £4bn savings could be made from full integration of health and social care services. Despite the almost unanimous consensus on levels of extra funding for the NHS, the lack of detail about how the extra money will be used and whether it will be available in the short term has attracted criticism. Beccy Baird, policy manager at the King’s Fund health think-tank, said: “We need a bit more clarity about the money next year. It’s all very well promising £8bn for 2020, but how that money is staged becomes really important. If it’s a little bit [of money] now and lots in 2020, that is not going got help the NHS, which is looking at nearly a £1bn deficit just in the provider sector this year.” Despite the financial question marks, Ms Baird suggested that trusts, particularly those in the acute sector, were still likely to increase their workforce next year. In contrast to the tight financial position, the three main parties also have ambitions to improve access to services at weekends and in the evenings – hoping to appeal to voters with promise to make the NHS a “truly seven-day service”. Anne Marie Rafferty, professor of nursing policy King’s College London, said there was a “gap” in the thinking across all parties about how they would ensure adequate community staffing levels to achieve the changes in services they had outlined. Come the 8 May, the profession must ensure that whichever party, or parties, comprise the next government stick to their promises on the NHS and nursing.

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Monday 4th May 2015

Our NHS

  • Why are GPs being told to hand billions-worth of NHS decisions to private health firms and their lobbyists?

    ‘The whole point of our NHS reforms,’ David Cameron said, is ‘to put the power in the hands of local doctors, so that they make decisions based on what is good for their local area.’ But now new information has emerged in the run-up to the election, showing just how far from the truth this claim is. Yes, most of the NHS budget was handed to GPs. But they are now handing it over to private firms. It’s phase two of the privatisation project. It is private firms who will determine how and where the NHS budget will be spent (through a process known in NHS speak as commissioning). Everything from deciding which hospitals stay open, which services are still available on the NHS, and who provides these services, the NHS or the private sector. As the Observer reveals this morning, the list of approved suppliers bidding for this work – the planning and buying of care – has just quietly been released. The list is dominated by management consultancies, outsourcing giant, Capita, and US health insurer, UnitedHealth, the previous employer of NHS CEO, Simon Stevens. Last year, Spinwatch uncovered how UnitedHealth’s lobbyist, Chris Exeter, chaired a discreet forum, the Commissioning Support Industry Group, giving these firms regular privileged access to senior NHS officials overseeing the creation of this new market in ‘commissioning services’. Capita was another member of the group, as were KPMG, PwC, EY (formerly Ernst & Young) and McKinsey. There are nine consortia set up to ‘supply’ local health purchasing decisions. UnitedHealth, Capita, KPMG and PwC are now approved suppliers to two thirds of them. McKinsey and EY are suppliers to half of them. These companies (and others) will supply GP commissioners with key services that have until now been done by the NHS for the NHS: planning services; managing relationships and contracts with healthcare providers, like hospitals; and crucially deciding what the NHS will look like in the future – what NHS England calls ‘transformation and service redesign’. GP groups will be forced to re-procure a lot of these services by April 2016 (apparently in order to comply with EU procurement law). It is thought that, consequently, between £3-5billion of services will be bought through these consortia. The privatisation of commissioning hands the private sector more power, more influence and potentially a lot more of the NHS budget.

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HSJ

  • New FT probed by Monitor after finances plummet.

    St George’s University Hospitals Foundation Trust is under investigation by Monitor because of a sudden deterioration in its finances. HSJ previously reported that just two months after being awarded foundation trust status the trust recorded a £10m unplanned deficit. It had previously expected to deliver a £6.9m surplus. This has now worsened to a £16.8m deficit at the end of 2014-15, and the trust is planning for a deficit of up to £30m at the end of this financial year. The trust has imposed “rigorous controls” on its spending including asking managers to cut bank and agency spending by 40 per cent. Monitor delayed approval of the trust’s FT status in December because of concerns over its finances. However, it was approved in February. The regulator has also questioned why the trust has failed to treat patients more quickly, something that was requested when the trust was given FT status. Monitor said it had authorised the trust on the basis that it would break even in 2014-15 and deliver a surplus in 2015-16. The trust has not met the four hour target to see, treat, admit or discharge 95 per cent of patients since October last year. A trust spokesman said the unplanned deficit had arisen because of “unprecedented demand from very ill patients and fixed capacity in terms of beds and operating theatres”. He added: “Towards the end of 2014-15 there was a significant divergence from plan ending the year with a £16m deficit instead of the small planned surplus. “As a major trauma centre, the trust has been particularly affected by the operational pressures that have been seen nationally. During the winter we were faced with unprecedented demand from very ill patients and fixed capacity in terms of beds and operating theatres. This resulted in a cancellation of planned operations and longer waiting times for some patients. Financially it led to reduced income from planned activity combined with increased costs of staff and supplies. “The St George’s Board is committed to maintaining quality and safety and takes its responsibility seriously for addressing these issues. We will work with Monitor to understand fully how and why this situation has happened, and to identify possible solutions.”

