Have you seen a story about the marketisation of the health service in your area that we have missed? Click here to contact us with news from your local paper or organisation about cuts, closures, outsourcing to the private sector, health service deficits, demonstrations, PFI deals - anything that you feel is relevant to the Keep Our NHS Public campaign.

You can search for key words. To find a phrase, put the words in quotation marks (such as "health service"). Leave blank to find all entries.
Search for

Friday 18th April 2014

Echo

  • Southend Hospital spends £29m on agency staff to plug staffing crisis.

    A whopping £29million has been spent on agency staff by Southend Hospital in the past four years, the Echo can reveal. The figure, released to the Echo under Freedom of Information laws, shows the hospital spent £4.19million on locums last year alone, up £1.34million on the previous year, while spending on agency nurses was up a quarter to £1.95million last year. The hospital is now spending £1million a month on agency staff which has led to the £29million spend since 2010/ 11. Part of the reason the hospital is having to rely on agency staff is because it has vacancies for 30 doctors and 119 nurses and has launched recruitment campaigns in Spain and Ireland to try to plug the gap. Brian Shipley, the hospital’s director of finance, said: “The hospital will always use a level of agency staff, but recently we have been experiencing increased difficulty in recruiting experienced and trained staff particularly for some medical specialties and for nursing, largely through national shortages. “The increased spend on medical and nursing agency staff reflects the increased usage. In addition to recruitment, retention can also be a challenge.” The hospital lost seven doctors from A& E in January alone and recently had to declare a “major internal incident” and cancelled all non-urgent operations after struggling to cope with the number of patients turning up for treatment. Dean Jones, from Southend Hospital’s Unison branch, said his organisation had been warning about staffing levels for a long time. He said: “The recruitment is necessary, but we’ve been saying for years we’re understaffed. "

    Read more ...

The Northern Echo

  • Group of Darlington mums organise ambitious march to London in support of the NHS.

    A group of North East mothers are organising a rallying cry for the NHS following in the footsteps of the historic Jarrow March. The People’s March, which already has more than 500 participants signed up, will cover about 300-miles from Jarrow to Westminster in what organisers hope could be one of the biggest mobilisations of people across England in support of the NHS. It has been organised by a group of working mothers from Darlington who have become disillusioned with the way the NHS is being handled by the government. The group, which use the name #darlomums on social networking sites, has already organised successful rallies in Durham and Darlington which attracted national high profile speakers. They are planning the march to start on August 16 and arrive in London on September 6. It will follow the route taken by the Jarrow Marchers who famously walked to Westminster during the 1930s depression to highlight the poverty in their North-East town. Darlomum Joanna Adams said the group is working with NHS campaigning groups nationally and has already won the support of key campaigners, unions and community groups across the country. She added: “Ordinary folk just like me are wanting to join the People's March for the NHS and that is why this project is so exciting. “At a time when armchair activism is the norm, emails are flooding in with offers to help organise, and to walk one or more of the legs of the route. The route is split up into sections of 10 to 15 miles making it easy for groups to join in. It may be #darlomums organising the People's March for the NHS but we want everyone across our communities on board.” Rehana Azam said that through her role with the GMB trade union she has seen first-hand the “devastating effects” government policy is having on the health service.

    Read more ...

Hospital Doctor

  • Top-up fees paid by care homes residents could be about to increase exponentially, claims a report.

    The advent of the Care Act legally allows council-funded clients to dip into their own savings in order to secure a bed in a more expensive long term care facility. LangBuisson research suggests that while the Act will bring about a dramatic shift in the number of clients who are eligible for local authority support, a move to allow greater use of third party payments to part-fund care places could mean that more people actively seek out care places which have a higher price tag than those typically funded by councils. At present councils fund care home places only for those people who have personal assets of £23,250 or less. Following recommendations made by in the Dilnot Commission in 2011, this threshold will rise to £118,000 in 2016. Chief executive of LaingBuisson, William Laing, said: “The implementation of the Dilnot reforms is expected to shrink the present ‘pure private pay’ market share from 44% to 35% as around 35,000 English care home residents become eligible for local authority funding. “A critical issue for the sector is whether most or all of these newly enfranchised residents will move into the quasi-private pay category by part-funding their care with top ups or whether they will become pure local authority-funded residents.”

    Read more ...

Our NHS

  • NHS Foundation Trusts - a democratic failure?

    NHS Foundation Trusts are ten years old this month. The Foundation Trust model was designed to allow NHS hospitals and other services a greater degree of operational and financial independence. The model has proven popular with politicians and NHS managers. There were 20 Foundation Trusts established in 2004, and that number has now risen to 146. The current Coalition government wants to go further and transform all NHS trusts into Foundation Trusts. It has also taken the highly controversial step of lifting the cap on Trusts’ private income – up to half their revenue can now come from non-NHS sources, including treating private patients. The launch of the first Foundation Trusts was accompanied by great fanfare about the democratic credentials of the model. New Labour’s Health Secretary Alan Milburn claimed that Foundation Trust status meant “local democracy will play an important part in health service provision,” and that, “for the first time since 1948 the NHS will begin to move away from a monolithic centralised system towards greater local accountability and greater local control.” Foundation Trusts are supposed to be democratic in the sense that patients, staff and anyone in the local community can join the Trust. Trust members then vote to elect a Council of Governors, the body which holds the Board and Chief Executive to account on behalf of members. Unfortunately, new research I have conducted suggests that participation in these democratic processes is so low that we have to consider this aspect of Foundation Trusts to be a failure. Only a tiny number of people have chosen to become a member of a Foundation Trust. Milton Keynes Hospital Foundation Trust serves an area of quarter of a million people but has a membership of 6,000 – only 2.4% of that population – and many Trusts are even less representative. Most Trusts have a public/ patient membership of somewhere between 3,000 and 20,000. However, the core population served by each Trust is invariably hundreds of thousands of people, even millions.

    Read more ...

Pulse

  • Dr Kailash Chand: 'Charging patients is not the answer'.

    In the long term, patient charges will cost more than they save argues BMA deputy chair Dr Kailash Chand The NHS is facing a tough economic climate – but charging patients for important medical equipment that improves their health is not the answer. I understand that CCGs are in a tight spot largely through the Government’s failure to provide the resources necessary for the NHS to cope with rising patient demand, especially from our ageing society. However, we should not move to a system where walking sticks, knee braces and wrist splints come with a price tag. If these are issued to patients it is because there is a clear clinical need for them from the patient’s perspective. It is not a nice little luxury they could do without, it is a key part of reducing pain and improving a patient’s life. By attaching a bill to these items all that will happen is that vulnerable people on low incomes, especially the growing numbers of people in their 70s and 80s, will not be able to afford them. From a practical point of view this will clearly damage the health of a section of a population that is prone to other conditions and circumstances that will no doubt necessitate more admissions to hospital, visits to the GP and so on. In the long term, this measure will actually end up costing the NHS more money and waste further time, exacerbating the very problem that the introduction of charging is supposedly designed to solve. Morally, there is also a strong, clear argument against charging people for treatment devices they need. This goes against the ethos of the NHS and could result in the beginning of a division between the ‘haves’ and ‘have nots’ in healthcare. I am certainly not against CCGs, and others, striving for greater efficiency and making sure every penny is spent wisely. But we cannot and should not begin to undermine the care of our patients and return our nation’s cherished health system to the dark period before the Second World War, when the quality of your health depended on the size of your bank balance.

    Read more ...

The Guardian

  • NHS waiting lists at their longest for six years.

    NHS waiting lists are at their longest for six years and an important target has been missed for the first time since 2011, official figures indicate. The data suggests that more than 10% of patients are waiting more than 18 weeks for treatment for the first time in three years, while the total number of patients on the list has risen to 2,885,253 – the highest February figure since 2008. The number of patients waiting more than 18 weeks has increased by almost half since May 2010 to more than 30,000 and those waiting more than a year for their treatment was also at its highest for a year at 544. According to Labour the figures are a consequence of the government wasting money on unnecessary NHS reforms, which could have been better spent on improving care quality. Andrew Gwynne, the shadow health minister, said this means the prime minister is personally "responsible for the problems" associated with increased waiting times. "Under David Cameron, waiting lists for operations are at their longest in years. He wasted £3bn on a damaging reorganisation and patients are paying the price. Labour left NHS waiting times at a record low but on David Cameron's watch the NHS is heading back to the bad old days with patients waiting months on end for treatment in pain and discomfort. This is further proof that Tories cannot be trusted with the NHS." Dr Barbara Hakin, chief operating officer of NHS England, acknowledged that the NHS faces a "challenge on the 18-week standard" but added that staff are "working incredibly hard to ensure patients are seen quickly. During February, around 270,000 patients were admitted for treatment within the standard, and around 400 waited longer than we would have liked," she said. "This shows we are treating more patients than ever, but we do need to treat patients in order of clinical priority. This means treating those who have waited the longest, which may mean that we miss the standard. "We are determined to redouble our efforts so that we do meet the standard and 90% of patients are treated within 18 weeks. But this may take several months as it is imperative we focus on those who have waited longest."

    Read more ...

Thursday 17th April 2014

Guardian

  • GPs braced for shutdown after 'toxic mix' of loss of funds and high demand.

    "Give it a year and I think we will have to close," says Naomi Beer, a frustrated and angry GP who works in a surgery which has been providing care to a largely poor and deprived area since the start of the NHS in 1948. In February, NHS England admitted that 98 surgeries could be under threat of closure as a result of what doctors' leaders have described as a "toxic mix" of a flawed funding system and seemingly uncheckable demand for medical care. It was thought that most of the surgeries at risk are small practices in rural areas. But Beer works at the Jubilee Street practice, on the traffic-choked Commercial Road in the East End of London. This is something of a model practice in an area where fewer than half of the patients speak English as a first language and many present with more than one serious medical problem. The 12 GPs (not all full timers), three practice nurses, two healthcare assistants and a physician's assistant all know their patients and provide old-fashioned continuity of care, yet embrace new ways of making access easier. The practice hits all the government's quality targets, has a 94% patient satisfaction rate, and has introduced internet-based consultations, appointments, repeat prescriptions, and while-you-wait phlebotomy. And it is the only surgery in Tower Hamlets that has received the Royal College of General Practitioners (RCGP) Quality Practice Award – for excellence in training and for the quality of its care. And these achievements are against a backdrop of intense pressure of work. Tower Hamlets is an area where demand is particularly acute – the population has mushroomed by over 25% in the last decade – the largest increase in England, according to official census figures, and the growth is mostly in the under-35 age group. And that demand is set to get worse according to research released earlier this month by the RCGP, which revealed that funding for general practice in England is due to fall by 17% in real terms by 2017/ 18, while patient demand in terms of consultations are set to rise by 69m to 409m a year. But, due to changes in the labyrinthine system of funding general practice, Jubilee Street faces the loss of many hundreds of thousands of pounds, which Beer and the equally angry practice manager, Virginia Patania, say will soon make it financially unsustainable. "We are now eating into practice savings to continue providing a quality service. But we are planning for a 'red button day' when we will have to dissolve the practice," says Patania, who gives a detailed breakdown of their financial crisis. "I have been raising our concerns with NHS England since Christmas and I get no satisfactory answer. I want to know sooner rather than later because I'd rather dissolve at six months than wait 12 and face even higher losses." Patania says the problems started last year when, ostensibly to reduce paperwork for GP surgeries, health minister Jeremy Hunt announced that a whole range of payment-related performance indicators known as QOF (Quality and Outcomes Framework) points were to be cut. While some indicators were removed, the value of the points, and therefore the hard cash value of the remainder, was increased but the total number of points available was cut from 1,000 to 900 – so the Jubilee Street practice lost 100 points worth £30,000. This year, by way of trying to equalise earnings, the government said that it would move the value of several income streams into the global sum – the general allocation for GP services in England adjusted for list size and age and sex with women, children and elderly people having a higher cash value. But Patania and Beer say the global sum is flawed as the allocation takes no account of the level of deprivation, ethnicity and general unwellness of their patients, nor the "immense" work involved in achieving top quality QOF points. One of the biggest financial hits comes as a result of a government decision to withdraw the Minimum Practice Income Guarantee (MPIG). Introduced in 2004 to protect surgeries from losses as a result of contract changes, MPIG is worth £219,508 a year to Jubilee Street. The loss of this element alone was the factor that NHS England said could put 98 surgeries at risk. Jubilee Street will also lose around £14,000 of start-up funding for providing "enhanced services" – such as caring for patients who are seriously ill or at risk of emergency hospital admission, assessing patients at risk of dementia, introducing telemonitoring of patients at home and introducing internet bookings and repeat prescriptions. They say these services will be cut because they don't have any money they can reallocate to keep them going. Beer and Patania say the loss of QOF, enhanced services and MPIG funding means the practice will be down £77,263 by the end of 2014-15. It already lost £30,000 QOF income last year and will lose its £219,508 a year MPIG allocation incrementally over the next seven years – the accumulated loss due to MPIG alone amounting to over £903,000. To make up those MPIG losses the practice would need to sign up 1,000 new patients. Beer says this is not an option. "If we do that the quality of care would suffer, you would get tick-box medicine, the focus on quality would be completely gone. To maintain quality would mean more doctors, nurses and ancillary staff which would simply perpetuate the existing funding crisis." Partners have taken wage cuts to try to keep the practice afloat and protect staff wages. "I have taken a £250 wage cut this month – with a mortgage in central London that is pretty tough," says Patania. While GPs elsewhere may earn six-figure sums, Beer says she expects to earn around £30,000 to £40,000 this year. "We are not complaining – for most people that is an excellent wage – but I work something like 50 hours per week – and this was the wage we started on 20 years ago." Dr Richard Vautrey, the deputy chair of the British Medical Association's GP committee, fears the Jubilee Street situation could be repeated in several hundred practices, not just the 98 identified by NHS England as at severe risk.

    Read more ...

Daily Mirror

  • Patients occupy clinic to save it from David Cameron's savage NHS cuts.

    For the past 12 years, Lifeworks has treated 200 patients who nearly all suffer from personality disorders. On March 28, the life-saving clinic was due to close as part of NHS cuts that have decimated local mental health services. In protest, around 30 women service users, four men and three dogs have been occupying the clinic since March 4 – an astonishing six weeks. When I ask how many of the dozen women sitting outside in the sunshine feel the clinic has saved their life, every single one of them raises their hands. Since it was founded 12 years ago, the clinic has offered a pioneering service for complex cases. It offers therapies including art, music, walking, cooking and drop-in services for vulnerable and often isolated men and women. But the women say the most important thing it offers is a daily Crisis Clinic. Instead of being admitted to A& E, patients can ring or drop in. Still, Cambridgeshire and Peterborough NHS Foundation Trust – currently implementing £6.5million in cuts – is closing the service. The group had only intended to make a single night’s protest chained to the railings with placards. But in the confusion of their takeover on March 4, one of the staff gave them the key. Local people have been bringing food, there have been protests in Cambridge, and they are being supported by local trade unions including Unite Community. Now, inside the clinic, a pool table is pushed up at the front door, and there are mattresses laid out on the floor. A cooking and washing up rota is in operation. In a statement, the trust says it is “one of the lowest-funded mental health trusts in the country, and earlier this year, NHS England named Cambridgeshire and Peterborough as one of the 11 most ‘financially challenged health economies’ in the country”. Despite David Cameron’s promise to protect NHS “frontline services”, since 2010, hundreds of mental health beds and services have been lost across the country – even as welfare reform tightens the screw through sanctions, the Bedroom Tax and the failures of the Work Capability Assessment.

    Read more ...

Open Democracy

  • Nuffield Trust report exposes Tory lies on Welsh NHS.

    The Welsh NHS is “sleepwalking to a mid-Staffs tragedy, claimed Jeremy Hunt. David Cameron went further, telling Welsh Conservatives the Welsh NHS was a “national scandal” and Offa’s Dyke “has become the line between life and death”. In fact a thorough comparison of the UK health systems - published earlier that day by the independent Nuffield Trust - showed that overall, NHS Wales compares well. Challenged on the discrepancy on BBC Radio Wales, Welsh Tory MP Alun Cairns was keen to bluster about longer waiting times for hip and knee operations. He didn't want to hear that cancer care was better. That acute admissions for chronic conditions were falling. That the Nuffield Trust report found that there was no evidence Wales was “lagging behind”. That it was "broadly in line" with the rest of the country on "avoidable deaths". That in fact Nuffield's study showed Wales' (far less privatised) NHS was improving faster than England's - on less money. Wales gets less funding per person than areas of England with similar levels of ‘need’ like the North East of England. There, the NHS gets allocated £2,100 per person - 10% more than Wales, which gets £1,900 per person. The Barnett formula which works out how much money Wales gets was established as a temporary fix - in 1978. 35 years later its inadequacies are clear to all - except the Tories and the Welsh Lib Dems. The devolved Welsh NHS uses about 40% of the total Welsh Government block grant, so the impact of the unfair allocation on its NHS is huge. Reported figures show an average hip and knee operation waiting time in Wales of 170 days as opposed to 70 days in England. However, they do not necessarily indicate much poorer treatment. The English figures are not collected and reported on the same basis as the Welsh. The English rules allow the English waiting times "clock" to be stopped in different ways. Some of the difference in reported waiting times is almost certainly down to England being better at gaming the data rather than being better at treating patients.Cameron and his fellow pro-marketeers are keen to disparage NHS Wales because it has not followed England's path of dramatically expanding the amount of private involvement in health provision. But as Welsh Health Minister Mark Drakeford said on Friday, the Nuffield report “has shot Cameron’s fox good and proper”.

    Read more ...

Southern Daily Echo

  • Strike threat in NHS pay dispute as 6,000 union workers are set to be balloted.

    Health services across the south could be hit by strikes, with up to 6,000 union members in Hampshire set to be balloted for industrial action. Unison agreed to take the step as its bitter dispute with the Government over pay continues. The union’s health conference backed an emergency motion calling for the union’s 450,000 NHS members to be asked whether they want to strike and take other industrial action over the decision by ministers not to award an across-the-board one per cent wage rise, as recommended by a pay review body. This would see the county’s thousands of Unison members working at Southampton General Hospital, Southern Health, Solent NHS Trust and the Royal South Hants all balloted. Christina McAnea, the union’s national officer for health, said: “We’re not asking members to strike for one per cent. We’re saying strike for a pay award that starts to redress the value of your pay, strike for a living wage for all, and because a demoralised and demotivated workforce is not good for patients.”

    Read more ...

Health Service Journal

  • Serco in pole position for combined call centre contract.

