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Friday 27th March 2015

Pulse

  • General practice has been deprioritised under this Government, says think-tank.

    The Coalition Government has ‘neglected’ general practice and this is likely to have had ‘real consequences’ for patients, the influential King’s Fund think-tank has said. The think-tank’s ‘The NHS under the coalition government’ report notes that patient satisfaction with general practice remains high and there has been a recent improvement in investment in primary care. However, it concludes that the steady decline in patient experience and staff morale in general practice will make the next parliament ‘extremely challenging’. It also found that the Government’s record in general practice has escaped measurement due to a lack of routinely collected data. The pre-election report reviewed the current Government’s record on the NHS since coming to power in 2010. It concluded: ‘The relative neglect of general practice… appears to have resulted in lower priority being given to primary care during this parliament as measured by the share of the budget allocated to it, although steps are now being taken to tackle this.’ The King’s Fund said that it was ‘not possible to quantify the impact on patients’, but added that the ‘consequences are likely to have been real’. Under the Coalition, the number of GPs per 1,000 of population has decreased, it added.

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OnMedica

  • NHS faces accelerating decline as election approaches.

    Whichever new Government that takes office in May will inherit an NHS that has run out of money and is operating at its absolute limits, the King’s Fund warned this morning. Its latest report into the fortunes of the NHS under the coalition, launched this morning, highlighted huge pressure on general practice, concerns over vulnerable patients’ access to mental health services, £800m of overspends, and a serious risk of deteriorating patient care as service and financial pressures overwhelm the NHS. The King’s Fund said in the second part of The NHS under the coalition government that the strain is being felt right across all areas of the NHS. It found:
    -Target waiting times for A& E, hospital treatment and cancer treatment have all been missed towards the end of the parliament.
    -Hospital bed occupancy has increased to very high levels, and delayed discharges have risen significantly over the past 12 months.
    NHS staff are under significant pressure, and morale is an increasing cause for concern.
    It urged the next government to commit to additional resources while avoiding grand reforming gestures and warned that without the estimated £8bn funding that the NHS requires, as a very minimum, there is a real prospect of accelerating decline in NHS performance. It cautioned: “This could mean staffing cuts that affect patient safety and quality of care … together with longer waiting times for patients to access services.”

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BBC News

  • NHS problems 'at their worst since 1990s'.

    Services in the NHS in England are deteriorating in a way not seen since the early 1990s, according to a leading health think tank. The King's Fund review said waiting times for A& E, cancer care and routine operations had all started getting worse, while deficits were growing. It said such drops in performance had not been seen for 20 years. But the think tank acknowledged the NHS had done as well as could be expected, given the financial climate. Professor John Appleby, chief economist at the King's Fund, which specialises in health care policy, said: "The next government will inherit a health service that has run out of money and is operating at the very edge of its limits. "There is now a real risk that patient care will deteriorate as service and financial pressures become overwhelming." He said in terms of how standards were slipping - not how low they had reached - the situation was the worst it had been since the "early 1990s". The report noted much of the deterioration has happened in the second-half of the Parliament with many measures of performance being maintained in the first few years. It said the next government had to address the funding situation, adding the extra £8bn a year NHS England says is needed by 2020, was the "minimum" that would be required. The report - a review of performance this Parliament - highlights a range of problems as well as achievements. These include:
    - Waiting time targets for A& E, hospital treatment and cancer care all being missed towards the end of the parliament.
    - Bed occupancy increasing to "very high levels", while delays in discharging patients have "risen significantly".
    - Funding being increased by 0.8% a year on average - higher than was predicted mainly because of the low levels of inflation.
    - Hospital infections, such as MRSA and Clostridium difficile, dropping to historically-low levels.
    - Public satisfaction levels reaching their second highest levels ever.
    - The number of doctors and nurses increasing, while management costs had been "significantly reduced".
    - Levels of deficits increasing though as the NHS struggles to keep up with demand.
    The report is the second part of the King's Fund pre-election review of the NHS this Parliament.

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The Guardian

  • The NHS needs serious money, but our politicians are refusing to face it.

    The wonder of the NHS is its remarkable resilience. It’s no surprise that waiting times are higher than for years, A& E targets missed by miles and cancer treatment times falling. This analysis comes from the King’s Fund, the respected independent institute that does for health what the Institute for Fiscal Studies does for tax and spend. Warnings came after George Osborne’s first budget, when the Conservative chair of the Commons health committee, the former health secretary Stephen Dorrell, said time and again that the NHS could not sustain 4% cuts year after year in “efficiency savings” without imploding. No health service, anywhere in the world, had done that. Technically Cameron kept his promise to increase funding – but only by 0.8% – or a fifth of the average percentage rise since 1948. Per capita funds fell as the population grew, as did numbers of people aged over 65 and over 80. Now add in 30% cuts in council budgets that saw 500,000 fewer frail people receive any social care: old people arriving in A& E were stuck in hospital beds for lack of services at home. Add in the ruinous disarray of the £3bn NHS and Social Care Act, like smashing a mirror into fragments. In what was once unguardedly called “creative destruction” for public services by backroom Conservative ideologues, 90,000 people changed jobs, senior staff departed. The perfect financial storm came with the Francis report on Mid Staffs rightly commanding that there should be more nurses. But the government had cut nurse training places, so hospitals competed in a dash to hire them from abroad, and agency-use skyrocketed. This lucky government has had mild winters and no great flu or norovirus outbreaks. Last minute bungs to A& E have just about kept the wheels on, despite the ambulances stacking up outside. The public remains relatively satisfied, at 65%, according to today’s British Social Attitudes survey. Pollsters suggest people now tend to say they are satisfied with the NHS as a gesture of support, not an evaluation of quality. But those saying that the NHS improved on Cameron’s watch fell from 40% in 2010 to 25% now. Only 10% support charging new fees – the fees rightwing thinktanks imagine would solve the crisis – though the US Commonwealth Fund year after year finds the NHS best for extracting the most bang for its bucks. Now the bucks have run out.

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The Independent

  • Meningitis B vaccine: Stalled negotiations sees private sales soar in wealthiest regions, a year after DoH announced it would be free on NHS.

    A year after Jeremy Hunt’s health department announced it would make a new vaccine against meningitis B available free on the NHS, stalled negotiations between the government and the drug manufacturer has resulted in private sales soaring in only the wealthiest regions of Britain. MenB, the most common cause of life-threatening meningitis, which can quickly kill young children or leave them facing traumatic limb amputations, has a more damaging impact in socially deprived area with higher infant mortality rates. Yet meningitis campaigners say the vaccine’s availability to only those who can afford it, demonstrates “health inequality in Britain at its absolute worst.” Figures on the private sales of the Bexsero vaccine, seen by The Independent, show that nearly 80 percent of the parents in England who can pay up to £1000 to protect their young children, are from London, the South East and the South – the wealthiest parts of Britain. The manufacturers’ data from the North East, which has the lowest disposable income in England, and where the disease prevalence is nearly twice the rate of the South East, shows less than two percent of total sales in that region.

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HSJ

  • Revealed: Virgin handed £280m Staffordshire contract.

    Virgin Care has been awarded a £280m, seven-year prime provider contract to manage services in East Staffordshire, HSJ can reveal. It beat competition from the only other shortlisted bidder, Optum, to win the contract to coordinate services for frail elderly patients, those with long term conditions and intermediate care. The programme, supported by the 19 East Staffordshire GP practices, will come into effect from April next year and serve around 38,000 people with long term conditions as well as an estimated 6,000 frail older people. It is a separate contract to a tender process being carried out by four other Staffordshire clinical commissioning groups for cancer and end of life care which is worth a total of £1.2bn. Virgin Care is bidding for the end of life care element of that tender worth £535m. East Staffordshire CCG has said it pursued the prime provider model because of expected increases in demand and costs, which Virgin Care will have to absorb over the seven years. The CCG said that without the contract it would be unsustainable by 2018 and overspend its allocation from NHS England by £10m. CCG accountable officer Tony Bruce told HSJ last year that he believed the deal would improve services. He said it was required because the CCG did not have the capacity to deliver the integration of services. “What we are talking about is supply chain management,” he said. “CCGs were not set up in scale or expectation to micro-manage the interactions between different providers.” The CCG said benefits of the deal could include better delivery of self-help support, joined up care, better use of technology, and a wider choice of seven day services. The group said Virgin Care will coordinate services across providers to deliver agreed outcomes, although it has not published what these outcomes are. Charles Pidsley, chair of East Staffordshire CCG, said: “We are delighted to be working with Virgin Care to put the Improving Lives programme into practice. We are confident it will bring about the changes needed to improve care to local people, particularly those with long term health problems. “We chose Virgin Care as a like minded partner with a strong track record and we will use its experience to help us tackle the local challenges patients and professionals have shared.” Neil Goulbourne, head of innovation at Virgin Care, said: “We’ve enjoyed working with the CCG and local people to design improvements to these services and we’re looking forward to continuing to work with patients, staff and carers to build the services with them that they need and want.”

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Thursday 26th March 2015

BBC News

  • NHS problems 'at their worst since 1990s'.

    Services in the NHS in England are deteriorating in a way not seen since the early 1990s, according to a leading health think tank. The King's Fund review said waiting times for A& E, cancer care and routine operations had all started getting worse, while deficits were growing. It said such drops in performance had not been seen for 20 years. But the think tank acknowledged the NHS had done as well as could be expected, given the financial climate. Professor John Appleby, chief economist at the King's Fund, which specialises in health care policy, said: "The next government will inherit a health service that has run out of money and is operating at the very edge of its limits. There is now a real risk that patient care will deteriorate as service and financial pressures become overwhelming." He said in terms of how standards were slipping - not how low they had reached - the situation was the worst it had been since the "early 1990s". The report noted much of the deterioration has happened in the second-half of the Parliament with many measures of performance being maintained in the first few years.

    Read more ...

  • East of England hospital trusts' £259m deficit 'risks damaging care'.

    The £259m deficit facing East of England hospitals poses a "genuine risk of damaging quality of care", it has been warned. Research by the BBC found the shortfall facing 22 hospital trusts in the region had risen by 63% compared to 2013-14. NHS Providers, a lobby group representing NHS organisations, said the level of debt represented about a quarter of the UK's total NHS debt. Ipswich Hospital forecasts a £12m deficit, while the Queen Elizabeth Hospital in King's Lynn, Norfolk, predicts a £14.9m deficit. Northampton Hospital predicts a £16.7m deficit. NHS Providers said "sustainable" funding solutions were needed. Saffron Cordery, its director of policy and strategy, said the whole NHS faced a £1bn deficit. Allyson Pollock, a University of London professor of public health research and policy, said it was likely hospitals would look to generate cash through providing "non-NHS services, such as more private patients".

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Ekklesia

  • Privatising NHS cancer and palliative care at patients’ expense.

    Controversy over the biggest NHS privatisation deal so far has intensified after details were leaked. £1.2 billion worth of cancer and end-of-life services in Staffordshire may be handed to a private firm to manage. A single organisation is to be put in charge of spending £700 million on cancer and another “prime provider” handed £500 million for end-of-life care, work usually done by NHS commissioners. The successful bidder can sub-contract some or all of the work and take a cut. If the transfer goes ahead, other such deals may follow. Indeed, those in charge of healthcare may have no choice. New regulations tabled in Parliament indicate that from April 2016, NHS contracts worth over £625,000 will have to be put out to tender. However, the publication of a secret memorandum of information in Open Democracy, setting out what is required of the successful bidder for cancer services, has caused alarm. This provides “no more than a blank cheque for whichever private firm is most ruthlessly willing to cut costs to shore up their own profits”, according to John Lister of Health Emergency. While two NHS organisations are among the shortlisted bidders, private contractors are in the running to take over key services for a 10 year period. They include a subsidiary of United Health (former employer of NHS England chief executive Simon Stevens), Virgin Care and Interserve Investments (chaired by Conservative peer Lord Blackwell, a former Downing Street policy advisor). The memorandum was leaked to Kate Godfrey, Labour candidate for Stafford. Ordinarily, tender documents state exactly what is expected of bidders. However in this case, details are to be negotiated during a two-year handover. This will allow the winning firm considerable scope to set its own quality standards and targets.

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Pirate FM

  • NHS 'Privatisation' Protest.

    Campaigners demanding Cornwall's biggest hospital does not sell off departments will stage a protest. Pathology, Sterile Services and IT at Treliske could be outsourced to a private company. Almost 8000 people in the Duchy have signed a petition to stop the plans. The demonstration is organised by national campaign organisation 38 Degrees. Campaign spokesman Neil Foss from St Just said: "Patients will get a worse service, probably cuts in the service, delays in the service, wrong results, possibly lives put at risk and conditions and treatments taking longer to come through for people. If the NHS can't do it at the right price in-house, how is a private company going to do it and make a profit and provide even the same quality of service; they'll start by ripping up employees contracts." A walk-out of hospital workers from the departments is also scheduled to take place to coincide with the demonstration. Campaigners are challenging their local parliamentary candidates to outline what they would do in office to protect the NHS from privatisation and increase funding for the NHS in Cornwall.

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Guardian

  • Why patients are campaigning against NHS outsourcing.

    Brian Fisher writes: The Save Lewisham hospital campaign has this month given a very clear message to our clinical commissioning group (CCG): we want care, not competition – do not sacrifice our clinical services to the market. NHS guidance states: “CCGs must not act in an anti-competitive way unless they can demonstrate it is in the interests of patients.” The campaign believes it is not in patients’ interests for competition to be integral to the NHS and they do not want their services outsourced. Residents of Lewisham, south-east London, have signed a letter to the NHS regulator Monitor in their thousands. The letter offers protection for a CCG that wants to avoid competitive tendering. It supports the CCG in refusing to tender for services and in countering a challenge on that decision from either Monitor, or a private contractor. The letter challenges the assumption that competition, now at the heart of the NHS, is in the best interests of everyone in England – an assumption that underpins the Health and Social Care Act and which drives Monitor. The campaign and a representative from the Unite union met representatives of Monitor last July when we handed in the first 2,000 letters. We argued that there is no evidence that a free market and competition benefit patient care. We also disputed the idea that it does not matter whether clinical services are run by the private or public sector. Instead, as we pointed out, there is ample evidence that, in order to meet their bottom line, private service providers cut corners, fragment services and take profits out of the NHS. When we met, Monitor agreed that there is little evidence for any benefit to patients of going to the market and competition. They also could not give us any idea of the costs of running an NHS on these lines. Monitor can also see that its guidance on tendering is confusing to CCGs, so much so that it has to go around the country offering guidance on its guidance. We would like campaigning groups around the country to use such letters from individual patients addressed to Monitor to press for change. We hope CCGs will use it to avoid tendering routinely – they can use evidence of strong local support to show that it is in their patients’ best interests to avoid a market in health.