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The Guardian

  • A new list of approved suppliers to the NHS has heightened fears of a multi-billion pound land grab by a handful of corporations

    Competition for contracts to supply support services to the GP-led commissioning groups will be dominated by management consultancies, outsourcing giant Capita, and the US health insurer UnitedHealth. NHS England insists that the companies bidding for the support contracts will supply a range of back office functions, cutting procurement times and allowing doctors to focus on how best to spend their £70bn share of the NHS budget. David Cameron has said the plan “is to put the power in the hands of local doctors so that they make decisions on behalf of patients based on what is good for health care in their local area”. But groups opposed to the further privatisation of the NHS claim the reality is that the scope of the private firms is being dramatically expanded so that they will be allowed to provide services that, until now, have been undertaken by the NHS. They say that the move will end up costing taxpayers more and result in conflicts of interest as a number of the private firms are also advising the GPs’ commissioning groups. NHS England has rejected these claims. Four companies dominate the list of approved suppliers published last week. Capita, KPMG, PwC and UnitedHealth, the previous employer of NHS CEO, Simon Stevens, are now listed as suppliers to six of the nine regional consortiums set up to help GPs’ commissioning groups procure services. Ernst and Young is a supplier to four consortiums while McKinsey has been named as a supplier to five. All are members of the Commissioning Support Industry Group, which is a low-profile body that affords them regular access to the senior NHS officials overseeing the creation of the new market in commissioning services. “Andrew Lansley [the former health secretary] promised GPs they would be in the driving seat, but the reality is that instead of handing the power and the money to GPs his reforms have handed them to corporations,” said Dr Jacky Davis, founder member of Keep Our NHS Public and co-author of the book NHS For Sale. This announcement marks the final step in giving the private sector the power, influence and a big slice of the NHS budget. There is now a massive conflict of interest with private companies like UnitedHealth, KPMG and McKinsey in charge of the GPs’ budget and increasingly buying care from the self-same private sector. The Tories have put Dracula in charge of the blood bank.”

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The Independent

  • A firm run by the Tories’ election chief, Lynton Crosby, devised a plan to lobby David Cameron to expand the role of private healthcare in the UK.

    A strategy paper, drawn up by Mr Crosby’s firm CTF Partners and seen by The Independent, proposed targeting key government figures, including the Prime Minister, to enhance the “size, acceptability and profitability of the private healthcare market”. It also stated that “insufficient public funds” were a strategic “opportunity” for private healthcare firms. It added the campaign’s long-term strategy should be “achieving decision-maker recognition that health investment in the UK can only grow by expanding the role and contribution made by the private sector”. The emergence of the document, just four days before polling day, has been seized on by Labour as evidence of the links between the Conservatives, private healthcare firms and the man entrusted to secure an election victory for the Tories on Thursday. CTF Partners’ website says Mr Crosby’s “intuitive sense of delivering the results that are needed” has been “finely honed through his many years of providing high-level advice to prime ministers, premiers, and leaders of business. David Cameron has serious questions to answer,” Labour’s shadow Health Secretary, Andy Burnham, said. “It looks increasingly like Lynton Crosby’s lobbying firm led a drive to ensure private health companies were the big beneficiaries of David Cameron’s health policies. Cameron must now come clean on the impact of Lynton Crosby’s business interests on Tory policy.”

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Friday 1st May 2015

Hospital Doctor

  • “Collaborate over competition in the NHS”.