    Suffolk commissioners plan to create a single “care co-ordination centre” as part of a contract bundling proposal which could put outsourcing giant Serco in pole position for the role. Proposals for the single call centre were unveiled in Ipswich and East Suffolk Clinical Commissioning Group board papers. These reveal that the board discussed a paper outlining exploratory plans for a “health and social care coordination centre” last month. Under the proposals, the call centre would field its NHS 111, out-of-hours and community services contracts, all of which are up for renewal. The centre would direct patients to new “urgent care hubs”, potentially based at one or both local acute providers, and community-based “spokes” which would also deal with urgent care matters. The CCG stressed the plans were only formative and that it had not yet decided what kind of contracting model to use or how many providers it would want to provide the services. Bundling together NHS 111 and OOH services is an idea being looked at by commissioners across England but drawing in community care, mental health and social care services is less common. Serco, which already provides all the CCG’s community services including the care-coordination function, has already built in the area what it calls a “care co-ordination centre”. The firm has described the centre as a “platform” to win more NHS contracts. The NHS 111 and OOH contracts, worth a combined value of around £7m, are both currenlty held by Harmoni, owned by Care UK. The CCG’s plans are being developed as part of a five-year strategic plan for Suffolk.

    Read more ...

  • NHS England faces 'unfunded' redundancy costs.

    NHS England has an “unfunded cost pressure” for 2014-15, which sources have linked to a large-scale redundancy programme it failed to finish last year. The lay-offs, understood to run into the hundreds, are being imposed as part of a major back office restructuring at the agency. The redundancies will affect NHS England’s primary care support services and two options for restructuring are up for debate at its May board meeting. One would see the function outsourced with some roles transferred to India. Under the second proposal, the functions would remain within NHS England but would be radically stripped back and centralised. The organisation is seeking to slash the bill for these services in two, from the £100m current cost to £54.1m. Both options would involve cutting several hundred jobs out of the 1,600 primary care support staff it currently employs. While NHS England originally intended to restructure primary care support services during 2013-14, the changes are not expected to be completed until September 2014. The agency set aside £130m in 2013-14 as a “transition fund” to cover restructuring costs, the most significant element of which related to primary care support service redundancies. But according to NHS England’s risk register last month, the way these redundancies would be funded was “still to be clarified”. Its January’s finance report shows a £141m unplanned surplus in running costs, and a December board paper on financial allocations refers to a £140m bill for “transition costs” in 2013-14 for which it had “no external funding”. This transition funding “will need to be found from savings elsewhere,” the December paper states. A discussion about the way the proposed lay-offs would be funded is slated for a private session of the the organisation’s May board meeting.

    Read more ...

Morning Star

  • The Tories Are Killing Our NHS.

    John Lister, director of Health Emergency, writes: Join the dots, you can see the emerging picture - the NHS is being suffocated through prolonged and deliberate cash starvation. What began under the banner of the Con-Dem coalition trying to address the deficits created by the banking crash has now emerged as a thought-out, long-term Tory plan to scale down public spending and permanently reduce the size of the state. David Cameron's recent denial that this is what they are doing is all the proof we need that it is indeed their plan. Everybody knows that the cash limits proposed by George Osborne between now and 2021 would be unsustainable for the NHS. The King's Fund admits it, outgoing NHS chief executive Sir David Nicholson admits it, even the Tories' own Office of Budget Responsibility has produced graphs showing the widening gap between required spending and available resources. Indeed OBR figures show that the share of national wealth (GDP) spent on the NHS, which grew in the 2000s, is set to decline from 6.5 per cent in 2012 to 6.2 per cent in 2015. John Appleby of the King's Fund has warned it could fall to 6 per cent or less by 2021, wiping out all the extra investment under Labour. The Nuffield Trust explained this situation in detail back in 2012, when it warned that the gap between demands on NHS services and the money available would grow to a massive £48 billion by 2021 if budgets remained frozen. Since then we have seen things get even worse - more billions of "unspent" NHS money have been clawed back by the Treasury, and £1.5bn of the frozen, allegedly "ringfenced," NHS budget has been forcibly handed over to councils this year to prop up the even more parlous finances of social care, with even bigger sums to be deducted next year. There's also a huge question mark over the future of NHS spending after the 2015 election - a year in which a further round of major cuts in public spending has been set in motion by Osborne, and many expect that as soon as the general election votes are counted the "ringfence" protecting the NHS against outright cuts would be scrapped if the Tories get back in. But even in the best-case scenario Osborne's plans would see a 10-year freeze in health spending while costs and pressures increase each year. So far almost all the "savings" that have been achieved towards the £20bn target by 2015 have come at the expense of long-suffering NHS staff, who have faced job losses, rising workloads and five years of pay freezes or below-inflation increases - with the threat of more to come. It's clear now that the increasingly desperate lack of cash is the driving force behind hospital cuts and closures and increasingly inadequate staffing levels in front-line services, resulting in poorer quality of care. But it's also again the excuse for various right-wing "think tanks," now including the King's Fund, opening up artificial one-sided "debates" over "hard choices" and hugely controversial policies, such as the hoary old Tory favourite of charges to see a GP - rejected by an overwhelming majority of the electorate in a recent poll - or for a stay in hospital or Lord Warner's loopy idea of a £10-a-month fee to "subscribe" to the NHS. Down the road of cuts there are only unpleasant choices and unacceptable compromises. So a change of policy is needed. It's clear that will not come from the Tories, who are only too happy to see the NHS reduced to its knees, putting even more pressure on those who can afford it to take out private health insurance. But another massive question mark hangs over Labour's policy on NHS funding. Ed Balls appears determined to lock the party in to endorsing all of Osborne's spending limits, which would mean it could be a Labour government that presided over the crash dive of the NHS into a cash-driven crisis. Anyone who spends any time in the real world knows that a promise to spend more to rescue the NHS would be overwhelmingly popular with the electorate, while clinging to policies that wreck our most popular public service could easily make a Labour government unelectable for many years. It's a no-brainer - but at present it seems there is no brain being used in shaping Labour's policy, which is only gradually evolving away from the Blairite fixation on markets, competition and the private sector, partially promising to reverse the Health and Social Care Act, and lagging behind the best Labour councils and campaigners who have been battling to save local hospitals and services. Now's the time to pile on the pressure for Labour to go big on the NHS, denounce Osborne's cuts and make the bold promise to rescue our health service from the Tories, who once again have starved it of cash and undermined it through competition and privatisation. It's decision time. Will Labour move forward with courage or dither and delay its way to ignominious failure and defeat ?

    Read more ...

Tuesday 15th April 2014

Daily Mirror

  • Hospital patients face higher risk of death at night because NHS cuts have left wards short staffed.

    David Cameron has been repeatedly warned his savage NHS cuts will lead to dangerous levels of patient safety in overstretched hospitals. The PM was accused of ignoring medical experts after a damning report revealed the chances of dying on wards at night was greatly increased due to a chronic shortage of nurses. Union chiefs fear the crisis could lead to another Mid Staffordshire-style disaster where patient deaths soared due to a lack of staff and sloppy care. A survey by Unison found 59% of nurses on night shifts are unable to deliver proper care because of cuts. The Tory-led ­Coalition has slashed 5,000 posts since 2010. The union’s Running On Empty report warns the shortages mean vulnerable patients are not being properly monitored at night to see if their condition is deteriorating or their needs are met.

    Read more ...

GP Online

  • Quarter of CCGs face 2014/15 deficit as experts urge NHS funding rise.

    One in four CCG finance directors fear their organisation will fail to achieve financial balance in 2014/ 15, a poll shows. Findings from a quarterly monitoring report by the King’s Fund think tank show that of 47 CCG finance directors polled, 26% are concerned or very concerned that their organisation will fail to achieve financial balance in 2014/ 15. A total of 40% were concerned that their CCG could end the 2015/ 16 year in the red. The findings show ‘deepening pessimism about the ability of the NHS to make ends meet financially’, the think tank warned.

    Read more ...

Guardian

  • Teachers left to pick up pieces from cuts to youth mental health services.

    Cuts to mental health and other services for young people mean teachers are increasingly having to fill the gap, even though schools do not always have the resources or training to provide the extra support pupils with mental or emotional issues may need.Child and adolescent mental health services (Camhs) have been particularly hard hit. These specialist services assess and treat children and young people with mental, emotional or behavioural difficulties. Typically, when schools cannot offer the support of their own counsellor, or when a child has especially serious difficulties, they will seek out their local Camhs for help. In many cases, local authorities commission and fund these services, and the impact of council budget cuts on Camhs in some areas has been severe. According to research by the charity Young Minds, two-thirds of councils in England have reduced their Camhs budget since 2010. And when the charity asked NHS trusts and councils about other mental health spending targeted at children and young people, such as youth counselling or specific services for schools, more than half had cut budgets – some by as much as 30%.

    Read more ...

Health Investor

  • Serco Health boss moves to The Huntercombe Group.

    Managing director of Serco Health Valerie Michie has been appointed chief executive of The Huntercombe Group, the specialist care division of Four Seasons Health Care. Serco has recently announced to investors that it will lose £17.6m in total on three of its NHS contracts, two of which it cancelled early. Michie will be taking up her new role in the summer. The three contracts Serco Health made losses on were: a contract to manage Braintree Community Hospital; a GP out-of-hours services contract in Cornwall, which was attacked by the Commons public accounts committee as “substandard” last July and a community care services contract in Suffolk. The former two contracts were the ones Serco cancelled early.

    Read more ...

Independent

  • Exclusive: NHS faces financial disaster in 2015 as politicians urged to find radical solution.

    The NHS faces a “financial crisis” next year as a budget freeze imposed by the Coalition risks pushing most hospital trusts into deficit, a leading think-tank has warned. In a grim message to all three major parties, the King’s Fund said that whoever wins next May’s general election will need to find more funding for the NHS or face up to the reality of “significant cuts to services”. The future of the health service is at risk unless politicians come up with radical solutions to the crisis in the coming months, it warns. Two-thirds of NHS trust finance directors were concerned that their hospital would go into deficit in 2015-16. Another 20 per cent said they were uncertain about the future, leaving a small minority confident that they could balance the books. The NHS in England has in effect had no real rise in spending since the Coalition Government came to power in 2010, and 65 trusts are already in deficit. The King’s Fund’s director of policy Richard Murray, a former economic adviser at the Department of Health, said that the scale of the slow-down in NHS funding under the Coalition was unprecedented, adding that the Government and the Opposition faced “a big political choice” over the impending crisis. Liz Kendall, Labour’s shadow minister for care and older people, said that the Coalition had exacerbated the NHS’s financial problems by “wasting billions” on reorganising the health service. She called on the Government to publish the final year-end finance figures in one annual account to allow Parliament and taxpayers to hold ministers to account.

    Read more ...

Monday 14th April 2014

Our NHS

  • Kings Fund suggests NHS fees - but is it really 'independent'?

    The question of NHS 'affordability' is used by think tanks and politicians to browbeat us into accepting regressive changes that suit the few, not the many. Better options to save money are ignored. The cost of healthcare is rising. We are living longer and technology, drugs, and skills are advancing. We currently spend £111bn (2013/ 14) on the NHS and we will need to spend considerably more in the future. Funding the NHS is about choices not affordability. If we invested a similar proportion of our national wealth as Germany and France do (both around 11.5%) the NHS would have about £25billion more than it does now. Affordability is the wrong question. The right question is what do we prioritise ? We could invest in the NHS and make it the best healthcare service in the world. We could refuse to invest in High Speed Rail 2 or the Trident replacement. Instead this month we have seen two proposals from 'independent think-tanks' about funding the NHS in the future. Both groups suggest we should all pay more through a range of additional fees. Most worrying are the proposals by The Kings Fund. This organisation has a rich history and was formed in 1897 to help the poor access healthcare in London. This appears to be the last thing on its mind today. Last week it published its Interim Report on the Future of Health and Social Care in England - 86 pages setting out what its ‘Independent Commission’ think must happen to save the NHS from becoming 'unaffordable' and 'unsustainable'. The author, Kate Barker CBE, a business economist, has suggested a range of 'options' to increase income for the NHS. By and large these mean those who use it having to pay more.

    Read more ...

Lancashire Telegraph

  • Fear for NHS as East Lancs physio goes private.

    Health campaigners fear another part of the NHS has been lost to the private sector after a controversial tendering process in Longridge and Chorley. Physiotherapy in Chorley, South Ribble and Greater Preston is run by Lancashire Care NHS Foundation Trust, but three new providers have now been chosen after the contract was put out to tender. Health chiefs have refused to reveal the names of the providers until a final decision has been made, but they are likely to be a mix of private companies and charities. The tendering followed the Any Qualified Provider process, which was introduced under the government’s health reforms and made it easier for non-NHS organisations to bid for health contracts. Julia Berry, Chorley Council’s lead member for health, said she ‘hated’ the health service being opened up to multiple providers ‘each pretending that they are better than the other’. She said: “I'm not convinced that any of them put the interests of patients first as they all seem to be interested in making money. I won't be happy until they can demonstrate that they really have the interests of patients at heart.” The service will remain free for patients, but will be provided by companies or charities that will receive NHS cash for the work.

    Read more ...

The Guardian

  • NHS nurses stretched to breaking point, says report.

    Half of nurses are working through breaks or beyond their shift, revealing a health service under severe strain, a report has warned. A survey of almost 3,000 nurses by Unison showed that two-thirds believed they did not spend enough time with patients, which most said affected care. Three out of five of those questioned felt that staff numbers led to lower standards of care, while almost half said they were looking after eight or more patients. The report, Running on Empty, said half of nurses were not confident about raising any concerns they had with their local managers Gail Adams, Unison's head of nursing, said: "One of the most damaging findings of this survey is how little has changed since last year. "Despite all the government rhetoric, despite the Francis, Keogh and Cavendish reports, the spectre of another Mid Staffs still looms large over the NHS. Progress on safe staffing levels has been glacial and that means poorer care and patients still at risk. "It's clear that despite nurses working through breaks and beyond their hours, they simply do not have enough time to give patients the care and attention they need. That is distressing for patients and for the staff trying to care for them. "The government needs to face up to the damage it is inflicting on patients and staff, by not introducing legally enforceable nurse-to-patient ratios, and take urgent action." The union claimed that the survey also revealed an overuse of agency staff in the NHS. In another study last week, Unison said the ambulance service was on the verge of breaking down because of stress levels among staff. The issues will be debated at Unison's health conference in Brighton, which opens on Monday.

    Read more ...

NHS Vault

  • What I would have said. Norman Lamb was on BBC Radio 4 Any Questions last night.

    The things he said about the NHS made me decide to call Any Answers today to refute his assertions. I called their number and spoke to a researcher who noted my response and said she would pass it on to a producer. I was then called back by a producer who checked my details but warned me that there was unlikely to be the time to discuss the NHS on this edition. She was right, the public apparently are more interested in a fiddling minister, an English Parliament or the middle class habit of taking kids on holiday in term time than the NHS. This is what I told the researcher, and I would have said on air. I am calling to refute the statement from Norman Lamb that the NHS is "horribly fragmented" and that his government is moving to a "joined up system". The effect of Norman Lamb's government's policies are that we are going in the opposite direction, the system getting more fragmented, not more integrated as Lamb claimed. I have had diabetes for 40 years and for the last 20 years I have had diabetic eye disease - retinopathy. I use diabetic services in my local hospital, I use services at their eye clinic and I use GP diabetic services. Before the election all three services were commissioned by one commissioner, the local Primary Care Trust. The commissioner plans a service and ensures that patients are able to access the service, and since there was one commissioner this meant that they could decide which services were carried out in hospital and which were provided by GPs. Since the Health and Social Care Act was enacted last April my care is commissioned by three different commissioners. The local Clinical Commissioning Group commission diabetic hospital services, the NHS England Area Team commission GP services and Public Health England commission the monitoring of my diabetic eye disease. Three different commissioners instead of one. Norman Lamb talked about "treating the whole person" but his policies have made that more difficult because there are three commissioners instead of one. I know where the CCG is located because the CCG are high profile, the other two organisations are not. I have only just found out that the NHS England Area Team who commission GP services are based 40 miles away from where I live and they commission GP services for 1.6 million people. GP are a thoroughly local service but are now commissioned by a remote and aloof organisation. I still do not know where Public Health England are based, they keep themselves to themselves.

    Read more ...

Friday 11th April 2014

The Guardian

  • Political interventions in NHS make little difference across UK, study finds.

    Healthcare has improved across all four countries of the UK in recent years, though waiting lists in Wales have lengthened following cuts in NHS spending, according to an authoritative report. The Nuffield Trust and the Health Foundation have compared NHS performance in England, Scotland, Wales and Northern Ireland since devolution. They find that, in spite of political mudslinging, variations in the running of the NHS across the four countries, including greater or lesser involvement of the private sector, have made little difference to outcomes. "Our study period coincided with the biggest sustained injection of cash the four health systems have ever seen, so it's perhaps unsurprising that staff numbers have increased and performance has improved," said Andy McKeon, senior policy fellow at the Nuffield Trust. "But what is interesting is that, despite hotly contested policy differences in structure, targets, competition, patient choice and the use of non-NHS providers, no one country is emerging as a consistent frontrunner on health system performance." Dr Jennifer Dixon, chief executive of the Health Foundation, said it was very good news that the quality of healthcare was improving everywhere. "But what is also humbling for politicians is that so far no one policy cocktail seems to be more effective than another on NHS performance. This is despite all the rhetoric about the benefits or otherwise of introducing competition among providers." England does marginally better than the others, but the gap has closed since 2010, when the Nuffield Trust last assessed the field. The biggest difference is the lengthening waits for common surgical procedures such as hip and knee replacements in Wales since 2010, as austerity budget-cutting set in. In 2012-13 a typical Welsh patient waited about 170 days for a hip or knee replacement compared with about 70 days in England and Scotland. But spending is slowing everywhere and it is too soon to assess the true impact of austerity measures across the whole of the UK, says the trust. Over the three years from 2010-11 to 2012-13, Northern Ireland spent 2% more, England and Scotland 1% more and Wales reduced spending by 1%.

    Read more ...

  • Half of Lesotho health budget goes to private consortium for one hospital.

    A flagship hospital built in Lesotho using public/ private financing with advice from an arm of the World Bank threatens to bankrupt the impoverished African country's health budget. More than half the country's entire health budget (51%) is being spent on payments to the private consortium that built and runs the hospital in the capital, Maseru, led by South-Africa-based Netcare, the biggest private healthcare provider in the UK. Oxfam, whose report is published on Monday, says the healthcare of the poorest people is at risk, as the Queen Mamohato memorial hospital draws off money that is badly needed for clinics in rural areas. The government is spending $67m a year on the hospital complex, which includes several primary care clinics, in loan repayments and the cost of patient care. Public/ private partnerships to build hospitals have a poor track record even in the wealthy west. PFIs (public finance initiatives) have proved a heavy financial burden on the NHS in England, where 22 hospital trusts in 2012 said repayments were endangering their clinical and financial future and one has since gone into administration because of PFI debts. Oxfam says this is a dangerous model for low-income countries in Africa. In Lesotho, it warns that the situation is unsustainable. It is sharply critical of the International Finance Corporation (IFC), the private sector arm of the World Bank, which advised Lesotho on the deal and is now discussing similar projects with Nigeria and Benin. "Everyone wants the people of Lesotho to have the very best quality healthcare. Oxfam is first to celebrate people being saved and healed at the new hospital. But the figures don't stack up," said the charity's health policy adviser, Anna Marriott. "The IFC is opening up Africa's health sector to private business but on this evidence it's a flawed and dangerous plan."