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Tuesday 24th March 2015

BBC News

  • Hospital staff absences for mental health reasons double.

    Staff absences for mental health problems have doubled at hospital trusts across England in the past four years. Figures obtained by the BBC revealed 41,112 staff were off sick with anxiety, stress and depression in 2014 - up from 20,207 in 2010. NHS England said it needed to do more to support staff. The Royal College of Nursing said the figures reflected the "relentless pressure" staff were under. Emma Mamo, from mental health charity Mind, said there had been funding cuts of about 8% to NHS services with 3,000 nursing posts lost. "The impact of these cuts, through increased workloads and changes to services, is bound to have an impact on staff morale and wellbeing. It's vital that hospitals put in place measures to help promote good mental health at work for all staff."

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Open Democracy

  • Is Nigel Farage talking bollocks about the NHS?

    John Lamport writes: I don't have much in common with Nigel Farage, but we do share one thing. Literally. We each lost a testicle to cancer - and we probably both hear the same jokes about it too. There the similarity ends. My gratitude to the NHS for saving my life led me to become a doctor. His anger at it for “nearly killing” him led to a lifelong disdain – except for emergencies, since it twice saved his life. Now he is arguing you're better off going private. As a doctor, I’d say his diagnosis is dead wrong. Nigel Farage likes a good debate I’m told, so here’s my offer. Head-to-head, one-ball to one-ball, let’s really hammer out what Nigel is selling the British public and why it's bollocks. Nigel has twice told the story of his cancer in print, four years apart and significantly different in detail. I can't pronounce on his case but I do know his amateur self-diagnosis – “All they had had to do that first night in A& E was to have me referred for a scan” – is bollocks. A painful swollen testicle fits at least four other conditions better than cancer. He was sent for immediate surgery, where the cancer might have been detected then and there. But the operation was halted – in his latest account – by an “Indian doctor” who wrote it off as an infection. His first account, strangely, called down blessings on the head of the “Indian consultant” who eliminated torsion as a cause and prescribed antibiotics for the next most likely diagnosis – infection. Again, nothing I would argue with as a doctor. Farage says the NHS then fobbed him off for “the best part of two months” – yet he was referred to a consultant the very same day when he went back to his GP. I'm puzzled, too, that the mysterious consultant who told him to keep taking the tablets doesn't appear in Farage's first account, but I do know he was fully entitled to a second opinion on the NHS if he wasn't satisfied. Still, I'm glad his Harley Street oncologist gave him the excellent service – as he was also giving his NHS patients at the time, though Farage never mentions them. (Ironically, the oncologist later resigned from NHS work amid the previous Tory government’s funding cuts!) Farage was also fortunate to have a leading NHS consultant from nearby Guy’s and St Thomas's as his surgeon. Neither staff nor patients are robots: the NHS sees a million patients every 36 hours so mistakes will happen, but they also happen in privatised systems that cost far more and exclude more people. Personally, knowing all that I do about private healthcare, I'd feel safer in an NHS hospital. That's where the private patient ends up anyway, brought by NHS ambulance, if complications arise. Nigel Farage is using a single, poorly understood, muddled anecdote from almost 30 years ago – when testicular cancer survival rates were far lower than today’s 98% – to trash the healthcare system which the Commonwealth Fund ranks as the best and most cost effective in the world. So politically and economically, as well as personally, he's talking bollocks. While it’s great that many thousands of NHS patients share Farage's happy-ending story - even though they weren't City brokers with access to private insurance - what worries me is how hard he works now to ensure this won’t continue. We'll all pay in for the emergency NHS that saved him when he stepped off the pavement drunk (by his own admission) into the path of a passing car and again when his plane crashed. But cancer ? It’ll be costly private insurance for the likes of him; whatever the government feels it can spare divided between the rest of us. UKIP’s health spokesperson is a personable young woman, previously an actor in Peak Practice and other prime time shows. She offers us reassurance that UKIP would sustain our NHS. But it turns out this will be funded by a mythical exit from the EU, and a mythical saving of billions of pounds from industrial-scale health tourism which simply doesn't exist. Meanwhile Farage openly says the future of the NHS lies in an insurance-based system, and his deputy Paul Nuttall is on film calling the NHS, “A monolithic hangover from days gone by". Farage is either ignorant or cynical in praising private insurance/ co-payment in France and the Netherlands. Is he not aware that the French pay 30% more per head for their healthcare and the Dutch almost 60% more ? Privatisation pushes costs up not down. If he really cared, Farage would back the NHS Reinstatement Bill; his two Tory MPs would apologise for the disastrous 2012 Health & Social Care Act; his deputy Paul Nuttall would applaud immigrants for keeping our NHS going. And he would back his funding pledges with real rather than mythical money. I’m standing for the National Health Action Party because it is committed to a fully-funded, publicly-provided and publicly-accountable NHS, free at the point of need. We'd scrap the market, halt privatisation, unwind PFI deals, and stop the waste ? on locums and management consultants. There are billions to be saved. And we won't shy away from asking for more money either. We think the British public understand the value they get from their NHS and will back a penny rise in income tax. We've got the balls to do it. Sadly Farage and his party don't.

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Daily Mail

  • £3,200 for just one shift in A&E: Agency doctors cash in on NHS staff shortages.

    Hospitals are paying up to £3,200 a shift to hire locum doctors in A& E. Short-staffed trusts are forced to pay exorbitant amounts as they compete to attract agency medics. Full-time doctors say it is ‘demoralising’ working alongside locums earning three or four times as much. United Lincolnshire Hospitals, which runs Lincoln County Hospital paid £3,258 for a consultant to work a 24-hour shift in A& E between Christmas and New Year. Figures obtained by Sky News show that United Lincolnshire Hospitals paid £3,258 for a consultant to work a 24-hour shift in A& E between Christmas and New Year. Leeds Teaching Hospitals in West Yorkshire paid £2,099 for a doctor to work a nine-hour shift in A& E over the same period – equivalent to £230 an hour. Three more trusts – the Royal Berkshire in Reading, Derby Hospitals and North Bristol – each paid around £1,800 for an A& E nurse to work 12 hours. The figures, obtained under the Freedom of Information Act, show that at one trust, Airedale in West Yorkshire, more than 70 per cent of all doctors’ shifts between Christmas and New Year were filled by locums.

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Monday 23rd March 2015

Cambridge News

  • Dr Allyson Pollock visits Cambridge to talk about ‘crisis’ of NHS.

    Eighty people flocked to an event in Cambridge to hear from a renowned author and health expert who visited the city to talk about the crisis facing the NHS. Dr Allyson Pollock, a professor of public health research at Queen Mary University of London, was joined by Green MP-candidate for Cambridge Rupert Read and speakers from the NHS frontline and the 'Keep Our NHS Public' Campaign for a lively presentation and panel discussion on Monday about the threats to the National Health System. The event held at the Friend's Meeting House, Jesus Lane, saw 80 people turn out for the discussion which included an impassioned speech from an Addenbrooke's nurse. Dr Read said part of the evening focussed on what is going to happen to the NHS and the extent it is already being privatised. giving the example of Hinchingbrooke Hospital, the country's first privately-run hospital which is being taken back by the NHS after management company Circle pulled out after just three years. "We know right here in Cambridgeshire how bad things can go," he said. "The hospital is going to have to be taken back over by the NHS we aren't going to get a lot of money back. Hinchingbrooke is a warning sign of what's going to happen if we go further down this road." The turmoil in the NHS caused by years of huge re-organisations, the widespread advance of private forces and under-funding has led public health experts, including Dr Pollock, to create an 'NHS Reinstatement Bill' which would abolish competition in the system and re-introduce the government's legal duty to provide the NHS.

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The Guardian

  • Virgin Care, which has been handed contracts worth hundreds of millions of pounds to run more than 230 NHS and social care services, is one of at least 10 private health firms seeking state-funded contracts whose company structures include tax havens, it can be revealed.

    An analysis by Richard Murphy, a chartered accountant at Tax Research UK, has found 13 holding companies, some of them offshore, between Virgin Care and its ultimate parent company, based in the British Virgin Islands. While not currently recording a profit in the UK after administrative expenses, Virgin Care borrows money solely from a holding company and says it will repay that loan, which will be corporation tax-deductible, when a profit starts to be recorded. That holding company is based in the UK but it, in turn, owes money to other parts of the Virgin empire, whose ultimate parent company is in the British Virgin Islands. Its principal beneficiaries are billionaire businessman Sir Richard Branson, reported to have a net worth of £2.7bn, and his family. Despite the company structure, which makes it unlikely to pay any tax in the UK in the foreseeable future, according to Murphy, Virgin Care recently won contracts worth £500m to provide 30 primary care services across England, including GP practices, GP out-of-hours services, walk-in centres, urgent care centres and minor injury units . Its website claims Virgin Care, which became part of the Virgin Group in 2010, runs 230 NHS and social care services while employing 5,500 people.

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Pulse

  • GPs to be 'rewarded' for cutting down referrals.

    A London CCG is considering introducing ‘local budgets’ for GPs to cut back on referrals, which it says will ‘reward more effective management’. NHS Bexley CCG said it is considering a raft of measures to cut referrals, including incentivising practices to peer review each referral, increasing ‘primary care investigation’ before referrals and encouraging the acute providers to reject inappropriate referrals. It said it is taking the measures due to a 16% spike in referrals last year. But the LMC has said that the CCG is placing the blame on GPs when the real reasons for the increase in referrals is due to extra patient demand and a lack of clinical pathways for some conditions, which can result in providers having to go back to a GP for further referrals for supporting tests. The 16% increase in referral numbers emerged when Bexley CCG compared GP referral activity in 2013/ 14 with that in April to September for 2014/ 15. The CCG said in board papers that, ‘given the rise reported in recent months and the significant risk to commissioned budgets’, it must develop a ‘further range of strategies to manage demand’. It said it was considering the ‘introduction of locality budgets for elective activity, which will reward more effective management by practices’. Other initiatives included ‘incentivising practices to peer review each referral’ and the ‘use of mandatory care pathways, requiring specific ‘work up’ and primary care investigation, before referral. A CCG spokesperson added: ‘We are currently reviewing data and working with practices to identify the most appropriate actions and will be giving further updates to the Governing Body as work progresses. Ultimately the CCG will work with practices to ensure that referral provide the best possible outcomes for patients.’

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HSJ

  • Provider deficit forecast tops £800m.

    The overall deficit forecast across trusts and foundation trusts has hit £823m, in the latest sign of the ‘continuing deterioration’ in the health service’s finances. According to board papers from the NHS Trust Development Authority, based on figures to the end of last December, the trust sector is forecast to end 2014-15 with an overall deficit of £448m. When combined with Monitor’s forecast that FTs would finish the year with a net deficit of £375m, also based on figures to the end of December, the total deficit for the provider sector exceeds £800m. The £448m trust sector shortfall is £140m worse than the £308m deficit the TDA was forecasting two months ago. The papers note that the “continuing deterioration in the financial position of NHS trusts” is a “consequence of the many pressures on providers and an issue of overriding concern”. They also say the early evidence is that “forecasts for 2015-16 will be more difficult still”. According to the TDA, the projected deficit is in spite of £1.3bn of efficiencies it forecasts trusts to deliver for 2014-15. The forecast deficit figure is also flattered by a significant but undisclosed amount of “provider deficit funding” that has been given to trusts which are in particular financial stress. The authority blamed the deterioration on unplanned growth in hospital demand, a significant increase in the use of agency staff, and the failure to deliver cost improvement savings planned at the start of the year. Within the TDA’s £448m net deficit forecast, 64 trusts forecast a break even or surplus figure, coming to a combined total of £123m. However, 35 trusts are forecasting a combined deficit of £572m between them, dragging the sector into a net deficit. The financial stress is concentrated in the acute sector, where 52 per cent of trusts are forecasting a deficit, while only four of the 39 non-acute trusts are predicting deficits. Nation-wide, London and the Midlands and East regions have 52 and 39 per cent of trusts forecasting a deficit respectively, compared to 26 per cent in the North and 22 per cent in the South. Commenting on the figures, Chris Ham, chief executive of the King’s Fund, said the next government would “inherit a health service under huge financial pressure, with deficits among hospitals and other providers likely to continue rising in 2015-16”. He added: “While there is still scope to improve efficiency to close some of the gap, this will leave new ministers facing an unpalatable choice between increasing NHS funding to restore financial stability, or allowing patient care to deteriorate as staff [numbers] are cut and waiting times rise.”

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Friday 20th March 2015

Our NHS

  • Staffordshire Cancer Privatisation.

    The Memorandum of Information (MOI) for the £700m privatisation of cancer care in Staffordshire has been published by openDemocracy. Working in partnership with campaign group Cancer – Not For Profit, OpenDemocracy also intend to publish documents relating to the separate £500m privatisation of Stafford’s End of Life care. Together, the documents have a combined value of £1.2b, making the joint privatisation the biggest in NHS history. The deals are the first time that it has been thought appropriate to put either cancer or end of life care on the open market. The published tender covers cancer services for a population of 800,000 people, and has considerable implications for the future of the NHS. Rather than working to deliver services to cancer patients, Staffordshire CCGs (Clinical Commissioning Groups) have decided to outsource care management from commissioning downwards. The resulting arrangement will be non-transparent, result in the further fragmentation of care, and ‘too big to fail.’ The Memorandum is a document that every NHS patient ought to read. Thanks to my years of health campaigning in Staffordshire, it was sent to me. And even I have been taken aback at quite how far project managers have taken the freedoms granted to them in the Health and Social Care Act. In order to help patients who may find the MOI of interest, Cancer Not For Profit have put together this rough guide, containing some of the frequently asked questions sent to our campaign group. Information and analysis has been collated from independent health experts, charities, campaign groups and clinicians, and where appropriate, is credited. It is an open source document, and sections and quotes are available for use under open commons licensing.

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The Guardian

  • The NHS could slip £2.5bn into the red later this year and its financial position could spiral “out of control”, with many hospitals and vast chunks of the service running out of money, one of its most senior figures has warned.