    Eight out of 10 rheumatologists believe that rheumatology services are no better now than in 2010, when a national audit highlighted deficiencies. This is the key finding of the State of Play report by the British Society for Rheumatology (BSR), which polled over 2000 rheumatologists on the major challenges currently facing services. They raise significant concerns over the potential for improving rheumatology services. Only 14% of respondents believed that there was sufficient clinical input into the tendering process and 7% that there was adequate patient input. 85% reported that education, training and research are not given proper consideration in tenders for new services. BSR President, Prof. Simon Bowman, stated: “Despite the pressures facing services in recent years in terms of rising demand, drives for efficiencies and diminishing resources, our members have managed to maintain the highest standards of care for their patients. However, they have also made it clear that so much more could be achieved if they and their patients were given the proper support to develop services. This report reinforces the need for collaboration over competition in the health service. Whether it’s collaboration between healthcare professional and patient, closer working across professional boundaries or better co-ordination between care settings, patients will only ever benefit from a more collaborative approach.” Furthermore, two-thirds rated their relationship with primary care colleagues as five out of ten or below, citing poor communication and lack of GP condition awareness as main factors.

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Our NHS

  • Discussion of the NHS has repeatedly fizzed to the surface of the election, but debate has been clipped and often short on detail.

    A good example is the way the coalition parties have dismissed privatisation. “It’s a tiny fraction of the health budget” is the ministerial mantra. However a new analysis of NHS contracts produced by the NHS Support Federation proves that the public are being denied the truth about the impact of the NHS changes. We are often told the NHS only spends 6% on the private sector. But this figure actually relates to 2013/ 4 – and so it tells us very little about the impact of the Health & Social Care Act. The Act only came into force in April 2013, and the process of making the first round of decisions under it, typically took another year or more. So today’s evidence from 2014/ 5 is the first to begin measure the true impact of the new competition regime. And it is shocking. Over the last year private firms have won £3.5bn worth of new clinical contracts – an increase of 500% on the previous year, our research shows. Two years on from the Health and Social Care Act we now have clear evidence that NHS privatisation is accelerating. Just as opponents predicted, the Act has stoked the market and forced open many more NHS contracts for private firms and charities to bid for. In the last two years over £21 billion worth of opportunities to plan and deliver NHS care have been advertised, though not all have been awarded yet. That’s over 1000 contracts up for grabs covering every aspect of healthcare.

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The Mirror

  • Filthy hospital ward 'cleaned' by private firm fuels fears Tory privatisation putting public at risk.

    G4S, handed a new contract at Lister Hospital, vowed to “rectify the issues” highlighted in our photos showing bags of clinical waste strewn across wards. A state-of-the art hospital has ordered an urgent probe after the Mirror uncovered shocking ­failings by the private firm in charge of keeping it clean. G4S vowed to “rectify the issues” after we showed bosses photos of bags of potentially infectious ­clinical waste strewn across the wards. The damning evidence, given to us by a whistleblower, emerged days after the security giant was handed a lucrative new contract to ­maintain and clean Lister Hospital in Stevenage, Herts. An appalled insider said: “This level of dirt puts the public at risk. Would you want your family going in to a hospital like this and receiving treatment ?” The images will fuel fears privatisation of NHS services by the Tory-led government is putting public safety at risk. They were taken in wards across the hospital – including the new £40million A& E unit, which was opened in March by Health Secretary Jeremy Hunt. Mounds of waste, bags of linen and biomedical containers are piled on top of each other. Clinical waste bags containing bloody dressings overflow from yellow bins. Nurses are said to have complained to health chiefs and a senior G4S boss resigned in protest. Emergency cleaners are also understood to have been called in. Our insider said: “The nurses are angry but there are simply not enough cleaners to cover the wards. People are sick of it – it’s dirty, it’s disgusting but no-one seems to be doing anything.” Another source added: “Leaving bags of clinical waste piled high in the corridors increases the risk of spillage and infections. 4S won a second contract for cleaning at the Lister Hospital earlier this month but sparked anger by restructuring workers’ pay. In a letter to staff in February, the firm warned cleaners it had to alter hourly rates due to brutal Tory NHS cuts. UCATT regional chief Ron McKay said the union raised concerns with G4S and NHS bosses about the “appalling treatment” of cleaners and the impact it would have.

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The Guardian

  • GPs are exhausted, A&E is overrun and hospitals are broke. What went wrong?