    Read more ...

Derby Telegraph

  • Firm’s poor performance means 21-month cut in Derbyshire ambulance contract.

    The firm which provides Derbyshire’s non-urgent ambulance transport has had its contract cut short by health bosses because of its “disappointing performance”. In July 2012, private company NSL took over a multi-million-pound contract from East Midlands Ambulance Service to provide this transport for patients in Derbyshire, Northamptonshire and Lincolnshire. But health bosses now say they are concerned that NSL is not meeting “key performance targets” – including how punctually it was dropping patients off at hospital and then getting them back home. This includes getting 95% of patients to their appointments 10 to 30 minutes before their appointment time, which NSL is not achieving. Two action plans were put in place last year to improve performance but members of the NHS Erewash Clinical Commissioning Group, the GP-led group responsible for overseeing NSL, said it was still disappointing. They have now decided to change the length of the original five-year contract to three years and three months, which means it ends in September 2015. In the meantime, the group said the specifications of the contract would be revised to make it “more in line with an NHS contract” – with new performance targets, financial penalties for failing to achieve them and “an incentive payment scheme to reward high-quality performance”. And it said patient transport services would then be put out to tender again in the summer – although NSL has confirmed it will bid for it again. Rakesh Marwaha, chief officer of NHS Erewash, said: “Clearly, the contract is not meeting the needs of our patients and delivering the high standard of service that they deserve.

    Read more ...

The Independent

  • Doctor who saved Lewisham Hospital's A&E department to stand for EU elections on pro-NHS platform.

    A senior A& E doctor who helped spearhead a campaign to save the emergency department at Lewisham Hospital in London is to stand in the European elections in the capital. Dr Chidi Ejimofo, a consultant in emergency medicine at University Hospital Lewisham, is the latest NHS employee to announce his candidacy for the National Health Action (NHA) Party – a new political movement which aims to alert people to privatisation and cuts in the NHS. Lewisham Hospital’s A& E department came under threat last year after administrators were brought in to transform services in the area. The Court of Appeal ruled that the health Secretary Jeremy Hunt acted unlawfully in seeking to shut wards at the hospital, which was performing well. Dr Ejimofo, who also appeared on television as part of an NHS choir in the BBC’s The Choir: Sing While You Work programme, said his decision to stand was driven by concern that the British public were “unaware of how close they are to losing” the NHS. “I witnessed first-hand senior clinical colleagues from NHS England intent on driving through Government policies that had been shown to both destructive and lacking in clinical evidence,” he said. “I witnessed Department of Health appointees in partnership with private sector management experts dust off an abandoned and discredited reconfiguration scheme at a cost of millions of pounds, while forgetting to address key concerns such as children’s health, mental health and women’s health.” The NHA Party was formed last year. Dr Ejimofo is the third candidate to stand for the party in London for May’s European elections, joining the comedian and actor Rufus Hound and the GP Dr Louise Irvine, who also campaigned to save Lewisham Hospital. NHA leader and co-founder Dr Clive Peedell will stand against David Cameron in Witney at the 2015 General Election.

    Read more ...

The Cockroach Catcher

  • It must be very obvious that all the talk about medical cover for visitors to England never mention the need for health insurance.

    Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US where cost of medical care is extremely high. It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all nobody in their right mind would dream of going to the US without proper insurance. We have managed to get people to insure their cars, why not their bodies. There is of course the need to fully control Health Insurers for those that live in England if they want cover. Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/ NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS. We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status. Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital. This will eliminate problems like PIP breast implants.

    Read more ...

The Mirror

  • Bupa 'harming NHS' by offering patients “bribes” of £2k to use public services instead of private hospitals.

    Britain's biggest medical insurer has been accused of harming the NHS by offering patients “bribes” of £2,000 to use public services instead of private hospitals. Bupa is offering the cash handouts to customers who agree to undergo cancer, heart and gynaecological ops on the NHS, we can reveal. A letter from the private health giant to a male cardiac patient explains: “The cash payment takes the place of private treatment funding. “If you are admitted to hospital under the NHS as an in-patient for any of the above procedures, we will pay you a fixed sum amount.” The cash payments have been condemned as “outrageous” and “disgusting” by doctors. And Labour demanded the Government immediately launch an investigation into the impact of the “bribes” on the NHS . Health campaigners raised concerns the “dumping” of patients onto the NHS would trigger “significant problems” in an “already over-stretched” health service. The official letter from Bupa detailing the scheme is headlined: “Giving our members improved choice.” The patient, speaking on condition of anonymity, said he was “shocked” to be encouraged to seek treatment on the NHS in exchange for money. The letter said: “The payment you will receive depends on the cardiac treatment you need. "Payments usually range from between £500 to £2,000.” Operations can cost fives times more than the cash payments offered by Bupa. One procedure patients can pocket £2,000 for having on the NHS is for a pacemaker to be fitted. Private hospitals charge a minimum of £10,000 for this procedure.

    Read more ...

Our NHS

  • Kings Fund suggests NHS fees - but is it really 'independent'?

    The question of NHS 'affordability' is used by think tanks and politicians to browbeat us into accepting regressive changes that suit the few, not the many. Better options to save money are ignored. The cost of healthcare is rising. We are living longer and technology, drugs, and skills are advancing. We currently spend £111bn (2013/ 14) on the NHS and we will need to spend considerably more in the future. Funding the NHS is about choices not affordability. If we invested a similar proportion of our national wealth as Germany and France do (both around 11.5%) the NHS would have about £25billion more than it does now. Affordability is the wrong question. The right question is what do we prioritise ? We could invest in the NHS and make it the best healthcare service in the world. We could refuse to invest in High Speed Rail 2 or the Trident replacement. Instead this month we have seen two proposals from 'independent think-tanks' about funding the NHS in the future. Both groups suggest we should all pay more through a range of additional fees. Most worrying are the proposals by The Kings Fund. This organisation has a rich history and was formed in 1897 to help the poor access healthcare in London. This appears to be the last thing on its mind today. Last week it published its Interim Report on the Future of Health and Social Care in England - 86 pages setting out what its ‘Independent Commission’ think must happen to save the NHS from becoming 'unaffordable' and 'unsustainable'. The author, Kate Barker CBE, a business economist, has suggested a range of 'options' to increase income for the NHS. By and large these mean those who use it having to pay more. These suggestions are really bad news for those over 60 and anyone who has any condition that may require frequent visits to their GP, other NHS service or prescription medication. Is the NHS really so ‘unaffordable’ ? By international standards, NHS expenditure per person is about average. After years of underinvestment, we now spend 9.3% of our country's annual wealth (GDP) on healthcare, which is about average for the 34 OECD countries. Removing the NHS ‘market’ would save at least £5 billion according to FullFact.org.

    Read more ...

Thursday 10th April 2014

Daily Telegraph

  • NHS spending doubles on private ambulances used for 999 calls.

    Spending on private firms to provide 999 ambulances across swathes of Britain has doubled in three years, an investigation has found. Senior medics and safety campaigners said they fear patient safety is being jeopardised by a heavy reliance on commercial firms to answer emergency calls. An investigation by The Telegraph reveals that the amount spent by the NHS on private and voluntary services to provide 999 care has risen from £24m to £56m in three years. The College of Emergency Medicine last night said the routine use of the firms was “incredibly wasteful and potentially dangerous” – with too little oversight of private firms which provide the service. Ambulance trusts said they had litttle choice, warning of a “national shortage of paramedics”.

    Read more ...

ITV News

  • Local MP 'demands' PM protects Westmorland General Hospital.

    South Lakes MP, Tim Farron, has demanded that David Cameron protect the Westmorland General Hospital. During Prime Minister's Questions Farron asked the Prime Mister to protect the hospital after it was announced that hospital bosses were thinking of 'gifting' the hospital to social enterprise. It's claimed two whistle blowers said social enterprise is 'a euphemism' for a private company that already runs another NHS hospital.

    Read more ...

Health Investor

  • NHS trust approaches private sector for help.

    Peterborough & Stamford Hospitals NHS Foundation Trust has approached private providers to potentially take over its management. The options the trust is considering include inviting a private operator to run the entirety of its services under a franchise model. It is also considering a sale or merger with another hospital, or renting its property to private sector hospital providers. It is expected to put out invitations to tender this summer, and submitted its plans to Monitor, the foundation trust regulator, for approval.

    Read more ...

The Socialist

  • Doncaster Care UK strike: national union support needed.

    Doncaster Care UK workers took a further two days of strike action on 6-7 April. This follows two seven-day strikes as around 100 care workers, members of Unison, fight back against privatisation of the NHS and cuts in pay. The strike remains solid, with at least 50 on the picket line each day. The determination of the strikers was illustrated when 50 waited for two hours in the pouring rain for TV cameras that didn't arrive. They were supposed to be filming the burning of more copies of contracts on a deadline day that the company has now extended for a third time! This shows that most workers have not signed up to the buy-out (14 months pay compensation in a lump sum to give up NHS terms and conditions and all legal rights). The company hopes that by extending the deadline to 25 April it can pressure more staff when they are back at work into accepting. A few more have returned since the start of the strike action but a hardcore, around two-thirds of those voting for strike action three months ago, remain committed to industrial action. Adrian O'Malley, Unison branch secretary at the Mid Yorkshire hospitals, told how nine days of strike action by 400 admin and clerical workers plus the threat of a branch-wide strike against similar pay cuts had forced his trust management into big concessions. Vicky Perrin, a low-paid worker in Yorkshire and member of Unison's NEC, said that she would be pushing for the union nationally to increase support for the strike. Money is pouring in that can sustain the strikers financially but more pressure needs to be put on the company, which is a major player in the increasingly privatised care sector. Unison should declare war on Care UK - the strikers are fighting for the future of the NHS and all care workers. Unison should also mobilise to support the Doncaster "FightBack" demo on Saturday 19th April and organise a mass protest outside Care UK's head office in Essex. Dave Prentis, the leader of this 1.3 million member union must be seen on the picket line during the next four-day strike over Easter. Such an escalation would signal the start of a serious campaign to defend the NHS against cuts and privatisation.

    Read more ...

BBC News

  • Cameron 'does not care two hoots for Welsh NHS', says Jones.

    Prime Minister David Cameron "doesn't care two hoots about the NHS in Wales", claims First Minister Carwyn Jones. Mr Cameron said Welsh Labour's health record was "dreadful" and the NHS in Wales was "a shambles". But Mr Jones said the prime minister was "trying to divert attention from his own problems - it's an old trick". He was speaking to BBC Radio Wales presenter Jason Mohammad about the NHS in Wales.

    Read more ...

  • Mental health cuts cost the NHS millions, charity says.

    Cuts to mental health care are costing the NHS millions of pounds long-term, a report has said. More cases of psychosis and schizophrenia now end up in hospital rather than being treated in the community, it said. Rethink Mental Illness published the report with the London School of Economics. Cuts mean fewer people have access to early intervention treatment, such as talking therapy, Rethink said. It said the NHS could save more than £50m a year by shifting its focus. Britain's recession in 2008 led to cuts across the NHS, as the government struggled to deal with ballooning deficits. The report said it costs on average £13 a day to support someone with psychosis or schizophrenia in the community. It said this compared with the £350 average daily cost of keeping a mental health patient in hospital. Meanwhile, 54% of the psychosis budget was being spent on inpatient care rather than on preventive community services, the report found. Family therapy, where families of people with psychosis and schizophrenia are supported, cognitive behavioural therapy, and peer support could help cut long-term costs of care, it said.

    Read more ...

Tuesday 8th April 2014

Guardian

  • NHS may need to apply more patient charges, says report.

    More patient charges may need to be introduced in the NHS, including fees for hospital and GP appointments and removing the blanket exemption from prescription charges for the over-60s, according to a report from the King's Fund, which suggests the current health and social care systems are no longer fit for purpose. The interim report from the five-strong Commission on the Future of Health and Social Care in England, chaired by Kate Barker, a former Bank of England economist, has been published as all three main parties decide how to approach the issue of social care in their election manifestos. The report concludes that social care is already in crisis and that the NHS is heading the same way. It points to "hard choices" that must be looked at "squarely in the eye", with several possible means of increasing revenue. Outpatients could be charged £10 for hospital appointments while those who fail to turn up could also be charged as a penalty. Costs for hospital stays or hospital treatment may also be considered. Extending charges for dentistry could also increase revenue, and a fee for visiting the GP – £5 to £25 – could be introduced, the report said.

    Read more ...

  • Why the new duty of candour could be detrimental to the NHS.

    Dr Michael Devlin, head of professional standards and liaison at the MDU, writes: Moves to introduce a duty of candour to ensure patients get an explanation when something goes wrong may seem positive, but the potential for confusion could cause problems. Candour is the duty to tell a patient when something has gone wrong, to try to put matters right where possible, and to apologise. For many years doctors have recognised the need for openness and honesty; this has resulted in opinion polls consistently placing doctors and nurses at – or near – the top of the most trusted professionals. Curious therefore, that the government sees a need to introduce a further legal duty of candour on hospitals, other healthcare organisations and extend it to GP practices. The implication is that medical staff can't be trusted to tell patients when something in their care or treatment has gone wrong. To add to the confusion there are different thresholds at which patients will be told when something goes wrong. Since 1955 the MDU has advised members that patients should be given an explanation if something goes wrong. In 1986 we advised doctors that "the patient is entitled to a prompt, sympathetic and above all truthful account of what has occurred ... It is very important that a sincere and honest apology is made." And in 1998, doctors' ethical duty was clarified by the General Medical Council (GMC) when it introduced an obligation to be open and honest when things go wrong. The MDU is often the first port of call for doctors. Often by the time they contact us for advice they have already told patients what has happened and have apologised. In a recent survey by the MDU of more than 600 doctors, 99% knew about their duty to be open and honest with patients. Of those doctors who had been involved in an incident (374), over 95% reported that an explanation and apology was provided to the patient or their relative. Given this, we question the need for additional legislation. The contractual duty of candour was introduced into standard NHS contracts in England in 2013 and applies to organisations, rather than individuals. It requires that patients or their relatives be told about moderate or severe harm, or incidents that result in death, and recognises it is almost always doctors who do this. Now the government intends to introduce a second, statutory, duty of candour on organisations, by amending the Care Quality Commission's (CQC) regulations. Patients might be surprised to learn that whether there is a legal duty to tell them might depend on an NHS manager grappling with definitions as to what fits into the contractual or statutory duty (or both). Doctors, however, know they need to tell patients when something has gone wrong. The proposed statutory duty, with possible criminal sanctions, is likely to do very little to contribute to the open culture of learning from mistakes that we need to build the safest platform on which to deliver care to patients. It could instead lead to delay and defensiveness that are inconsistent with the delivery of safe care.

    Read more ...

Financial Times

  • NHS hospital trust seeks private help.

    Britain’s most indebted NHS foundation trust has approached private sector bidders to take over its management in a move that underscores the depth of the financial crisis in the National Health Service. Peterborough and Stamford NHS Foundation Trust, which runs two hospitals in Cambridgeshire and Lincolnshire, has been left grappling with a £40m annual budget deficit after using the Private Finance Initiative (PFI) to build a new hospital. The trust spends £42m a year servicing its PFI debts – the largest in the country – and receives a £40m subsidy from the Department for Health to stay afloat; a situation the professional services firm PwC has warned is “financially unsustainable”. The trust is expected to put out invitations to tender this summer, and submitted its plans to Monitor, the foundation trust regulator, for approval last week. This could see a private sector operator such as Serco, Circle Health or the private equity owned Care UK taking over the management of an entire foundation trust for the first time. Monitor confirmed that this was the first time an entire trust had sought a private sector bidder. The search for a private sector partner at Peterborough underscores the extent of the funding crisis faced by hospitals built under PFI, the off-balance sheet initiative introduced by John Major and continued under former Labour chancellor Gordon Brown and the present coalition government.
    Private sector companies forward-funded the construction of public projects, and are being paid back with interest over decades, while picking up additional fees for service contracts attached to the deals. The total cost of the Peterborough hospital is expected to near £2bn over the 33-year life of the scheme, nearly seven times the original £289m capital value of the building. The trust is considering a range of options, one of which includes inviting a private sector operator to run the trust’s services under a franchise model. Other options include a sale or merger with another district hospital, or renting out part of the site to other private hospitals to run services from. The hospital’s fourth floor is currently rented out as less profitable office space, but could take 100 beds. The deal will be closely watched by other NHS trusts, which are seeking to redesign hospital services. The likely invitation for private sector companies to tender comes amid fresh signs of political nervousness over the role of the private sector in healthcare, and is likely to spark claims that the privatisation of the health service is accelerating. Last month, the NHS embarked on its biggest outsourcing of services so far by inviting companies to bid for £1.2bn in contracts to provide frontline cancer treatment and care for the terminally ill in district hospitals across Staffordshire. However, there is frustration among private providers at the perceived failure by Jeremy Hunt, the health secretary, to give a stronger signal of support for their entry to the sector.

    Read more ...

Our NHS

  • Don't believe Cameron's hype - the Welsh NHS has much to teach the English.

