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Friday 30th January 2015

Open Democracy

  • What 'austerity' has done to Greek healthcare.

    In October I visited Greece to see the impact of austerity on the Greek people, in particular on health and healthcare. I joined healthcare workers and the Greece Solidarity Campaign to visit hospitals, clinics and food markets. I spoke to healthcare staff, volunteers, politicians and local government officials. What I witnessed appalled me - and brought tears to my eyes. In Greece’s biggest hospital, the Evangelismos Hospital in Athens, conditions were worse than those I have seen in developing countries. The moment the hospital doors open on ‘emergency’ days, people flood in. The collapse in official primary and community health care services means everyone who needs healthcare comes to A+E - whether for a major accident, medication for a long term condition or to get their child immunized. Staff told me that serious trauma cases often have to wait hours for X-rays and treatment due to understaffing and that, if too many cases come in at the same time, people die before they can be treated. The ‘austerity’ conditions imposed on Greece by the Troika (European Commission, European Central Bank and IMF) as the price of its debt bailout have closed many hospitals (including three psychiatric hospitals) and primary care clinics. Those that remained face drastic staff cuts. Thousands of health workers have been sacked. 30% of the Greek population is living in poverty, with no access to affordable healthcare. Healthcare is funded through insurance paid by employers and when people lost their jobs they lost their health insurance. The Government claimed to have reinstated health care for the neediest but doctors and nurses told me it was a sham. The promised tribunals to assess and means test the claims of those who can’t afford health care have yet to be established.

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Hospital Doctor

  • Hospital groups still buying consultants’ private referrals.

    The GMC has been criticised for failing to act after receiving evidence of widespread payments to consultants in private practice in exchange for referrals to certain hospital groups. An investigation by a major health insurance company uncovered covert schemes often worth ‘tens of thousands’ of pounds, with some payments exceeding six figures. The insurance company called on the GMC to “take a clear position on this” but the regulator took no action. Land Registry records showed that many independent practices were housed in expensive London properties owned by private hospital groups. One document seen by The BMJ showed 73 properties, many in West End locations, including Harley Street and Wimpole Street, owned by the giant American hospital corporation HCA alone. In 2014, the Competition and Markets Authority (CMA) issued an order that prohibits inducement schemes. But there’s evidence that some hospitals are continuing to “buy” referrals. One senior surgeon said he had been approached by a hospital group hoping to attract his referrals away from a rival as recently as nine months ago. A spokesperson for The London Clinic, London’s largest independent hospital and an opponent of consultant incentive schemes, said that although the rules had been “tightened considerably” by the CMA order “we are still seeing consultants being approached by competitors”. The GMC said it “would encourage anyone who has concerns about the conduct of a doctor or evidence of wrongdoing to share this information with us in order for us to investigate these concerns and, if appropriate, open an investigation.”

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The Independent

  • NHS budget crisis as hospitals rebel against Government cuts.

    Hospitals have carried out an “unprecedented” rebellion against national NHS spending plans, warning officials they can no longer guarantee safe patient care under funding proposals for this year. Objections to the NHS tariff for 2015/ 16 have been submitted by hospitals that between them represent 75 per cent of the work the health service carries out. The tariff sets the rates at which hospitals and other providers are paid for the services they provide. Proposals for this year amounted to a 3.8 per cent real terms cut. Their intervention is highly significant as it means some of England’s major hospitals have reached the conclusion they can no longer afford to carry out the operations, treatments and other services they are constitutionally bound to provide. Chris Hopson, chief executive of NHS Providers, which represents hospitals, as well as community, mental health and ambulance services, said that objecting to the tariff was a “last resort”. “It is a clear response from the NHS frontline that they can no longer guarantee sustainable and safe care and meet constitutional performance targets from 1 April 2015 unless immediate changes are made to the way they are paid for services,” he said. Richard Murray, a former senior economist at the Department of Health and now director of policy at the King’s Fund think tank, said the move was “unprecedented” and would throw “financial planning in the NHS into disarray”.

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HSJ

  • Hospital objections scupper controversial 2015-16 pricing plans.

    The NHS will go into what is expected to be its toughest financial year yet with no nationally agreed set of prices for services, after controversial 2015-16 tariff proposals were resoundingly rejected by the dominant providers. Speaking exclusively to HSJ this morning, Monitor chief executive David Bennett revealed that providers responsible for a 75.1 per cent share of all NHS services had lodged formal objections to the proposed tariff. That means objections have clearly breached the 51 per cent threshold at which the pricing authorities must either refer their proposals to the Competition and Markets Authority for review, or consult the health service again on revised prices taking into account the objections. It marks the first time NHS objections have scuppered a proposed tariff since the new pricing rules introduced by the Health Act 2012 came into effect. Whichever course pricing authorities decide to take, it is now certain that they will not be able to get a new tariff for 2015-16 confirmed before the start of the financial year. Mr Bennett said Monitor was now working with NHS England, which shares joint responsibility for the tariff, to decide “as soon as possible” whether to refer their tariff to the CMA or to revise it and re-consult. He told HSJ that he and NHS England chief executive Simon Stevens were speaking regularly about the issue, but would not commit to a “definitive date” by which a decision would be reached.

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  • Trust sector deficit deteriorates to £414m.

    The NHS trust sector’s financial position has deteriorated to an overall deficit of £414.2m, providing new evidence of the pressure trusts are under. Papers presented at the NHS Trust Development Authority’s board meeting last week show that for the eight months to November last year the trust sector is £38m further into the red, compared to the £376.2m deficit it reported in the six months to September. The TDA is forecasting the sector will finish the year with a deficit of £308m – £25.7m worse than the £282.3m it predicted previously. However, the underlying financial performance is worse than these numbers suggest, as figures for the trust sector have been improved by the inclusion of “provider deficit funding” bailouts distributed to 15 trusts by the Department of Health. The TDA said trusts were under pressure because of “unplanned growth” in hospital care, an increase in contract and agency staff, and failure to deliver savings planned at the start of the year, with a “larger proportion of cost improvement scheme being delivered non-recurrently”. Thirty trusts are forecasting a combined deficit of £452.1m, but with 69 trusts forecasting a surplus of £144m between them, the aggregate position for the sector improves to the £308m deficit.

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The Guardian

  • England’s biggest hospitals veto NHS budget over patient safety fears.

    England’s biggest hospitals are refusing to sign off their annual budget deal with the NHS, claiming that the £1.7bn of cuts involved will mean they can no longer guarantee the safe care of patients. In an unprecedented move, hospitals that provide 75% of all NHS hospital care have vetoed plans drawn up by Monitor, the NHS’s financial regulator, to reduce their income to help the service balance its books. “We have now reached the point where patient care is at risk,” the hospitals said. NHS Providers, which represents 94% of hospitals, said its members could no longer “achieve the impossible” by absorbing a fifth successive year of cuts to the payments they receive for treating patients under the tariff system. “After five years of unprecedented price cuts, with NHS providers realising more than £20bn of savings over this parliament, objecting to the tariff for many represents a last resort to have their concerns heard, as they can no longer guarantee safe and effective care unless they are properly and fully paid for the patients they treat,” said Chris Hopson, the chief executive of NHS Providers. Some patients could end up not being treated at all as a result of the public row over where the NHS’s money went, he warned. If hospitals were not paid the full amount for the care they provided, he said, they might only provide as much care as they could, based on their budget. An estimated 80% of England’s 160 acute hospital trusts are either already in the red or at risk of ending the 2014-15 financial year in late March with a deficit. Hospitals are already facing the loss of another £1.9bn of their £40bn annual income to help fund the Better Care Fund, which starts in April and is meant to keep patients healthier at home to relieve the growing pressure on hospitals.

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Thursday 29th January 2015

Daily Mirror

  • Jeremy Hunt GAGS NHS staff to cover up the health service crisis crippling hospitals.

    Jeremy Hunt has been accused of a shocking attempt to cover up the crisis crippling the NHS. The Tory Health Secretary was confronted with detailed new guidelines doctors say “tie their hands” over declaring major incidents. It sparked claims the Conservatives are desperately trying to bury bad news about the chaos gripping hospitals in the run-up to May’s general election. One whistle blower warned the guidelines would make it more difficult to trigger emergency measures - meaning fewer negative headlines highlighting the crisis in accident and emergency units across the country. The insider outlined a checklist of 17 questions that must be answered before they can announce major incidents.“This is the enhanced criteria that has been introduced by NHS England to effectively stop trusts from calling a major incident,” the whistle blower revealed in emails obtained by the BBC. “Worth sharing with emergency department consultants as our hands will be tied in most cases if they wish to call a major incident for capacity reasons.” An A& E consultant replied: “It strikes me as an attempt to dampen down the heat and media attention on the emergency departments and their major incidents.” Mr Hunt tried to dodge responsibility for the document, claiming it “was issued by local NHS in the West Midlands”. But NHS England says “major incidents should be agreed with the director on call from NHS England”, MPs heard. Meanwhile, David Cameron came under attack after it emerged 29 hospital units he promised to keep open have been axed since he became Prime Minister.

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  • Ex-Labour Health Secretary Alan Milburn accused of being £1million 'Tory collaborator'.