    When Stephanie de Giorgio, a Kent GP, sat down at a medical conference last year in Liverpool to hear the health secretary, Jeremy Hunt, she expected to be annoyed.. A partner in a busy practice by the sea in Deal, Kent, she had almost given up on medicine because of the stress of dealing with shrinking budgets while the pressure built up to do more. However, her irritation soon became hostility as the Tory politician pitched for doctors’ votes by saying he had always supported GPs. In the question-and-answer session, she asked what Hunt “was going to do (about) … the elephant in the room. The ever increasing inappropriate demand from patients. Instead of addressing this, you … make it worse by continually denigrating general practice and encouraging patients to be ever more demanding. We are exhausted, drowning and, quite frankly, furious with you.” The applause was thunderous but fell flat when Hunt responded with a plea for GPs to realise that if “something goes wrong on a Saturday morning patients don’t want to wait until Monday morning. They want to get it sorted out straight away.” Since then De Giorgio has become a leading light in Resilient GP, an association of about 1,000 doctors who regard the past few years as an assault on the medical profession. She said: “The [Health and Social Care Act 2012] is a big part of it. People being ditched in favour of targets. We are seeing our GP budgets cut. The competition from private interests. I am not against innovation but it has to be for the benefit of patients. This isn’t.” Spending a day with De Giorgio involves a whirlwind of activity. In the morning there are a dozen patients, about 25 prescriptions and a blizzard of phone calls. Lunch is a sandwich between home visits and the afternoon involves another dozen calls with patients, 45 more prescription requests to go through, 25 more lab results and 26 letters.

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The Independent

  • Private providers of out-of-hours GP services deliver poorer care than NHS, research finds.

    Private providers of out-of-hours GP services deliver poorer care than NHS alternatives, according to a new research. In the second study in the space of a week to uncover concerns about the quality of private companies working on behalf of the NHS, academics found that patients were more likely to be dissatisfied with their out-of-hours service if it was run by a commercial provider. Basing their findings on 900,000 responses to the 2012/ 13 GP Patient Survey, researchers at the University of Exeter Medical School found that NHS providers scored highest on timeliness, patient confidence in doctors, and overall care experience. Last week a study from Imperial College London found that private providers of in-hours GP services performed worse than traditional GP practices. Since 2004, evening and weekend GP care has been provided by a variety of NHS, private and not-for-profit providers. While two thirds of patients say their out-of-hours service is very good, satisfaction rates have been slipping in recent years.

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HSJ

  • Hinchingbrooke Health Care Trust has forecast a £14m deficit for 2014-15 – nearly double the size of its deficit for the first eight months of the financial year.

    The deficit is significantly adrift of the £2m surplus the trust predicted at the beginning of the financial year while still under the management of private provider Circle. It is also well above the £12.2m “pessimistic” forecast for year-end the trust made in January. Hinchingbrooke, which posted revenues of £112m in 2013-14, returned to NHS control on 1 April following the termination of Circle’s franchise agreement in January. The finance report for the trust’s April board meeting attributed the deterioration in its financial position to a combination of external pressures, a substantial agency staff bill driven by increased demand, and failure to achieve its cost improvement programme. The report, by new interim chief finance officer Ian O’Connor, said: “For the 2014-15 financial year Hinchingbrooke is reporting a deficit of £13,993,000 on its income and expenditure. As a consequence of reporting a deficit the trust has not delivered its statutory duty to break even.” It added: - “during commissioning negotiations reductions in local prices cost the trust in excess of £3m”; - a high demand for agency staff generated by “increased volumes and acuity of non-elective patients” has seen the trust’s “interim staffing bill for the year [reach] nearly £12m”; - “external pressures on trust finances have been exacerbated by the impact of failed [cost improvement programme] schemes. - In addition to the failure of the original programme, the recovery programme that was initiated in quarter 3 has not delivered the necessary reductions in interim staffing costs”; -the trust has also had to pay an estimated £1.3m towards the Transforming Pathology Partnership joint venture it owns with six other trusts, which was considerably more than had been budgeted for. The pathology provider has estimated a £4.5m loss in its first year and members are sharing the cost burden.

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Pulse

  • CCGs issue 40% of contracts to private providers.

    Two fifths of NHS contracts have been issued to private providers since the introduction of the Health and Social Care Act by the coalition in 2013, the Labour Party has claimed. A Labour FOI of CCGs found that 40% of all contracts put out to tender by CCGs have been awarded to private firms, compared with 41% being awarded to NHS organisations. Labour’s findings contradict the Government’s line that just 6% of contracts go to private providers, and shadow health secretary Andy Burnham pledged to repeal the ‘market framework’ that was introduced by the HSCA and which he said had put the ‘founding NHS principles under threat’. A Labour statement said: ‘Labour will repeal the Health and Social Care Act to scrap David Cameron’s NHS market. This will include scrapping the rules that force services out to tender and repealing the competition regime that is tying up hospitals in competition law. ‘And where private companies are involved in delivering NHS-funded clinical services, Labour will cap the profits they can make from the NHS to ensure resources are spent on patient care.’