    Cameron this week labelled the Welsh NHS 'a scandal', and some Blairites have echoed him. But Wales is 'doing more with less' more effectively than the English NHS - and without privatisation. The Welsh created the NHS, modelled on miners’ mutual aid schemes. They have so far strongly resisted attempts to return healthcare to market competition. Since devolution a new generation of socialists has been quietly running NHS Wales as a public service - not for private greed. And for this reason, the Welsh NHS is now under attack from a propaganda Blitzkrieg. The crescendo of political and media attacks on NHS Wales are light on evidence. So why do we hear hardly a squeak of dissent from the opposition front bench in Parliament, to defend their own Party in Welsh regional Government ? Nine out of 10 patients who used Welsh hospitals and GPs last year were satisfied or very satisfied with their care. In contrast across Britain as a whole only six out of 10 respondents said they were satisfied with the NHS (a sharp decline from peak approval of 71% in 2007). Why is Labour not pointing this out ? In the English NHS central planning has virtually disappeared. Each hospital is supposed to compete with its neighbours for survival. Every state service must compete with other services for its share of the budget. Labour's regional government in Wales, on the other hand, still believes that public services should be centrally co-ordinated and planned towards shared social goals. If a local hospital is performing badly, people in Wales still expect state action to improve it, not personal choice to go to a competing hospital elsewhere. Welsh central planning has enabled co-ordinated action across separate institutions and budgets. In Cardiff hospital A& Es and local police share anonymised information, leading to fewer violent incidents and hospital admissions. There is no question that times are hard. The Welsh government has faced disproportionately higher cuts in its centrally allocated funding - 20% across the board, a context many saw as politically motivated to discredit the Labour-led government. Faced with such bitter austerity, the Welsh Labour Government decided not to ring fence NHS spending. Instead it took advantage of its more planned environment to allow it to better integrate health and social care services. As a result, councils’ spending on all services (except education) fell by only 9.3% in Wales last year, compared with 15.6% in England, according to the Institute for Fiscal Studies. But key indicators for Wales NHS are moving strikingly in the right direction as a result of improved working across primary community and acute healthcare and social services. In Wales, emergency hospital admissions of people with chronic conditions fell sharply in 2011-12, by almost 15% for diabetes and 17% for lung diseases. Similar falls were not seen in England. In Wales, re-admissions for these diseases (probably the best single measure of clinical failure) dropped even more steeply, by almost 30% and 25% respectively. In Wales there is one minister with overall responsibility for both the NHS and Social Services. There are strong democractic Local Health Boards and the still powerful role of the Chief Medical Officer for Wales. In England, in contrast, the Health Secretary now has no responsibility to secure a comprehensive health service, the Chief Medical Officer role has been marginalized to the point of invisibility, the whole public health system is in tatters, and Public Health medical staff are streaming out of the service. Of course there is plenty of genuinely bad news about health in Wales, and some (though much less) about health care in Wales. The Welsh have been poorer and sicker than the English for at least 300 years. They have more of the principal causes of ill-health and premature death: more heavy industry, more unemployment, and lower average earnings. Valid comparisons would compare Wales not with UK, but with the North East of England. But the Blitzers don’t care about validity. Any stick will do, to keep Britain on the Right course - to privatisation. So far, the attack on the Welsh NHS has met little effective resistance from Labour at Westminster. Labour should be proud - not ashamed - of its record in Wales. We should all reject the Blair-era voices calling for more markets, ‘choice’ and 'private solutions' on both sides of the border.

    Read more ...

Western Morning News

  • Stop trying to sink the NHS.

    David Halpin FRCS writes in a letter: SS NHS – steady as she goes ? This large and complex ship is steaming at maximum knots. It is crammed to the gunwhales with passengers. On the bridge and down in the engine room there are the GPs, specialists, nurses and all the important others keeping the ship on course and the screws turning. ‘Sparks’ the radio officer is doing his best to keep up with the stream of often contradictory messages coming over the short wave from the owners’ offices. Hunt, Dr Poulter, Nicholson, Keogh, Hakin et al are barking out the orders across the ether. The hands are moving the deck chairs furiously about as directed from the Westminster head office, whilst the band plays on, and on. There is dense fog and there are icebergs about. Should the officers of the watch go to ‘slow ahead’ and change course ? If the course and speed are held, disaster is sure. If the SS NHS sinks, it will be sunk for ever. It will never be re-floated. So let the head office pipe down. Let these people think deeply before they demand yet more ‘change’ to add to the lowered morale and the confusion on board. And have quiet on board so that everyone from those key GPs to the porters can apply their knowledge and their skills to this fine ship. Every man jack is to know his task and to stay at his station. That way, SS NHS will continue to steam safely ahead. As she comes into port, with flags streaming, we will cheer in our pride for a fine ship and as fine a crew. Encourage the workers. Let them get on with it, without damnable interference.

    Read more ...

Morning Star

  • The Cat Is Finally Out Of The Bag.

    Michael Meacher, Labour MP for Oldham West and Royton, writes: Tory-in-disguise Lord Warner has confirmed what campaigners knew all along - the plan to end our NHS as a service free at the point of use. So now we know the latest steps being proposed to make the NHS into a full-blown private health service, just like it was before 1948. The various steps to achieve this supreme goal of the private marketeers have been prepared right from the start with great care. First, Tony Blair encouraged and then pressured NHS hospitals to become foundation trust hospitals, with more independence and financial self-reliance - the first nudge towards becoming self-standing suppliers within a competitive market. David Cameron took this further by announcing that all health services would be open to tender by any qualified provider. That began the massive process of privatising and outsourcing every chunk of the NHS that the free marketeers, nearly always a very small cabal of the biggest healthcare multinationals, could get their hands on - or rather teeth into. Meanwhile the Lansley plan for the wholesale privatisation of the NHS had been hatched in deepest secrecy between the Tory high command and the big private healthcare companies before the election, with not a word about it in the Tory 2010 manifesto because if it had been known it would have blown the Tories away. But all the time the mantra was repeated that the NHS would remain free at the point of service. But now the cat has been let out of the bag - that the Tories and their big corporate friends had in fact intended all along that it would become a fully paid-for service. Only they didn't dare say so before now. We now see why the Tories, especially Jeremy Hunt, have been so keen to demean and vilify the NHS on every occasion they can over the last several months - cue the need to junk the old, failing NHS and to announce the dawn of a brand-new burnished private healthcare system and - what a surprise - you're going to have to pay for it if you want to get any medical attention. Oh yes, they've fixed the initial fee at the loss leader level of £10 a month, but don't be taken in by that. If every adult in the country paid the £10 a month, this new tax would raise £5.4 billion. If that were tripled, it would offer serious money for the healthcare privateers. It is incredible that Warner has the gall to claim the NHS is "unaffordable" without mentioning that the Tories have deliberately imposed a £20bn cut on the NHS over the current five-year period to put it under intolerable strain and potential breakdown in order to pave the way for a fully paid-for private service, which has always been their secret aim. But then the Tories would never put profit at risk by telling the truth.

    Read more ...

Friday 4th April 2014

BMJ

  • 56 private organisations were granted access to NHS patient data last year.

    Around a third of the organisations that gained access to NHS patient data last year were from the private sector, a new register has shown. The Health and Social Care Information Centre (HSCIC) published a register1 of approved data releases on 4 April, describing it as part of a drive towards greater transparency and building public trust. The register showed that, between April and December of last year, of the 160 organisations granted access to data 104 were health and social care organisations or bodies such as universities and charities, and 56 were private sector organisations. Among the private organisations were McKinsey, AstraZeneca, Roche, PwC, Bayer, Finnamore Management Consulting, Care UK, Ernst & Young, and Dr Foster Intelligence, as well as the BMJ Publishing Group. Overall, data were released 347 times in pseudonymised form (with key identifiable details removed such as NHS number, full postcode, and full date of birth) and 75 times in identifiable form—although in the latter cases patient consent was obtained or there was a section 251 exemption, where identifiable data can be released without consent if approved by an independent advisory group. The register will be updated quarterly from now on. Kingsley Manning, HSCIC chairman, said, “By placing this register before the public the HSCIC is taking an important step towards the full transparency needed to help the public gain confidence in the services we provide. “This is about ensuring citizens and patients are clear about how data is used to improve the health and social care received by them directly and by communities as a whole.” A separate review of data releases will cover those approved from 2005 to 2013 by the present information centre’s predecessor, the NHS Information Centre, and is due to be published next month.

    Read more ...

Our NHS

  • Who is behind Reform's call for NHS charges?

    People in England should be forced to pay a £10-a-month NHS "membership charge" if we want to save the service from ruin, according to a new report by the think tank Reform. Solving the NHS care and cash crisis also recommends that people staying overnight in hospital should pay ‘hotel charges’. Reform, which has long advocated free-market reforms to the NHS, is funded by companies which would benefit greatly from the introduction of changes to the way we pay for healthcare. These have included General Healthcare Group, the UK’s largest private hospital firm, but more significantly a large number of corporations in the private health insurance industry. In recent years Reform has been funded by: Prudential, Legal & General, Scottish Widows, Aviva, Benenden insurance, Gen Re (reinsurer of health products) and US health insurance giant UnitedHealth, which has faced accusations of overcharging and malpractice. The industry’s trade body, the Association of British Insurers, is also a donor. Prudential was Reform’s most generous funder in 2012, handing over £67,500. What it received in return is not known. Reform describes itself as determinedly independent and states that none of its research is funded by either companies or individuals. However, in the mid-noughties, a lobbyist for Standard Life Healthcare, which is now part of PruHealth, grumbled about the communication challenge facing the private healthcare industry (page 6 of pdf). When money for health services is tight, how to get more British people to buy private health insurance, without being seen to undermine the NHS, was proving difficult. 'The problem we will always have is that we’ll get accused of “Well you would say that, wouldn’t you ?”’ he told an industry roundtable on the Future of Healthcare.

    Read more ...

The Guardian

  • Jacky Davis - There's no financial, ethical or clinical justification for NHS charges.

    Simon Stevens, until recently a vice-president of the US health giant United Health – and ersthwhile Blairite health adviser to New Labour – took over this week as the NHS chief executive. It can hardly have been by chance that his arrival coincided with two new reports recommending the introduction of up-front charges for NHS care –one from the King's Fund, the other from an unholy alliance between the former Labour health minister Lord Warner and the rightwing thinktank Reform. Both reports start from the unchallenged but erroneous assertion that the NHS is "unsustainable", and are padded out with a plethora of platitudes about more care in the community and the merging of health and social care services. But at their heart are radical recommendations for the introduction of upfront charges for the NHS. In the case of Reform, this would be a "suggested" £10 "membership fee" a month. Research is clear that charges of this sort deter the poor and the elderly – the very people who need the NHS most – and as a result they present later with more advanced illness. To Warner and the pundits at Reform £120 a year may not look much, but it will feel like the last straw to those already struggling with the consequences of austerity. The public understand this and, as a recent survey shows, are overwhelmingly against upfront payments. There is no financial, ethical or clinical argument in favour of upfront charges for the NHS. The most efficient and the fairest way of funding it is through progressive central taxation. Flat-rate charges, such as those proposed, would need to be means-tested, a fact that Warner was forced to concede in a radio interview. He also admitted that the charges as laid out would only raise £2bn a year, a drop in the ocean of the NHS funding gap. This raises the question of the point of introducing a system of means-tested charges that would almost certainly raise less money than it would cost to administer. But there is no secret about the agenda here. Reform is funded by the very people who would benefit from undermining the fundamental principles of the NHS. The list of their donors includes major insurance companies, management consultants and private healthcare providers.

    Read more ...

Health Service Journal

  • Competition to run district general hospital is abandoned.

    A tender process for the running of George Eliot Hospital Trust has been abandoned, it was announced today. The three remaining bidders in the process, run by the NHS Trust Development Authority, were South Warwickshire Foundation Trust, which wanted to take the trust over, and Circle and Care UK, which had both submitted bids to run it as a franchise. HSJ understands the decision does not mean the NHS is abandoning management franchising as an option for NHS trusts altogether. It remains an option for Weston Area Health Trust, in the south west. George Eliot chief executive Kevin McGee, speaking to HSJ about the decision to scrap the process today, said it was due to recent improvements in clinical performance, particularly in its emergency department and avoidable harm. However, he also indicated that an ongoing national review of how hospital “chains” could be established in the NHS was a factor. He said the trust had developed a relationship with University Hospitals Birmingham Foundation Trust, which was helping it improve care quality. George Eliot was “buddied” with the UHB when it was placed in regulatory special measures last year due to care quality concerns. UHB chief executive Dame Julie Moore is an outspoken advocate of small district general hospitals being run in “chains” by larger providers, such as hers. Mr McGee said about the link to UHB: “Its an important relationship for us. The decision that has been made is the George Eliot Hospital will continue as the George Eliot Hospital for the foreseeable future. We recognise that to do that, that we will have to, and want to, continue with the support from UHB.”

    Read more ...

  • CCG leaders: Reforms have not improved control of cost and activity.

    The ability of the NHS to control costs and curb hospital activity has not improved with the government’s reorganisation of the NHS, according to many leaders of the clinical commissioning groups created by the reforms. HSJ’s latest Barometer survey, carried out with PwC, asked CCGs’ most senior leaders to rate whether the NHS’s situation in various important areas was now better or worse than it was before the reforms. The findings come a year after CCGs became statutory bodies on 1 April last year. For several issues the majority said the situation was either better or significantly better. These included GP engagement, NHS relationships with local authorities and the ability to create better integrated services. CCG leaders also rated their confidence they could make significant improvements in the next year at a strong 7.3 out of 10. However, the findings suggest many CCG leaders feel they cannot control critical aspects of their health system. A majority said the situation was either the same or worse in areas including commissioners’ ability to control costs, to stabilise hospital activity, and to support sustainable providers. The greatest concern was about areas CCGs do not directly control such as specialised services, which is commissioned by NHS England, and public health, for which responsibility is divided between local authorities, Public Health England and NHS England. However, a significant minority of 40 per cent said capacity to change acute and general hospital services – which are within CCGs’ responsibilities – was the same or worse.

    Read more ...

New Statesman

  • The biggest threat to the NHS is the Tories, not the EU-US trade deal.

    There are good grounds for believing we will succeed in ensuring the NHS is exempt from the transatlantic agreeement. Late last year, George Osborne lauded forecasts from the European Commission that Britain will have the fastest-growing economy in Europe over the next two years. He was silent, of course, on the same report’s view that Britain will also have the biggest 2014 trade gap of any major industrial country. At 4.4 per cent of GDP, this trade deficit would be the largest since the Second World War with the exception of the Lawson boom year of 1989. George Osborne has spectacularly failed to secure the "export-led" growth he promised in 2010, while our economy is still smaller and production levels lower than in 2008 before the global financial crisis. It’s plain that the UK badly needs negotiations on the EU-US trade and investment deal (TTIP) to succeed. It would be a global economic game-changer and could set the standards for worldwide trade and investment for a generation in the absence of any serious moves on multilateral trade. And it is different to other trade deals. It’s the biggest ever bilateral trade negotiation and the first between economic equals. The EU and US are evenly matched in economic wealth and power, and together we account for half the world’s economic output. Despite the potential boost to British jobs and economic growth, there is growing concern about the consequences of any agreement on public services, and especially on the NHS.When I’ve challenged ministers to commit to securing an exemption for the NHS in the House of Commons, they’ve refused to do so. So no one can blame NHS campaigners for fearing the worst. As the BMA has argued in a letter to former trade minister Lord Green, commercialisation is bad for patients and bad for the health service. Any trade deal that advanced Tory moves to turn the NHS into a full-scale market, and privatise health services, would be fatal. But I believe we can safeguard the NHS, settle such fears and make sure people see that the real threat to the NHS comes from the Tories, not TTIP.

    Read more ...

Mirror

  • NHS will charge a fee over my dead body - whatever 'Labour' traitors and private healthcare vultures might think.

    But it had its contract broken up by the Coalition into 46 tenders and sold to the cheapest providers for the far inferior 111 service. They included private healthcare companies who replaced nurses with call handlers. As a result, attendances at A& E went up by 53 per cent and ambulance call-outs increased, trebling in some areas. NHS Direct only won 11 of the tenders. It could not afford to run the service on such a small scale – that’s why it had to shut on Monday. The same day Lord Warner, a former Labour health minister, wrote in a report for a right-of-centre think-tank with close links to the Tories that the NHS should charge people a £10 monthly membership and £20 a night to stay in hospital. It already does charge people – it’s called National Insurance and general taxation. The professed Labour supporter’s call, in his pamphlet and a newspaper article, is in direct opposition to the principle of treatment based on need, not the ability to pay. He rules out further taxation to fund the £30billion gap in funds for the NHS. Perhaps he could consider, for a similar amount of our money, scrapping future spending on the Trident nuclear deterrent. Lord Warner, a career civil servant, was actively involved in advising private healthcare firms who have lucrative contracts in the NHS. Last year he was the only Labour peer to vote with the Conservatives and Liberal Democrats on proposed NHS regulations to allow companies to bid for almost all health services. When he was called before a ­parliamentary select committee to discuss his lobbying as a peer for private ­healthcare, he said: “The point I’m trying to make is that we do not have constituents. There is not a group of people who have voted for us... We are not elected to represent a particular geographical area and we are not paid a salary.” But he was nominated by Labour to be one of its peers. Warner admitted he does not ­represent the people. Instead he ­speaks up for the private healthcare industry through his private ­consultancy firm Sage Advice Ltd.

    Read more ...

Thursday 3rd April 2014

GP Online

  • Contract uplift delivers just £1,600 per practice, as RCGP warns of 17% cuts.

    Practices will gain just £1,620 in additional funding on average from last month's pay award, official figures suggest, leaving 'little option' but staff and service cuts.The revelation came as the RCGP warned of a ‘grim future’, with general practice funding set to plummet by a fifth over the next three years. Research commissioned by the college predicted a 17% real terms fall in general practice funding by 2017. Official details of the implementation of the 2014/ 15 contract, which came into effect on 1 April, show global sum payments will rise by £7.31 per patient, from £66.25 to £73.56. NHS England confirmed to GP that the uplift would deliver just 27p of the £7.31 per patient global sum increase. An average practice, with a 6,000-patient list, will receive just £1,620 additional funding this year. Such a ‘tiny rise’ would be ‘laughable if it wasn't so serious’, GPC deputy chairman Dr Richard Vautrey said. ‘Practices across the country have already made any possible cost efficiencies they can and so, taken together with the big cuts in PMS and correction factor/ MPIG funding for the majority of practices, they will now have little option but to start looking at reducing staffing levels and making service cuts. This is bad news for patients as well as GPs and their staff.’ Research by financial services firm Deloitte found that on current trends UK general practice funding will fall to a ‘record low’ of just 7.29% of the NHS budget by 2017/ 18 – down from 8.39% in 2012/ 13.

    Read more ...

Financial Times

  • Regulator scales back order to sell UK private hospitals.

    Private hospital operators were able to claim a significant victory after Britain’s competition watchdog scaled back plans to force them to sell nine luxury hospitals. The surprise retreat comes despite a two-year investigation into the £5bn private healthcare industry in the UK that concluded they had overcharged patients because they face little competition. The Competition Commission, rebranded the Competition and Markets Authority, said that just one or two hospitals would need to be sold, both by HCA, the world’s largest operator of private hospitals. Despite the climbdown, Mike Neeb, president and chief executive of HCA International, said he was “furious and possibly a little paranoid” that it had been singled out by the watchdog. The Wall Street-listed corporation was told it must sell either the Wellington Hospital in north London or two smaller sites in the capital: London Bridge and Princess Grace hospitals, all three of which are popular with royals, celebrities and the wealthy. The commission’s decision marks a significant climbdown from its original determination, made in August, that BMI, HCA and Spire Healthcare had to sell up to 20 hospitals. In January the regulator reduced this to nine, seven by BMI, and two by HCA. Both companies had launched vociferous attacks against the decisions, suggesting the rulings would have been challenged in the courts.The watchdog said it had “compelling evidence” that HCA, which operates seven hospitals in London, was charging significantly more than competitors and was overcharging for routine procedures. It found that HCA accounted for more than 60 per cent of private cancer care, orthopaedics, obstetrics and gynaecology, and gastrointestinal medicine in the capital.It will also review and potentially block any proposal by a private hospital operator to enter into an agreement to run a private patient unit in an NHS hospital in an area where it is judged to lessen competition.