    The deficit, by far the largest in NHS history, will pose a serious problem for the next government, said Chris Hopson, chief executive of NHS Providers. Ministers will have to rescue the NHS with an unprecedented bailout or risk damaging the quality of care because hospitals start slashing staff numbers to balance their books, Hopson added. An unprecedented financial squeeze meant that hospitals are already at the point where quality of care is at risk. He told an audience of NHS decision-makers at the King’s Fund thinktank that the collective £1bn deficit expected in the NHS in England by the end of the financial year is likely to at least double in the 2015-16 financial year starting on 1 April. He said “there’s a real danger that the strategic deterioration [in NHS finances] could speed up and get out of control”. The warning from such a senior figure – whose organisation represents 93% of all NHS trusts in England – will worry the main political parties and raise questions about whether their pledges of extra money for the health service will prove sufficient after the election. The deficit incurred jointly by hospital, mental health and ambulance trusts is likely to reach £2bn-£2.5bn despite the extra £2bn the chancellor, George Osborne, handed to the NHS in his autumn statement last November, Hopson said.

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Pulse

  • GP practices in one borough 'to lose £20m over seven years'.

    GP campaigners are warning that practices in one London borough will lose £20.4m over the next seven years unless the formula for practice funding is changed to increase amounts for surgeries in deprived areas. The Save Our Surgeries campaigners have told NHS England chief executive Simon Stevens that surgeries with good reputations – including The Limehouse Practice in Gill Street – will be forced to close due to MPIG cuts. They also warn that every surgery in the borough will have to make cuts to staffing and patient services. It follows a long campaign by the group by the Jubilee Street Practice against MPIG cuts, including taking a signed petition to Downing Street, which won some concessions from NHS England on the pace of the cuts for 15 practices across England However, the campaign group says that the method for calculating who was eligible for this concession was flawed, and its own research shows that a number of other practices should be given financial support. The campaigners made a presentation on the issues to Mr Stevens in January at a special meeting of Tower Hamlets CCG. Maggie Falshaw, manager of The Limehouse Practice and chair of Save Our Surgeries, said that 70% of Tower Hamlets residents are in the most deprived national quintile and that people aged 50-69 from poorer areas consult their GP twice as often as people from richer areas. About a third of the population in Tower Hamlets needs language support when accessing healthcare, and the borough’s primary care workload is around a third higher than current funding formulas allow for, she said.

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  • Charging non-EU visitors to the UK for GP appointments ‘would backfire’, researchers say.

    Charging non-EU migrants for access to primary care would increase health risks to the rest of the population and place an even bigger financial burden on the NHS, experts from the London School of Hygiene and Tropical Medicine have warned. Their research revealed that undocumented migrants would not go to a GP and were more likely to end up in A& E if they had to pay for appointments. The research team, led by global health lecturer Dr Helena Legido-Quigley and leading public health expert Professor Martin McKee, also reported that many migrants already find it difficult to get access to the care they are entitled to, and called for better training for practices on what non-EU residents were entitled to receive. It comes as Pulse has revealed that the DH is considering ‘where to draw the line’ on charging non-UK resident patients to use general practice services. In light of the debate around immigration and potential introduction of charges in the run-up to the general election, the researchers carried out a series of interviews with 16 undocumented migrants, and four volunteers working with refugees and asylum seekers. All of the migrants said they would not be able to afford to access primary care if the proposed charges were introduced. Most did not know they were already entitled to free care from a GP, but many were aware they could get emergency treatment at A& E departments for free and as a result considered A& E the first place to seek medical attention. In addition, the researchers said many migrants had found it difficult to register with a GP practice, with practice staff demanding ‘excessive’ documentation, with inconsistencies in requirements between practices, combined with language barriers, creating a ‘sense of confusion’ and ‘helplessness’.

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HSJ

  • Exclusive: DH agreed extra bailouts for trusts where performance was at risk.

    The Department of Health arranged at least £39m in extra ‘essential’ capital funding for foundation trusts where patient safety or ‘ongoing operations’ were at risk because of maintenance backlogs, HSJ can reveal. Documents released under the Freedom of Information Act show the workings of the DH’s independent trust finance facility (ITFF) in 2014-15. This committee used to deal solely with requests for capital funding from foundation trusts, but now assesses requests for money, revenue or capital from any trust. The ITFF increasingly deals with applications from trusts in financial distress. An application to the ITFF from Monitor in July said: “It has become apparent that a number of trusts… have reduced capital expenditure, often for a sustained period, in order to mitigate the impact of income and expenditure performance on cash balances.” The documents show six trusts given more capital funding than they would otherwise be entitled to under the funding system because of the backlog. In July, the ITFF approved £39.3m for the trusts, two of which no longer exist - Mid Staffordshire FT was dissolved in October, and Heatherwood and Wexham Park FT was taken over by Frimley Park Hospital FT in the same month. Work at Milton Keynes Hospital FT included upgrading the phone network, with the trust’s application saying the organisation “has had a number of incidents over the past six months where server instability has caused a serious incident to be raised”. It also said ultrasound, ventilators and anaesthetic monitors were on its list for replacement, as they were “considered [at] high risk of decommission”. Sherwood Forest Hospitals FT’s application saw it ask for items including an “operating table”, intensive treatment unit beds, theatre lights and colonoscopes. Kettering General Hospital FT’s application for extra funding included £1.1m for a new maternity theatre because current facilities faced “significant risk of closure”, plus £4.4m to upgrade the boiler after it failed. The overview document stresses that the applications do not “represent a funding request for capital expenditure associated with solvent or insolvent restructurings”.

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Thursday 19th March 2015

Morning Star

  • Privateers’ Dirty Hands All Over ‘Failed’ NHS Trust.

    England’s largest hospital trust was put under special measures yesterday, with campaigners laying the blame squarely at privateers’ feet. The Care Quality Commission revealed a catalogue of failures including overcrowding, staff shortages and a culture of bullying at east London’s Whipps Cross University Hospital, which — with five others — is run by Barts Health NHS Trust. The hospital had failed to reorganise after two healthcare assistants were jailed in 2013 for abusing old ladies at the hospital, the commission — which slapped three formal warnings on Whipps Cross at the time — said. Now staff are overstretched, agency workers left untrained and Whipps Cross consistently fails to meet national targets for waiting times, according to the inspectors who carried out a six-day inspection in November. Since the inspection the CQC has issued four warnings demanding the trust improve patient care, assessments, staffing levels and complaints handling. Keep Our NHS Public (KONP) chair Professor Sue Richards said inspectors had failed to blame Barts’s huge debt burden, unleashed when the health service was thrown open to profiteers under the private finance initiative. “Barts’s PFI scheme is one of the worst in the NHS,” she said. “Earlier this year we were told that the hospital would be in deficit of £43 million this year. Now it is more likely to be £93m. No doubt the extra £50m will also be found by cutting staff and reducing services to vulnerable patients. Barts’ PFI scheme is clearly not viable and health services for millions of people are being put at risk to line the pockets of the ‘investors’ who lent the money. This deal was signed off by government and they should now come in and pick up the pieces rather than continuing to wash their hands and absolve themselves from responsibility.”

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Newmarket Journal

  • Taxpayer 'exposed' by NHS franchise.

    The failure of a project which saw the first private healthcare operator run an NHS hospital trust, in Cambridgeshire, has meant the "taxpayer has been left exposed", a report has warned. Hinchingbrooke Health Care NHS Trust was taken over by Circle Holdings in 2012 but the company announced it was pulling out of the deal in January, hours before the release of a highly critical report by the Care Quality Commission (CQC). Inspectors uncovered a number of serious concerns about staffing, risks to patient safety - particularly in the casualty department - and medical care as well as further issues relating to the way in which the trust was led and run. It also became the first trust in England to be rated inadequate for caring. But giving evidence to the House of Commons Public Accounts Committee (PAC) last month, Circle Holdings chief executive, Steve Melton, said the CQC report was not the reason why the company had decided to withdraw early from the contract, which he blamed on financial unsustainability caused by rising demand and cuts in funding. In a report released by the PAC its chairwoman, Labour MP Margaret Hodge, said that while some financial risk and demand risk had transferred to Circle, it was always clear that the NHS would have ultimate responsibility for maintaining the service for patients. Ms Hodge said: "Whilst this was an innovative - but ultimately unsuccessful - experiment, we are concerned that none of those involved in the decisions has been properly held to account. Despite our warnings about the risks, oversight of the contract by the various parties who had a role was poor and inadequate and no one has been held accountable for the consequences. Circle was not able to make the trust sustainable and the NHS Trust Development Authority did not take effective action to protect the taxpayer. It was clear at the time the franchise was let that the trust would only survive if it secured substantial savings, but the savings projected in Circle's bid were overly optimistic and unachievable. However, the total deficit incurred during the franchise will be well above the level that Circle is contractually committed to cover, leaving the taxpayer to pick up the rest of the bill."

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Public Finance

  • Manchester’s £6bn NHS deal sparks ‘queue to be next’.

    The leader of Manchester City Council has said he expects other cities to replicate the landmark agreement for the conurbation’s combined authority to take control of its £6bn NHS budget. Speaking to Public Finance after the historic deal between the government, councils and the NHS in Manchester, Sir Richard Leese said the reforms provided the basis for improved integration between health and social care. An outline business plan, to be published in October, will set out the scope for possible savings through integration, as well as the capital investment needed to deliver the shift from acute care to the primary and community sectors. Leese, who chairs both the Core Cities Cabinet of England’s eight largest urban areas outside London and the Local Government Association’s city regions board, said Manchester offers a potential template for other areas. There is ‘a queue of people who want to be next’, he added, and they are learning from the work of Manchester in establishing its combined authority, which was the first in the country when formed in 2011. Leese also highlighted the key role of Simon Stevens.

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Independent

  • Budget 2015 – NHS: 'Glaring omission' of National Health Service measures in Osborne's 59-minute speech.

    It was the longest Budget speech of his career but George Osborne mentioned the NHS just once in a passing comment. Failing to lay out any specific measures related to the future funding of the health service, Mr Osborne said: "And because savings have been driven by efficiency and reform, the quality of public services has not gone down – it’s gone up. Satisfaction with the NHS is rising year on year." The future of the National Health Service is a key battle ground for the election, with Ed Miliband putting it front and centre of his campaign so it was strange the Chancellor didn’t repeat his typical line that the NHS can only prosper in a strong economy. It begs the question: did he forget to mention it ? The Labour leader described it as a “glaring omission” and claimed it was because the Tories were planning “massive” cuts in the next five years, labelling this "the plan that dare not speak its name". It echoes David Cameron’s decision not to include the NHS in six themes he said would be at the heart of the Conservative election manifesto at the start of the year.

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Guardian

  • Key Labour NHS pledge impossible to deliver, says influential thinktank.

    One of Labour’s key NHS election pledges, designed to protect services from being privatised, has been rejected as impossible to deliver by the King’s Fund. The influential health thinktank has warned that it would be extremely unlikely that a Labour government could implement Andy Burnham’s promise to exempt the NHS from EU procurement and competition rules. The shadow health secretary committed Labour to “claiming a full exemption for the NHS from EU procurement and competition law” when he launched the party’s 10-year plan for the NHS in January. He has pledged to repeal the unpopular Health and Social Care Act and reverse the creeping privatisation of services that has occurred under the coalition. But in a briefing paper the thinktank, which is politically neutral, concludes that: “An incoming government could not, in our view, secure formal exemptions for the NHS from EU procurement or competition rules.” On procurement policy, it says that while Labour ministers could repeal the coalition’s controversial section 75 regulation, which came into force in 2013, commissioners of NHS services would still need to comply with EU procurement rules. Similarly, it says that an NHS optout from EU competition law would be extremely difficult to secure. “Such a change would require changes to some of the most fundamental provisions of the EU treaties, which would be extremely unlikely to be negotiable. The European commission has no formal powers to exempt a particular sector in a particular member state from rules established in the EU treaty.” The only way Labour could secure their objective, in the fund’s view, is by instigating another overhaul of the NHS, which it has already ruled out. It would have to regain the sort of control over the NHS in England that the Scottish and Welsh governments have over their NHS, in order to evade EU law. “Labour could achieve their aim of insulating the NHS from EU procurement and competition rules, but this would require broader changes to policy than legislating for exemptions. Specifically, it would mean bringing foundation trusts back clearly under the direct control of government. This would be a shift against the direction of government policy over the last 15 years,” said Richard Murray, director of policy at the thinktank, which consulted legal experts in procurement and competition in drawing up the briefing. Labour, however, said the King’s Fund had misinterpreted its policy. “We have checked our position with the European commission and we have been given clear advice that we can legislate to place the NHS outside of EU procurement rules. The King’s Fund has got Labour’s policy wrong. In fact, this report validates our policy,” insisted a Labour spokesman. “Labour will change the policy architecture of the NHS so it is exempt from these rules. By ‘claiming an exemption’ we mean making the necessary changes to ensure the NHS is not subject to EU procurement and competition law, as it is our right to do.”

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Tuesday 17th March 2015

Daily Mirror

  • Half of private firms behind NHS privatisation have links to Tories.

    Half of the private firms which jointly won the largest NHS privatisation deal in history have links to the Tories, shock research reveals. The Mirror told how the Government had signed a record £780million contract with 11 companies to help tackle the backlog of thousands of patients waiting for surgery and tests. The news was met by anger, not least because three of the 11 profit-driven firms had previously been slammed for providing poor quality of care. And it has now emerged that at least half of the companies have close links to Tory politicians or the Tory party itself. Dr Clive Peedell, a leading cancer doctor and co-leader of the National Health Action party, said: “I think the public will be totally sickened by this apparently incestuous relationship between the Tories and private healthcare companies.” Vanguard, one of the 11 firms to win the £780million deal, is majority owned by private equity firm MML Capital, whose founder and chief executive Rory Brooks has donated more than £300,000 to the Tory party, according to research by Labour. Mr Brooks is also a member of David Cameron’s exclusive leaders group. Circle, which pulled out of running the first privately-run NHS hospital, Hinchingbrooke, in Cambridgeshire, is another of the 11 firms to have links to the Tories. The party has been gifted hundreds of thousands of pounds by Sir Paul Ruddock and Crispin Odey, who are major investors in Circle. Care UK, another winner in the £780million deal, was previously slammed by the Care Quality Commission for the quality of care at two nursing homes it runs in Suffolk. John Nash, a former chairman of Care UK, has, with his wife donated almost £300,000 to the Tory party and was given a peerage by Mr Cameron in 2013. Three other firms involved in the deal also have links to the Tory party, with Tory peers or MPs having previously held positions with them.