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  • Gerada quits NHS England to be able to speak out on NHS privatisation.

    Former RCGP chair Professor Clare Gerada has quit NHS England to be able to speak out against what she calls the Conservatives’ ‘desperate quest for privatisation’. She told Pulse that running the primary care ‘transformation’ programme in the capital as chair of NHS England London’s primary care clinical board had been ‘fantastic’ but that she saw her ‘bigger role’ as a whistleblower on NHS policy - especially in the run-up to the general election. Professor Gerada, who has filled the time by adding more sessions of clinical work as a GP in Lewisham in south London, said it was ‘no secret now’ that people working within the NHS both at senior and junior manager level were ‘frightened of speaking out and whistleblowing’ and she had not wanted to ‘embarrass’ her employer by doing so. She said: ‘I think the big things that are wrong cannot be fixed by me [working for NHS England]. These are big things like restoring the secretary of state’s duty to provide a comprehensive health system, like ensuring that we have equity of funding across different areas. Those are the things that are being rapidly removed and being put into the hands of quangos, really.’ The former RCGP chair said that the ‘important thing’ is to bring the NHS ‘back to public ownership, back into proper finance to being properly delivered - and stop this desperate quest for privatisation’ She added: ‘Despite what the Conservatives are saying, as GPs we only need to look around us to know what is going on, and that is that people are no longer able to access the care that they need to because of serious problems with funding and a constant move towards tendering and all things like that.’ Professor Gerada’s NHS campaigning work in the election run up has included an open letter to the Guardian signed by 140 doctors casting a damning verdict on the Coalition’s NHS track record, but she faced a backlash when Tories seized on her membership in the Labour Party, calling the letter a ‘Labour-instigated stitch up’. Professor Gerada, who told the Telegraph newspaper that she was ‘not a Labour Party activist’, told Pulse that ‘as an outed Labour card carrier’ she hopes the party will win but she thinks next week’s election is too close to call.

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Thursday 30th April 2015

Guardian

  • My plea to the NHS: decide whether or not my life is worth saving, and call me.

    Stacie Lewis writes: Two years ago, my world fell out from under me when I was diagnosed with acute myeloid leukaemia.there was one option that could save me: a second bone marrow transplant. The team had had a lengthy discussion about it, and they were unanimous: I should have it. But, it wasn’t up to them. It was up to NHS England. I sobbed. I drowned in sobs. What, I asked, is NHS England ? My doctor took her time to try to reassure me about the process, though I was barely able to follow. How they’d fill out an individual funding request (IFR) on my behalf. It would take about two weeks. The Tuesday after Easter they’d have a decision, we were told. It was meant to be two weeks. It’s six weeks now. No word on how long the decision will take. This wait is psychological torture. Then I made a discovery that shook my confidence further. Online, I found a blank application for the IFR to NHS England. Questions on the form included:
    9b. If this treatment were to be funded for this patient on an individual basis, would the decision set a precedent for other requests ?
    11. What is the evidence base for the clinical and cost effectiveness/ safety of this procedure/ treatment ?
    17. What is the cost of the treatment/ procedure and how does this compare with the cost of the standard therapy it replaces ? Please ensure you include all attributable costs that are connected to providing the treatment/ procedure eg drug/ staff/ follow-up/ diagnostics etc.
    I know these questions have to be asked. Bone marrow transplants are expensive. Estimates I’ve been given are around £100,000. That’s a tremendous amount of money. But I have some questions too: 1. What is my life worth ? 2. Are decisions made within NHS England based on money, or what is the best treatment to save my life ? As the reality of my complete dependency on the NHS sinks in, I begin to wonder. Over the past few years, I’ve read article after article about billions of pounds being wasted in the NHS. Is that the same money that could have funded treatments such as mine ? Here are the facts: there has been a £790m real-terms cut in cancer funding for the NHS by the coalition government since 2010. According to a report by the New Economics Foundation (NEF), the costs of the government privitisation of the NHS “have been conservatively estimated at £4.5bn a year – enough to pay for either 10 specialist hospitals, 174,798 extra nurses, 42,413 extra GPs, or 39,473,684 extra patient visits to A& E”. Or, for that matter, 45,000 bone marrow transplants. Are these, I wonder, the real numbers that are stopping my doctors from treating me in the manner they think is best ? My worry turns to fear. Weeks later, I am still in the dark. After being bumped around from office to office, today I finally tracked down the number of someone at my local commissioning support unit for NHS England – and they don’t even have a record of my application. He did tell me they try to finish applications in 20 working days. It is now 42 days and counting. This is an open plea to NHS England: On your website you describe yourself as “transparent about the decisions we make, the way we operate and the impact we have”. I have no idea of how you are forming your decision. I have no point of contact at NHS England. My doctors send emails and leave messages. As far as I’m aware, no one calls them back – and you certainly don’t phone me. Call me. Please. I can’t take it.