    Read more ...

Left Foot Forward

  • 4 things you should know about new NHS England chief Simon Stevens.

    The new head of NHS England, Simon Stevens, only started his job yesterday, but he is already facing criticism from unions over comments made by him about the role of private healthcare companies in the NHS. In a speech delivered to 300 healthcare professionals in Newcastle yesterday, Stevens praised “the innovation value of new providers” in the provision of health services. Both Unite and Unison have criticised the speech. But there are some additional things that you should know about Simon Stevens, things which arouse more suspicion about what he might be planning to do to the NHS.

    Read more ...

Guardian

  • How much do we want to keep the NHS publicly funded and free?

    Lord Warner, the former Labour health minister, must be delighted with the reaction to his report proposing, among other things, a £10-a-month NHS "membership fee" and the imposition of £20-a-night "hotel" charges for hospital stays. Despite the criticism heaped upon his ideas (and upon him personally), Warner has posed an important question – "how much do we want to keep a health service publicly funded and free at the point of delivery ?" It is his description of the NHS as "outdated, cosseted and unaffordable" that is crucial – a challenge to the dominant paradigm of the past 60 years. Warner makes two assumptions. First that the austerity programme based upon reducing public spending is the only way to deal with the deficit, and secondly that the NHS of the future is only viable if people pay more towards the costs. His regressive NHS Poll Tax of £10 per person per month (regardless of income) is certainly an odd subscription alternative to a more straightforward increase in general taxation or national insurance contributions. Warner estimates that the measures he proposes would raise around £6bn a year to plug the NHS funding gap but fails to mention other ways of raising many more times this amount. As an alternative to Warner's menu of charges and co-payments we might consider: the official estimate (and almost certainly an underestimate) of annual uncollected tax is £32bn, yet HMRC is suffering staff cuts. Uncollected VAT alone accounts for around £10bn a year. A capital gains tax levy on the £200bn of wealth accumulated by the richest 1,000 people (yes individuals) in the UK since the financial crash would raise about £50bn. The unwanted and botched NHS reorganisation has cost around £4bn, not much more than the amount lost to the exchequer by the under-valuation of the recent sale of Royal Mail. Many other examples could be cited of misjudged priorities and wasteful expenditure. While the NHS is far from perfect in its use of resources, Warner surely sets up a false dichotomy in claiming that funding the NHS risks seriously damaging other important public services. Hitherto, breaches of the principle of publicly funded healthcare free at the point of use (such as prescription charges) have been portrayed as regrettable but necessary aberrations. The importance of Warner's report is that he challenges the very principle underpinning the NHS. Although the membership charge of £10 a month might seem modest to many, it would hit those on low incomes hard and would, inevitably, be a rising annual charge. Do we want to slide down this slippery slope towards charges, co-payments and dependence upon private medical insurance cover ? The Scots and the Welsh would certainly not be coming along for the ride, and we can be sure that no sane political party will want to go to the people in 2015 offering a manifesto of co-payments for healthcare. Polls consistently find huge support for not only maintaining the current system of funding but also for extending it to social care. So it is a measure that is both unfair and unpopular. However, what Warner has helped create is a "zombie policy" – currently politically dormant but waiting to be given the kiss of life in the future. The political dilemma is that while polls consistently show high support for retaining the current funding model for the NHS, the same polls show much less willingness to countenance higher taxes to pay for it. Warner has posed an important question and come up with the wrong answer, but can the electorate be persuaded to will the means as well as the ends ?

    Read more ...

Tuesday 1st April 2014

Full Fact

  • How much is the 'NHS market system' costing?

    “We’re wasting £10 billion a year at the moment in the English NHS on a market system that nobody wants except the private sector.” Dr Jacky Davis on BBC Radio 4 Today, 31 March 2014.

    The think tank Reform proposed today a £10-a-month NHS membership charge – one of a number of measures it thought could improve NHS funds. Dr Jacky Davis, co-author of campaign group NHS SOS, criticised the perceived trend towards ‘market-centred’ funding. Dr Davis’ estimated that this approach had a £10 billion annual cost attached, based on a calculation of the difference in administration costs in the 1980s compared to the modern day. But estimates vary, are difficult to trace, and provide no guarantee of comparability across the years. A full analysis of the financial impact would also need to take into account the possible benefits of the changes: in reality, there’s no robust way to quantify either. The National Health Service and Community Care Act in 1990 first introduced the ‘internal market’, where health authorities were able to manage their own budget. The internal market system was adapted recently by the Health and Social Care Act in 2012, which put GPs in charge of budgets via Clinical Commissioning Groups. Dr Davis told us that her cost estimate was based on the increase in NHS administration costs since the market system was introduced. She said these had increased from 6% of NHS spending before the internal market, to about 15% now. The 9% difference amounts to £10.9 billion of the 2012-13 NHS resource spending total of £121.4 billion. However there are problems with this approach. The Department of Health has previously published estimates of administration costs going back to 1996-97, which put them at 4.9% in 2004-05 and 6.1% back in 1996-97. However it is explicit in saying that these aren’t directly comparable, so we have no official figures to compare across the years. The only other way that we can attempt to quantify cost implications from the market system is looking at the more recent changes. The Government’s Impact Assessment of the 2012 Health and Social Care Act actually estimated that the commissioning reforms would bring about a reduction in the administrative costs by about a third, in real terms - or around £1.07 billion per annum. Whether or not these savings will materialise in practice remains to be seen.

    Read more ...

Shropshire Star

  • Campaign launched to save Shropshire hospital services.

    The Shropshire Defend our NHS Campaign has been launched in response to what the group describes as “an escalating crisis in the NHS, locally and nationally”. Gill George, spokesman for the new campaign, said: “The immediate threat is to the A& E. It’s clear that NHS bosses have already taken a decision to close one of the A& Es. That would be a disaster. Once you close an A& E, you rip the heart out of a hospital. The intensive care unit closes at the same time, and that means the end of consultant-led maternity services, most surgery, and care for anyone who is seriously ill. It’s about closing down a hospital”. The group was formed at a meeting of The People’s Assembly Against Austerity, held at Shrewsbury Abbey. The group has been formed by local community groups, campaigners and political parties to fight against Government cuts. In Shropshire, children’s inpatient services, gynaecology services and consultant-let maternity services are all moving to the Princess Royal Hospital in Telford into the new Women and Children’s Unit. Acute stroke services have also moved to Telford’s hospital temporarily, where they will remain until at least the end of the year. The group has said this makes it look like the Royal Shrewsbury Hospital is being run down in preparation readiness for closing other services.

    Read more ...

Independent

  • New NHS chief: Stakes have never been higher for service, warns incoming Simon Stevens.

    The NHS needs to “think like a patient” but “act like a taxpayer” if it is to maintain standards of care in times of austerity, the new head of the organisation will warn today. On his first day as chief executive of NHS England, Simon Stevens will call for a fundamental overhaul of disjointed services that are not focused on patients. And he will warn that “the stakes have never been higher” with “service pressures” intensifying at a time when budgets are likely to be constrained for years to come. A former health adviser to Tony Blair, he was appointed to take over from Sir David Nicholson as head of the NHS last October. Sir David took early retirement following widespread media criticism for his role in the Mid Staffordshire scandal. Mr Stevens, who joined the NHS as a management trainee in 1988, held a number of roles within the organisation before moving into politics and pioneering Labour’s health reforms of the early 2000s. Most recently he was president of the global health division of the American company United Health Group. He is due to address about 300 NHS staff and other health professionals in the North-east today, where he is expected to lay out what he sees as the key challenges facing the organisation.

    Read more ...

Health Service Journal

  • Two CSUs advertise for long term commercial partner.

    Two commissioning support units have become the first to publicly call for bids from third parties wishing to become their long term strategic partner. Greater Manchester CSU and Cheshire and Merseyside CSU, who plan to merge later this year, have received 30 expressions of interest after placing an advertisement on the NHS Supply2Health website. Leigh Griffin, managing director of Greater Manchester CSU, told HSJ that without pre-judging the outcome the process was likely to result in “a couple” of partnerships. “To develop a consultancy business or provide world class intelligence services, for example, we will have to work with others,” he said. “It’s a necessary step.” According to the advert, a strategic partnership would go beyond a supply chain relationship and could involve “an element of exclusivity” in some areas or service lines. “It could include elements such as shared risk and reward in terms of pursuing wider market opportunities”, the advert says. Mr Griffin rejected the suggestion that any partners chosen would necessarily be first in line to take an ownership stake in the merged CSU when it became independent of NHS England in 2016.

    Read more ...

Coventry Telegraph

  • Hospital chief brands bid for George Eliot a 'waste of money'.

    A six-figure sum spent on an NHS bid for George Eliot Hospital has been branded a waste of money. South Warwickshire NHS Foundation Trust was the only NHS provider left in the running to take over the hospital in Nuneaton. And the Trust’s boss has told the Telegraph it spent more than £100,000 preparing its bid before the procurement process was sensationally axed last week, after more than two years. SWFT chief executive Glen Burley branded the time, money and energy spent on the procurement a waste. He said: “We have given a lot of time, a lot of thought and a lot of energy and resources to going through this process. What we spent was more than £100,000. We have never bid for anything on this scale before and while we tried to minimise the costs it is hard to bid for anything on this scale without incurring any. Now it feels a bit of a waste.” Mr Burley had planned to form a new Warwickshire NHS Foundation Trust to bring together health services in north and south Warwickshire. He was confident his vision would beat rival bidders, private healthcare providers Care UK and Circle Health, to be named George Eliot’s strategic partner. The decision to pull the process because of “significant improvements” in care at George Eliot has left him feeling bitterly disappointed and frustrated. Mr Burley says SWFT had aways wanted to help George Eliot but was told the only way that would be possible was by bidding through the procurement process.

    Read more ...

Daily Mirror

  • Top cancer doctor's damning letter: "NHS cuts will kill patients".

    The country’s leading brain doctors have warned savage cuts are putting cancer patients’ lives at risk. Lead consultant neurosurgeon Matthias Radatz said last night: “The changes last year were draconian and patients who wait for radiosurgery have been left totally in limbo. To the layman it’s appalling. To the expert it’s appalling.” In a damning letter to NHS bosses, he and other experts have expressed their frustration and anger at the planned closure of 18 specialists centres to treat victims of brain cancer. And they lay the blame squarely at controversial ConDem changes to the NHS implemented one year ago today, part of Health Secretary Jeremy Hunt’s plan to slash £20billion from the NHS budget by 2015. In the letter leaked to the Daily Mirror, 13 of Britain’s top clinicians revealed the problems they are experiencing in dealing with the new NHS England set-up. They include proposals to change the way patients are treated and slashing the number of specialists units from 25 to just seven. Other issues levelled at the new system include changes that restrict access to advanced radiotherapy treatments, a lack of trained staff, delays to treatment and multi-million pound cancer machines sitting “idle” instead of being used on patients. NHS England was also accused of using incorrect data which ended up “skewing” the potential of the treatment docs could realistically provide. Dr Radatz, the chair of the influential Radiosurgery Clinical Review Group, said NHS England was “acting out of spite or ignorance”.

    Read more ...

BBC News

  • Pay £10 monthly NHS England charge, says ex-Labour minister.

    A former Labour health minister has suggested people in England pay a £10 monthly membership charge to use NHS services. The plan comes from a report for the Reform think tank, which argued the money was needed to fill a £30bn funding gap, expected by 2020. Lord Warner told Jo Coburn on the Daily Politics that the government could not go on "shoving more money into the NHS from general taxation with the situation we have got."

    Read more ...

Monday 31st March 2014

BMJ Blogs

  • David Wrigley: Standing up against the fragmentation of the English NHS.

    On a little known website an advert popped up recently that didn’t catch the eye of many people. Those that did see it realised the implications of it when they read the details. The website is called Supply2Health and is the location for all outsourced tenders for services in the English NHS. It is a veritable goldmine for the private sector wishing to take over profitable services and get their hands on a piece of the juicy NHS £120bn pie. You may remember the debate last year over Section 75 of the Health and Social Care Act. That piece of pernicious legislation in effect means that local commissioners are forced to put services out to tender once the current contract expires. If they don’t offer them to the market then clinical commissioning groups (CCGs) and commissioning support units (CSUs) are open to costly legal action (that they cannot afford) when the private sector says “you can’t just give that to the NHS, we want to bid for it.” So the safe route is taken and services are put up for sale on the Supply2Health website. This is the reason why NHS campaigners are so keen for the NHS to become the “preferred provider” of services to give them first bite at the cherry of any contract. Bidding for these contracts are huge undertakings. The complex tender documents to be completed run to hundreds of pages. Local charities and small organisations, and even hard pressed NHS organisations, just do not have the resources to complete such applications. However you can be sure the global health firms with rooms full of lawyers, accountants, and experts are willing, able, and expert at completing such tender documents. This NHS contract playing field is about as level as the Winter Olympics downhill slalom course. The advert that caught my eye was one of the biggest NHS contracts on offer in recent times. This contract puts up for sale the design and provision of cancer services in the East Midlands and it is worth a mammoth £687million. That is a contract that would make the City of London firms salivate at the prospect of winning. The opportunities to asset strip, cut corners, and make “efficiency savings” will be huge—and of course any savings made will make more profit for the lucky shareholders of the private healthcare company.

    Read more ...

Our NHS

  • Politicians should have a "duty of candour" about the NHS too.

    Jeremy Hunt insists the NHS should be more open when things go wrong. Laudable - but why does the same openness not apply to decisions to close A& Es and outsource ambulances, being made in the shadows ? Government health ministers Jeremy Hunt and Norman Lamb are splashed over the news with the message that NHS staff have a duty of candour to patients and their families. If a patient’s treatment or care goes wrong, staff must be honest about what’s happened and how this is going to affect the patient, we are told. This is clearly right. Patients and their families must receive a full, honest, compassionate account from NHS health care staff if anything goes wrong. Jeremy Hunt should practice what he preaches. It’s equally important that politicians and NHS managers practice a duty of candour to the public whose health service they are responsible for planning and running. But this doesn’t seem to have occurred to them. Government has been hollowed out by the incursion of corporate interests, providing huge opportunities for corruption. It’s now commonplace for corporations to second staff to government ministries where they work on drawing up government policies. Shady public-business deals have become endemic. Hundreds of peers and MPs with vested interests in private health companies voted to pass the stealth-privatising Health and Social Care Act 2012. “There is nothing in the [Health & Social Care] Bill that promotes or permits the transfer of NHS activities to the private sector”, then Health Secretary Andrew Lansley told Parliament. The total absence of candour that characterised the Health and Social Care Act’s passage into law has spread throughout the institutions that it created: NHS England, Monitor, the Clinical Comissioning Groups, the Commissioning Support Units and Healthwatch. To take some examples from my own neck of the woods, West Yorkshire.

    Read more ...

Socialist Health Association

  • NHS campaigners have never been so important as now, but the best is yet to come.

    It had been possible once upon a time to discredit NHS campaigners as merely NIMBY activists who couldn’t see the big picture of running the NHS. And yet they have been more than an eyesore to this current Government, which, like previous governments, has tried to promote ‘patient choice and control’. The philosophy of ‘think global, act local’ has clearly run into problems as local activists continue to argue correctly that the big picture has been uncompelling. They cite a lack of resolution in the costly PFI programme which has acted as a malign influence on the NHS since the late 1980s. It’s also impossible to ignore patient campaigners who complain about unsafe hospitals. So, whatever gloss political parties themselves want to put on the importance of the NHS, the reality is that many people in the general public have a very clear idea what has been going on. Whichever political party can capture the public mood will win the trust of many voters. In as much as problems in the NHS have been rarely discussed by mainstream media who are either ignorant or wilfully neglectful, it is not easy to ringfence complaints from the last few years, since May 2010, as “one offs”. They represent, rather, fundamental faultlines in English policy. Whichever political party can do the least worst job of managing them will make a killing, but it’s clear now many voters are clearly sick of the endless crap. They should like to see a properly funded NHS from general taxation, and are particularly sensitive to any initiatives which sound nice but can lead to commissioning decisions cutting services in reality, such as ‘Big Society’ or ‘dementia friendly communities’. Only last week, it was announced that controversial moves to offer the running of George Eliot NHS hospital in Nuneaton to private companies have been abandoned, as described here in this excellent article by Caroline Molloy. The barrage of foul-smelling media stories and focus on the hospital standardised mortality index have left many Trusts unable to come to the surface for air. But some Trusts clearly asphyxiated by the toxic attitude of some in the media have come out fighting to their credit. For example, the volte face in Nuneaton has been put down to an improved performance, with A& E and mortality figures now in line with the average or better.

    Read more ...

Public Finance

  • After Atos: is the policy fit for purpose?

    The early termination of Atos’s contract to carry out fitness-to-work tests offers an opportunity for transparency and reflection. We must know the details of the deal struck, while ministers should review whether the policy is fundamentally flawed The news today that Atos’s contract with the Department for Work and Pensions to deliver Work Capability Assessments has been terminated 12 months early is not surprising given the torrid media coverage that it has attracted for many months. It would appear that Atos has not always performed to the standard required by its client, the DWP, and certainly not to the standard expected by many of those being assessed and their representative bodies. Atos is responsible for delivery of the service to a specification set by DWP. The government is responsible for the policy underpinning these assessments. Accordingly, Atos should be held accountable for its performance, but not for the policy. I can see why early termination would be seen as beneficial by both the company and the DWP. The government is seen to be tackling contract under-performance and there will be few tears spilt for Atos, especially among service users, their families and carers, and the charities that represent them. Atos found itself, one assumes, financially challenged on this contract, and was most certainly being heavily damaged in terms of its market and public reputation. When agreement is reached to prematurely terminate public service contracts, one assumes that both parties (the client and the provider) will bear the costs and risks. In this case, it is interesting to note that the government has stated that Atos has not received any compensation. And the chief executive of Atos is quoted as saying that: ‘We are pleased to have reached an agreement with the government to allow us to exit this contract early and we remain committed to delivering essential services to the UK government as a strategic supplier.’ The public is entitled to know the details of the commercial deal that has been struck between the government and Atos to enable the ending of the contract. I very much hope that both parties will willingly publish this without the need for too much external pressure.