    Alan Milburn was accused of putting his own business interests first after attacking Labour’s plans to save the NHS from privatisation. The former Health Secretary, who has made a fortune from working with private health firms, claimed it was a “fatal” error to halt NHS reforms. Mr Milburn also joined forces with another former Blairite minister, John Hutton, to attack Ed Miliband and Ed Balls for failing to defend New Labour’s economic policies. Their comments sparked a furious backlash, with ex Deputy PM Lord Prescott accusing them of being “Tory collaborators.” Mr Milburn’s company AM Strategy reportedly accumulated £1,357,131 in profits by March 2013 - £518,854 more than the £838,277 it made up until 2012. Since standing down in 2010 Mr Milburn has worked as a consultant for Bridgepoint Capital, a venture capital firm involved in financing private health care companies moving into the NHS. The former Labour MP is also vice-chairman of the Lloyds Pharmacy advisory board and is chair of PriceWaterhouseCoopers’ new Health Industry Oversight Board. On his appointment two years’ ago, Mr Miliburn claimed there were “strong opportunities for growth” in the private healthcare sector.“The UK health industry offers strong opportunities for growth in the wider economy and my aim is to bring together a panel of industry experts to drive change across the health sector and PwC growing presence in the health market.” Mr Milburn also sits on the strategic advisory board for private healthcare company WellDoc, and chairs the healthcare industry company I Want Great Care which claims to turn “patient experience into a robust quality metric.” John Prescott tweeted: “I see those Tory collaborators Milburn and Hutton are attacking Labour’s brilliant NHS plan. Go back to advising Pepsi and the nuclear industry.”

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Cambridge News

  • Hinchingbrooke Hospital: MP Julian Huppert says privatisation was ‘deeply flawed’.

    Privatising the management of Hinchingbrooke Hospital was a "massive failure", Cambridge MP Julian Huppert has said. He told Prime Minister David Cameron that the move under the last Labour government had been "deeply flawed". Mr Huppert said the hospital should be brought back under the NHS. Circle, which won the contract to run the hospital, pulled out after three years and on the same day the Care Quality Commission (CQC) unveiled a scathing report which branded the hospital inadequate. The Hinchingbrooke health trust is appealing against the CQC's findings. Speaking at Prime Minister's Questions Mr Huppert said: "The decision by the last Government to put Hinchingbrooke Hospital out to tender, with the last three bids under them all led by the private sector, was deeply flawed and a massive failure."

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Birmingham Post

  • £60m cuts at Queen Elizabeth Hospital to be piled on 'untenable' financial pressures.

    Birmingham's flagship Queen Elizabeth Hospital is facing demands to make savings of up to £60 million - which it insists it simply cannot do without putting patients at risk. Officials warn the only way they could make the required savings would be by drastically cutting staff numbers, which would hit patient safety - but said this is not an option they would consider. The Queen Elizabeth faces soaring costs thanks to rising patient numbers, an increase in the number of older patients and the availability of new and more expensive forms of treatment. This comes on top of demands from Monitor, the official watchdog which oversees NHS foundation trusts, to cut the cost of treatment by 3.8% and changes to the way the NHS funds specialist treatment. It means the trust will have to find savings of up to £60m to avoid plunging into the red. The 1,213-bed hospital in Edgbaston cost £545 million to build and was opened in 2010. In the last 18 months the trust has opened a further 170 beds, four theatres and a day case surgery unit in the original Queen Elizabeth site. NHS England, the body now responsible for overseeing health services in England, is proposing to pay hospitals only half the standard fee if the number of patients treated for complex conditions increases. It means hospitals will receive the full payment as long as the number of patients receiving specialist treatments remains the same. But if the number goes up, the hospital only receives half the usual rate of funding for the extra patients. Dr David Rosser, the trust's executive medical director, has written to Simon Stevens, the chief executive of NHS England, to warn hospitals face a choice between turning patients away or trying to treat them without proper funding – and patients may die as a result. Some 450 doctors from UHB and other specialist hospitals across England also added their signatures to the letter.

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Belfast Telegraph

  • Health workers strike over pay.

    Health workers in Northern Ireland will mount picket lines outside hospitals and ambulance centres in a strike over pay. Members of the GMB and Unite unions will go ahead with industrial action after hopes of a last-minute agreement collapsed. A third union, Unison, will hold a strike ballot next month among its members in Northern Ireland over pay. Unions said a proposed pay deal for staff in England drawn up after lengthy talks with the Government in Westminster had not been matched by the Department of Health in Northern Ireland. A strike planned by NHS staff in England was suspended so union members could be consulted on a new offer. The GMB expressed "surprise and disappointment" that the deal hammered out between unions and the coalition in Westminster to avoid strike action had not been approved by the Northern Ireland government. Michael Mulholland, GMB regional officer, said: "The response from the department puts us back to square one. On that basis GMB and Unite members will take strike action. There is no confirmation that the pay offer for NHS staff in England will be applied in full as has been the practice for over 60 years. Instead we are invited to make reference to it in the discussions we have been offered. There is also no pay offer on the table for 2014/ 15. This is moving the goal posts and is totally unacceptable. NHS workers are furious and the public will want to know why the Department of Health is not putting the offer in England on the table as they are expected to do."

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Guardian

  • NHS hires up to 3,000 foreign-trained doctors in a year to plug staff shortage.

    Up to 3,000 doctors have been hired from overseas by the NHS in the past year, as the service battles to tackle staff shortages that medical professionals say are serious and growing. Dr David Rosser, medical director of University hospitals Birmingham, one of England’s biggest trusts, said: “The NHS doesn’t have the number of doctors it needs. The shortage is real. We aren’t training enough doctors in this country, and so we are dependent on foreign-trained doctors. Doctors in more and more branches of medicine report shortages, especially in specialities such as A& E, where it’s tough work.” Overall figures from the General Medical Council show that the number of foreign-trained doctors on its register rose by 2,957 between 31 December 2013 and 6 January 2015. They made up two-fifths – 39.4% – of the 7,500 year-on-year increase in the overall number of doctors, which rose to 267,150. Of the 267,150 doctors of all types registered with the GMC on 6 January, 97,915 (36.6%) were foreign-trained, including 34,120 (41.2%) specialists. Rosser blamed the shortages of doctors on two things. NHS central workforce planning, which is supposed to ensure the service has enough staff to meet future medical need, “has never worked and has been a shambles forever”, he said. And the tightening of visa rules under the coalition, which has made it harder for junior doctors from the Indian sub-continent to stay in Britain long enough to complete their training, has prompted some of the doctors who have traditionally made up a key part of the NHS workforce to go instead to places like Canada, where they are allowed to stay until they become senior doctors. “The NHS is the loser because of that, because we get the offer of high-class trainees subsidised by their countries’ governments and so come at a much lower cost than employing our own trainees, but the number who come over is getting smaller because they want to come here for five, six or seven years but the visa rules can mean they only get two years, which is too short for them”, added Rosser. The 32 trusts that responded to a Guardian request for information between them have hired 321 doctors and 1,075 nurses from abroad since the start of last year. But, as they represent only a fifth of the 160 acute trusts, the overall figures will be much higher. Hospitals and ambulance services are also having to use employment agencies abroad and send staff to recruitment fairs in Europe and the far east in an effort to find thousands of nurses and paramedics. The NHS is also increasingly short of nurses, prompting concern from medical leaders. “Here we are wholly reliant on our overseas staff. About a third of our nurses are from overseas. This situation isn’t ideal,” said Keith McNeil, chief executive of Addenbrooke’s hospital in Cambridge. Overseas staff cost the NHS more than UK-trained personnel because they take longer to familiarise themselves with the service and receive clearance to work, he added. Shortages are so severe that hospitals are competing with each other for staff, notably nurses. The lack of staff is so acute that NHS trusts in England are spending £2.6bn a year on agency and temporary staff, official figures show.

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Tuesday 27th January 2015

BBC News

  • NHS 'most important issue' suggests BBC/Populus poll.

    A BBC/ Populus poll suggests that people think the National Health Service is the most important issue to be covered by the news ahead of the election. The NHS came ahead of the economy, immigration, welfare and jobs. Of 4,209 adults asked, 74% ranked it "very important" while 93% found it either "very" or "fairly important". The findings of the poll, which was carried out between between 14 and 18 January 2015, comes 101 days before the general election on 7 May.

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  • Northern Ireland ambulance workers prepare for strike.

    Ambulance workers in Northern Ireland are preparing to strike in a protest over pay. Talks were held in England on Monday and the unions in Northern Ireland met their bosses to discuss contingency plans for the strike. In Northern Ireland, the workers plan to walk out from 12:00 GMT and stay out until 23:59 GMT. The action is in response to a decision not to implement a 1% increase in NHS staff salaries across the board. The government pay review body recommended a minimum increase of 1%. That has been implemented in Scotland and Wales, but not in England and Northern Ireland.

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Inside Housing

  • Stop focusing on quick, one-off land sales, NHS told.

    NHS bodies should stop looking for the quick sale of hospital land and be more ‘creative’ to raise extra cash, the National Housing Federation (NHF) has said. The NHF said although selling surplus land quickly maximised the ‘one-off cash sum’ received through a sale for the NHS, it also limited ‘the potential to be creative and achieve a greater financial return’. The representitive body believes that releasing more public sector land to social landlords is a key part of solving Britain’s housing crisis. However, housing associations are often unable to compete in buying public sector land because landowners want to achieve quick sales to the highest bidders. The NHF said last year: ‘The high prices paid for land often prevents housing associations being able to access sites and build affordable homes. The open market is a tempting and alluring proposition for many NHS trust providers especially if they have foundation trust status.’ It made four recommendations to change the way the NHS disposes of its surplus land in the document ‘Surplus NHS land; a best value alternative’. NHS foundation Trusts - local units of the NHS which have semi-autonomous status - are in a ‘strong position’ to sell surplus land to housing associations, the NHF said. However, NHS trusts not awarded foundation status, which do not have the same freedoms, will need ‘more clarity and guidance’ from the Department of Health (DoH) before they are able to strike such deals with social landlords, the NHF added.

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Left Foot Forward

  • GP workforce is shrinking, says NHS.