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Open Democracy

  • Leak reveals worrying truth behind the biggest NHS privatisation yet.

    A leak has revealed deeply worrying details of one of the largest NHS privatisations yet - the proposed privatisation of cancer care in the Staffordshire area. A secret “Memorandum of Information” - published exclusively here by OurNHS openDemocracy - sets out details of what will be in the £700million, ten year contract. The document - which is labelled ‘commercial in confidence’ - was obtained by Kate Godfrey, Labour parliamentary candidate for Stafford. The leaked proposals include handing all responsibility for commissioning cancer services for 800,000 patients to a ‘prime provider’ - which can be a private company - who will then sub-contract services to companies of their choice, after an initial 2-year handover period. The first tranche of patients to be handed over to new companies will be breast, lung, bladder and prostate cancer, with others added later, we learn. The most worrying thing about the leaked plans is their lack of accountability or redress and their shocking vagueness.

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Guardian

  • The biggest privatisation in NHS history: why we had to blow the whistle.

    Kate Godfrey writes: I’m not a journalist, but as of this morning I know what it feels like to be part of the biggest leak in NHS history. Published on openDemocracy, the memorandum of information for the £700m sell-off of Staffordshire cancer services is now available for the 800,000 directly affected and 3 million indirectly affected patients to read online. That document, together with others relating to the joint £1.2bn privatisation of cancer and end-of-life services in Staffordshire, was sent to me. They are commercially confidential, secret agreements that will rebuild NHS services for hundreds of thousands of people, but are for the eyes of the bidding companies only. Not only is this the first billion-pound NHS privatisation, it is the first time that it has been deemed acceptable to put care designed to meet the needs of our most vulnerable patients on sale. Uniquely for a privatisation on anything of this scale, there has been no public consultation, simply a series of weak “engagement” events led by paid “patient champions”. For the past year unpaid patients have not been able to have their say. Thanks to the brave person who shared the documents, now they can. The background is this: Staffordshire commissioners want to hand the management of all care for cancer and end-of-life patients to a private company, a “prime provider” that will take responsibility for the delivery of care, subcontracting and performance management. There are lots of firsts here. It is the first time that cancer or end-of-life care has been contracted out. The first use of the prime provider model on anything like this scale. The first privatisation without formal consultation. The first huge international NHS contract that could fall under TTIP. Transfer these services out of the NHS now, and we may never get them back. The leading bidders are all US private healthcare companies, some of them implicated in failures of care elsewhere. One is Optum, the US brand facing allegations over the American hospice-packing scandal. (Optum is defending itself against the allegations.) It is the first time that the commissioning responsibility held by local clinical commissioning groups (CCGs) – the right to spend a billion pounds on behalf of the NHS – will simply be gifted to a private company. And it looks like it will be a private company. There are clauses in the published document that simply have no place in a project that will stay within the NHS. To me, it looks as though local commissioners simply got bored, and decided they didn’t want to be responsible for cancer care any more. To the health expert John Lister, it looks worse. He says the contract is “no more than a blank cheque for whichever private firm is the most ruthlessly willing to cut services to shore up their own profits”. The original plan was to sign the deal in March – before people could have their say at the polls. The campaign group I work with – Cancer Not For Profit – fought for more time. When the awarding of the contract was put back until June, we thought that we had won a small victory. Our source heard differently. The project wasn’t delayed, they were told, but simply hushed up. The political implications of pushing through the biggest privatisation in NHS history two months before a general election were too serious. It had to move forward with speed, and if the contract lacked benchmarks or risk management, forget it. It could all be resolved later. The only thing being delayed until after May was the announcement, which would now be made in June. “I’m going to publish,” I told the source. “Tell me if you don’t want me to publish.” I never heard from them again.

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Monday 16th March 2015

Our NHS

  • Public health concerns mount as 'personal health budgets' imposed on 10,000 chronically ill patients.

    Patients across the country are to have their health funding rolled into their social care funding and be expected to manage both themselves. Is this empowerment, or something more sinister, health experts wonder ? Thousands of patients across England will from 1 April be expected to individually manage the funds allocated for their healthcare, which have been merged into their social care ‘entitlements’, the NHS announced this week. In Barnsley, Cheshire, Tower Hamlets, Hampshire, Portsmouth, Stockton and the South West of England, 10,000 patients with complex needs will be a single ‘pot’ of money from which they will be expected to purchase both their health and their social care needs. The details vary by area but the main groups affected are older people with multiple health needs, children with disabilities, and people with diabetes, dementia, learning disabilities, or serious mental health problems. The move was hailed by new Chief Executive of the NHS Simon Stevens as a ‘radical initiative’ which would ‘make a reality of person-level health and social care integration’. But the announcement comes as new research reveals widespread fears amongst health professionals, that ‘Personal Health Budgets’ (PHBs) represent the privatisation of the National Health Service - and considerable doubt amongst patient groups that they will be effective, safe or appropriate. In an article published in International Journal of Health Services, Public health expert Professor Alex Scott-Samuel exposes the different views about PHBs amongst healthcare experts, healthcare providers, patients and support groups. Baroness Barbara Young, the Chief Executive of Diabetes UK, raises concern over the effectiveness of Personal Health Budgets to diabetes patients: “Diabetes is a complex condition. The development of its complications can be unpredictable and lead to multiple co-morbidities. Research in this area has identified that personal budgets are likely to work best when conditions are stable and predictable.

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The Guardian

  • Labour and Tories refuse to commit to doctors' £8bn NHS funding plea.

    Labour and the Conservatives have rejected a plea from doctors’ leaders to “put their money where their mouth is” and guarantee the NHS an extra £8bn a year by 2020. The two main parties have spurned the pre-election demand by an alliance of bodies representing GPs, hospital consultants, A& E specialists and other doctors that they commit to finding the “substantial” sum if they form the next government. The Lib Dems have pledged the extra funding. Simon Stevens, NHS England’s chief executive, has made clear that the service will need at least an extra £8bn a year by the end of the next parliament if it is to remain viable in the face of mounting pressures and unprecedented demand for care linked to the ageing population. That would take the NHS’s budget, currently £113bn, to over £120bn. In a letter to the Guardian, the leaders of six medical royal colleges warn that without at least the extra £8bn, the NHS’s future will be at risk. They have increased the pressure on the parties over what is expected to be a key issue in the forthcoming election campaign by stressing that their recent pledges of extra cash risk being seen as mere “window dressing”. The letter says: “All the major parties say they want to maintain the NHS as a service that delivers excellent patient care, free at the point of access. But voters, concerned about the future of their health service, will want to see the parties vying for their support put their money where their mouth is and pledge to increase investment in the NHS in line with the sums for which the politically-neutral Mr Stevens is calling”. Signatories include Dr Maureen Baker, chair of the Royal College of GPs, Prof Jane Dacre, president of the Royal College of Physicians (hospital doctors) and Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists. It has also been signed by the leaders of the equivalent organisations representing anaesthetists, psychiatrists and paediatricians and child health experts in the NHS, and A& E doctors.

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Pulse

  • GMC 'creating a climate of fear', local GP leaders say.

    The GMC is creating a climate ‘where doctors practise in fear of their registration’, Scottish GP leaders said today. Delegates at the Scottish LMCs Conference in Glasgow today voted in favour of a motion criticising the regulator, despite opposition from a GPC negotiator. However, the conference voted down a motion that expressing concern that the GMC was failing doctors, and that the fitness-to-practise process was ‘intrusive and inhumane’. The conference voted in favour of the statement that ‘the GMC is creating a climate where doctors practise in fear for their registration’. It also called on the GMC to allow Scotland-based doctors to attend FTP proceedings in Scotland, without the need to travel to Manchester. Dr John Ip, proposing the motion, said: ‘I am not arguing against effective and robust regulation. The public needs doctors who are properly trained and of good quality. ‘However, I think the GMC is failing doctors and the public by creating a culture of fear in how doctors work… The FTP process is harsh, legalistic, formulaic and lacks compassion.’ He added that the process was especially intrusive for doctors with health problems, who would have to submit ‘full confidential medical records or otherwise face a negative impact on the case’. Dr Ip referenced the GMC-commissioned report that found there had been 26 suicides of doctors going through FTP cases, which recommended a support service for sick doctors and a move towards an ‘innocent until proven guilty’ attitude. But Dr Dean Marshall, a GPC executive, urged delegates to reject the main part, and said that the cost of moving FTP proceedings up to Scotland would be prohibitively expensive, which would be reflected in fees. He added: ‘The [FTP] is a fair process, it is tiring, it is stressful, but it is not inhumane or intrusive.

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  • GPs set to face contractual diabetes screening targets.

    NHS chiefs are planning to introduce incentives for GP practices to carry out targeted screening and follow up of patients at high risk of diabetes, under the new national prevention programme announced this week. Pulse can reveal that the new drive, aimed at curbing the growing incidence of type 2 diabetes, will see practices paid to create a register of patients at high risk of going on to develop diabetes and for reaching targets on follow-up interventions. The national diabetes prevention strategy, led jointly by NHS England, Public Health England and Diabetes UK, will see at-risk patients receive free cooking classes and Zumba on prescription and is set to be rolled out nationally from April next year. In the meantime, seven pilots have been set up to assess ways to identify people at risk, for example through GP practice-run schemes and the NHS Health Checks programme, as well approaches to help people lose weight and normalise their blood glucose. But Dr Jonathan Valabhji, NHS England’s clinical director for obesity and diabetes, told Pulse the programme is likely to involve ‘levers’ such as the QOF and enhanced services, in order to make targeted screening and prevention – in line with NICE recommendations – more systematic in general practice.

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The Independent

  • Over a quarter of board members on new bodies commissioning NHS care have links to the private health sector.

    More than a quarter of board members on the new bodies charged with commissioning care for the NHS have links to the private health sector, new analysis shows. Research by the Unite union showed that nearly 1,000 Clinical Commissioning Group (CCG) board members have professional connections to private healthcare firms – with many holding directorships or owning such firms outright. The figures will fuel concerns that CCGs, which were introduced by former Health Secretary Andrew Lansley, will be biased towards awarding lucrative contracts to healthcare companies rather than state providers. Critics have claimed the reforms represent “privatisation by stealth”. CCGs were established in 2013 to replace Primary Care Trusts. They are led by local GPs and were intended to put doctors at the heart of commissioning care provision for services like mental health and elective surgery. They have at their control a budget of £60bn a year. Of the 3,392 CCG board members, a total of 513 were directors of private healthcare companies: 140 owned such businesses and 105 carried out external work for them. More than 400 CCG board members were shareholders in such companies. In some of these cases, the directorships and shareholdings may be related to GPs’ own surgery companies. But the majority are those of CCG board members with interests in other health providers. Those who carried out external work for the private sector included consultancy, advisory or private practice work for private hospital operators Circle, Spire and BMI and drug companies Lily and AstraZeneca.

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The Conversation

  • Five key moments that shaped the NHS under the coalition.

    The end of a parliament is an opportune time to take stock of the state of health and social care. Policy here consists of meeting perennial challenges of maintaining access to services, improving quality of those services, and keeping costs under control.
    Lansley Reforms - The coalition agreement promised to “stop top-down re-organisations of the NHS” but the reforms introduced by Andrew Lansley, who was secretary of state for health until September 2012, were described as so big they could be seen from space.
    Mid Staffs - As with other NHS scandals, the name Mid-Staffs has come to refer not only to the poor standard of care at the Mid-Staffordshire NHS Foundation Trust but the wider response to the issues raised in the formal inquiry by Robert Francis and published in a February 2013 report. Though clinicians do not escape opprobrium, the managerial regime during the 2000s was roundly criticised.
    Winter crisis 2014-2015 - For several months, the media were reporting on the state of Accident and Emergency (A& E) services across the UK. Ostensibly, this has been in response to failure (to varying degrees across the UK) to meet a four-hour waiting target, but it is indicative of wider pressures across the health and social care system.

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Friday 13th March 2015

Our NHS

  • Is 'DevoManc' the beginning of the end of the National Health Service?

    On July 5th 1948 in Manchester Labour Secretary of State for Health Aneurin Bevan announced the birth of the NHS. On March 27th 2015 in Manchester Conservative Chancellor of the Exchequer George Osborne signed a piece of paper that would bring about the end of a National Health Service. In a surprise announcement just weeks before a General Election the Tories signed a deal with the Association of Greater Manchester Authorities, which includes Labour-run Manchester City Council and the 9 other councils in the Greater Manchester area. The actual deal can be read here. It hands over £6bn from central government (or from local NHS structures) to a new organisation to run health and social care services for 2.7 million residents in the Manchester area. On the face of it this may sound attractive - no longer having Whitehall poking its nose into local health issues, but there is much to be concerned about. The very fact this deal was hurriedly signed off just before a General Election should ring alarm bells. Many local MPs had not been aware of how advanced the negotiations were and more shockingly the public had not been consulted or asked to make a decision on this huge change to their local NHS. Councillor Jim McMahon, Labour leader of Oldham Council, admitted to the BBC Sunday Politics programme on 1st March 2015 that 'the changes happened too quickly to ask the public what they thought'...

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The Guardian

  • 'Chronic underfunding' of social care increases burden on NHS, say GPs.

    Nine out of 10 GPs believe deep cuts to social care under the coalition have added to the growing overcrowding at both their own surgeries and hospital A& E units. In a poll of 830 family doctors in England, 92% did not think that enough social care is available to stop patients ending up in emergency departments or to avoid them having to stay in hospital despite being medically fit to leave. Almost as many (88%) said big reductions to the social care that local councils are able to provide to older and disabled people have contributed to the pressure facing their surgeries. The same number (88%) of GPs believe social care services, which are intended help people remain safe and well-supported at home, offer an inadequate level of care for their patients. The Care and Support Alliance, which commissioned the poll, said “chronic underfunding” of social care had increased the burden on the NHS. “The care system is on its knees. The message from GPs is clear – cuts to social care have directly led to extra pressure on primary care as well as huge challenges for hospitals,” said Richard Hawkes, the chair of the CSA, a group of more than 75 organisations working with old and disabled people receiving social care. Councils in England claim £3.5bn has been taken out of the social care system since 2010 as a result of austerity-driven deep Whitehall cuts to many local authorities’ budgets. Some 500,000 people who would have received social care in 2009 no longer qualify for it, despite the ageing population, London School of Economics research has found.