    Read more ...

Value Walk

  • Ireland Considering Obamacare-Style Universal Health Insurance.

    In an earlier Valuewalk article, we examined how the Irish government was allowing the cost of health insurance in Ireland to spiral out of control, while simultaneously introducing legislation that was hampering competition in the sector. Now it seems ‘Obamacare’, or the Affordable Care Act in the US, signed into law by President Obama, may be about to cross the Atlantic. Minister for Health, Dr. James Reilly and his Department officials have drawn up a White Paper on Universal Health Insurance (UHI) under which everyone in Ireland would be required to have private health insurance for at least standard level of cover by one of a number of competing insurance companies. Obamacare in the US is very similar. Citizens there are required to buy health insurance from health insurance exchanges. Those who don’t take out a policy pay a penalty. Under the Irish proposals, those who refuse to buy mandatory cover would have the costs deducted from their earnings or benefits. Details on implementation and costs are still very sketchy. There is disagreement among ministers on how it will work and the exact composition of the standard package for Irish citizens will not be determined until after a comprehensive consultation process. However, private health insurance costs across Ireland have surged since 2012. Recently, some health insurance companies announced price rises of 20% or more. So, it’s hardly surprising that more and more people, especially, younger people are opting out of health insurance altogether. A recent survey found that 51% of younger people in Ireland said that cost was a barrier to healthcare – the fourth highest in Europe. Despite that, Reilly says that it’s the current system that’s unaffordable: “Without reform, taxes will go up and services will come down. It is inevitable. With the right kind of reform, however, we can lower costs even as we improve services, and deliver better, safer outcomes for patients.” Ironically, he added that the current system had given Ireland “one of the highest priced, most expensive systems in the developed world – once you adjust for the fact that Ireland’s population is still much younger than most other developed countries. We cannot afford this broken health system. We must reform it.” Under the new proposals, he said that no one would be denied care because they couldn’t afford it: “Parents are not forced to choose between bringing a sick child to the GP or paying the electricity bill.”

    Read more ...

BBC News

  • Councils diverting public health cash, says journal.

    Councils in England are using public health budgets to fund other services, the British Medical Journal has said. Local councils in England took over responsibility - and funding - for public health last April. The BMJ says Freedom of Information requests reveal a third have stopped at least one public health service, with money being spent on other services such as parks and leisure instead. But the Local Government Association said the report was "scaremongering". A spokesman said: "Spending levels on public health have remained consistent and it is inaccurate and wholly misleading to suggest that local authorities have been siphoning off funds to prop up services elsewhere." The BMJ report says it found "examples of councils reducing funding for a wide range of public health services, including those for substance misuse, sexual health, smoking cessation, obesity, and school nursing". Public health funds had been diverted to other areas including trading standards, citizens' advice bureaux, domestic abuse services, housing, parks and green spaces, and sport and leisure centres, it said. The BMJ contacted all 152 councils to ask for information on all services commissioned and decommissioned since April 2013 and plans for the coming financial year. Of the 143 that replied, almost a third (45) had cut at least one service, while others had reduced funding to other services. Gabriel Scally, a former regional director of public health for the South West and now professor of public health and planning at the University of the West of England, Bristol, told the BMJ: "Of course, local authorities are having their budgets reduced, but the Department of Health has provided that funding to local authorities to spend on public health, not to be siphoned off to prop up other services.

    Read more ...

Local Gov

  • Councils ‘rationing’ care for the elderly.

    Most local authorities are ‘tightly rationing’ their social care for older people, according to new research. The research, from the Nuffield Trust and Health Foundation, reveals that many councils are cutting or reducing services for the over-65s, with home and day care spending falling by 23% between 2009/ 10 and 2012/ 13. The number of older people receiving home-delivered meals has halved in the same period, and nearly a quarter of a million (245,855) fewer older people received publicly funded community services. The report warns that these cuts have left hundreds of thousands previously eligible older people without local authority support, but a lack of data means it is impossible to quantify the impact of cuts on health and wellbeing. Holly Holder, report lead author and fellow in health policy at the Nuffield Trust, said: ‘Our analysis paints a picture of increased rationing of social care by hard-pressed local authorities in response to deep cuts from central Government, despite the growing numbers of older people in the population. ‘It is highly likely that this is having a negative effect on older people’s health and wellbeing and that of their carers, but without adequate data to assess this impact, the NHS and Government are flying blind when it comes to managing demand and planning for the future.’ The report also suggests that local authorities have focused remaining resources on those most in need, with the number of people receiving 10 or more hours of care staying constant between 2009/ 10 and 2012/ 13. In the same period, 42% fewer people received lower-intensity care. Jennifer Dixon, chief executive of the Health Foundation, said: ‘Across the English NHS A& E departments are creaking, in part because of rising demand for care from frail older people. Emergency hospital admissions have risen by almost a third in ten years: many of these were preventable and many were short stay admissions for older people with multiple conditions. Good quality social care can help to prevent attendances in A& E.’

    Read more ...

Friday 28th March 2014

Pulse

  • GP commissioners given green light to sidestep competition process for well-performing services.

    GPs have been given a boost in their bid to hold on to enhanced service income after the healthcare regulator told CCGs they can avoid putting services out to competitive tender if providers are already meeting the needs of patients. Speaking at the Commissioning Live conference yesterday, David Furness, a competition adviser at Monitor, said CCGs should continue services that are ‘working well’ without putting them out to a full tender process or via the ‘Any Qualified Provider’ route. GP commissioners have expressed concern about competition rules, with some CCGs putting all existing enhanced services out to tender for fear of legal challenges from other potential providers. GP leaders welcomed the comments from Monitor, and said they could help prevent practices from having to complete vast amounts of paperwork associated with competition processes and potentially losing enhanced services income. Under Section 75 of the Health and Social Care Act, commissioners are compelled to put a service out to competition unless they can prove there is only one potential provider. Providers who feel that the CCG has not adhered to the regulations have the option of appealing to Monitor.

    Read more ...

Belfast Telegraph

  • Acute services in the NHS in England are facing a year of particular financial pressure in 2015/16, when changes to funding arrangements will see £2 billion transferred to community health and social care provision, a parliamentary report has warned.

    The House of Commons Health Committee highlighted a warning from the chief executive of health regulator Monitor, David Bennett, that the reduction in funding resulting from the introduction of the Better Care Fund from April next year will present a "huge challenge" to NHS providers of acute care - medical and surgical treatment mostly provided in hospitals. In its report on Monitor's work, the committee warned that the current model of care is "not changing quickly enough" to cope with demand and funding pressures, resulting in a threat to both the quality of care received by patients and the financial stability of individual providers. The cross-party committee called on both the regulator and NHS trusts to "address the need to develop different structures to meet changing needs". It warned that Monitor must not get in the way of necessary change by imposing "heavy-handed regulation" on trusts. "At a time when NHS providers face an unprecedented need to change the care model, Monitor must be a facilitator of change, not an obstacle," said the report. The report quoted evidence given by Dr Bennett when he appeared before MPs in November: "In 2015/ 16... there is an additional £2 billion taken from the NHS to be put into the integration transformation fund. That is expected mostly to come out of the acute sector, which means that the acute trusts in particular are going to face a very significant funding squeeze in 2015/ 16. "Just dealing with 2015/ 16, I think, is going to be a huge challenge... We are in intensive discussions now with NHS England, with the TDA (Trust Development Authority) and with the Department of Health to try and work out how that gap between underlying costs and funding can be closed in 2015/ 16."

    Read more ...

Our NHS

  • Tory links of health agencies exposed as Hunt lines up next NHS sell-off in England.

    Whilst understaffed wards and surgeries turn to well-connected private sector agencies to fill the gaps created by Cameron's health 'reforms', the NHS's own in-house recruitment agency is to be sold off, it has emerged. Last week it emerged that Jeremy Hunt plans to sell off the National Health Service in-house recruitment agency, NHS Professionals, before the election. The agency was established in 2000 to reduce the amount spent on recruitment fees. It has 40,000 workers on its books, providing bank nurses to 65 NHS trusts. Christina McNea, UNISON’s head of health, is outraged: "Selling off NHS Professionals might inject short term cash, but will cost NHS trusts vast amounts in the longer term and deliver worse results.” It’s the Department of Health’s second attempt to privatise the agency - in 2010 they failed to find a buyer. This time they have given the sell-off to the same bank that ran the Royal Mail privatisation, suggesting another gone for a song sell-off. Despite a turnover of about £450million, the agency operates with low profit margins, with most funds going to staff pay rather than commission. Selling off the state staffing agency will merely raise the cost of temporary staffing for trusts. Temporary staff costs have already risen 20% between 2011 and ’13, a Nursing Standard investigation found. Last year, Jeremy Hunt spent £1.4bn on NHS redundancies - then spent £3.9 billion filling the gaps with temporary agency staff in the NHS – tripling costs in just 3 years. 7,000 frontline clinical staff have been axed since 2010, the Department of Health has admitted. Understaffed wards turn to private firms that supply agency nurses and doctors. These firms have pocketed millions in profits over the past year – charging up to £1,000 per shift. Meanwhile, owners of these companies are earning up to £2million a year.

    Read more ...

Health Service Journal

  • Major pathology reorganisation to go ahead after OFT all clear.

    The NHS’s biggest pathology reorganisation will take place in May, after the Office of Fair Trading ruled it would not be investigating the plan further. The competition watchdog announced this week that the consolidation, which involves six trusts and will be hosted by Cambridge University Hospitals Foundation Trust, does not “qualify” for OFT scrutiny. The plan is a collaboration involving six trusts. Cambridge University Hospitals and Ipswich Hospital Trust will be hubs carrying out most pathology work for the area. East and North Hertfordshire and Hinchingbrooke Health Care trusts, and Colchester Hospital University and West Suffolk foundation trusts will retain host satellite laboratories which will carry out only urgent work. A new provider organisation established to run services under the arrangement, called the Transforming Pathology Partnership, said it now planned to transfer staff and services on 1 May, rather than a previously planned date of 1 April. An announcement on the partnership’s website said: “The contracting processes for establishing the new organisation are complicated and this short delay will ensure that all the arrangements between the six trusts, five clinical commissioning groups, the OFT, and Public Health England are completely ready for the start of the new service.” The OFT this week said, following an initial consultation, that the arrangement did not qualify for further investigation. A short statement on the regulator’s website said full details of its decision “will be available shortly”. The OFT instigates review of a merger if the enterprise being acquired has a turnover of at least £70m, or if the enterprises coming together have a combined market share of 25 per cent or more.

    Read more ...

  • Treasury claims £650m legacy debt pot.

    NHS England has admitted that £650m of provisions made by primary care trusts last year to pay for historic continuing healthcare claims will not be available to clinical commissioning groups. Commissioners are now asking why their predecessor organisations were required to set aside the huge sum – which was intended to ensure CCGs did not come into being with inherited “legacy debts” – if it was not going to be available in future years. Department of Health accounts show the provisions made by PCTs contributed to a large revenue surplus for the department in 2012-13, which was returned to the Treasury and used to reduce the national budget deficit. In 2014-15 £250m will be topsliced from CCG budgets to cover anticipated costs of settling the backdated care claims. During 2012-13 PCTs made provisions totalling £800m to pay for financial liabilities expected to arise in future years. Of that, £650m related to retrospective continuing healthcare claims. However, it has now emerged that CCGs will not be able to access any provisions set aside by their predecessors, meaning future continuing healthcare payouts will be funded from CCG allocations. An 18 March letter from NHS England’s director for commissioning development, Ros Roughton, to CCGs’ representative body NHS Clinical Commissioners said: “Under Treasury accounting regulations the payment of legacy provisions count against the NHS budget only when they are actually paid. “Therefore any provisions made in prior years are not available under Treasury accounting to cover these commitments.”

    Read more ...

The Guardian

  • 'Control freak' Jeremy Hunt accused of manipulating NHS for political ends.

    The health secretary Jeremy Hunt has had a series of standoffs and rows with NHS leaders amid claims from senior figures in the service that he is an interfering "control freak" who is trying to manipulate it for political purposes. Senior NHS figures have told the Guardian privately of their fears that Hunt has torn up the coalition's pledges to "liberate" the NHS from political control and make it operationally independent. It is understood that Sir Bruce Keogh, the NHS's medical director, had to personally instruct Hunt not to announce his blueprint for restructuring A& E services in a highly charged encounter between the two last November. Keogh and senior colleagues at NHS England, which is meant to be independent of Hunt's Department of Health, were annoyed that Hunt appeared to want to hijack Keogh's plan to announce the overhaul by unveiling the details himself first. "Bruce basically took the secretary of state to one side and said 'bugger off'. There were some fairly tense conversations between Bruce and Jeremy Hunt at that time," said an NHS source. NHS England leaders were also annoyed that when Hunt announced that hospitals in England would get an extra £250m to help their A& E departments cope with the winter, he gave them very little credit, even though they supplied the money. But Hunt and the department declined to respond directly to claims by NHS figures that he is improperly "controlling" the service that is supposed to be run at arm's length following the controversial reforms instituted by his predecessor, Andrew Lansley. The Department of Health argues that he was doing the job expected of him.

    Read more ...

  • An NHS free from day-to-day political interference is far from reality.

    At noon on Mondays, Jeremy Hunt's office on the fourth floor of the Department of Health's Whitehall headquarters fills up. Always hosted by the health secretary himself, the midday meeting focuses on what the department calls "NHS delivery" – that is, how the NHS is performing its vital role. There are usually 25-30 in Hunt's room, with a few having to stand because there is not enough space around the table. Top brass from the three key NHS bodies charged with overseeing the health service are always present. There's also one or more of Hunt's ministerial team: Earl Howe is a regular while Norman Lamb and Dr Daniel Poulter are semi-regulars, along with Hunt's permanent secretary, Una O'Brien, and sometimes the prime minister's health adviser, Nick Seddon. Those meetings began shortly after Hunt was appointed in September 2012 and have taken place almost every week since. But last October, amid gathering fears that the impending winter would be very tough for the NHS, he instituted a second regular weekly meeting in his office, on Thursday afternoons, which looks at how the service is coping. Fewer people attend the Thursday gathering, though the three key organisations – the department's arm's-length bodies (ALBs) – always do. They are NHS England; Monitor, which regulates semi-independent foundation trust (FTs) hospitals; and the Trust Development Authority (TDA), an arm of the health department that looks after non-FTs. Civil servants jokingly refer to it as "the meeting of the three Davids" because the three bodies are headed by, respectively, David Nicholson (although he steps down at the end of March to be replaced by Simon Stevens), David Bennett and David Flory. These meetings are unusual – indeed, unprecedented – and controversial. Until now, their existence had not been reported, nor the concern and annoyance that senior NHS figures feel about them. Some of them see them as evidence of Hunt's "control freakery" and an opportunity for him to call the organisations together to give them their "orders" for the week. Such is the health secretary's modus operandi that Professor Chris Ham, chief executive of the King's Fund health thinktank, says: "Effectively Jeremy Hunt has become the executive chairman of the NHS." Hunt can seek a detailed report into one hospital's failing finances, ask to be briefed on the planned reorganisation of hospital services somewhere in England – the potential political fallout from the rundown of any hospital so close to the election is a priority –or demand improvements in a hospital's A& E performance if it is not treating the required 95% of patients within four hours. Unusually, while notes are taken at these meetings, no minutes are made or circulated. However, a series of "action points" – specific tasks the ALBs must now pursue – are agreed instead.

    Read more ...

  • John Middleton: 'Public health is about making ordinary lives richer'.

    John Middleton is England's longest-serving public health director. He retires at the end of the month after 26 years in the job in Sandwell, in the West Midlands. He has presided over striking improvement in many, though not all, of the borough's health indicators. But he leaves deeply worried about the prospects for continued improvement, in particular among young people, who have suffered years of joblessness since the economy crashed. "It became clear in the early 2000s that middle-aged Sandwell men were dying prematurely because their lives had been robbed of work, activity and hope by the Thatcher recession," says Middleton. "Now that pattern will be repeated for the nearly 1 million under-25s who are unemployed and without hope today." One may infer from this that Middleton – "Dr Johnny" as he is known locally – is an unashamed campaigner for public health and against those who undermine it. He believes that the last Labour government did much to boost public health with policies such as Sure Start for young children, the minimum wage and the National Service Framework for reducing heart disease, and he fears those gains are at risk as the NHS struggles with reform and spending curbs, and as income inequality remains stubbornly high. "It's not who your parents are, but how deep their pockets are, that will determine how healthy you can be," he says. Leaving will be a wrench. But one thing he won't miss is working with NHS England. He describes the body created in last year's health service shake-up to run the NHS across England as "a dysfunctional organisation that really isn't fit for any purpose I can see". He has more time for the equally new Public Health England, where he thinks chief executive Duncan Selbie is doing a good job in difficult circumstances, but, like many working in the health field, Middleton is generally exhausted by structural change. "I've had 13 reorganisations in 26 years, seven of them national, so I've never been able to get to the point where I think I am doing the same thing twice," he half-jokes.

    Read more ...

National Health Action Party

  • “Isn’t it terrible, you know, about that £5 billion lost to fraud in the NHS.”

    What £5 billion ? “You know, that – well, they say it might actually be £7 billion actually. Every year. Terrible…” Who say ? “Well, the BBC and that. Panorama. Oh, and it was on breakfast telly.” Oh that £5 billion. The £5 billion that doesn’t exist, never existed and has turned out to be what my Mum would have called “a load of old toffee”. The invisible, imaginary £5 billion that nevertheless looks to make “fraud” a second stick alongside “waste” to beat the NHS with. Yes, let’s talk about that £5 billion for a minute. Well, if someone who earned his living by fraud investigation, who worked for a large international consultancy that plied its forensic accountancy expertise to health services around the globe, knocked on the door of your health system and said there was a bloody great hole in the roof and that £5 billion was floating out of it up into the wide blue yonder, wouldn’t that have taught you to ask, “Really, can you show me any evidence for that ?” Panorama didn’t. Maybe they are a little more trusting that their Watchdog colleagues. Perhaps they are a little more innocent. Because what Panorama said is “Really ?” “Staggering” and “With potentially billions in savings on offer, the cost of ensuring rigorous monitoring of NHS finances seems a small price to pay to safeguard our money.” And those, believe it or not, are actual quotes from The Great NHS Robbery, the Panorama “investigation”, broadcast by the BBC on 24th March. Apart from the “Really ?” that is. Because in fact, they didn’t seem to question at all where the figures had come from, how they had been calculated, and what possible motive apart from sheer altruism might have prompted a company with 23 offices, 250 partners and 3,500 staff to produce the “secret report” that underpins that hitherto unthinkable figure of £5 billion of fraud in the system, some 20 times the figure recognised by the NHS’s own fraud investigators. It’s ironic really, because the person making the claim, Jim Gee, Director of Forensic Accounting at BDO – though introduced by the BBC as “ex-director of NHS Counter Fraud Services” – was for eight years in charge of tracking down fraudsters in the NHS. In fact, it is one of his employer’s proud boasts that, during those eight years 1998-2006, losses to the NHS were reduced by up to 60%. Which, unless the system has gone to pot since, means that when he first arrived at the NHS the levels of fraud must have been hovering at around… ooh £12.5 billion.