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BBC News

  • Election 2015: A party with a prescription for the NHS?

    The future of the NHS has been one of the major topics of the election. The Tories, Labour and the Lib Dems have all been promising more money and better services. But according to one party, which should in theory be best qualified to talk about the health service, the mainstream politicians are living in "cloud-cuckoo land". The National Health Action Party, set up in 2012 by doctors, nurses and paramedics in opposition to the coalition's health policy, is fielding 12 candidates next week. Its co-leader Clive Peedell, a cancer doctor from Middlesbrough, is standing against Prime Minister David Cameron, while another candidate, London GP Dr Louise Irvine, is fighting Health Secretary Jeremy Hunt in his South West Surrey seat. Co-leader Dr Richard Taylor, who won the Wyre Forest seat in 2001 off the back of a campaign to save Kidderminster Hospital's A& E department, is also standing. Dr Peedell says the promises of extra money by the parties have been made on the basis of the NHS making more than £20bn of efficiency savings over the next five years to make up a £30bn shortfall. 'The chance of achieving this is almost impossible, and the parties are living in cloud-cuckoo land if they think it can be done," he says. Instead, his party says the NHS should get an immediate £4.5bn cash injection followed by cash rises of 4% a year. If inflation stays low, this would probably cover the entire £30bn, negating the need for efficiency savings. Dr Peedell says that does not mean savings cannot be made. The party believes £4.5bn a year can be saved in bureaucracy by dismantling the market structures, while there is potential for another £2bn from renegotiating private finance initiative (PFI) hospital deals (something experts say is notoriously difficult). This would involve a repeal of the 2012 Health and Care Act, but - and this is where the party differs from Labour, which is also promising such a move - Dr Peedell would go further and end the purchaser-provider split in the health service. This is the system whereby services are paid per patient treated, which was introduced to encourage internal competition in the health service. But he favours greater public accountability, with patients and local politicians forming bodies that could "hold the NHS to account". He says "being optimistic" the party could conceivably end up with two seats, although he is conscious that that is a "long-shot".

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ITV News

  • Warning over 'challenging future' for NHS.

    The next five years will be the "most challenging and decisive that the NHS in England has ever faced", a group of medical experts has warned the next health secretary. In an open letter to the next health secretary, Dr Fiona Godlee, editor-in-chief of the British Medical Journal, and her colleagues warn that "England's NHS is stretched close to breaking point" and that it is "still reeling" from the "costly and distracting" reforms of the coalition Government. They wrote: "Extreme cuts to social care have exacerbated the pressures, causing knock-on effects across the service. Waiting times for treatment are the longest for many years. Staff morale in many parts of the service is at rock bottom because of real terms pay cuts and the relentless workload. Many GPs are retiring early, and new recruits are thin on the ground." They added that patient safety is now at risk, with 13 NHS trusts currently in special measures because of concerns about the quality of care being delivered. They point out that NHS England chief executive, Simon Stevens, said savings of £22 billion over the next five years are necessary, "but this level of saving will still require efficiency gains never before achieved by the NHS, and a further £8 billion is needed from government by 2020 just to stand still". Their letter sets out a number of requests they urge whoever comes into power next month to commit to, starting with ensuring that the NHS remains publicly funded and free at the point of need.

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Lichfield Live

  • Green Party vowing to buy out PFI deals to safeguard NHS.

    The Green Party say they will seek to buy out PFI contracts within the NHS to safeguard the health service for Lichfield and Burntwood residents. Instead of government funding projects, a consortium of private corporations provides the finance – they then rent the buildings back to taxpayers for 30 to 35 years. The public purse is liable for £300billion or more over the next 30 years for 719 projects, according to Lichfield parliamentary candidate Robert Pass. PFI was the brainchild of the Conservative Party in the 1990s and has been used to build new roads, schools and hospitals. But use of such contracts expanded rapidly under Labour during their 13 years in power from 1997 until 2010. Now the Greens want all public services to be funded through taxation, and are demanding an end private sector involvement in health care. The Greens also want to scrap the Health and Social Care act, which was introduced by the coalition government in 2012.

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