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BBC News

  • Election 2015: National Heath Action on NHS policies.

    The National Health Action Party - set up in response to the government's NHS reforms in England - has launched its election campaign. It is fielding candidates in 13 seats, including those of the prime minister and the health secretary, and is proposing a 1p increase in income tax to raise £4.5bn per year. Co-leader Clive Peedell told Jo Coburn on the Daily Politics that "health care spending actually promotes economic growth" by keeping people healthy and redistributing wealth. The doctor and cancer specialist explained the party was planning to abolish the market system in the NHS, and to divert money from accountants and lawyers to frontline patient care.

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Newstatesman

  • Later today, in the dusk of this parliament, a new Bill will get its first and perhaps only reading in the Commons.

    It’s unlikely to set pulses racing in any of the main party machines, but in certain circles the NHS Bill represents the last ditch to save a dying public service. It is the result of three years of patient work led by two leading public health experts, Professor Allyson Pollock and Peter Roderick of the Centre for Primary Care and Public Health at Queen Mary, University of London. In the bill, they say, lies a trail of breadcrumbs to take us back to a different era. A time before the Health and Social Care Act; before the NHS was such fertile ground for profiteers. A time when money allocated for patient care wasn’t routinely squandered on futile bidding wars, failed private experiments, a contrived internal market and debilitating PFI repayments. “We’ve been working on this ever since the Health and Social Care Act came in,” says Allyson Pollock, speaking to me earlier this week. “We knew this time would come. What we’ve got in the Health and Social Care Act is a destructive reorganisation which has started the breakup of the NHS. “If we don’t bring in legislation then privatisation and the breakup of the service will continue; by 2020 the NHS will be unrecognisable”. Andy Burnham has said in no uncertain terms that a Labour government would repeal the Health and Social Care Act, and end the “Tory market experiment in the NHS”. Strong words, and a welcome departure from the New Labour days when much of the damage was done. But this isn’t a Labour Bill. The political will has come from the Green Party’s only MP, Caroline Lucas, and a Liberal Democrat, Andrew George. It's backed by rebels from across the benches, PPCs, medical professionals and campaign groups throughout England. Why do this now, with such a solemn pledge from Labour firmly and repeatedly on record ? “They have said they would repeal the act”, says Pollock, “but they haven’t said what they would replace it with and how they would go about reinstating the principles of the NHS”. If Labour wins enough power to repeal the Health and Social Care Act, and stays true to its word, it will be a tremendous victory. But with contracts in place and business plans cooked up, there will be plenty of clearing up to do even from the two years since the Act came into effect. Arguably, too much than simply canning it can possibly manage.

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The Guardian

  • NHS agrees largest-ever privatisation deal to tackle backlog.

    The NHS has agreed the biggest-ever privatisation of its services in a deal worth up to £780m intended to help hospitals tackle the growing backlogs of patients waiting for surgery and tests. The deal will see 11 private firms paid by the NHS to carry out heart, joint and other types of operations and perform scans, X-rays and other diagnostic tests on patients. Under the contract many services will be provided in mobile facilities rather than hospitals. The NHS has been using mobile services for breast screening programmes but the contracts mark a large expansion into other areas of treatment and testing. The system is seen as more patient-friendly but it will also allow the NHS to rapidly buy in services from firms to help meet key waiting times targets. The deal has been struck by the little-known body called NHS Supply Chain, which helps the health service with procurement. NHS Supply Chain has agreed the scale of the work across the health service and individual NHS trusts will now be able to hire the mobile firms to help clear backlogs. The contract has raised concern because three of the 11 profit-driven companies involved have been heavily criticised, including two by the NHS regulator, for providing poor quality of care in hospitals and care homes. Labour’s shadow health secretary Andy Burnham said it showed that “chunks” of the NHS were being sold off – but the Department of Health insisted there had been no significant increase in the privatisation of the health service. Depending on how many hospitals use them, the 11 firms stand to pocket up to £780m over the four years to December 2018. That eclipses the previous record NHS privatisation deal, which saw Virgin Care get a £500m contract in 2012 to provide community services in south-west and north-west Surrey until 2017.

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HSJ

  • Circle drops challenge to ‘inadequate’ Hinchingbrooke rating.

    Circle has dropped its plan to request a review of the ‘inadequate’ rating given to Hinchingbrooke Health Care Trust by the Care Quality Commission. The Cambridgeshire district general hospital, which is the only privately operated trust in the country, was rated “inadequate” by the regulator in January in relation to whether it was caring, safe and well led. It has been put into special measures. The company announced its intention to pull out from the Hinchingbrooke contract shortly before the CQC published its highly critical inspection report. Earlier this week CQC chief executive David Behan told HSJ that while Circle had “stated their intention to ask for a review… they’ve not pursued that, as yet”. Mr Behan said the watchdog had met with Circle last week to have “a conversation with them about what their concerns were”. He said the regulator would “consider and reflect on” those. Circle had previously indicated that it intended to appeal against its rating. Shortly before the inspection report was published, Circle chief executive Steve Melton said the company “fully [expected] it to be unbalanced and to disagree with many of its conclusions”.

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  • £188m of bailouts switched to loans in DH clampdown.

    A group of foundation trusts that received £188m in Department of Health bailouts this year has been told the funding will now be switched to loans, as part of a push for financially distressed organisations to ‘manage their finances better’, HSJ has learned. Monitor last week wrote to the 11 FTs saying that the DH had decided to move from making “interim support” payments in the form of public dividend capital to loans, in a “departure from current practice”. The letter, from the regulator’s finance and risk director Jason Dorsett, said the terms of these loans were not yet finalised, but it would share them with the trusts this week. The terms will not be negotiable. Interim support is paid out to providers in financial difficulty to allow them to continue delivering services. Public dividend capital is treated as a kind of equity investment in a trust, and – unlike a loan – is not expected to be paid back. Mr Dorsett’s letter, seen by HSJ, said loans would now replace both interim support funding paid out in “future years” and any support paid out in the form of a “temporary borrowing limit” during 2014-15. A Monitor spokesman said there were currently 11 FTs that “have been granted interim support funding on a temporary basis that will need to be converted into loans”. This funding was worth around £188m and was a mixture of capital and revenue.

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  • FT to receive £328m as part of takeover of neighbour.

    The Department of Health has agreed a package of support and capital payments totalling £327.7m with Frimley Park Hospital Foundation Trust as part of its takeover of another trust, HSJ can reveal. The news comes as the newly merged organisation, Frimley Health FT, is forecasting a £22.9m deficit for 2014-15 - £17m worse than its planned end of year position. The £277m-turnover Frimley Park acquired £253m-turnover Heatherwood and Wexham Park Hospitals FT in October. Documents released to HSJ by the DH under the Freedom of Information Act have now revealed the full scale of the package agreed to support the merged organisation over the next four years. The amount includes £127.2m of public dividend capital and £59m of loan funding to support rebuilding and refurbishment of parts of the Heatherwood site. The application document said the money would counteract the “significant historical underinvestment in estates” that had followed Heatherwood’s unsuccessful attempts to stay out of deficit.

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Thursday 12th March 2015

BBC News

  • Why not introduce more NHS charges?

    In the early 1950s, the NHS was going through a tough period. Money was tight and demand was rising. So ministers came up with a radical plan - they introduced charges for dentistry, prescriptions and spectacles. The move in 1952 was controversial, but did enough to get the NHS out of a tricky hole. With the finances tight again, should extending charges be under consideration now ? It is a question that has been asked several times in recent years. Research in 2013 by Reform, a centre-right think-tank, found a £10 charge for GP consultations could raise £1.2bn a year even with exemptions for age and income. The issue was also discussed at British Medical Association and Royal College of Nursing conferences last year. Although at both the motions drawn up calling on more charging to be introduced were not passed. When it comes to charging, there are several options that could be pursued. As Reform suggested, a charge for seeing a GP could be a valuable source of income. Charges for visiting A& E would generate less income unless they were set at a higher level as there are just under 22m visits a year and introducing them could prove problematic given the busy nature of departments. Another option that gets an airing from time-to-time are "hotel" charges for hospital stays. At anyone time there are about 120,000 beds occupied so a £10 charge would raise £450m a year or a £50 charge, £2.25bn. If that seems unfair, consider this: under the government's plan for a cap on care costs people in care homes will still having to pay about £33 a night in living costs. Anita Charlesworth, chief economist of the Health Foundation, says that even though there are already charges in the NHS, there is still a fear that it would be seen as a "challenge to the founding principles of the NHS". "The issue that people keep coming back to is whether this will have an impact on people accessing health services. If you deter people, it can just mean treatment is delayed and more expensive care is needed later on," she adds. Last year the Barker Commission, set up by the King's Fund to look at how the NHS and care system should be organised in the future, concluded introducing new charges "fail the criterion of equity" and, therefore, there was "little scope for introducing them".

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ITV News

  • 15,000 signature petition against north Wales maternity downgrade handed in.

    Campaigners have delivered a 15,200 signature petition to the Senedd. Consultant-led maternity services will be temporarily removed from Ysbyty Glan Clwyd in Denbighshire and will be centralised at two other hospitals in Wrexham and Bangor. It follows concerns over staffing and patient safety.

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Guardian

  • NHS agrees largest-ever privatisation deal to tackle backlog.

    The NHS has agreed the biggest-ever privatisation of its services in a deal worth up to £780m intended to help hospitals tackle the growing backlogs of patients waiting for surgery and tests. The deal will see 11 private firms paid by the NHS to carry out heart, joint and other types of operations and perform scans, X-rays and other diagnostic tests on patients. Under the contract many services will be provided in mobile facilities rather than hospitals. The NHS has been using mobile services for breast screening programmes but the contracts mark a large expansion into other areas of treatment and testing. The system is seen as more patient-friendly but it will also allow the NHS to rapidly buy in services from firms to help meet key waiting times targets. The deal has been struck by the little-known body called NHS Supply Chain, which helps the health service with procurement. The contract has raised concern because three of the 11 profit-driven companies involved have been heavily criticised, including two by the NHS regulator, for providing poor quality of care in hospitals and care homes. Labour’s shadow health secretary Andy Burnham said it showed that “chunks” of the NHS were being sold off – but the Department of Health insisted there had been no significant increase in the privatisation of the health service. Depending on how many hospitals use them, the 11 firms stand to pocket up to £780m over the four years to December 2018. That eclipses the previous record NHS privatisation deal, which saw Virgin Care get a £500m contract in 2012 to provide community services in south-west and north-west Surrey until 2017. The companies include several that have previously held controversial contracts with the NHS. Vanguard was the sole winner of a contract worth up to £160m to help NHS trusts undertake surgical procedures in mobile operating theatres. It is facing legal action over a series of eye operations carried out in 2014 at Musgrove Park Hospital in Somerset. A confidential NHS report into Vanguard said the operations appeared “rushed” and surgeons were allowed to continue even after patients reported serious complications. The hospital terminated its contract with Vanguard after just four days as a result of the problems. A second firm, Circle, is in line to share up to £240m for providing imaging services, such as scans and X-rays. It will also provide services within operating theatres. Circle is the firm which pulled out of running Hinchingbrooke hospital in Cambridgeshire – the first private firm to manage an NHS hospital – following the publication of a damning Care Quality Commission (CQC) report into the quality of care patients were receiving at Hinchingbrooke. A third company involved in the deal, Care UK, was criticised by the CQC for the quality of care at two nursing homes it runs in Suffolk. Paul Evans of the NHS Support Federation, which tracks outsourcing of NHS services and campaigns against privatisation, said: “How can the public have trust in companies that have so recently been the subject of such damning criticism ? Despite ministerial denials, this is yet more proof that privatisation is an everyday reality in the NHS. The scale of contracts is increasing as companies are seizing the opportunity to bid to run a huge range of NHS services,” Evans added.

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Wednesday 11th March 2015

Independent

  • NHS chief unveils 29 ‘vanguard’ areas in his new reforms.

    Five million people in England will have their local NHS services transformed in the first wave of radical reforms aimed at preparing the health service for the burden of an ageing population. Pilot schemes in 29 areas will involve three entirely new “care models” being rolled out. In some areas it will mean GPs working more closely with hospitals and local councils, while patients in other parts of the country will have specialist services such as chemotherapy and dialysis provided outside of hospitals, closer to their homes. NHS England chief executive Simon Stevens said the “vanguard” areas would bring about change from the bottom up, led by “frontline” NHS staff. The reforms, part of Mr Stevens’s five-year plan for the NHS, which has the backing of the three main political parties, have been widely welcomed. However, they represent another significant reorganisation of the health service only two years after then Health Secretary Andrew Lansley’s controversial overhaul led to significant disruption. The changes will be supported by a £200m transformation fund. Following the publication of Mr Stevens’s plan, 269 different local plans were submitted, of which 29 have been chosen to pilot new ways of working, starting next month. The announcement follows a landmark decision to hand over £5bn in NHS spending to a joint local council and NHS authority in Greater Manchester, dubbed “DevoManc”. However, Mr Stevens denied the new localised plans would “Balkanise” the NHS.

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  • If I were Prime Minister: I would restore the NHS to its original vision.

    Richard Horton, Editor-in-Chief of the Lancet, writes: As Prime Minister, first I would repeal Andrew Lansley's disastrous Health and Social Care Act. His “reforms” were a fatal blow to the health service Aneurin Bevan first conceived in 1948. I would begin the task of reversing decades of damage caused by the creeping marketisation of healthcare. But the future prosperity of Britain's people depends on more than restoring the NHS to its original vision. Our society faces multiple health threats that demand serious attention. I would address the immediate and urgent crisis in general practice. Chronic underfunding of general practice has turned one of the most coveted features of Britain's health service into one of its most desperate emergencies. General practice in Britain should be our jewel in the NHS crown. Instead, it has been tarnished by successive governments. We need to restore general practice to its preeminent position, providing 24 hour, 7-day a week high-quality care from a doctor you know and trust. I would make children and adolescents my priority. Investing in first-class child health services, implementing programmes to support early child development (the most powerful means to achieve a fairer society), and taking adolescent health more seriously would create the foundation for a healthier, happier, and wealthier nation. I would launch a new national movement for better mental health. I would make the care of our elderly population a cross-government priority.

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BBC News

  • Lib-Dem and Tory leaders clash over NHS commission plan.