    Read more ...

Thursday 27th March 2014

Health Service Journal

  • Minister: Mental health trusts should 'fight' over contracts.

    A health minister has indicated mental health providers should “fight” contracts with commissioners in cases where they would be “losing out” due to the greater price reduction for the sector specified in controversial national guidance. Norman Lamb, speaking at the annual Mental Health Network conference in London, repeated his strong criticism of NHS England for its decision to set the 2014-15 price deflator at 1.8% for mental health and community trusts, compared to 1.5% for acutes – implying a 20% greater price reduction. Mr Lamb said the decision was “flawed, not based on evidence and cannot be defended” and that NHS England’s justification – that acute trusts faced greater costs due to the Francis inquiry report – was “nonsense”.

    Read more ...

Plymouth Herald

  • Plymouth hospitals fined £2.4million this year for missing targets.

    Health chiefs have racked up more than £2m in fines after failing to meet government standards, The Herald can reveal. Plymouth Hospitals NHS Trust has been ordered to pay £2,379,000 of penalties for this financial year – and the figure could rise if further fines are charged for March. The mammoth figure comes after a range of targets were missed involving superbug outbreaks, referral to treatment standards and cancelled operations. Penalties totalling £1.4million have been charged to the trust for failure to meet the 18 week stop clock referral to treatment standard.

    Read more ...

Bicester Advertiser

  • Warning over a cut to mental heath care fees in Oxfordshire.

    A cut to mental health and community care fees will hit finances hard, a county NHS boss has warned. Oxford Health NHS Foundation Trust chief executive Stuart Bell criticised moves to cut tariffs by 1.8% for non-hospital trusts but 1.5% for hospital authorities from April 1, hitting it by £750,000. The trust is paid by Oxfordshire Clinical Commissioning Group, to use 1.8% as a guide. Mr Bell said it would have a “serious impact” on the trust’s financial position.

    Read more ...

Wednesday 26th March 2014

Socialist Worker

  • ‘If Care UK gets away with it here, God help the NHS’, says Doncaster striker.

    A firm at the forefront of NHS privatisation faces a rebellion from its own staff. Workers who care for adults with learning disabilities in Doncaster ended their second seven-day strike in a month. The Unison union members are battling a huge attack on their terms and conditions after Care UK took over their service last September. Unison steward Lorraine Cotterell told Socialist Worker that Care UK promised changes would be “minimal”—but “these proposals couldn’t be more maximum if they tried”. "They want to get rid of enhancements for weekend pay, unsociable hours, sleepovers and bank holidays,” she said. “They’re sabotaging everybody’s lives. It’s absolutely criminal that a private company can come in and do this. If Care UK gets away with it God help the rest of the NHS.” Strikers collectively burnt the new contracts on the picket line. The Doncaster strike has laid bare the reality of NHS privatisation, destroying services and robbing the workers who pour their lives into it.

    Read more ...

Guardian

  • NHS workers' views are 'damning indictment of Jeremy Hunt's record'.

    The vast majority of NHS staff want health services to be merged with social care in order to help ensure the NHS survives amid the growing pressures of ageing, tight budgets and the need to look after older people better. Four out of five of the 1,069 respondents to the latest survey of members of the Guardian's Healthcare Network, who do a wide range of clinical and management roles in the NHS, said they backed a policy aim sometimes described as the "holy grail" of healthcare. Participants from a range of NHS organisations, including GPs, consultants, nurses, strategy and policy managers at NHS trusts, and officials from NHS England, shared their views just before the first anniversary of the coalition's radical restructuring of the service in England. When asked, "Are you in favour of integrating health and social care ?", 81% said yes, 9% said no and 11% were unsure. A much smaller majority (61%) believed that merging the two services into one was achievable, – though 18% disagreed, with 21% unsure – but given that integration would inevitably involve change, pain and a loss of autonomy and control, that is a fairly positive response. Ministers are trying to encourage health and social care providers to come together and offer joint services across England through the creation, from April 2015, of the Better Care Fund. The Department of Health (DH) says its fund would "bring £3.8bn of health and social care funding together into a single seamless service to keep our elderly and most vulnerable well for longer." It will lead to pooled budgets in every part of England, with £200m to help smooth the integration. It is seen as a vital way of prompting the joint working, and possibly ultimately the merger, of services experts believe are needed to keep the NHS sustainable. Many of the rest of the findings make worrying reading, both for the health secretary, Jeremy Hunt, and for staff, bosses and supporters of the NHS. For example, 77% said their job was harder now than last year, with just 5% disagreeing, and 50% said they now had less time with patients than before the 2013 shakeup, while a mere 6% said they had more time. "Increased workload", "less staff, more patients" and "pressure to make more savings" were among respondents' comments.

    Read more ...

  • General practice is in crisis – the government must act.

    The BMA and Royal College of General Practitioners' latest poll shows that many GP practices are heading for the rocks as workload rises, morale drops and the government continues to ignore the problems stacking up in this crucial part of the NHS. Almost all GPs said their workload was heavy all of the time, while half reported it was unmanageable or unsustainable. In real terms, this means GPs are struggling to see all the patients that are coming through their doors or don't have enough staff to provide the services the public needs. As the BMA poll shows, another problem is starting to rear its head. More than half of all GPs say their morale is either low or very low and two-thirds are considering early retirement. This is a dire situation because we could have a scenario where we don't have enough GPs to replace the ones leaving the NHS, which would have a terrible impact on patient care. To avert a recruitment and retention crisis, funding for general practice needs to be increased to at least 10% of the NHS budget immediately. Without this, the reality is that patient care – and the very future of the NHS – is at risk.

    Read more ...

  • Mental health services need targeted investment, not even more cuts.

    By 2030, there will be an estimated two million more adults with a mental health problem. So, what should the new NHS England chief executive Simon Stevens's priorities be when it comes to improving mental health in the NHS ? First, focus on those areas where the NHS can both improve people's lives and save cash. At least £1 in every £8 spent on long-term conditions is linked to poor mental health. If we could support those people better, we could make massive improvements. For example, cognitive behavioural techniques have been shown to help patients reduce their anxiety, cope better with their illness, and be admitted to hospital less. A recent pilot found that targeting mental health support at some patients with chronic obstructive pulmonary disease could save £5 for every £1 invested. Second, improve the physical health of people with mental health problems. Mind and Rethink Mental Illness have campaigned consistently on this issue. By giving mental health service users tailored advice on stopping smoking, we could start to make real headway in improving quality of care. As a third priority, exploit the opportunities presented by digital technology. Budgets have been cut for three years in a row. And NHS England and the regulator, Monitor, recently recommended cutting funding for mental health services by 20% more than for acute hospitals, when referrals to community teams are up 13%, and have increased by 16% for crisis services. NHS England must make sure mental health services are not subject to a fourth year of cuts.

    Read more ...

The Argus

  • Medical secretaries protest at outsourcing of Crawley patients' letter typing.

    Hospital workers have been protesting against the use of a private company to type up patients' letters. Last year Surrey and Sussex Healthcare NHS Trust agreed to allow a private company a trial to type up dictated letters instead of its medical secretaries. At the end of the year it launched a consultation on outsourcing some of the duties carried out by medical secretaries. Staff fear this could lead to staff either taking a pay cut or losing their jobs.

    Read more ...

Health Service Journal

  • Exclusive: 'Cost neutral' Francis policy has cost £2.5m.

    More than £2.5m is being spent piloting a government scheme to make aspiring student nurses work as healthcare assistants for a year before university courses, apparently contradicting a commitment that it would be cost neutral, HSJ can reveal. The flagship policy was championed by health secretary Jeremy Hunt as part of the government’s initial response to the Francis report. It followed Robert Francis QC’s recommendation that all aspiring nurses have at least three months’ hands on experience. However, it was met with almost universal opposition from senior nursing figures who felt mandating a year’s experience for all new recruits was excessive, would undermine the existing HCA workforce and be logistically extremely difficult for providers to organise without costing more money. The Department of Health response, published a year ago, said the scheme must be “tested and implemented carefully to ensure that it is neutral in terms of costs”. However, figures obtained by HSJ under freedom of information legislation show Health Education England spent £1.9m on the first cohort of 165 HCAs, equivalent to more than £11,000 each. They started work between September and December. More than 80 per cent of this was paid to NHS providers to subsidise the salaries paid to HCAs on the scheme, many of whom are additional to trusts’ nursing establishment. In addition HEE has provided funding for recruitment, mentorship, and management costs to providers, universities and local education and training boards. An additional £646,000 has been budgeted for two further cohorts of about 80 participants during 2014-15. If the scheme was extended in the same way across all 19,206 nursing undergraduate places commissioned for 2014-15, the figures suggest it could cost more than £225m for the year. It could mean every NHS provider taking on about 80 HCAs.

    Read more ...

GP Online

  • Out-of-hours service 'falling apart' warn Northern Ireland GPs.

    The out-of-hours service in Northern Ireland is 'falling apart' because of underfunding, GP leaders have warned. Speaking at the annual Northern Ireland LMCs conference, GPC Northern Ireland chairman Dr Tom Black said the service would ‘fall over’ this year because of workload and workforce pressures. The conference called on the government to act urgently to address the severe underfunding. Southern LMC chairwoman Dr Frances O’Hagan said people needed to realise the service was ‘disgracefully underfunded’. GPC Northern Ireland believes funding has fallen from £23m in 2004 to £21m today, and is negotiating with the Department of Health, Social Services and Public Safety for GPs to take full control of the service from trusts under non-profit mutual organisations, but with no return to individual or practice responsibility. In February the minister and GPC leaders signed a framework agreement for the out-of-hours service. The government is understood to have proposed a 10% funding increase to the services, but GPC has called for a rise closer to 70%.

    Read more ...

Belfast Telegraph

  • NHS acute services 'facing cuts'.

    Acute services in the NHS in England are facing a year of particular financial pressure in 2015/ 16, when changes to funding arrangements will see £2 billion transferred to community health and social care provision, a parliamentary report has warned. The House of Commons Health Committee highlighted a warning from the chief executive of health regulator Monitor, David Bennett, that the reduction in funding resulting from the introduction of the Better Care Fund from April next year will present a "huge challenge" to NHS providers of acute care - medical and surgical treatment mostly provided in hospitals.

    Read more ...

Monday 24th March 2014

BMJ

  • NHS hospitals set to make overall loss for first time since 2006.

    NHS hospitals are set to make a loss of nearly £250m (€300m; $410m) by the end of this financial year, and experts have warned that budgets are coming under greater strain. David Flory, chief executive of the NHS Trust Development Authority, has warned in papers to its board that the deficits were “very worrying” and posed a “very significant risk to the sustainability of the sector.” In all, 26 NHS trusts of the 102 that do not have foundation status are forecast to be in the red at the end of March, posting a combined deficit of £457m. Some 76 trusts are expecting to at least break even, and their combined surplus is estimated at £210m. This gives a projected net deficit overall of £247m. This is more than three times the £76m that was forecast last April to be the position at this financial year’s end. Earlier this year Monitor, the body that regulates the 147 foundation trusts, reported that overall they were set to make a £135m surplus by the end of March. Taken together, the figures mean that NHS hospitals as a whole would make a net loss of £112m for 2013-14, the first such loss since 2006. The figures reported to the NHS Trust Development Authority’s board meeting on 20 March showed wide variation in trusts’ financial positions. The biggest projected deficit, £39.8m, is recorded at University Hospitals of Leicester NHS Trust. Nine of 22 NHS trusts in London (41%) are forecasting a deficit, compared with two of 19 trusts (11%) in the north of England. Many acute care trusts have signalled that they face operational pressures in urgent and emergency care.

    Read more ...

Upper Calder Valley Plain Speaker

  • NHS England recently announced that it is “looking very actively” at how it can make Clinical Commissioning Groups get involved in commissioning primary care.

    From September 2014, NHS England will hand over a role in commissioning primary care to Clinical Commissioning Groups. This handover is related to setting up a new system of integrated primary and community health and social care – just like the new system that the Calderdale and Greater Huddersfield Strategic Outline Case plans to set up. It doesn’t seem to bother NHS England that this would create a clear conflict of interest for Clinical Commissioning Groups (CCGs), which are groups of local GPs; or that the GPs’ trade union, the British Medical Association, had just a week earlier said it opposed CCGs commissioning or decommissioning GP contracts because of conflict of interest. As Greater Huddersfield CCG Clinical Lead Dr Steve Ollerton said yesterday at a Kirklees Healthwatch public meeting, it wouldn’t be right for the CCG to commission GP services, because it would mean he would be deciding how much to pay himself. GP contracts are currently made with NHS England. GP Online reported that Birmingham Local Medical Committee secretary Dr Robert Morley said: ‘The idea … is absolutely nonsensical, it’s barmy, it’s lunatic, it’s barking mad.’ Since GPs say it’s wrong and barking mad, why is NHS England suggesting it ? The Calderdale Clinical Commissioning Group (CCG) Draft 5 Year Strategic Plan 2014/ 15-2018/ 19 includes a section on risks associated with delivery of the Strategic 5 Year Plan. One of the risks is: “The rigidity of primary care contractual models impact on delivery of new integrated community provision”. It identifies “emerging dialogue with NHS England” as a way of reducing that risk. “New integrated community provision” is central to the Strategic Outline Case for transforming NHS and social care in Calderdale and Huddersfield. Calderdale CCG’s Strategic 5 Year plan is very much about how to put this SOC into action (where it isn’t already well underway). Section 6.1g in the Strategic 5 year plan says that Calderdale CCG aims to save money by reducing A& E admissions and also by reducing “non-elective spend and activity” to “deliver a shift from non-elective care” and “reduce time spent in hospital”. This translates to reducing the number of beds at CRH to 80.

    Read more ...

BBC News

  • London NHS services 'unravelling', new report says.

    A report into the service provided by the NHS in London has described it as "cash strapped, fragmented health care and unravelling". The People's Inquiry, commissioned by the Unite union, found the public have "no real voice" in health care because of a lack of an overarching strategy. It called for a London strategy-making body, a review of ambulance services and midwife-led maternity units. Health minister Dr Daniel Poulter said key decisions are made by doctors. "I always take these reports with a pinch of salt, particularly when it's Unite the union who are backing the report," he said. "But what we have seen is that by the improvements the government has been putting into the NHS...it is doctors and nurses who make the decisions about delivering frontline patient care." NHS England, the public body set up to oversee the budget, planning, delivery and day-to-day operation of the NHS in England, said it had already given a "call to action" on many of the issues raised by the report. Unite is one of the largest British and Irish trade unions for workers in sectors ranging from transport to education. Last April, NHS London was replaced by 32 Clinical Commissioning Groups (CCG)- aimed at designing local health strategies. But, the report said, that had "fragmented" commissioning and its authors called for the formation of a London-wide strategic health authority which would involve local people. A "review of funding" was also needed, it claimed, as the £10bn annual budget for London's CCGs did not account for inflation and rising costs. The report also demands "an urgent review of emergency ambulance services", "further research into the clinical safety of stand-alone midwife-led units" and a "moratorium on any further reductions in mental health provision". Roy Lilley, the chair of the inquiry, said: "I was truly shocked at the unravelling services, the complexity and the enormity of the difficulty involved in trying to plan and deliver cohesive, integrated services from the wreckage of a fragmented care landscape."

    Read more ...

Hospital Doctor

  • Public health consultants and trainees say the recent health reforms have failed to benefit the public’s health and more than half of specialists have considered leaving the profession, research reveals.

    The Health and Social Care Act 2012 transferred most public health responsibilities from the NHS to local authorities and the newly created Public Health England in 2013, meaning that public health professionals were no longer working within the NHS. The BMA survey highlights a potential workforce crisis. More than half of public health consultants and just under half of those in training, have recently considered leaving public health due to issues around career fulfilment, work-life balance and fears about future changes to terms and conditions. There is also significant concern that the current workforce is being spread too thinly, with only 12% of survey respondents believing that, in ten years time, there will be enough public health consultants available to serve the increasingly complex needs of the population. Worryingly, the survey also shows there is still little support for the public health reforms in England. The majority of those surveyed do not think the reforms have benefited the public’s health and believe the level of unnecessary bureaucracy has increased. The report highlights the risks associated with fragmentation of the workforce and of some healthcare services. There was particular concern about a lack of ability to collaborate with other health professionals and to influence commissioners in the planning and delivery of healthcare services. The survey also reveals wide variation in public health provision across England and signs that local authority public health may become the ‘poor relation’ of the profession.

    Read more ...

Peoples Inquiry

  • A landmark report on London's NHS has been published which highlights a cash strapped and fragmented health service – and proposes an 18-point plan to save the capital's NHS.

    The report, London's NHS at the crossroads, outlines an unravelling of services as the NHS becomes more fragmented and financially squeezed. This is coupled with a management vacuum at the strategic level – with the public having no real voice in decisions that affect them. Available for download (follow link).

    Read more ...

Friday 21st March 2014

Health Investor

  • Government to sell off struggling NHS Professionals.

    The National Health Service’s in-house recruitment agency, NHS Professionals, is to be sold within the next 12 months, HealthInvestor understands. The government first said it would explore the privatisation of the agency in 2010, but never found a suitor. However, sources said the Department of Health (DH) was in talks with advisors and would pick a bank to run a sale process later this month. The agency is likely to be sold in the last quarter of this year or the first of next, they said. NHS Professionals was established in 2000 to improve management of the NHS’s temporary workforce and lower the costs of recruitment for trusts. According to its website, it has 40,000 workers on its books and is understood to have bank nursing contracts with 65 trusts. While its scope to win more contracts is a plus, sources claim its low profit margins could prove a turn-off to investors. The agency’s ebitda is thought to be just £7 million to £8 million despite revenues of £450 million. “They make a tiny margin as most of the money goes to paying the staff,” said one source. “Their commission for placements is small.” The sale has also attracted criticism from unions who believe a sell-off represents further privatisation of the NHS and will raise the cost of temporary staffing for trusts. A Nursing Standard survey in December showed that staffing agency costs across 100 NHS organisations rose by some 20% in 2011/ 12-2012/ 13 – up from £143 million to £175 million. Unison’s head of health, Christina McAnea, told HealthInvestor: "It is absolutely scandalous that the government is selling yet another internal service of the NHS.