    There is a GP workforce crisis in England, says the NHS. In a report titled ‘Securing the Future GP Workforce’, it concludes that the crisis ‘must be addressed immediately’ and that ‘evidence is also emerging that the GP workforce is now shrinking rather than growing’. This year’s census of GPs shows that there are 356 fewer than last year, and in some regions, only 60 per cent of places for GP training were filled. The problem is compounded by a growing number of trained GPs leaving the workforce. According to the General Medical Council, the number of GPs in England applying for paperwork to emigrate doubled from 266 in 2009 to 529 in 2013.

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Daily Express

  • Labour's NHS plan 'will close hospitals'.

    Labour plans that could slash the number of hospital beds by merging health and social care were blasted by Health Secretary Jeremy Hunt. Mr Burnham has indicated he may favour cutting bed numbers – even if it resulted in hospital closures. His comments emerged as Labour prepares to reveal more details about its health and social care plans. Mr Burnham’s plan came in an interview with Fabian Review magazine in 2013. Asked about his project to integrate the NHS and social care system, Mr Burnham said: “Partly what I’d cut to pay for my policy are hospital beds. Some social care could be met for free from a much more preventative, home-based system.” When pressed that the logical knock-on effect would be fewer hospitals, he replied: “None of this is sacrosanct. We’re not going to be on every picket line opposing every closure.”

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This is London

  • MP calls for answers over East Barnet Health Centre closure.

    An MP is calling for an urgent meeting with the NHS to discuss why a “well-needed” health centre has been shut for more than eight months. Theresa Villiers, MP for Chipping Barnet, is demanding to know when East Barnet Health Centre will reopen. The centre was closed in June 2014 after asbestos was discovered in the building. It was due to be reopened in September, but is still closed more than eight months later. Ms Villiers said: “I am concerned that the East Barnet Health Centre has been closed for so long and there is still no definite plan in place for when it will reopen. I know how concerned my East Barnet constituents are on this issue. It is vital that the health centre reopens. I have raised this issue with NHS Property Services who assure me that they are committed to providing a fit-for-purpose building for GP services in East Barnet. I have been assured that the NHS has no plans to sell the site for housing development. This is welcome news since there is a clear need for facilities for GP services and primary care in East Barnet." In the meantime, patients are being told to go to Vale Drive Health Centre – which is a 30-minute walk or a 15-minute bus journey away.

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Portsmouth News

  • Bupa backs out of bid to take on services.

    Negotiations aimed at awarding a huge slice of NHS orthopaedic services to a privately-run body have fallen through. Bupa CSH has withdrawn from the procurement process that could have seen it take on £235m of musculoskeletal services across coastal West Sussex. The decision was made after an independent impact assessment looking at the effect the procurement would have on wider services – including at St Richard’s Hospital in Chichester – found the financial position of Western Sussex Hospitals NHS Foundation Trust would be worsened if Bupa provided the service.

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Monday 26th January 2015

Open Democracy

  • Carnival of incompetence - or, how nobody knows how to privatise a health.

    William Goldman, the famous Hollywood screenwriter once said about motion pictures that ‘nobody knows anything’ about whether a film will work. If Goldman had watched the calamitous privatisation of our NHS in recent months he’d have been struck by the similarity between the Hollywood studios and our embattled NHS. Putting aside for a moment that privatisation is a fundamentally less effective way to run a public health service, nobody actually knows how to do privatisation. If you were a government who wanted to pull to pieces our most treasured national institution, the most cost efficient health service in the world, without a democratic mandate, you’d at least want to do it well -, wouldn’t you ? In West Sussex, local health bosses decided last year that they need to open up MusculoSkeletal services (MSK) to competition. I say ‘decided’ - such ‘local decisions’ start with central government, who handed £80bn to brand new health bosses (CCGs) with little experience of large-scale commissioning, then passed both law and policy that seemed to effectively force CCGs to open up all potentially profitable NHS services to private takeover bids sooner or later, or risk costly legal challenge if they didn’t. And it’s central government who have been imposing cuts at the same time, thus forcing the inexperienced CCGs to simultaneously restrict services. Here in West Sussex, two organisations submitted bids to takeover MSK - the local NHS Trust already running the services, and BUPA Central Surrey Healthcare.

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The Guardian

  • New doctors offered NHS fund ‘golden hello’ to become GPs.

    Newly qualified doctors will be offered “golden hellos” if they become a GP under a £10m NHS plan to help overcome the growing shortage of family doctors. The initiative is part of a new package of measures designed to boost the number of GPs joining the profession, deter early retirement and encourage those who have taken a career break, for example to work abroad or have children, to rejoin the workforce. The move has been prompted by concern among health service leaders, ministers and GP organisations that a lack of family doctors will worsen the growing problems GPs face dealing with more and more patients seeking an appointment. Under the action plan, which is being led by NHS England, recently qualified medical graduates who agree to work for three years as a trainee GP in places with too few family doctors – mainly deprived areas – will receive unspecified “additional financial support”. Young doctors who agree to work as GPs in such areas will also be offered an extra year’s training in a branch of medicine that interests them, such as child health, psychiatry or emergency medicine, or help with acquiring business skills. Experienced GPs who are considering retiring early will also be offered incentives to continue working, including mentoring and help with qualifications, such an a MBA. The £10m for the scheme is part of the extra £1bn ministers have made available to improve general practice from fines levied on banks for their part in the Libor scandal, although most of that money is to upgrade GP surgery buildings and equipment.

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HSJ

  • NHS consortium challenges NHS England £80m contract decision.

    A consortium of NHS trusts have lodged a formal challenge against NHS England following its decision to hand a 10 year, £80m contract for PET CT scanning to a private company. University Hospitals of North Midlands Trust, Wirral based Clatterbridge Cancer Centre Foundation Trust and the Royal Liverpool and Broadgreen University Hospitals Trust had bid together last year to run PET CT scans across Staffordshire, Cheshire, Shropshire and Lancashire. But the contract, which would cover around 5 million patients, was awarded to independent company Alliance Medical just before Christmas. HSJ understands this bid would cost £7m more than the NHS consortium bid. The consortium confirmed it has lodged a formal challenge to the procurement decision. The challenge is believed to focus on the process followed by NHS England, although details have not been released. The decision to award the contract to Alliance Medical has also been discussed in the House of Commons, with Stoke on Trent North MP Joan Walley calling for a debate on NHS procurement.

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Friday 23rd January 2015

NHS Vault

  • Fill in the gaps.

    This is my response to Bill Morgan in a blog on the Spectator. Bear in mind that Morgan was a Special Advisor to Lansley so there is a whiff of the Mandy Rice-Davies about his post. "You rightly start by saying that the 2010 winter was affected by a flu outbreak. However, you then go on to say that 2011, 2012 and 2013 were uneventful. This is not true. There was more flu and norovirus at this point last year compared with now. Last year the NHS could cope (just) with the flu, this year the NHS cannot cope even without flu. It is this problem we have to address. The run up to Xmas was mild - just like it was the year before - so why wasn't 2014 like 2013 ? It isn't a small dip in A& E performance. Every winter you will find that *some* trusts will fail to meet targets (the usual suspects), but what is characteristic about this winter is that *every* trust has been effected, even the best performers. Since the dip (you claim "small", well on the front line it isn't seen that way) is universal, so there must be a universal reason for it. You're right to say that Labour have jumped upon the Lansley "reforms" (well, fragmentation of the NHS) without explaining why it has affected A& E performance. The problem is that most trusts will say that they really don't know - the problem started in the summer when we had winter activity all year with no lull. As you rightly say, no trust, nor NHS England can explain why, but the facts are clear - there are large numbers of frail elderly people, who are sick with multiple conditions and these are the reason for the drop in performance. People from different parts of the health service and different political persuasions, will have their theories, but it is rather silly to blame it on the GP contract because the performance problems is not due to the people who would have otherwise gone to a GP. You dispute the cuts in social care, which I think is brave since many social services are close to collapse. (My theory, is that it is community health services, that has failed. I think we have got to the limit of treating people "in the community", at home or in nursing homes, certainly at the level of funding there is now. Nursing homes are a particular problem, there isn't enough NHS medical care in those homes (which is their right), so people are deteriorating unseen. You *can* blame GPs for that. Consequently people are being admitted from care homes in a poorly state. But I can be wrong, just like anyone else.)..."

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Big Up the NHS

  • Socialised or commercialised healthcare for the UK – which would you prefer?

    There has been much debate in the media recently about “privatisation” of the NHS. Should we allow parts of the service to be subcontracted to private companies or do we believe that our future health care needs will be better provided by not for profit, publically owned organisations ? learly this is a crucial issue but in some senses the “p” word is unhelpful and can be misleading. Much of the current service is already in private hands. All GPs are independent (private) practitioners and are not employed directly by the NHS and many existing services are already provided by the private healthcare industry under the NHS banner. The law has been changed so that further privatisation is pretty much inevitable and effectively irreversible, so the argument about privatisation is not about “if” but about “how much” and “how fast”. The main weakness of the term “privatisation” is that it allows the argument that that as long as the NHS remains free at the point of need the financial basis of its providers is irrelevant. I don’t believe this argument to be true but will park it for the moment and come back to it at the end of this piece.

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OnMedica

  • Hospital finances in ‘parlous state’ as risk of NHS crisis rises.