    Plans to form a cross-party commission on the future of the NHS in Wales have been axed. The decision came after Plaid Cymru announced it would not take part, following on from the Conservatives who previously pulled out. The commission was meant to be a place for the parties to freely debate the future of the NHS. Leader of the Welsh Liberal Democrats Kirsty Williams said the collapse would leave patients in Wales disappointed.

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Guardian

  • The NHS is teetering on the brink of privatisation. We must stand up for it.

    Caroline Lucas writes: In 2012 the secretary of state’s legal duty to provide NHS services was severed and the structures for destroying the NHS were put in place. Today, with the general election around the corner, we are presenting a cross-party bill in parliament to stand up for the NHS we are all so proud of. The NHS that was such a defining part of our identity during the stunning opening of the 2012 London Olympics. The NHS that was ranked as one of the best health services in the world in a 2014 study. Our much-loved service is in danger. Thousands of jobs have been axed, including more than 4,000 senior nurses. More than 50 of the 230 NHS walk-in centres have been closed and 66 A& E and maternity units have been shut or downgraded. On top of this, the future mandated by the 2012 act is one where all hospitals in England that we think of as NHS hospitals only have to be 51% NHS – and 49% non-NHS. Why would anyone pay if they could get exactly the same on the NHS ? This is setting up a queue-jumping service for the better-off. The private sector is circling – there is, after all, a very tempting prize to be picked off – an annual NHS budget of £120bn. Private health firms already pocket £18m a day – that’s £6bn in the last year – from the NHS budget. More than 170 GP surgeries are run by corporations. Today, if you call 999 it could be a private ambulance crew that comes to treat you. Based on the trends that these figures show, private firms are on course to net £9bn of the NHS contracts that are up for grabs. The direction of travel is plain to see. The inescapable truth is that the private sector is camping out on the lawn of the NHS, cherry picking. Even Norman Tebbit pointed out the dangers of this, and wondered how young NHS surgeons would learn if the private sector had nicked all the easy stuff. This is a problem that is getting worse, but it is not new. Private hospitals’ share of NHS-funded patients grew rapidly between 2006 and 2011. By 2010-11 private companies performed 17% of hip replacements, 17% of hernia repairs and handled 8% of patients’ first attendances in relation to orthopaedics or trauma, such as a broken limb. But we know the private sector avoids the chronic long-term, complex conditions and, when it does try and take over, it fails – Hinchingbrooke hospital being the latest example. Last week, Michael Sheen rightly made a blistering NHS speech calling on anyone with any political power or influence to stand up and to fight for the equality, fairness and compassion that our NHS was founded on. The bill we present today, to reinstate the NHS, is an attempt to do just that. It is the culmination of months of hard work and consultation by campaigners, grassroots keep-our-NHS-public groups and health experts, led by Prof Allyson Pollock and barrister Peter Roderick. That’s why our bill is guided by the principles of the National Health Service Act 1946, and reinstates the secretary of state’s duty to provide services throughout England. As it stands, without this duty and with the other 2012 changes it is now legal for NHS England to be whittled down to a core service. We are on the precipice. This is because, under the 2012 act, the list of services that foundation trusts must provide after April 2016 will be reduced. Senior health service managers from the NHS Confederation are already warning we may need “hotel fees” for hospital stays. Unless we act now, services will be restricted, people will go without care or will end up with private health insurance, charges or co-payments. The NHS reinstatement bill would put a stop to this once and for all, while also stopping costly market mechanisms that are frittering away NHS money that could be spent on patient care. Administering the artificial “marketplace” that has been created over the last 25 years is hugely wasteful. The NHS must be the provider if our health service is to have coherence and avoid being reduced to a set of contracts and bidding wars that leaves its heart hollowed out and resources wasted. In March 2010, just before the last general election, the respected health select committee found that running the NHS as a “market” cost the NHS 14% of its budget a year. In the pre-market late-80s, the NHS spent only 5% of its budget on administration. On that basis we are wasting 9% of a £120bn budget. That’s more than £10bn down the tubes. The committee concluded its report by saying that “after 20 years of costly failure, the purchaser/ provider split may need to be abolished”. They were right then and the case remains ever more urgent today. As we present our bill, today also happens to be NHS Change Day celebrating the solidarity and co-operation in the NHS. Our bill is drafted to enable a grassroots, bottom-up reinstatement of a public NHS, guided by exactly those people sharing ideas and best practice today. Scotland has done it, so why can’t we ? A national service has to be about whole systems, not isolated institutions. In 1946, Bevan and those who fought for and created our NHS did so following six years of toil and unimaginable sacrifice. What the founders of our NHS achieved was radical and far-reaching and they did it in the face of strong opposition. So can we.

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Monday 9th March 2015

Stafford Newsletter

  • Stafford hospital: call to take cross-party campaign to Westminster.

    Campaigner Cheryl Porter told a meeting last night that illness paid no attention to people's political views - and the whole town should unite in lobbying the Government and the Department of Health to reinstate a fully functioning hospital. "We all live in Stafford, and we all need these services in Stafford," she told the meeting at Oddfellows Hall, which was called by Jeremy Lefroy MP and attended by more than 100 people. Why can't every single councillor and all the election candidates go to London and say we have had enough ?" Mrs Porter said. "We need to show the country that we will fight for our health services. We have to make a stand."

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BBC News

  • MPs to debate reversing NHS reforms.

    MPs are to debate a Green Party bid to reverse key elements of the government's health reforms. A private members' bill debate on Wednesday will be led by Green Party MP Caroline Lucas. It calls for the purchaser-provider split within the NHS to be abolished and the role of private companies to be restricted. But the Department of Health said it had "no intention" of repealing the legislation. With only a few weeks left before parliament is dissolved for the general election it is highly unlikely that the bill will make much progress. But campaigners who have drawn up the draft legislation say the fact it will be debated in the Commons is an important step. They say they will be challenging candidates from all parties during the campaign to say whether they would support the bill. It aims to abolish the split of the NHS into purchasers, including the GP-led commissioning groups which buy services locally - and providers made up of hospitals and other health trusts. The bill also attempts to restrict the role of commercial companies in the NHS, as well as setting out plans to reinstate an obligation for the NHS to provide listed services across England. The proposed legislation is based on an NHS Reinstatement Bill drawn up by campaigners including Allyson Pollock, professor of public health research and policy at Queen Mary, University of London. They argue that their planned reform would go further than a private members bill aimed at curbing the private sector's role in the NHS introduced by Labour MP Clive Efford. Caroline Lucas said: "Our NHS is being dismantled piece by piece. A fragmented, market-based structure isn't the 'national' service that so many people fought for so courageously."

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The Independent

  • Jeremy Hunt under fire for failure to publish critical NHS report.

    Health Secretary Jeremy Hunt has been accused of undermining his own plan for a “transparency revolution” in the NHS by refusing to publish a report said to be critical of the Government's handling of the health service. The report by Conservative peer Stuart Rose was submitted to the Government in December and was due to be made public before the general election in May. However, the Department of Health said publication has been delayed because the Rose review’s remit had been expanded and “further work is required”. The findings of another NHS report also needed to be taken into account, it added. In a letter to Mr Hunt that has been seen by The Independent, Labour’s shadow Health Secretary Andy Burnham said this reason was not credible and noted that the chair of the Health Select Committee, Conservative MP Sarah Wollaston, was also concerned. Mr Burnham said the delay undermined Mr Hunt’s stated aim to “hard-wire transparency into the health and care system”, to prevent whistleblowers being victimised.

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The Guardian

  • Should I quit the NHS for private practice?

    I have worked for the NHS in one of the allied health professions for seven years. Due to cost cutting and service reorganisations the opportunities for career progression have over time drastically reduced. I recently succeeded in gaining a promotion to the next pay grade, however my job will not change as I have been functioning at this level for a number of years waiting for a role to become available. Almost simultaneously I was offered a job with an independent practice which is offering to match the pay scale and leave entitlement I currently have with the NHS. I haven’t received a contract yet, but I am sure as a small business they will be unable to match the other benefits of working for a large organisation – the pension, sick pay etc. On the other hand, the benefits of working for the private firm are a much reduced caseload of patients, where I will be able to make a real change to the lives of individuals rather that plastering over the cracks, and much better resources to complete tasks efficiently. I consider it a great drawback that I will only be able to provide this service to people who can afford to pay for it, but all in all I feel I will achieve better job satisfaction in the independent practice. It was always my long-term aim to set up my own independent practice, and by working for a successful practice I will be able to learn how to do this from the inside. Should I give up the job and pension security of the NHS in favour of a less stressed working day ?

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  • NHS shakeup created widespread conflicts of interest, says union.

    More than one in four governing members of NHS clinical commissioning groups have links to companies involved in healthcare, according to research by Unite. The trade union claims its findings provide evidence of conflicts of interest on a massive scale, facilitated by the Health and Social Care Act, which gave CCGs responsibility for commissioning services. The groups comprising GP representatives, managers and laypersons have responsibility for budgets totalling £65bn a year. Unite’s general secretary, Len McCluskey, said: “The Tory-designed Health and Social Care Act handed the NHS budget, worth tens of billions, over to clinical commissioning groups and in doing so created a monster, where personal financial interests run amok. As a result our NHS is being privatised.” He said the act should be scrapped and called on David Cameron to use his veto to get the NHS out of the Transatlantic Trade and Investment Partnership (TTIP), which he said would make outsourcing of health services permanent. Critics claim that TTIP would allow US multinationals, or any firm with American investors, to sue any future UK government if it attempts to take privatised health services back into public ownership, jeopardising their profits. Unite looked at the registered interests of 3,392 CCG board members, in what is says is the most extensive research undertaken into their interests. It found that 932 (27%) had a link to a private company involved in healthcare. They included 513 company directors, 140 business owners, 105 external workers, 17 partners, 15 chairs, 10 company secretaries, five chief executive officers, one trustee, a financial officer and 125 others, including consultants.

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HSJ

  • Troubled CCG says its deficit could reach £40m.

    A clinical commissioning group has warned that its deficit could hit an enormous £40m by the end of the financial year, which would be the largest recorded by any group so far. Bedfordshire CCG’s chief operating officer John Rooke has also announced his departure - although a CCG spokeswoman told HSJ this was not related to the deficit. The CCG became embroiled in a dispute with Bedford Hospital Trust over and MSK contract The CCG started 2014-15 predicting a £4.9m surplus, and by November its forecast had deteriorated to a £24m deficit. A report to its governing body this week revised the forecast down further, to a £28.1m deficit. However the CCG said the deficit may be “up to £40m”. Either figure would be the largest year-end deficit record by any CCG since they were created in April 2013. The CCG blamed the deterioration on a difficult winter, increased hospital activity and a high number of expensive out of area placements for mental health service users. A report to the board earlier this week said: “In addition, a root and branch investigation of our contracting and financial processes has revealed historical contracting issues.” Former finance director James Corrigan stepped down in November and was replaced by an interim. Of the group’s overspend at month 10 of this financial year, £5.6m was with private mental health providers. Overspending with Luton and Dunstable Hospitals Foundation Trust and East and North Hertfordshire Trust was £4.5m and £2.5m respectively. Bedfordshire CCG became embroiled in a dispute with Bedford Hospital Trust last year when the hospital refused to sign up as a subcontractor to Circle, which had been awarded a five. The CCG’s board papers this week said it was owed money by Circle.

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Friday 6th March 2015

Our NHS

  • Lives are being lost due to the heart-failure of marketised healthcare.

    As a young psychiatrist forty years ago I heard hopeful talk about how more scientific diagnosis and specialist, focused treatment would make longer-term and residential care unnecessary. As with surgery, improved speed, accuracy, and efficiency would benefit mental healthcare (and deliver economic savings). The closure of large mental hospitals became a celebrated symbol of this. My view, though youthful, was jaded: we were over-reaching our medically-modelled treatments to complex human distress. Most of these early doubts have proved dishearteningly accurate. As a now veteran inner-city GP I have seen the dismemberment, then disappearance, of our better forms of long-term containment and care. It is not just that the asylums have closed. It is that the wider ethos of ‘asylum’ – compassionate containment – has become increasingly rare. I find it almost impossible now to find for my patients the kind of protective spaces and relationships that are essential for many kinds of healing and growth – the kinds of investment I could more easily make as a young practitioner. How has this happened ? How – amidst our plethora of Royal Colleges, think-tanks, specialist trainings and massive resources (yes!) – have we departed so far from our better sense and sensibility ? We have failed to heed the subtle differences yet synergy between treatment and care, and have thus lost our capacity to craft our best therapy. Care comes from ethos, while treatment comes from technology. Care is about wholes and relationships, treatment is about parts and mechanisms. Care springs from – then returns to – the intersubjective, treatment remains closely tethered to the objective.

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Lancaster Guardian

  • Sneaky way to privatise.

    Greater Manchester to control £6bn NHS budget – Greater Manchester is to become the first English region to get full control of its health spending, as part of an extension of devolved powers. Chancellor George Osborne said the £6bn health and social care budget would be taken over by the region’s councils and health groups. Mr Osborne said it was a “really exciting development”. A Labour spokesman said NHS workers would “want to be persuaded of the case for a new layer of management”. The plan will come into force from April 2016. Mr Osborne added: “This is what the NHS wants to see as part of its own future. And it’s also about giving people in Manchester greater control over their own affairs in that city, which is central to our vision of the ‘northern powerhouse’, so it’s a very exciting development.” The plan would see local leaders, and ultimately Greater Manchester’s new directly elected mayor, control how budgets are allocated. The government hopes integrating health and social care services will ease pressure on hospitals and help to improve home care services for patients who need it. A shadow Greater Manchester Health and Wellbeing board will be appointed, which will work closely with existing clinical commissioning groups of GPs. The board is expected to run from April, before control of the budget is handed over a year later. Manchester City Council confirmed 10 local authorities, 12 clinical commissioning groups, 14 NHS partners, NHS England and the government are in discussions on a “groundbreaking agreement for health and social care”. What will happen if Greater Manchester over-spends ? And if this ‘Grandiose Plan for the NHS’ is extended to other parts of the UK, who will provide health care, should Greater Manchester, other Health Trusts run out of money ? Therefore it begs the question, does it not, that I firmly believe is this – privatisation of the NHS by the back door by the Tory Party, and the only people to benefit will be NHS consultants, GPs and medical manufacturers; and also not forgetting MPs, who will, no doubt, have their snouts in the trough with ‘interested parties’. Therefore, may I respectfully suggest that if David Cameron MP is elected Prime Minister in May will he please confirm his Electoral Pledge of many years ago – ‘that the NHS is totally safe in Tory hands’.