    Read more ...

The Cockroach Catcher

  • Anorexia Nervosa & CAMHS: AQPs & Money Tree!

    It has been a few years since The Cockroach Catcher retired and in that time, the landscape of child & Adolescent Psychiatry has changed. Without much public notice, much of this sub-specialty has shifted into private hands. Just around half the last time I looked. I have personally dealt with "gaming" by private insurers. Now, it looks like the gaming is over as the payer is the NHS. You only need to look at the papers to realise that Anorexia Nervosa in particular is a growth industry. They are difficult to treat, recovery is not guaranteed and when the payer is the NHS: WOW! Looks like the attack is now on Anorexia Nervosa. The Cockroach Catcher had to face a team from a private hospital wanting to make money from the NHS by asking the NHS to continue to fund anorexia treatment as she has USED UP her health insurance money. Now the situation is much worse in our beloved NHS as there is a number of closures of NHS Adolescent Psychiatric inpatient units and many such In Patients are sub-contracted to the private sector even before the term AQP emerged. Has it not occurred to anyone that there are some very clever people working for the so called AQPs. As we move into the gaming era of the NHS, The one diagnosis that will be on AQP's list will be Anorexia Nervosa. Unlike hip replacement, the variation of the condition is such that it is ripe for Private Providers to make a case for a fairly long drawn out treatment. AQP will not worry as "the longer, the better". Of course the patient must not die and if you think I am skeptical, I am as I have seen it even before all this Reform or Deform. That is why I have argued that where there is such an incentive, "gaming" will happen and Mr Cameron. Don't say that nobody told you.

    Read more ...

Socialist Health

  • Whenever you hear news about wanting to bring in charges for the NHS, attention is never paid to the very rich who could afford to pay.

    Politicians of a certain ilk, enabled by a supine media, perpetuate the meme ‘the NHS is not sustainable’ demonstrating unsurpassable stupidity. It is not that the NHS is unsustainable – it’s just that some people feel they ought not to be contribuing to it out of general taxation. And the rest of the sheep follow. The Cameron-led government may have wished to convey an ethos of ‘libertarian paternalism’, where we are nudged into decisions in the market. But it is now generally conceded that there are many decisions which are profoundly unsuitable for ‘Nudge’. Like a stubborn stain which refuses to go on a repeat wash and spin cycle, the Conservatives still want to be patricians. The problem is they’re failing at that. Books have been written on the famous Harold Macmillan phrase, “You’ve never had it so good.” A number of reasons converge into Macmillan’s economic failure, but the phrase itself reinforces a sense of ‘them against us’. In spite of the talk about a social revolution in capitalism has not changed. It is still a system of minority wealth and mass poverty and insecurity. The only real dispute may be quite how large the “squeezed middle” is. Profits, stock exchange prices and the emergence of new crops of millionaires may truly mark the phase of “you never had it so good”. The Conservatives and high income Liberals don’t mind rubbishing the NHS as they hope not to use it. Whenever Grant Shapps talks about ‘hardworking people’, curiously he always talks about “them”.

    Read more ...

Our NHS

  • Treat your own dementia, Essex patients told.

    There are now about 800,000 people living with dementia in the UK. Ensuring they can live well has never been more important. But as Chancellor George Osborne MP unveiled his budget, interesting details emerged of how a particular Conservative council is deciding to balance its own budget. Essex County Council has just finalised plans to axe £200,000 funding for Mundy House, the only dementia day care centre in South Essex. This week local Tory councillors said people living with dementia should instead treat their own condition and advised them to attend one of four one-day workshops in a “dementia cube” visiting Chelmsford, Harlow, Basildon and Colchester to learn how to do so. 60 people people living with dementia have been attending Mundy House in Basildon, typically arranged through social services, once a week or more. However the centre will now close at the end of this month. Day care centres provide company and activities for people with dementia. A person with dementia attending a day centre can also provide carers with a much needed break. How could Essex councillors think it acceptable to offer a “Dementia awareness campaign” as an replacement for day care provision ? In national policy, “self care” is a philosophy which tries to encourage people with dementia in living well independently. It might include promotion of actions that people take daily to stay fit and maintain good physical and mental health. It might also include the prevention of illness or accidents, as well as the effective care of minor ailments. In my book “Living well with dementia” I review the evidence for interventions to improve the quality of life of people living with dementia. I feel very strongly that shutting of Mundy House Day Care Centre is a massive step backwards for the cause of encouraging people with dementia to live actively and independently. The NICE guidelines in England for some years now have emphasised the critical importance of leisure activities in ‘supporting people to live well with dementia’, re-stated in last year’s guidelines.

    Read more ...

GP Online

  • Viewpoint: Dr Kailash Chand: Budget could be catastrophic for GP morale and patient safety.

    It is 'another blow' to general practice that could be catastrophic for the profession’s morale and patient safety. Most NHS staff and GPs in particular have been carrying the NHS through austerity for the last three years. Last week’s decision by the governments in England not to award in full the already meagre independent recommendation of a 1% pay rise and now ignoring resourcing and funding of the NHS sends a clear message what this coalition thinks of the NHS and patients. With growth forecasts rising, it is even more shameful that the government won't uplift the NHS budget. While the government claims the NHS budget is protected, in reality it has suffered £20bn of cuts - billions of which have come from a sustained attack on staff pay. The cost of living crisis is hitting the NHS family the hardest. The assertion that NHS spending will grow in real terms is baseless: a commitment to a 0.1% real-terms rise in annual spending — just about the lowest level that could still claim to honour the government’s pledge – is neither here nor there. With inflation in healthcare currently running at more than 4%, the health service’s purchasing power for drugs and equipment is suffering significantly. Considerable money from the NHS budget is being siphoned off to help to pay off debts accrued from the private finance initiative (PFI). The annual charge that the NHS pays for acute PFI facilities is about 11-18.5% of hospital turnover, compared with 5-8% for non-PFI facilities. This produces an affordability gap that is filled only by diverting money from patient care and creating new pressures for hospital, community and primary care service closures in the medium and the long term. There is also the wide-scale pay decrease that NHS staff in general and primary care in particular, have to contend with, at a time of rising family expenditure and a real threat to pensions. The NHS reforms have neither improved patient safety nor quality, but basically outsourced the NHS at turbo speed. Public resources have been allocated to the private sector.

    Read more ...

Supply Management

  • 'NHS procurement is a mess needing central leadership'.

    The head buyer at Barts Health NHS Trust has said procurement in the NHS is a “mess” and needs to be led from the centre. John Watts, interim director of procurement and ecommerce at the trust, told a conference change was “desperately needed” but it had be driven from the centre because individual trusts did not collaborate enough. “At the moment the centre has no teeth,” he said. “In the private sector that would be absolute madness. There is no-one at the centre driving change. I think it has to be centre-led without a doubt but it has to be locally delivered. “There is no sharing of data or best practice and there’s no best use of resources or skills.” Watts said Barts was “probably the largest acute trust in the UK”, though when he joined 15 months ago it had an annual deficit of £100 million. He said they had a target to get this down to £50 million this year but they were on course for £39 million. “It’s a massive agenda,” he said. Speaking at the Government Opportunities NHS Procurement Conference in Birmingham, he also said they had to cut costs by £250 million over the next three years and had saved millions through a combination of strategies including standardisation and reducing the number of suppliers.

    Read more ...

The Independent

  • Atos ‘misled ministers’ to win lucrative contract assessing disabled for benefits

    A controversial private outsourcing firm misled the Government in its official bid to win a multimillion-pound contract to assess the needs of disabled benefit claimants, MPs have claimed. In its tender document, submitted to the Department of Work and Pensions, Atos suggested that more than 700 healthcare providers, including 56 NHS hospitals, had contractually agreed to provide accommodation where assessments for new Personal Independence Payments could take place. It claimed the “hyper-local” network would mean that no disabled claimant would have to travel more than 60 minutes to attend an assessment, with “over 90 per cent of claimants able to reach the centres in 30 minutes”. But the Public Accounts Committee heard that, since the scheme was launched, over 40 per cent of all claimants have had to travel for more than an hour to reach an assessment centre, with only 40 per cent being able to reach a suitable location in less than 45 minutes. Atos had in fact contracted fewer than 100 healthcare providers to provide accommodation – and a miscalculation by the DWP over how long each session would take meant that some severely disabled people were waiting longer than six months to be seen. MPs accused Atos of “playing fast and loose with the truth” in the bid document – resulting in ministers misleading Parliament about how the scheme would work. Personal Independence Payments began to replace Disability Living Allowance in April last year. Most people applying for PIP have a face-to-face assessment to determine eligibility, which is carried out by Atos Healthcare and Capita Business Services. But a report from the National Audit Office found claimants were waiting an average of 107 days, and terminally ill patients 28 days, for a decision on their cases – much longer than had been predicted. MPs told Lisa Coleman, senior vice-president of Atos, that they believed the firm had been misleading in its bid document. Ms Coleman told the committee that because the DWP had pushed back its plans for mandatory re-assessment of all DLA claimants until 2015 fewer sites were needed than had been suggested in the bid document. “We have had sufficient coverage,” she said. “If we had used all 750 sites they would [each] be doing about three assessments a week.” Ms Coleman added: “What we talked about in the tender document was what we thought we could achieve. When you write a tender document you say this is the specification that I can deliver. This is what I am responsible for.” An Atos spokeswoman subsequently said the company categorically denied making misleading claims in the tender document.

    Read more ...

Thursday 20th March 2014

Pulse

  • Extra 'named GP' funding in doubt as CCGs struggle to stump up cash.

    Some GPs may not receive the additional £5 per patient funding supposed to support the new contractual responsibility to be a ‘named GP’ - and those that do may have to undertake additional work. As many as a third of CCGs have yet to decide if they will offer GPs the extra money, which has been promised by NHS England and the health secretary and is due to begin in April, with one CCG admitting it is waiting on uncertain ‘quality premium’ payments before committing to paying GPs. Among those who are to offer the funding, meanwhile, many have yet to determine what extra work it may be tied to over and above the new named GP duties, with one CCG planning to commission ‘additional services’ and two others in the process of negotiating ‘baseline outcomes’. LMC leaders warned that CCGs were likely to struggle to find additional cash to fund GPs’ new duties.

    Read more ...

Nursing Times

  • NHS staff in Budget day protests over 'insulting' pay offer.

    Health workers will stage Budget day protests today against the government’s “insulting” pay offer. Demonstrations are expected in Westminster and Bristol, amid continuing anger over the coalition’s decision not to accept recommendations from a pay review body. Around half of NHS workers in England and Wales will have to rely on their annual incremental increase for a pay rise this year. Rehana Azam, national officer of the GMB, said: “In the last Budget the chancellor announced that NHS workers would receive a pay rise, but health secretary Jeremy Hunt has decided to take an axe to the NHS pay review body recommendations. It comes to something when the chancellor says one thing and government departments do another,” she said. She added: “If it’s fair for the MPs’ pay review body recommendations to be accepted by the government, why can’t the same principle apply to hardworking NHS workers ?” Health workers and activists, organised by Unite, will be protesting outside Bristol Royal Infirmary.

    Read more ...

BBC News

  • Doncaster Care UK workers stage seven-day strike.

    About 150 care workers have begun a second seven-day strike over changes they claim could see some workers lose up to 50% of their take-home pay. Unison members employed by Care UK in Doncaster claim their income would drop due to changes to rates for evening and weekend work. Care UK rejected the claim and said the proposed changes would protect jobs. It cares for 140 people with learning disabilities in around 40 properties in Doncaster. Union members previously walked out for seven days at the end of February. Unison said the fresh action followed the breakdown of talks at the conciliation service Acas.

    Read more ...

Stoke Sentinel

  • Calls for improvements to private ambulance contract after patient left waiting for three hours.

    Patients are calling for urgent improvements to a private ambulance service after they were left hours late for critical dialysis appointments. London-based NSL took over the £3m contract from West Midlands Ambulance Service in August. And in March the patient transfer service made changes to how it takes people receiving dialysis. But the changes have left some patients waiting for several hours for a lift to the University Hospital of North Staffordshire.

    Read more ...

Nottingham Post

  • EMAS spending £7m on private ambulances due to lack of staff.

    Private companies and volunteers were paid £7 million last year to respond to 999 calls – because the ambulance service did not have enough staff. The figure is more than twice as much as East Midlands Ambulance Service spent in the previous year and seven times higher than in 2010. The news comes after the Post revealed that the service’s own ambulances were being left unused for up to 12 hours, hundreds of times a month, because of a shortage of paramedics. However, EMAS says it is currently recruiting more frontline staff and it expects to spend less on cover from outside bodies in coming years.

    Read more ...

Nuneaton News

  • George Eliot Hospital privatisation protesters off to the capital.

    Campaigners opposed to a private company taking over the running of the George Eliot Hospital are to take their battle to the nation’s capital. Around 50 protesters from Nuneaton are to set off this morning to take their fight to the door of the Trust Development Authority (TDA) in Victoria Street, London.The group, led by union Unite, say that a meeting is to be held there which could see the three candidates left in the running to take over the Nuneaton NHS Trust reduced to just two. The Unite members and local community campaigners are to gather outside the TDA offices to highlight their opposition to privatisation. Unite believes that the people of Nuneaton and North Warwickshire will be better served and the long term future of the small district general hospital secured through a merger with South Warwickshire NHS Foundation Trust, rather than by a profit-driven private company takeover. The three organisations currently left in the running to takeover George Eliot are two private companies, Circle and Care UK, alongside South Warwickshire NHS Foundation Trust. The Nuneaton hospital is the first district hospital that the TDA has given the green light to private companies to tender for in a bid to improve it’s failings, including, its high death rate, which are now being addressed.

    Read more ...

Health Investor

  • DH U-turn furthers private sector access to NHS pension scheme.

    The Department of Health (DH) has scrapped plans to make independent operators of NHS services provide a financial guarantee to join the NHS pension scheme. In December, the DH said private providers would have to obtain a three-month contributions guarantee or bond if they wished to access the scheme, open to them from April 2014. This move was intended to safeguard the taxpayer from having to cover private provider employees if the provider defaults on paying contributions. Following a consultation though, the idea has been dropped, after the DH decided the move would be expensive and indirectly increase NHS costs when procuring services. The DH said, in a response to the consultation, that it was “satisfied that many [independent providers] would find it difficult to secure suitable guarantees at reasonable cost, and the providing such cover would, as claimed, tie up [their] capital and potentially drive up costs to the NHS in a counter-productive way.” Now, providers who default on payments will have the unpaid amount deducted from its fees for providing a service. If the non-payment continues for a significant period of time, the company’s access to the NHS pension scheme will be revoked. A bond, however, could still be required if a provider has a history of non-payment or has a particular financial risk. From April 2014, the NHS pension scheme will be open to independent sector as part of plans to create a level playing field between the two sectors. Under the terms of the scheme, NHS staff who transfer over to private operators providing NHS care will still be able to access the pension. The scheme can also be offered to any existing staff in a private organisation who mainly work on delivering NHS care.

    Read more ...

Guardian

  • The NHS is being put up for sale to private healthcare companies.

    Rachael Maskell, Unite's head of health, writes: So far this year, hardworking and dedicated NHS staff have seen continued attacks on their pay and conditions, as well as the continuing creation of a health service dominated by private healthcare companies. The NHS, as the British public has known it since its foundation in July 1948, is being transformed before their very eyes. The 1.3 million NHS staff have seen their pay being eroded by up to 15% since 2009, by the down-banding of staff grades and loss of on-call payments. Some of our members have seen their incomes plummet by a third. The screw was turned even more viciously when Jeremy Hunt vetoed the recommendation for all staff to receive a very modest 1% pay rise. Some 600,000 staff are, therefore, being denied a cost of living rise on 1 April. Behind this continued depression of wages of nurses, health visitors, paramedics and speech and language therapists is the deep-rooted intention of the coalition to privatise large swathes of the NHS as quickly as possible. The Tory party has strong links with private healthcare companies, which are set to garner rich pickings. Since last April, 70% of the contracts awarded for NHS work have gone to the private sector. The recent acquiescence of supine parliamentarians to the passing of clause 119 (formerly clause 118) of the care bill – which will allow the health secretary to close hospitals in England without proper consultation within 40 days – is another weapon to soften up the NHS for hiving off to the profiteers. What is so insidious about Hunt's actions is that they are being conducted under the false premise that profit-hungry healthcare companies will provide a better service. They are good at driving down costs to satisfy their shareholders, but big question marks hang over their ability to improve services for patients and to uphold professional standards. A drive on costs is normally reflected in falling quality. The government has adopted a culture of secrecy, as well as legal and parliamentary ruses, to hide from the public the extent that the NHS is being put up for sale to private healthcare companies. The NHS is rapidly being turned from a fully integrated, complex, interwoven organisation that has evolved over 65 years to optimise high-quality clinical care to metamorphise into a pick-and-mix counter, where any qualified provider can scoop up their preferences and not have to worry about what others are doing – or what is left behind. The rush to privatise renal units, intensive therapy units and A& Es has not happened because these services cost a lot of money and will therefore reap no financial reward for the profiteers. However, hip and knee replacements are frequently conducted in the private sector. Taking out low-risk, high-volume, interventions which injected money into the NHS – due to the pricing of the tariff – is exposing NHS hospitals to the risk of financial failure. This is because high risk, expensive services that are hard to price are left for the NHS to pick up. The system is collapsing because this model will force the NHS into financial failure, resulting in the administrator being brought in. It won't be in the Tory heartlands where we see hospital closures, but Labour areas where there are the greatest areas of health inequality and deprivation and which will witness local services being moved beyond reach. If you join up the dots, you can see how ministers are creating a world that gives private healthcare companies a distinctive advantage when they bid for NHS work. This must be fought tooth and nail.

    Read more ...

  • NHS hospitals suffer annual loss for first time in eight years.

    NHS hospitals will end the financial year in the red for the first time in eight years, according to official figures, with 26 loss-making trusts reporting a combined deficit of £456.8m. The University Hospitals of Leicester NHS trust has run up the largest deficit: £39.8m. The figures will renew fears that the NHS's finances have been deteriorating sharply in recent months, especially as a result of many trusts having to hire extra staff, notably nurses, in order to ensure safe and high-quality care in the wake of the Mid Staffordshire scandal. Experts including Professor Chris Ham, the chief executive of the King's Fund thinktank, are warning that hospitals can't hire the necessary number of staff without busting their budgets. After surpluses at other hospital trusts are taken into account, NHS hospitals overall will end the financial year £112m in the red, the first loss recorded since 2006. The losses of £456.8m were recorded by 26 of the 102 hospital trusts that have not achieved foundation trust status.

    Read more ...

Click here for items older than 30 days