    The NHS is creaking at the seams with far wider problems than the widely reported A& E crisis, and with hospital finance in a “parlous state” the risk is increasing of an NHS crisis, reported The King’s fund this morning. But in its quarterly report it also found that most clinical commissioning groups are optimistic that they’ll be breaking even, or even in surplus, at the end of this financial year. In today’s Quarterly monitoring report, The King’s Fund said that hospitals are stretched to the limit by increasing demand for services and an “unprecedented financial squeeze” – and waiting times for treatment, and other key performance indicators, are worsening. It found that: The proportion of inpatients waiting longer than 18 weeks for treatment rose to 12.5% in November – the highest since the target’s introduction in 2008. The target that no more than 5% of outpatients should wait longer than 18 weeks for treatment was breached in November, for the first time since 2008. Waiting times for cancer treatment continued to worsen in the second quarter of 2014, with only 83.5% of people receiving treatment within 62 days of urgent referral by their GP – the fewest since this target was introduced. The number of delayed discharges from hospital increased sharply to more than 5,000 a day in November, a nearly 20% increase since January. The number of cancelled operations during November to January was up by a third on the same period in 2013.

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The Guardian

  • NHS will need extra £65bn by 2030, say analysts.

    The NHS will end up with a £65bn hole in its finances by 2030 unless ministers plug the gap or allow the quality or availability of care to slip, say health economists. The Health Foundation analysis identifies the sum as the extra amount of Treasury funding the NHS will need by then because it is unlikely to meet unrealistically optimistic productivity targets. It says the NHS will need its budget to rise by 2.9% a year above inflation each year between 2015-16 and 2030-31 if it is to maintain the standard of services and avoid having to ration access to treatment. That 2.9% is higher than the expected 2.3% annual rise over that period in gross domestic product, which means the government will have to boost NHS spending faster than the economy is growing. The £65bn will also be needed because the health service is likely to make only 1.5% annual gains in productivity and not the 2% and 3% envisaged in the Five Year Forward View, NHS England’s recent blueprint for securing the service’s uncertain future. The Health Foundation wants whoever forms the next government to make reaching “a public and political consensus” on the NHS’s long-term funding needs a priority, and also to give it further additional money from April as a “transformation fund”, so new ways of delivering healthcare can be created. “The next government will have to act immediately in order to secure the future of the health service in years to come,” said Anita Charlesworth, the thinktank’s chief economist. Frank Dobson, Tony Blair’s first health secretary after his election victory in 1997, has blamed the current overcrowding in A& E units on the government spending too little on the NHS and investing too little in services outside of hospitals.

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Thursday 22nd January 2015

BBC News

  • NHS strike talks to resume on Friday.

    Talks aimed at averting strikes by NHS staff in England will resume on Friday, unions have said. Union leaders met Health Secretary Jeremy Hunt for a second time to try to resolve the pay dispute. Industrial action remains on for 29 January, as unions criticise ministers for not accepting a recommended 1% pay rise for all NHS staff. Unison's Christina McAnea said unions were willing to continue with talks. Several NHS walkouts were staged across the country last year.

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  • Scots votes on English NHS laws.

    Nick Robinson writes: I have been speaking to Scotland's First Minister Nicola Sturgeon about how SNP MPs will vote after the next election. With the polls predicting a doubling in the party's support and, potentially, a huge increase in the number of their MPs this really matters. Specifically, Nicola Sturgeon says that SNP MPs will vote on the English NHS. She says the move is necessary to protect the Scottish NHS from the knock on effects of cuts and privatisation in England. "We would be prepared to vote on matters of English health because that has a direct impact on Scotland's budget. So if there was a vote in the House of Commons to repeal the privatisation of the health service as has been seen in England to restore the National Health Service we would vote for that because that would help to protect Scotland's budget. If there are decisions taken to further privatise the NHS in England, and I don't think anybody thinks the Tories are progressively privatising the health service in order to increase the public funding of the health service, so decisions are taken, that reduce over time the public funding of the health service in England then that has a direct knock on effect to Scotland's budget." Traditionally, the SNP position at Westminster is not to vote on matters which don't impact on Scotland unless they have a direct impact on the budget of Scotland via the so-called Barnett funding formula. I asked the First Minister about figures that suggest spending on the English NHS has gone up faster than the Scottish NHS in recent years. This was her reply: "[The figures] don't take into account for example our non profit distributing capital investment in the health service we gave a simple commitment that we would pass on all of the consequentials to the health service to the revenue budget of the health service, we've increased the revenue budget of the health service in real terms. I've given a commitment if we are re-elected to be the Scottish government in 2016 we will do that for each and every year. ... we have protected the budget of the health service exactly as we said we would do."

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Independent

  • Leaked documents show Ukip leaders approve NHS privatisation once it becomes more 'acceptable to the electorate'.

    Secret documents leaked from a Ukip executive meeting appear to suggest that a government under Nigel Farage would consider plans to privatise the NHS and use current policies as a stepping stone to more “radical” change. Mr Farage has repeatedly denied that Ukip would seek to privatise Britain’s health service if the party got into power, refusing to go further than telling the BBC’s Nick Robinson that “we are going to have to find ways” to deal with caring for a growing, aging population. But videos have emerged showing the Ukip leader advocating an insurance-based system in the past, and according to Political Scrapbook newly-leaked documents show the party’s ruling committee unanimously approving a pro-privatisation policy at a meeting in October 2012. The minutes from that meeting reportedly show executive members complaining that “the NHS is highly valued by the British people, despite its problems and limitations”, while another said that “we cannot change it wholesale because the public love it”. Agreeing that a Ukip government would commission a cost-effectiveness study into privatisation while more minor policies were pursued, another said: “We can focus on stopping health tourism; we do not have to commit ourselves much further. In the longer term we want a radical approach but we cannot do that in this time frame.”

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Maidenhead Advertiser

  • Private hospital plans on hold until after May's General Election.

    The team behind plans to build a multi-million pound private hospital say plans are on hold until after May's General Election. The Institute of Medicine & Surgery Berkshire (IMSB) hopes to build a Maidenhead sister hospital for the Kent Institute of Medicine & Surgery. The Kent hospital opened in Maidstone in April 2014 at a cost of £95m. James Dickmann is a director at KIMS. He explained that IMSB will wait until after the election to push forward with the plan. But he says the hospital - which would cater for private and NHS patients - is needed in the area.

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Pulse

  • One-third of CCGs concerned about achieving financial balance.

    A third of CCG finance leads are worried about achieving financial balance in 2015/ 16 according to the latest King’s Fund quarterly monitoring report, at a time when they are looking to take over responsibility for the GP contract. The report was based on 51 responses from CCGs. Seven said that they were ‘fairly concerned’ about balancing their books while nine said that they were ‘very concerned’. Around 30% of CCGs also said they were ‘very concerned’ about achieving their quality, innovation, productivity and prevention (QIPP) targets. This comes as CCGs are looking to take over commissioning reponsibilities for the GP contract, with Pulse reporting that around 40% of CCGs want to take on full responsibility for commissioning primary care.

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Guardian

  • Would the NHS benefit from privatisation? – video.

    An expert panel debate whether the NHS would benefit from more private investment. The panel, speaking at a Guardian Live event in London chaired by Guardian health correspondent Denis Campbell, comprised Julia Manning, CEO of thinktank 2020health; Norman Lamb, Liberal Democrat health minister; Prof Bruce Keogh, NHS England's medical director; and Dr Mark Porter, chair of the British Medical Association.

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  • Three GP surgeries put into special measures over patient safety concerns.

    NHS inspectors have put three GP surgeries into special measures for the first time after finding failings they judged to be so worrying that patients’ safety was at risk. The Care Quality Commission has taken the unprecedented step after uncovering “significant areas of concern” at practices in Reading, Liverpool and Sale, Cheshire. It rated all three as offering patients an inadequate service overall. They are the first surgeries to be told to make major improvements urgently or risk being shut altogether by the NHS care watchdog taking away their licence to operate. Inspectors found problems including too few staff, patients waiting up to four weeks to get an appointment, medical records not being kept up to date and medicines not being looked after properly at the practices. But the watchdog’s action sparked a row with the doctors’ union, which warned that naming and shaming particular surgeries was unfair and would deepen their problems, for example by dissuading GPs from going to work there to help it improve. In all 19 hospitals have been put into special measures since July 2013 as a result of weaknesses in the way they operate, although five have come out of the regime – which the health secretary, Jeremy Hunt, pushed the CQC to adopt – after making changes.

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Tuesday 20th January 2015

Daily Mirror

  • Mum with KK bust gets free breast reduction from sympathetic surgeon after NHS refuses operation.

    A mother who suffered with spinal arthritis due to her massive KK bust but was refused surgery by the NHS has finally had her giant breasts reduced. Kim Mills faced crippling injuries because of her huge bosom but the NHS would not help the 32-year-old, from Chelmsford, Essex. She had been refused surgery by the NHS five times, but was delighted to accept an offer for a free operation after a surgeon took pity on her. She is now living pain free. But when Kim approached NHS doctors to find out whether she might be eligible for reduction surgery, Kim was told she needed to lose weight before she would be even considered. She then lost five stone - but her whopping breasts did not get any smaller. Kim was in despair after five unsuccessful attempts for surgery. After being diagnosed last year with arthritis of the spine, she was warned that if she did not get a reduction, she could be left crippled.

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Independent

  • Nigel Farage: NHS might have to be replaced by private health insurance.