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Hospital Doctor News

  • Extra A&E funding didn’t reach the frontline.

    Only 1% of the £700m allocated by the government was spent on staff or other resources in their emergency departments. This is the key finding of research by the Royal College of Emergency Medicine which surveyed 142 clinical leaders in emergency medicine across the UK - representing about two thirds of emergency medicine units. Off the back of the survey, the college has released a report - called Ignoring the Prescription - which finds that implementation of recommendations to reduce the A& E crisis has been patchy at best. Last year, four medical royal colleges and many other organisations met to discuss how to make the urgent and emergency care system more resilient. Their report Acute and emergency care - prescribing the remedy was published in June and was welcomed by the NHS confederation and the Department of Health in England. But progress has been slow despite an additional cash injection of £700m. Less than half of EDs in the UK have fully implemented co-located primary care out-of-hours facilities. Less than a third of departments have an appropriate skill mix and workforce in place to deal with their patient volumes and case mix. It also finds that more than half of departments are not assisted by senior decision makers from in-patient teams at times of peak activity. The College concludes that a combination of failure to implement consensus recommendations coupled with the failure to invest allocated monies in frontline services has led to extraordinary winter pressures which were largely avoidable.

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The Guardian

  • Focus on targets in NHS poses threat to patient care, says thinktank.

    A “targets and terror” approach to ensure large hospital A& E departments in England treat, admit or discharge 95% of patients within four hours may undermine their care, a former senior NHS official has said. The micro-management culture within the NHS and Department of Health coupled with increasingly tight budgets will hasten the point at which entire urgent care system reaches breaking point, says Nigel Edwards, chief executive of the Nuffield Trust thinktank. Senior managers in hospitals are so busy collecting information on how they are doing each week to satisfy regulators, NHS bosses, health commissioners and politicians that they are not sorting problems on their own frontline, Edwards and two co-authors claim in a briefing paper. Major A& Es have not hit the 95% mark since summer 2013 despite all the attention paid to weekly figures in recent months, they say. But emphasis on the four-hour measure distorts the picture of how big hospitals are doing in the face of a 12% increase in attendances at their A& E units and a 27% increase in emergency admissions in a decade. The A& E rise is “entirely in line with what would be expected based on population growth”, according to the paper, which warns that 17,000 extra hospital beds could be needed by 2022 unless more could be done to treat people outside hospital. The NHS response was based “on the anxiety of the hierarchy rather than on the care of patients and the flow of patients through the system”, it said.

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The Telegraph

  • Lancet condemns NHS for creating 'culture of fear' in wake of scandals.

    NHS reforms introduced following the disclosure of serious failings at the Mid-Staffordshire Trust have left staff feeling fearful of persecution, according to a respected medical journal. The stinging editorial in the Lancet criticises the NHS' efforts to rebuild the reputation of the health service following a string of high profile scandals. The journal has taken the unusual step of publishing its own manifesto for health ahead of May's general election. The article says: "The regulatory regime created in the aftermath of Bristol, Shipman, and most recently mid Staffordshire, has created a culture of blame, fear, and intimidation in the UK’s health system.” "Instead of regulation being a means to bring the best out of our health professionals, it is used as a tool to threaten, punish, and harm. The conditions we have created for health professionals in the NHS mean that few people are cherished. "Instead, they are seen as problems to be managed. An obsession with inspection has also blinded us from thinking about health as more than a health-sector issue." The piece has been timed to create maximum impact ahead of the election, even carrying a distinctive 'Election UK 2015' logo, complete with a stylised ballot. An NHS England source said: "It's a very interesting article. The bit that focusses on the regulatory regime, it's the Government that sets that up. For us its business as usual, we deliver what's set out by the Government. There should be an NHS voice in this. But as for why things are the way they are that's Government policy." The editorial calls for a more open-minded approach to the issues facing the NHS, demanding “immediate action to improve the interface between general and emergency medicine”, describing the current situation as “atrociously poor”.

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HSJ

  • Monitor could be asked to examine £350m contract.

    A decision by NHS England to hand more than half of the country’s PET-CT imaging services to one company could be the subject of a formal complaint to market regulator Monitor, HSJ has learned. News of the potential complaint comes after the government was asked in the Commons to reassure MPs that no “undue influence” was brought to bear over the £350m contract. The decision in January to award all four regional lots to Alliance Medical sparked fears over the long term impact of the decision on competition. Concerns have also been expressed by another provider over the near “monopoly” Alliance Medical will have over the provision of PET-CT services in England for the next 10 years, as well as the majority control of production and supply of a radioactive drug known as FDG, which is vital to the PET-CT imaging process. HSJ understands Siemens Healthcare, which is the only other producer of FDG in England after Alliance took control of two other companies in 2013-14, is taking legal advice over the decision by NHS England. The company was not a bidder in the PET-CT imaging tender but could be heavily affected by NHS England’s decision.

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Thursday 5th March 2015

Guardian

  • Charities should be preferred NHS providers, says Andy Burnham.

    Charities could get 10-year contracts to help deliver NHS services if Labour wins the general election, the shadow health secretary, Andy Burnham, has told voluntary sector leaders. Not-for-profit care organisations would be given “a form of preferred provider” status under legislation that a Labour government would introduce to replace parts of the coalition’s 2012 Health and Social Care Act. The move would recognise their contribution to strengthening communities. The announcement came as Burnham sought to allay fears in the voluntary sector that his plan to restore NHS trusts’ preferred provider status for delivery of health services would hit charities as well as private companies.

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Winsford Guardian

  • NHS campaigners rally on streets against privatisation.

    Protestors in Winsford joined thousands around the UK in taking to the streets to help gather support to protect the NHS from privatisation. Around 170 people signed the ‘Save our NHS’ petition in Winsford. The petition asks each MP candidate to commit to protecting the NHS from privatization and to keep it out of the Transatlantic Trade and Investment Partnership (TTIP) trade deal with the US. The day of action, coordinated by campaign group 38 Degrees, was held across England with more than 10,000 people taking part.

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Health Service Journal

  • Monitor could be asked to examine £350m contract.

    A decision by NHS England to hand more than half of the country’s PET-CT imaging services to one company could be the subject of a formal complaint to market regulator Monitor, HSJ has learned.

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Left Food Forward

  • The NHS has never been in more danger.

    Kailash Chand OBE writes: In 2010 David Cameron’s coalition government betrayed pre-election promises to protect the NHS. Instead they imposed savage spending cuts and pushed through ‘reforms’ which put at risk the health of the entire population. The Health and Social Care Act 2012 has been described as so ‘complex, confusing and bureaucratic’ that the organisation of the NHS ‘is not fit for purpose’ as a result. The NHS is now at the brink of extinction. The public has been misled about the objectives and consequences of the 2012 Health and Social Care Act. But the coalition’s repeated denials of NHS privatisation do not stand up to scrutiny. The 2012 Act has not just repealed society’s contract with the health service, it has put the NHS on the chopping block, ready to be sold in pieces to private corporations. The Health and Social Care Act raised the cap hospitals could generate from private income to 49 per cent from an average of around two per cent. Privatisation is an ideological luxury which wastes money and destabilises the NHS. It has no purpose other than diverting money to shareholders and enriching a privileged few. We all know people should always come before profit, but the current government thinks otherwise. In the past year, £9 billion worth of our NHS has been put up for sale, while thousands of jobs have been axed, including over 4000 senior nurses. Half of our 600 ambulance stations are earmarked for closure. 50 of the 230 NHS walk-in centres have been closed and 66 A& E and maternity units have been shut or downgraded. The coalition’s policies and privatisation mean the NHS as we know it will be gone in as little as five years if no one speaks up. The NHS will just be a logo; reduced from being the main provider of health services in England with one of the biggest workforces in the world, to a US-style insurance scheme, divorced from the delivery of care. Fewer treatments will be available as cuts start to bite. The ‘new’ NHS is now more fragmented than ever before. It has no primacy over provision, and money is squandered over lost causes such as procurement of contracts and fighting competition from within. There has been a proliferation of small and large providers in the NHS in the last two or three years and the other winners in this revolutionary reform are management consultants. The proliferation of private service providers spells serious problems for the future. For while the public sector seeks to maximise quality and coverage of services, the private sector aims to provide services in order to maximise profits. John Major attempted to suffocate the NHS by bringing in the internal market. David Cameron is fulfilling the dream of the ‘Tory right’ to privatise health care lock-stock and barrel.

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Tuesday 3rd March 2015

Guardian

  • 'By God, believe in something,' Michael Sheen tells politicians.

    The actor Michael Sheen, best known for playing Tony Blair in a series of TV dramas and the award-winning film The Queen, has delivered a passionate defence of the NHS against “bland” politicians in thrall to the market from both Conservative and Labour parties. Speaking at a St David’s Day march to celebrate the NHS and its founder, Aneurin Bevan, Sheen approvingly noted Bevan’s “burning hatred for the Tory party” and attacked Margaret Thatcher’s infamous claim there is no such thing as society. But his anger was also aimed at the timidity of Labour politicians and the party’s record in office. Sheen said British political leaders had a hidden agenda to privatise the NHS, despite what they claimed. He said: “No one says they want to get rid of the NHS, everyone praises it ... But for decades now there has been a systematic undermining of it [the NHS’s] core values. This is beyond party politics. The Labour government arguably did as much damage to the NHS as any Tory or coalition-led one. In today’s political climate, where politicians are careful, tentative, scared of saying what they feel for fear ... all political parties drift into a morass of bland neutrality and the real values we suspect are kept behind closed doors. Is it any wonder that people feel there is little to choose between ?” Sheen appeared to plead directly to the Labour leadership. “You must stand up for what you believe, but first of all, by God, believe in something,” he said. Sheen also attacked austerity and the political consensus about the effectiveness of market solutions. He went on to stand up for those on benefits.

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Monday 2nd March 2015

The Star

  • Campaigners take to Sheffield streets in fight to save NHS.

    More than 100 campaigners took to the streets of South Yorkshire over the future of the NHS. Volunteers were out in Sheffield city centre and on Ecclesall Road on Saturday, with similar events taking place in Rotherham and Chesterfield. It was part of a national protest, organised by campaign group 38 Degrees, involving about 9,000 people across the country. Campaigners were asking members of the public to sign a petition which is calling on general election candidates to pledge to oppose the privatisation of NHS services. Becci Simpson, one of the volunteers, said there had been a ‘generally positive’ reaction from members of the public in Sheffield city centre. She said: “We are just raising awareness and we have been talking about the cause, which is to save the NHS. “The campaign is against privatisation and cuts and to protect the NHS from US health companies.”

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World Socialist Socialist Site

  • A revealing exposure of the destruction of health care in the UK.

    In his 57-minute documentary, filmmaker Peter Bach reveals the extent to which the National Health Service (NHS) has been privatised since the introduction of the internal market by Conservative prime minister Margaret Thatcher in 1989-1990. Bach was first approached by a group of doctors in 2013 and asked to make the documentary. Over the course of several months, he interviewed the doctors about their jobs and the ways in which privatisation policies have affected them and their patients. He brings in the comments of several others, including a lawyer, journalists and activists, to widen his exposure of the constant attacks on the NHS. His shots are mainly close-ups of the people speaking, capturing their facial expressions in detail. Shots of London, where the documentary was filmed, include scenes of Bach outside St. Paul’s Cathedral, site of the 2011-2012 Occupy protest, and by the Thames, where Dr. Peter Brambleby is interviewed. Other interviews take place in GP (general practitioner) surgeries and other health care settings. Split into 10 sections, the film’s aim is to make the public aware of the “tsunami of structural changes” and the huge level of privatisation that has gone on behind closed doors, as well as the steps taken to keep the public in the dark. All the professionals interviewed passionately contribute to exposing the steady dismantling of health services. The aim is to replace the NHS with an “American model” that enriches the private health companies. The documentary compares the NHS with the US for-profit health care system. The US spends $8,233 per person per year on health care while the UK presently spends $3,433. Yet, it is well established that the NHS is the most cost-effective and best health service in the developed world. By breaking up the NHS, which has been a model for publicly funded health care for more than 60 years, the private sector is attempting to set a precedent for other countries and to open up new profitable markets.

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Hospital Doctor Blogs

  • Reaction to Manchester’s devolved health spending.

    Dr Mark Porter, BMA council chair - “There is no doubt that patients would benefit from more joined-up health and social care. However, any plans to do so would have to be underpinned by clear funding to ensure that an already dangerously over-stretched NHS budget isn’t used to prop up a woefully underfunded social care budget. These wide sweeping changes will affect millions of people. We need to look carefully at exactly how they will affect the commissioning and delivery of services, and what the impact on patient care will be. We must also ensure clinicians have a central role in decisions over health care, something which was undermined by the Health and Social Care Act 2012. We need assurances on who is responsible if these changes go wrong. Doctors believe the secretary of state for health should have the duty to provide a universal and comprehensive health service, and must take responsibility for guaranteeing national standards in the of quality care across the country, especially if the delivery of care is to be devolved to local authorities."

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Our NHS

  • From electricity suppliers to doctors, why do many reject the modern imperative to 'shop around'?

    A new report by the Competition and Markets Authority highlights how poorer people are failed by energy markets. Jonathan Tomlinson finds the same for health - and for understandable reasons. Last week, the Competition and Market Authority reported that those least able to take advantage of competition and choice in the energy market were, "less educated, less well-off, more likely to describe themselves as struggling financially, less likely to own their own home, less likely to have internet access, more likely to be disabled or a single parent." They were also more likely to stick with providers with whom they had an established relationship. These vulnerable people also stand to benefit least from competition and choice in healthcare, because of the associations between poverty and ill health. Dr Smith was well past his due retirement, but was unable to find anyone to take over his surgery in a pretty rough part of town where he had been a single partner for nearly 40 years. One day, at work, Dr Smith had a heart-attack and died at his desk. When Dr Jones and partners took over his list, they found that the patients were more likely to be, "less educated, less well-off, more likely to describe themselves as stru..." They were also more likely to be over 65 and have cognitive-impairment, learning difficulties or long-term mental illnesses. Other patients had changed GP long before Dr Smith retired. They didn't need Friends and Family tests, NHS choices feedback, 'I want great care' or any other on-line rating system to recognise that the shabby waiting room and the ever-changing locum GPs weren't 'great'. The NHS is founded on the basis of equality and fraternity but competition and choice are new values for the NHS. 'Liberating the NHS' was the name of the 2010 government white paper that preceded the NHS Act, and the focus on liberty has increasingly eclipsed equality and fraternity. Competition and choice are enforced by a new NHS organisation called Monitor and strongly advocated by government advisers including Tim Kelsey, National Director for patients and information and Andrew Taylor, founding director of the NHS Competition and Cooperation Panel and now adviser to NHS providers on competition issues.