    Nigel Farage has suggested that the NHS might have to be replaced by a system of private health insurance within 10 years. The Ukip leader was forced to back down and declare his party’s support for a state-funded health service last November after a film emerged of him backing a switch to an insurance system. After Labour claimed that Ukip would privatise the NHS, he admitted he had not carried his Ukip colleagues with him. Now Mr Farage has revived the idea, saying his party will have to “return” to it after the May general election. In a BBC Radio 4 interview, he said: “I triggered a debate within Ukip that was outright rejected by my colleagues, so I have to accept that. As time goes on, this is a debate that we’re all going to have to return to. His latest remarks on health will worry modernisers inside Ukip, who want to broaden the party’s appeal and are worried that such free thinking alienates some voters. The leaked film recording showed Mr Farage telling Ukip supporters in 2012: “I think we are going to have to move to an insurance-based system of healthcare. Frankly, I would feel more comfortable that my money would return value if I was able to do that through the marketplace of an insurance company, than just us trustingly giving £100bn a year to central government and expecting them to organise the healthcare service from cradle to grave for us.” Later Mr Farage used his column in The Independent to insist that his party supports a state-funded NHS free at the point of use. He said: “I don’t want to hand faceless private-sector companies control of our health service. We’ve now have two successive governments who have done that and it is clear that it doesn’t work.”

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Guardian

  • NHS cannot cope with ageing population, warns top doctor.

    The NHS’s future is in danger because its model of care cannot meet the relentlessly growing demand for treatment caused by the ageing population, the service’s top doctor has warned. Prof Sir Bruce Keogh, medical director of the NHS in England, said that without massive changes to the way the NHS treats patients, including far less reliance on hospitals, the service risked becoming unaffordable and could see its entirely taxpayer-funded status challenged. An unprecedented shift of resources and care into GP surgeries was necessary to help the NHS withstand the twin pressures of rising demand and tight budgets, Keogh added, given the increasing numbers of patients turning up at A& E who needed to be admitted to hospital. “If not, this will open up a whole series of discussions about whether the NHS is fit for purpose, whether it’s affordable, and whether the compact with the citizen of free healthcare for all is sustainable in the longer term.” Keogh said that the NHS would have to undertake a “complete transformation” of the way it operates over the next few years in order to keep itself sustainable. That would require hospital consultants to visit patients in their GP surgery and the sickest patients being given much more time to discuss their health than the usual 10-minute appointment with a family doctor. In future, many patients will be able to get much of their care, including diagnostic tests and an expanded range of treatments, at their GP surgery to save them having to go to their local hospital. Keogh pinpointed the lack of local services such as district nurses, beds in community hospitals and mental health support as a key cause of the ever-rising demand for care from A& E units and for hospitals running out of beds.

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Monday 19th January 2015

Big Up the NHS

  • The Future of the NHS – What can we do?

    The primary purpose of the NHS is to deliver high quality healthcare in a reasonable time-frame to every UK citizen. The fact that it is free at the point of need regardless of financial means and that it does not require subscription, substantial cash top ups or insurance claims is a huge bonus which is sometimes not fully appreciated by the British public. It removes most of the financial worries which are an inevitable accompaniment to serious illness in every other country in the world. I hope that I have convinced you in part 1 and part 2 of this blog that there is a real threat to these underpinning principles and that inactivity is not an option. What needs to be done to protect the NHS ? I do not believe that fiddling at the edges of the problem will do the trick. We need big and brave decisions which will lead to a radical overhaul of the way the NHS is managed at both national and local levels. I suspect that many of you will be more than a tad sceptical about achievability as you read through my suggestions but please keep going to the end – there is a plan.

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Open Democracy

  • Hinchingbrooke - how a disastrous privatisation duped the political class.

    This month the only private company to run an entire NHS hospital threw a tantrum and stormed off. Circle Health pulled out of its 10-year contract to manage Hinchingbrooke hospital in Cambridgeshire after just two years, leaving the hospital’s survival in doubt. A Guardian editorial said our first concern should be with the patients, for whom “uncertainty allied with ill health is a terrible combination.” But what about the other victims in need of our support ? I’m referring, of course, to the journalists, commentators and politicians who hailed Circle as a “miracle cure” for the NHS, and have cruelly been made to look like fools. Circle, to all appearances a PR company that also runs hospitals, took over Hinchingbrooke in 2012. It immediately began grooming innocent and credulous journalists to do its bidding. Some were even trafficked to Cambridgeshire for “exclusive access.” But when the hospital inspector, the Care Quality Commission, paid Hinchingbrooke a visit, Circle knew the game was up. Just hours before the release of the Commission’s report, the company announced it was walking out. It was soon clear why – the inspectors rated Hinchingbrooke “inadequate” for safety, “inadequate” for leadership and, for the first time ever, “inadequate” for patient care. The hospital was put into ‘special measures.’ We must now do all we can to care for the victims of this calamity, those vulnerable, impressionable opinion-formers that Circle mercilessly used, as they learn to live with that least curable of conditions – reality. Let’s take a closer look at how they were deceived.

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  • Dear patient - why your care is getting shattered, not more 'joined up'.

    It has been a while since I last wrote. Since then the steady drip, drip of changes occurring around me have become easier to spot. They make my working life and your care so much more difficult. When you come to see me you often tell me your lovely GP sent you for some ultra-sound and x-ray imaging, to help my diagnosis. Very thoughtful and sensible of them. Unfortunately, these days I find such scans have often been outsourced to a company outside of the NHS. The NHS still pays for it but because it is a private company, the images are stored in their own system. So as an NHS worker, I can’t always see the images. Which is a pity, because I do need the pictures as well as the report really, to make a good diagnosis. The same problem arises for the poor patient who has a quick in-and-out job (the most lucrative) at a private facility funded by the NHS. They get their bits x-rayed there then. Later in the year, they see their regular NHS specialist consultant for their long-term ailment. The NHS consultant has a look to see if the patient has had any scans lately - and finds no images on the system. I wonder who owns your images; the images of your body ? I’m finding the same problem with your blood test and other pathology and microbiology results lately. Several times a day I need to check recent results ordered by the different NHS health professionals who care for you. All your results used to be carried out in county NHS pathology labs and stored in one NHS-run system. But someone decided such services were ideal for outsourcing to other labs - including privately run labs - and now I struggle to find results of tests. They aren’t getting put on to an easily-accessible system for NHS workers. Sometimes the only way to see results is order more tests myself. It is all getting really quite tedious. Apparently, a lot of the recent changes that have caused this fragmentation are in the name of better joined-up care. Who knew ?!

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The Guardian

  • Nurses at breaking point as number off work with stress soars.

    The number of nurses taking time off due to stress has soared as the NHS has struggled to cope with rising demand for care. Responses to freedom of information requests submitted to NHS organisations by the Observer show that both the number of nurses on stress-related leave and the amount of time taken off are up significantly in the past three years in London, Scotland and Wales. The figures have prompted claims by health unions that the NHS’s 400,000 nurses are being stretched to breaking point as a result of having to work more demanding and longer shifts at a time when understaffing and the increasing complexity of illnesses add to pressures. In London, almost 1,500 nurses at 31 NHS trusts took time off because of stress during 2014, up 27% on the 1,179 who did so in 2012. That meant that one in every 29 nurses were off ill with stress. The 1,497 nurses took an average of 38 days off for stress. Some may have had anxiety or depression rather than stress, as the NHS includes those conditions in its definition of stress-related leave. The number of nurses’ working days lost to stress at the 28 acute trusts and three mental health trusts rose from 38,654 in 2012 to 57,156 last year – a rise of 48%. Writing on observer.co.uk, former Labour cabinet minister Tessa Jowell, who is standing down as MP for Dulwich and West Norwood and intends to stand for mayor of London, says the capital’s hospitals have returned to the sort of crisis levels she saw when she entered parliament 23 years ago. Jowell says many doctors and nurses are leaving or taking time off due to stress because the NHS is failing to provide necessary 24-hour services, as well as care in the community and in people’s homes. “Last week, King’s College hospital in south London had the equivalent of a whole ward full of elderly people ready to go home, another full with people who need never have been admitted,” she writes.

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The Telegraph

  • NHS is failing patients, cancer charities warn after life-saving drugs are dropped.

    An alliance of cancer charities has condemned the system for allocating life-saving drugs in the NHS as a failure after the decision to pull the plug on funding for 25 separate treatments. In a letter to The Telegraph, the heads of 15 cancer charities described the announcement last week as a “knee-jerk” reaction to save money, which would leave thousands of sufferers facing uncertainty – and do nothing to solve the problem of funding new treatments. But they disclose that talks are getting under way between the Government, the pharmaceutical industry and charities to design a new system to help the NHS cope with demand. An estimated 8,000 cancer patients a year could have their lives cut short following the decision to scale back funding from April. It came after the Cancer Drugs Fund, set up by the Coalition in 2011 following a Conservative election manifesto pledge that treatments should no longer be denied on grounds of cost, announced it is on course to overspend its £280 ?million budget. In the letter, Owen Sharp, of Prostate Cancer UK, and the heads of charities including Breakthrough Breast Cancer, Beating Bowel Cancer and Leukaemia Care, say there is an “urgent” need for an overhaul of the system. “The establishment of an additional Cancer Drugs Fund was a clear sign the current system for the commissioning of cancer drugs in England was failing to achieve its objectives,” they wrote. “Now even this additional pot is crumbling under demand and the high cost of cancer drugs. The knee-jerk reaction has been to save money by re-evaluating the availability of these drugs, regardless of need.

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Friday 16th January 2015

The Guardian

  • Simon Jenkins takes aim at the wrong targets when decrying the problems facing the NHS (Here’s what my fantasy Labour party would look like, Opinion, 15 January).

    It is not GPs or hospital doctors who are holding back the NHS; their hard work means patients continue to receive high-quality care, including emergency care around the clock. Doctors want to do more, but they can do that only if they are given the resources, facilities and staff to do so. For example, a recent British Medical Association survey showed that seven out of 10 GPs felt their facilities were too small to provide extra services, even though GPs want to do more for their patients. We also need to ensure that the resources we do have are used appropriately: is there really a widespread demand, as Simon Jenkins suggests, for routine GP appointments at 3am ? Would the money not be better spent having more healthcare staff available in a range of disciplines in better facilities when patients are more likely to use them ? Moreover, calling for people to declare their income when they need to see a GP or have an operation so they can pay means-tested charges would destroy the social solidarity the NHS is based on. There is little doubt that the NHS is under unsustainable pressure and, in a general election year, we need a serious debate, underpinned by the need for healthcare to be free at the point of use, about how we meet the challenges we are facing. Doctors want to be part of these solutions. Dr Mark Porter.

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HSJ

  • Monitor delays controversial tariff decision.

    Providers will have to wait to see if controversial tariff plans for 2015-16 will be enforced as Monitor wades through hundreds of responses to establish if it received enough formal objections to trigger a new consultation. The regulator said this morning that a decision would be made on the 2015-16 payment rules at a board meeting “in due course”. This is expected to be this month’s meeting on 28 January. The law on tariff setting says 51 per cent of the provider sector - defined by turnover - must object in order to trigger a reconsultation on revised proposals or a referral to the Competition and Markets Authority. A one month consultation on the proposed tariff, which is set jointly by NHS England and Monitor, closed on Christmas Eve. Monitor said it had received 310 “formal” responses “together with about 109 emails, 38 letters and 6,765 signatories on an e-petition organised by a mental health charity”. The regulator must decide how much of this correspondence should be considered as formal objections from an organisation rather than an individual employee. The proposals have already outraged providers. These include a 3.8 per cent efficiency target and a new marginal rate rule that restricts payments for specialised services to 50 per cent of normal rates for all activity above an agreed baseline.

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Our NHS

  • Shocking examples of poor care are the real reason Circle withdrew from running Hinchingbrooke Hospital - they've got their eyes on easier ways to privatise the NHS, anyway.

    Last Friday private healthcare company Circle announced it was pulling out of its contract to run the Hinchingbrooke Hospital in Cambridgeshire, blaming a £5million loss and an NHS crisis including “unprecedented increases in accident and emergency attendances, insufficient care plans for patients awaiting discharge, and funding levels that have not kept pace with demand". True enough - but the real reasons for Circle’s snap exit emerged later that day, when the hospitals inspector the Care Quality Commission (CQC) released its delayed report into Circle’s management of Hinchingbrooke Hospital. It was damning. Hinchingbrooke - the flagship of NHS privatisation - was given the CQC’s worst ever rating for ‘caring’. Both safety and leadership were also bottom of the heap. Circle’s cleverly branded ‘mutual’ model, far from ‘liberating’ NHS professionals’ to make grassroots-led improvements, had in fact replicated some of the worst hierarchical, bullying practices to be found in the NHS. And it had lost the caring and expertise that are the NHS’s strengths, principally as a result of poor leadership and financially-driven staff cuts to satisfy investors.

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Thursday 15th January 2015

Guardian

  • Paramedics in crisis: ‘When there’s nobody else to turn to, we get the call’.

    Paramedic Ian Whittern admits that at the end of a 12-hour shift (which has already rolled into its 13th hour), he feels a little weary. He ought to be. Over the past two days he has dealt with the victims of road accidents, strokes and a mugging. Like most paramedics, Whittern turns up early to check his vehicle and equipment, knowing that as soon as his shift actually starts he will be off on a job, and almost every workday overruns, sometimes by as much as two hours. His first break for a cup of tea on Saturday came at 3pm – seven hours into his duty. “It is hard, there’s no doubt about it, and getting harder all the time,” said Whittern, who is based in Bristol and works for the South Western ambulance service (Swas). “The pressure is growing. There aren’t enough paramedics and as the NHS becomes more broken up, more fragmented, we are left to pick up the pieces. When there’s nobody else to turn to, we get the call even if we’re not the people who should be dealing with an incident.” The focus of the health crisis over the past fortnight was A& E departments – as hospitals across England declared major incidents because of the surge in patients arriving at their doors. But the pressure on ambulance crews has been extraordinary. Across the country, crews have been working extra shifts and extra hours. The Red Cross, St John Ambulance and firefighters have tried to help reduce the burden on ambulance trusts but bosses – already having to explain why they missed response targets in November – concede the statistics for December across England will make ugly reading when they are published later this month. Whittern, 48, who has worked for the ambulance service for 20 years, said he and his colleagues were the busiest they had ever been. “We end up doing the job community nurses or social services really should be doing – making sandwiches, brewing cups of tea for people who have nobody else.” He is a union official but does not attack the management or the trust. Whittern and his colleagues blame a range of problems from the 111 phone service (the concern is that because most staff are not medically qualified but follow an algorithm, they tend to play safe and send an ambulance out to a patient when it is not needed – though Parkin would disagree with the thesis) to the pressure control rooms are under as they try to help meet government response targets. Then there is the huge problem of other professionals – GPs, social workers and so on – not being readily available on weekends and evenings: the reason Whittern ended up organising food and power for one patient at the weekend.

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Midweek Herald

  • Axminster hospital beds closure back on.

    The temporary transfer of inpatient beds from Axminster Community Hospital to Seaton is to go ahead immediately after an interim court order was suspended. The transfer is taking place as originally planned by the Northern Devon Healthcare NHS Trust following the outcome of its public consultation into resolving significant staffing and patient safety concerns. The Trust received a court order preventing the transfer until a full hearing next month. But this was suspended at the High Court, after a judge ruled that the order should not have been made without notice to the Trust and that the issue should instead be fully addressed and resolved at an urgent hearing. Following a consultation with the communities of the Axe Valley, the Trust board decided to accept a £300,000 offer from Axminster Hospital League of Friends to urgently explore ways to maintain the inpatient beds at Axminster. In the interim, and because the very real staffing and safety concerns were escalating, the board also agreed that inpatient services at Axminster would temporarily transfer to Seaton, creating one 18-bedded unit.

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Independent

  • NHS staff are working unpaid to help avert a winter A&E crisis.

    NHS staff have been coming into work voluntarily and unpaid to help their hospitals cope with extreme winter pressures, MPs have been told, as the country’s top emergency doctor warned over a dramatic increase in A& E visits. Dr Clifford Mann, president of the College of Emergency Medicine, said that the additional patients coming to A& E this year could fill “eight or nine extra emergency departments”. MPs on the Health Select Committee were taking evidence on accident and emergency services in England, in response to a string of major incidents declared at hospitals throughout the country last week, as A& E waiting times rose to their highest levels in a decade. Official figures show that there were 14.6 million A& E attendances in England in 2014, an increase of 446,049 on 2013. The demand placed on hospitals has been such that doctors, nurses and managers have worked overtime and even come into work voluntarily and without pay to support colleagues. The Labour MP and Health Committee member Valerie Vaz said she that she was concerned staff were “working in the NHS for nothing”. The Royal College of Nursing said that coming to work early and leaving late had become “a daily reality” for many hospital staff, while the doctors’ union the British Medical Association said “taking advantage of the goodwill of already overstretched staff to meet rising demand” was “unfair and unsustainable”. Warnings over staffing pressures came as NHS England faced further questions over the role the 111 helpline has played in managing pressures on A& E. Dr Mann told MPs it would be “absurd” to blame patients for the pressures because they were being advised to go to A& E by the phone line. He said 220,000 had been advised by 111 to go to A& E this year, and 220,000 had an ambulance despatched. “If you put those figures together you have more than 95 per cent of the rise in type 1 [major A& E] attendances,” he said.

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Tuesday 13th January 2015

Leamington Observer

  • Bed shortage at Warwick sees patients treated elsewhere.

    A shortage of beds at Warwick Hospital has led to patients temporarily being cared for elsewhere. Several patients from the Lakin Road Hospital - which recently suffered an outbreak of winter vomiting bug norovirus - have been taken to Ellen Badger Hospital rehabilitation hospital in Shipston, where six extra beds have been made available. But Shipston district councillor Jeff Kenner has voiced his concerns the extra beds would place more pressure on the hospital's services. He told the Observer: “Ellen Badger has beds mainly for elderly patients who need constant care. It also has a Minor Injuries Unit and a range of other services which are going to be under additional pressure as a result. I do not blame the Trust for having to take crisis measures - there is a superb team at the hospital who will do everything they can to ensure all the patients receive the care they need. The fault lies with the Government which has cut social care, cut nurse training and thrown the NHS into chaos through its costly re-organisation."

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Independent

  • Cancer Drugs Fund: Life-extending drugs to be denied to NHS patients in England as fund overspends.

    Sixteen life-extending cancer drugs will no longer be available to patients in England from March after the NHS announced it would not pay for them through the Government’s flagship Cancer Drugs Fund (CDF). The drugs have been removed from a list of treatments paid for by the CDF in a bid to cut costs. The £280m fund was due to overspend by £100m in 2014-15.

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Monday 12th January 2015

The Guardian

  • Doctors warn of patient misery as A&E crisis hits planned surgery.

    Thousands of patients whose operations have been cancelled because of the growing turmoil in the UK’s A& E departments are facing prolonged anxiety, discomfort and pain while they wait for a new date for their surgery. A sharp rise in the number of procedures hospitals are postponing has prompted the leader of Britain’s surgeons to warn that patients affected will suffer “considerable distress”. Unprecedented demand has led to a third more elective (planned) operations being cancelled in England this winter than last year, latest figures show. A total of 12,345 were called off at short notice between 3 November and 4 January, a rise of 32% on the 9,320 seen in the same period in the winter of 2013-14. Some 3,771 procedures such as hernia repairs and hip or knee replacements were cancelled in the three weeks before and during the festive season alone, as the NHS experienced some of the most intense pressure in its history. Clare Marx, president of the Royal College of Surgeons, said: “The continued rise in the number of operations cancelled for non-clinical reasons remains of deep concern. “Telling a patient that they cannot have the operation they have waited and planned for can cause considerable distress to the individual and their family. As surgeons we are doing our best to manage our patients’ conditions and to make sure they can have the surgery at a time when they need it.” The Royal National Institute of Blind People (RNIB) has warned that people with failing eyesight awaiting cataract operations will suffer as a result of extended delays to surgery.