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The Independent

  • Private hospitals ‘lack facilities to deal with emergencies’, study finds.

    NHS patients are putting their lives at risk by opting for operations in private hospitals which lack the facilities to deal with emergencies if things go wrong, senior doctors have warned. More than a quarter of the 1.6 million operations conducted by private hospitals last year were carried out on NHS patients and GPs are increasingly being encouraged to refer more of them to the private sector, partly to ease the burden on NHS hospitals. Doctors are also warning that the guidelines governing private hospitals, particularly concerning deaths and other serious cases, are not as stringent as they are in the NHS. The Centre for Health and the Public Interest, a leading medical think-tank, found that between 2010 and 2014, 800 patients, including those referred by the NHS, died unexpectedly in private hospitals. It also documented several cases where mistakes had been made by private hospitals but not detected until up to a year later. In one incident, surgeons had replaced the wrong knee joint on three separate patients. Colin Leys, author of the report, told the BBC’s London Inside Out programme, due to be broadcast tonight: “In the NHS, you have a national reporting and learning system that is independently operated, to which all hospitals must report all serious incidents and if they see a pattern building up they intervene and that doesn’t happen for private hospitals.

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HSJ

  • Manchester NHS calls for regulation shake-up after devolution deal.

    NHS providers across Greater Manchester have called for a ‘new set of relationships’ with health regulators to underpin the newly agreed £6bn devolution of commissioning responsibilities to the conurbation. NHS England has today signed a memorandum of understanding with Greater Manchester’s NHS commissioners and local authorities to work towards radical delegation and sharing of health and social care commissioning across the area. In joint letters of support for the plan sent to NHS England chief executive Simon Stevens, the conurbation’s 14 acute, mental health and community providers say that it will require “the development of a new set of relationships with the regulatory and inspection bodies within health and social care, including Monitor, the NHS Trust Development Authority and the Care Quality Commission”. The letters continue: “It has been proposed that a memorandum of agreement should be developed to define the new relationship. We strongly welcome this proposal and would want to play an important role in developing the agreement. “The key objective of the agreement must be to create a [Greater Manchester] sub-regional focus for the regulatory and inspection functions, whilst maintaining proper consistency. This will allow the regulators to gain a far clearer understanding of the strategic and transformational agenda in Greater Manchester, and to provide advice and support that facilitates rather than impedes change.” As HSJ reported earlier this week, a leaked draft of the memorandum of understanding suggested that Greater Manchester’s clinical commissioning groups and local authorities should “lead the regulation of its provider community, with support from Monitor, the TDA and CQC”. However, that wording has been changed in the final agreement, which now states that the parties will work towards Greater Manchester playing a “clearly defined leadership role in the oversight of its provider community”, in “close partnership” with the regulators. The document also expresses an intention for Greater Manchester’s commissioners to become “responsible for designing and creating the provider structure and form to support its commissioning intentions” in collaboration with the regulators. The providers’ letters note that the memorandum focuses on “commissioner responsibilities” and “needs to reflect the devolution of powers and resources from NHS England to [Greater Manchester’s] CCGs and local authorities”. However, they welcome the inclusion in proposed governance arrangements of a formally established provider forum, and the “centrality of a co-design approach” to the strategic transformation of services. The letters add that emphasising co-design from the outset will ensure that “whilst there is still an important role for competition between providers” there are “clearer mechanisms for cooperation between providers and with commissioners”. Central Manchester CCG chief officer Ian Williamson told HSJ: “We are enthusiastically seeking to have a constructive conversation with regulators about how we work best with them in a way that serves the city region, because all of our trusts and FTs have individual bilateral relationships with the TDA or with Monitor.” He added that the conurbation and NHS England had agreed the principle that, where possible, all decisions about Greater Manchester should be made with Greater Manchester and “that’s the principle we want to agree with regulators as well”. “Decisions about individual institutions, individual hospitals – increasingly we are going to be asking for those decisions to be made in conjunction with us in Greater Manchester, rather than just with an individual organisation,” he said.

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  • NEW (Northern, Eastern, and Western) Devon accused of conflict of interest in £100m contract award.

    A community services provider has accused the country’s largest clinical commissioning group of a conflict of interest in its decision to award a £100m contract without a tender. Northern Devon Healthcare Trust alleges that the process followed by Northern, Eastern and Western Devon CCG to award the three year community services contract was “automatically skewed” in favour of a neighbouring provider. The trust says in a document submitted to Monitor that senior figures involved in drawing up plans regarding the service’s future configuration were also involved in identifying the preferred provider. The CCG categorically denies the claim. Monitor is currently investigating the contracting process. Last November the CCG named Royal Devon and Exeter Foundation Trust as its preferred provider of the contract, for which Northern Devon Healthcare is the incumbent. The services cover the eastern locality of the group’s area. The Northern Devon Healthcare document, which lays out the full extent of the provider’s grievances, also alleges that:
    - the CCG had always intended to transfer the contract to another provider;
    - the CCG and Royal Devon and Exeter were not transparent in their correspondence during the decision process; and
    - commissioners engaged in “discriminatory” and “anti-competitive” behaviour in coming to their decision.
    The document says: “[Northern Devon Healthcare] remains concerned that individuals who were involved in the development of the original… strategic framework, were also involved in the process that resulted in the identification of the preferred provider. This would have represented a conflict of interest.” “The decision [to change providers] was clearly preordained to the extent that many CCG senior managers and commissioning GPs openly talked about ‘when’ services would transfer, irrespective of any process going on at the time.” The trust also alleges that NEW Devon CCG was not clear with providers about the process to be followed in choosing the service’s next provider. It argues: “The overarching process to be followed has never been made clear to providers, or at least to [us]. Changes and delays have occurred with no explanation.” “It is undeniable that the public desire greater integration of services, as we all do - but the public were not asked [which provider] should provide the community services.” Royal Devon and Exeter has suggested that Northern Devon Healthcare’s objections to the contracting decision appeared to be based on the idea that a competitive tender process took precedence over the wishes of local stakeholders. In its own submission to Monitor, Royal Devon and Exeter wrote: “[Northern Devon Healthcare’s] premise appears to be that there is no place for an outcome determined through consulting the community and patients. “The complainant appears to contend that the views of the public should be discarded and a process that is anything other than fully competitively tendered is not acceptable.” Royal Devon and Exeter also denies the accusation that it was not transparent in its dealings with the CCG. The CCG, in its submission to Monitor, says it had concerns “that a formal competitive process would stop ongoing transformation and would also require a service specification which would inhibit transformation over the life of the contract.” It adds: “During the procurement process, none of the GPs that work for Northern Devon Healthcare Trust or any other providers forming part of this process were involved in any decision making.” Responding to allegations that it was not transparent with providers during the process to decide on the best future provider, the CCG said: “[We have] communicated with provider chief executives at key milestones throughout the entire process both in letters and also other meetings and phone calls, including Northern Devon Healthcare Trust.”

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Friday 27th February 2015

BBC News

  • The long road to NHS devolution.

    Senior Treasury officials first started talking to me about how they would dearly love to see the NHS broken up back in the late 1990s, when New Labour was in power. Their argument was that an organisation as big as NHS England, with its annual budget these days of around £100bn and 1.2 million employees, was simply too big to be manageable in an efficient and effective way. They were far more excited about the possibility of securing more bang - or medical effectiveness - for taxpayers' buck from creating smaller devolved health units than from privatisation. It has taken 20 years or so for the Treasury to begin to get its way - with plans to devolve to Greater Manchester control over a £6bn health and social care budget. Naturally any reorganisation, especially one as apparently radical as this one, will create unease among healthcare professionals. But breaking up the NHS into smaller units goes with the grain of current thinking on how best to improve productivity and manage risk. If you want an idea of what can go wrong when organisations become bigger than a certain size, just think about the recent financial and reputational woes of the UK's most enormous companies, from Royal Bank of Scotland, to BP, to HSBC and Tesco.

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Our NHS

  • What’s happening to my local GP? Carrots, sticks, and the long game of NHS privatisation.

    The NHS needs ‘fundamental changes’ to save it from ‘disaster’, the Kings Fund told us last week (as they seem to most weeks). New NHS plans mean GPs ‘will deliver more integrated services in the community’, they tell us. GPs already have lots of ‘autonomy’ and can embrace ‘disruptive innovation’, be more ‘flexible’ over payments, take on new ‘leadership’ roles, and ‘collaborate’ better with a wider range of ‘providers’, including (it is left implicit) private healthcare corporations. The Kings Fund seems to be living in a parallel universe. As a GP, I see my colleagues having lost autonomy, morale and now income to such an extent that they are leaving in droves - clearing the way for the private sector. And what’s caused this fundamental disaster now rapidly unfolding in General Practice ? The pro-private sector policies pursued by politicians for decades. Policies that the once highly respectable Kings Fund now promotes as effectively - if more circumspectly - as more obviously right-wing ‘think tanks’ like the Adam Smith Institute have done for years. Since taking over a small family practice on the London and Kent border, I have endured multiple reforms imposed on general practice. The reforms have been cleverly crafted and spun using the privatiser’s favourite language of ‘patient choice’. In 2004 New Labour’s GP contract allowed GPs to give up responsibility for organising out of out of hours care by paying £6000. Already overworked, the vast majority of GPs did so - having been given the impression that the service would be provided by already long-established co-operatives of GPs sharing the work.

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HSJ

  • Controversial MSK contract could stay with current providers, CCG says

    Commissioners in West Sussex will begin discussions with local providers to continue delivering musculoskeletal services after the preferred bidder pulled out of the contract. Coastal West Sussex Clinical Commissioning Group’s “preferred approach” is for the 16 current providers to deliver the new service model put forward in the original tender and discussions will begin shortly. Private provider Bupa and social enterprise CSH Surrey pulled out of the contract last month after an independent probe suggested that the loss of the services could put Western Sussex Hospitals Foundation Trust into deficit. There was a public outcry after Bupa CSH was named the preferred bidder by the CCG last September. The CCG has abandoned the tender process for the £235m contract after seeking legal advice. It was considering whether to approach the unsuccessful bidders for the contract to take on the service. However, the CCG has decided to “halt” the tender process instead. The providers that currently provide MSK services in the area have had their contracts extended until September. In response to a freedom of information request, the CCG revealed that the procurement process had cost £348,000.

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  • Details of £6bn Manchester health devolution plan.

    Radical plans for Greater Manchester to take control of £6bn of health and social care spending will be overseen by a new statutory body from April 2016, according to draft plans obtained by HSJ. A draft memorandum of understanding between NHS England and the conurbation’s local authorities and clinical commissioning groups sets out plans to put the Greater Manchester Strategic Health and Social Care Partnership Board on a statutory footing by the end of 2015-16. It would set Greater Manchester wide strategies and priorities and allow system-wide management to assure they are achieved. It would sit above a joint commissioning board – made up of NHS England, the CCGs and councils – which would be responsible for agreeing all Greater Manchester-wide spending on health and social care. The draft document sets out a “roadmap” for full devolution of powers and budgets to commission services including acute and specialised services, primary care, community and mental health services, social care and public health. It builds on a previous devolution agreement which gave the Greater Manchester Combined Authority greater powers over other budgets spent locally.

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Thursday 26th February 2015

Guardian

  • Coalition sneaking out regulations to speed up NHS privatisation, Labour says.

    Labour has accused the government of trying to sneak out legislation to accelerate the privatisation of NHS services. Andy Burnham, the shadow health secretary, said regulations tabled in parliament on 6 February without any government announcement would force all contracts worth more than £625,000 to be put out to tender. The rules mean that from April 2016 all NHS contracts worth more than €750,000 (£625,000) must be put out to tender, Labour said. Non-NHS organisations, including private health companies such as Virgin Care and Ramsay Health Care will be eligible to bid. The rules could potentially apply to many thousands of contracts, which will be advertised in the Official Journal of the European Union (OJEU). The change could remove the freedom of NHS hospital trusts and the 211 GP-led clinical commissioning groups in England, which hold local NHS budgets, to award contracts without advertising them. At present, contracts only have to be advertised in the EU’s official journal if there is a cross-border interest in them. Burnham told MPs that Jeremy Hunt, the health secretary, had tried to deny that NHS privatisation was increasing under the coalition. Referring to the “ideological privatisation of a cancer scanning service” in Stoke, he said privatisation “could get much worse” as a result of the new regulations, which are the result of EU procurement rules agreed last year. Dr Mark Porter, leader of the British Medical Association, accused ministers of failing to be transparent about their plans for the NHS, especially about the market’s role in delivering care. The privatisation of NHS services has increased significantly under the current government. The health minister, Dr Dan Poulter, revealed in a parliamentary answer last month that NHS spending on private providers had risen by almost 60% under the coalition.

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BBC News

  • Greater Manchester to control £6bn NHS budget.

    Greater Manchester is to become the first English region to get full control of its health spending, as part of an extension of devolved powers. Chancellor George Osborne said the £6bn health and social care budget would be taken over by the region's councils and health groups. The plan will come into force from April 2016. The plan would see local leaders, and ultimately Greater Manchester's new directly elected mayor, control how budgets are allocated. A shadow Greater Manchester Health and Wellbeing board will be appointed, which will work closely with existing clinical commissioning groups of GPs. Manchester City Council confirmed 10 local authorities, 12 clinical commissioning groups, 14 NHS partners, NHS England and the government are in discussions on a "groundbreaking agreement for health and social care". Andy Burnham MP said, "I am a bit worried what I'm hearing because it does point to further break-up of the idea of the National Health Service." Richard Humphries, assistant director of the King's Fund think tank, said a full transfer of responsibility would be a reform "on a breathtaking scale" but could pose serious risks. Speaking on BBC Radio 4's Today programme, he said: "Depending on the detail - and the detail is really crucial and we don't have that yet - you could either see this as a triumph for local democracy or creating real risks of yet another reorganisation of the NHS when it's barely recovered from the last one."

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