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  • Circle pulls plug on hospital deal and sparks storm over private firms in NHS.

    The company behind Britain’s first privately run hospital has announced that it plans to pull out of its contract to run the Cambridgeshire facility, triggering a political row about the role of private companies in the NHS. Circle Holdings issued a statement to the London Stock Exchange blaming its decision to pull out of running Hinchingbrooke on funding cuts of 10% this year and the surge in demand for accident and emergency services. Its claim that it had also been the victim of an “unbalanced” report by the Care Quality Commission became clearer later in the day when it emerged the hospital would be placed in “special measures”. The CQC report, released in the afternoon, revealed a catalogue of serious failings, finding that there were major problems in its A& E unit, that patients including children were put in danger and there were delays in relieving patients’ pain. CQC rated Hinchingbrooke as “inadequate” overall, and specifically for patient safety, showing care towards patients and leadership. It is the first hospital trust that the watchdog has ever found to be “inadequate” in how it cares for patients, and the verdict followed a five-day inspection last September and follow-up visit on 2 January, which showed that some improvements were still needed.

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Daily Express

  • Crisis-hit NHS to be given radical shake-up.

    In the shake-up, GPs will be parachuted into over-stretched A& E units to weed out time-wasters and ease the burden on the service. Other measures will see pharmacists, nurses and paramedics take on roles traditionally taken by GPs. Professor Keith Willett, who heads the NHS Urgent and Emergency Care Review, told the Sunday Express: “The current system is unsustainable. We have no choice but to change.” The plan to station GPs in hospital emergency wards to filter out non-urgent cases was recently rubber-stamped by NHS England along with the other measures. The busiest hospitals will be the first to adopt it. Chemists will be trained to diagnose, prescribe and treat patients and will have access to medical records with patients’ permission. Doctors and nurses working for the NHS 111 telephone advice line will also be able to see medical records, again with permission. They will be called upon to divert callers to dentists, GPs and other health workers. Paramedics are to have new training in diagnosis and will be able to prescribe drugs and refer patients to other health or social care workers. People with serious and life threatening illnesses, such as strokes, heart attacks or major trauma, will be diverted away from casualty units to medical centres of excellence.

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Friday 9th January 2015

The New Statesman

  • The real root of the A&E crisis lies far beyond the wards.

    How restful it must be to be Jeremy Hunt. Lesser health secretaries would regard the NHS’ worst ever A& E performance happening on their watch as a damning indictment. More insecure an operator might take the calling of an urgent summit to discuss the unfolding crisis as a sobering reflection on their own ability. Perish the thought. Outcry from Labour over the alarming figures is merely “an example of the politicisation of the NHS that people find so distressing,” he said, during an urgent question session called today by Labour in the hope of prising some answers from him. Since the figures were published yesterday the Tories have done everything but accept them for the depressing landmark they are. They have continuously blamed unprecedented demand from an ageing population for the surge, combined with the traditional winter spike in admissions. Before we go any further, it’s worth pointing out that A& E attendance in England was actually higher over the summer than the “unprecedented demand” in December that has led to this crisis. But let’s leave that to one side. Even accepting that overall admissions are increasing, it’s facile of Hunt to blame increasing demand on an ageing population alone. Accident and emergency is not an island, entire of itself. Cut the wider social and welfare system, squeeze GPs, and enforce a hugely wasteful internal market - as this government has done compulsively - and A& E figures will go up, hospitals will be less able to cope with them.

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Our NHS

  • Life, the universe, and the NHS crisis.

    Accident and Emergency services have gone into unprecedented meltdown across England, health professionals tell us this week. Waiting times in A& E departments have plummeted to their worst levels in more than a decade. The NHS’s capacity to treat those with serious injuries and illnesses is in “crisis”. Hospitals across the country are declaring they simply can’t admit any more patients. Is it the fault of frontline NHS staff ? I popped into my local hospital in Worthing to check. I can confirm that there was no queue of doctors and nurses on prolonged cigarette breaks outside the hospital. No paramedics snoozing in their ambulances with do not disturb signs on the windows. So why is it happening ? Fans of Douglas Adam's Hitchhikers Guide to the Galaxy will recall that the answer to life, the universe and everything is 42. But the answer to the current A& E crisis is 35. Yes, suspend your disbelief. 35 is the single number that explains the meltdown in A& E services across the nation this week. It’s the key number in the “supply and demand” game that our mainstream politicians indulge in during times of crisis. The rules of the political game are quite simple. Rule one: you need an NHS crisis. Without this you can't play. Consider it the dice of the political board game. Rule two: if you are the party in power your role is to blame the crisis on “demand”. You say there is an overwhelming and unprecedented demand on NHS services that could not have been predicted. It is regrettable, you say. And you talk about the aging population - your trump card. If you are the party in opposition, your role is to blame the crisis on supply. Supply of doctors, supply of nurses, supply of funding, supply of ambulances, supply of social care. You mention this a lot.

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The Guardian

  • The A&E crisis is an inevitable consequence of ideological cuts.

    “Rationing by payment may offend tradition, but rationing by chaos is cruel,” says Simon Jenkins . SImon Jenkins needs to consider some important questions. Why is it kinder to ration by pricing rather than a lottery ? Is that because restricting some healthcare randomly potentially affects everyone, including the rich and powerful, making the problem more visible ? Has Simon Jenkins taken into account the fact that charges mean additional costs in management, thus causing a further reduction in the resources available to actually deliver services ? Perhaps Jenkins could also try to explain why the NHS is rated the most efficient health service across 11 major developed nations as assessed by the Commonwealth Fund. “The UK ranks first overall, scoring highest on quality, access and efficiency,” states the report. The US, despite the massive costs of its health system, ranks bottom. The Commonwealth Fund is Washington-based and respected around the world for its analysis of the performance of different countries’ health systems. Of the 11 countries assessed, only New Zealand spends less per head of population than the UK, yet the NHS provides the best service. It’s obvious that the NHS model works well despite the lack of investment. The difficulties of the NHS are due not to the model of healthcare, but the lack of funding. The obsession with reorganisations and marketisation is what damages the NHS.

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The Independent

  • NHS funding: Many parts of England are not getting their 'fair share,' claims report.

    Many parts of England are not getting their “fair share” of health funding, the influential Public Accounts Committee has said. In a warning to the Department of Health and NHS England, committee chair Margaret Hodge said that the Government was failing to provide “equal access for equal need”. In a new report, the committee found that funding for some areas of England was more than £100 per person below what they were entitled to. Funding allocations to Clinical Commissioning Groups (CCGs) and local authorities are determined based on health need, using a formula which takes into account population size as well as other factors such as life expectancy. Some areas receive more money than they are entitled to under the latest funding formula and efforts have been made to rebalance spending. However, Ms Hodge said that the pace of change had been “very slow”. She said there were “huge variations” across the country, with Corby receiving £137 per person below its fair share, and West London receiving £367 per person above it. Overall, around two fifths of CCGs and three quarters of local authorities were receiving five per cent below or above their target funding allocation, the committee said.

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HSJ

  • Revealed: the biggest winners from the NHS funding boost.

    Around half the extra money for clinical commissioning groups from George Osborne’s NHS spending boost will go to just a quarter of groups. NHS England decided to allocate £1.1bn of the extra 2015-16 funding directly to CCGs, and to give much bigger increases to those that are a long way behind their “target” budgets under its allocation formula. HSJ has analysed the impact of the resulting revised allocations, which were published by the national body shortly before Christmas. We compared the percentage allocation growth CCGs had been expecting in 2015-16, based on indicative NHS England figures from December 2013, with the allocation growth they will now receive under the post-autumn statement revised figures. There are 54 CCGs whose growth has been increased by more than 3 percentage points as a result of the new allocations. These CCGs account for £579m extra growth - more than half the £1.1bn total national increase. Focusing the funds on CCGs that are behind their target allocations means there is variation in impact by NHS England area team (see map, above). There are also more CCGs and health economies with financial problems in the areas receiving the greatest increases (see table, below). Of the 54 CCGs whose growth is rising by more than 3 percentage points, nine forecast overspending in 2014-15. They will receive average cash terms growth in 2015-16 of more than 6 per cent, while inflation is only 1.4 per cent.

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Thursday 8th January 2015

Guardian

  • The Secret Doctor: A&E is run on pure fear – how much more can we take?

    Over the Christmas and new year period, the doctors and nurses here have been whispering to each other that the department must be cursed. But it turns out that this curse is nationwide. It’s unbelievably busy everywhere, and waiting times are the worst since records began. I stop to wonder why the out-of-hours setup has scaled down instead of up today. The GP helping triage patients before they even arrive in our hospital greets me like a comrade: “It’s busy, isn’t it ?” Yes, I concur. He continues: “It didn’t help that we were on skeleton staff today. There was only one GP on shift to do home visits – and she had 40.” So who had the clever idea to scale back to skeleton staff on one of the most notoriously busy days ? Traditionally, the GP continued, such services were fully staffed, with extra doctors brought in, in anticipation of heavy numbers. But more recently, this appears to have fallen away because of cost-cutting, putting extreme pressure on staff. One doctor, 40 home visits: how can that be right or safe ? We are not robots working like machines – we are human, and we have our limits. How much longer can we keep this battle up ? It was bad last year, and apparently problems with A& E are now worse than ever. And what about next year ? It is in the interest of everyone to stop this spiralling “crisis” – because, unlike any other service out there, A& E is something we will all need at some point in our lives. And right now, the prognosis is not good.

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BBC News

  • Political row deepens over A&E problems.

    The government has "betrayed patients", Labour leader Ed Miliband says, as the political row over the problems facing A& E units deepens. Data for the last three months showed waiting times in England had dropped to their worst levels for a decade. In the first prime minister's questions of 2015, Mr Miliband said the government's policies were the cause. The row surfaced as a number of trusts have declared major incidents in recent days, with cases emerging of patients being treated in corridors and ambulances queuing outside A& E. Addenbrooke's Hospital in Cambridge is the latest big hospital to have declared a major incident. Dr Keith McNeil, chief executive of Cambridge University Hospitals NHS Foundation Trust, said the hospital had been under "extreme pressure" since New Year's Eve. The hospital had nearly 200 beds occupied by patients who were ready for discharged - a fifth of the total. Research by the BBC has found this is not an isolated problem. BBC News contacted 64 NHS trusts around the UK to ask about these delays. Of the 29 trusts who responded, all but one had problems with 1,584 beds in total taken up by patients who were ready to go home. These delays happen when there is not support in the community from either social care teams or health services to care for those patients who need help.

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Western Daily Press

  • Bed-blocking blamed for the crisis in A&E.

    The crisis in hospital accident and emergency departments was blamed squarely on a dramatic rise in the phenomenon of "bed-blocking", where the "madness" of cuts in social care at the "back-end" of the NHS have gridlocked the system.
    With the emergency measures in place for a third day at two Gloucestershire hospitals, and routine operations and appointments cancelled again at other hospitals across the West, it emerged that the Government was warned seven months ago of a crisis this winter, because of the problem of "delayed discharge". The director of Age UK, who warned of an impending crisis back in June, said the real cause of the crisis came in the creaking social care system. That caused a double-whammy for the rest of the NHS – firstly because elderly patients who have to stay in hospital because there is no care package or bed in a care home available means gridlock in admitting people out of A& E at the "front end" of the hospital. And secondly, elderly people at home without an adequate social care package are much more likely to end up in A& E. "We know that social care spending has fallen dramatically and that without social care older people are more likely to end up in A& E because of a health crisis," said Caroline Abrahams, Age UK's director. Meanwhile, health chiefs behind the NHS "non-emergency" 111 number defended it from criticism that its operators are sending too many people to A& E needlessly.

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Tuesday 6th January 2015

Nursing Times

  • Standards dropping as NHS staff made redundant, claims Labour.

    Labour has attacked the Conservatives for having “damaged” the NHS over the past five years, claiming that thousands of frontline redundancies are partly to blame for the service’s deterioration. Speaking today in Salford as he launched Labour’s election campaign, party leader Ed Miliband placed the NHS at the centre of the opening salvo in his bid to become prime minister in May. Mr Miliband pledged that if his party were elected he would protect the NHS by introducing new measures such as guaranteed GP appointments within 48 hours and a one-week wait for cancer tests. He re-iterated his commitment to a £2.5bn Time to Care fund, which would pay for 36,000 additional NHS staff, including 20,000 extra nurses. His speech follows a document published by Labour, which lays out how NHS standards have allegedly fallen under the Conservatives and how Labour intends to “save” the service. Drawn up by the Labour’s election campaign coordinator Douglas Alexander, the 27-page dossier is titled The NHS as you know it cannot survive five more years of David Cameron. Citing Department of Health figures, it claimed more than 9,000 frontline NHS staff were made redundant between 2010-11 and 2013-14. It pointed to lower numbers of district nurses and modern matrons in 2014 compared with 2010, and highlighted that nurse training places have been cut over the same period – by around 7,000 commissions. The Labour dossier also used a recent Nursing Times survey to highlight the “real nursing pressures in the NHS”. It quoted our survey published in February 2014, which found more than half of nurses believed their ward or unit remained dangerously understaffed a year after the Francis report.

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Financial Times

  • Data cast doubt on Andy Burnham’s NHS privatisation claims.

    At the heart of Labour’s attack on Conservative management of the NHS on Monday was a claim that the coalition’s actions over the past four years will lead to the service’s “privatisation”. Labour hopes this charge will resonate with a nation that, in contrast with its European neighbours, has long regarded private sector involvement in healthcare provision with suspicion. Andy Burnham, shadow health secretary, on Monday told the BBC that the NHS would be sunk by “a toxic mix of cuts and privatisation”. He made two specific charges: that the Health and Social Care Act, enacted in April 2013, obliged health commissioners to put all contracts out to tender. His second argument was that legislation that allows hospitals to earn up to half their income from treating private patients, would “change the way our hospitals worked”, creating a US-style two-tier system. Away from the political rhetoric, what does the data show ? Overall just six pence in every healthcare pound is spent with the private sector, according to official figures. Expenditure with private companies has actually risen at a slower rate in the four years from 2010 than in the four years that preceded it, when Labour was in power. However, in one area of healthcare provision the role of the private sector has unambiguously expanded, according to figures from the Nuffield Trust — community services. The think-tank’s figures show that one pound in every five spent by commissioners on community health services in 2012-13 was spent on care provided by independent sector providers, an increase of 34% in one year. Mr Burnham’s charge that health commissioners have felt obliged to put all contracts out to tender is also questionable. The British Medical Journal, in an article in December, examined just under 3,500 contracts awarded between April 2013 and August 2014. They found that just 6 per cent had been awarded through competitive tender and of those contracts, the private sector won more than 40%.

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New Statesman

  • NHS pressures hitting A&E causes a political crisis for the Tories.

    Emergency departments in our hospitals have reached a "tipping point", according to Dr Clifford Mann, the president of the College of Emergency Medicine. He is referring to the release of figures today expected to show the worst performance of A& E units in a decade, with the government's four-hour target waiting time almost certainly missed. NHS England is set to publish some damning data on the last quarter of last year today, revealing the pressure on our hospitals that the increase in patients attending A& E, up 20,000 since 2013, has had. A number of hospitals have filed "major incident" warnings in recent days, because their emergency departments have been overstretched. In spite of a number of senior figures in the medical world, including those working in some of the hospitals issuing major incident warnings, regarding the situation as an unprecedented situation, government figures have so far refused to call this a "crisis". Dr Ian Proctor of one of the affected teaching hospitals used the word in an interview on the BBC's Today programme, but the Health Secretary, who was interviewed afterwards, refused to use such terms. It's clear there is a capacity and, to some extent, a resource issue affecting our hospitals, but government ministers – specifically Conservative ones – would fall into a political crisis if it treated the situation with the gravity it calls for. This is because Labour's narrative for over a year has been about an "A& E crisis" in our hospitals. As Labour ramps up its rhetoric on the NHS, and the rhetoric manifests itself as a reality in our beleagured health service, it will become increasingly difficult for Tory figures like Hunt to close the credibility gap in its approach to the public service that could well become the general election's central battleground.

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GP Online

  • BMA demands long-term NHS investment as election campaigns begin.

    Doctors' leaders have called for long-term investment in the NHS, not just political promises, as party leaders kicked off election year with the health service at centre stage. Labour made clear its intention to ensure the NHS is a top election issue as the unofficial campaign ahead of May’s vote got underway. The party said the health service could not survive a second term of Conservative government. BMA chairman Dr Mark Porter said it was vital decisions on patient care were clinically - not politically - led, and essential the next government works in partnership with doctors. He said: ‘We have repeatedly voiced our concerns that year-on-year reductions in real-terms NHS funding are continuing to threaten the quality of patient care and access to it. Equally, we believe that the changes to the NHS pursued by successive governments, such as increased privatisation and competition, are eroding the core principles of our healthcare system. Instead of focusing on delivering high-quality care for patients, the NHS is being damaged by distracting reorganisation and increasing transaction costs.’ The NHS, he added, had reached a crossroads with pressure on services at a critical point with cracks beginning to appear including longer queues for GP services.

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Monday 5th January 2015

The Guardian

  • Are five-hour waits for ambulances the sad state of our healthcare system?

    The first sign of trouble was the sound of a smash. There on my street in Kentish Town, north London, was a sheepish looking teenager on a moped, another sitting down, and a third lying in the road, groaning. Otherwise the street was deserted. At first it appeared the boy on his back, who I’ll call Nathan, was just drunk and embarrassed. But the scream when he tried to move his leg suggested otherwise. So I called 999. It was 1.12am on Monday morning, and three degrees below freezing. The events that followed are small in the scheme of things. But the inadequacies of the response to Nathan’s accident raise troubling questions about the state of our ambulance services, and the ground-level consequences of cuts that can often seem like a political abstraction. Once the situation was explained, the operator said he couldn’t be sure when an ambulance would be available. Nathan’s mates left. (Police believe the moped was stolen.) Two other neighbours brought blankets and pillows. Operators called back a few times, to little effect. Nathan, who’s 16, seemed to be in shock. He required repeated reassurance that he wasn’t going to die. After half an hour, the police arrived. Initially, they seemed more concerned about the alleged moped theft – they’d had a run-in with Nathan and his mates earlier that night – than about his injury. But as they realised that he wasn’t putting it on, their focus changed. And they were clearly exasperated. Over the radio, they were told that an ambulance was out of the question. The service was in a “surge purple enhanced” state, once vanishingly rare, now quite common, and, the London ambulance service (LAS) says, particularly so in the last month. That status means that only life or death calls will get an ambulance.

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HSJ

  • Marginal specialised tariff would hit critical and neonatal services, providers warn.

    Some trusts may be forced to scale back specialised services, including critical care and neonatal units, if a marginal rate payment is introduced for them, NHS Providers has warned. In a response to NHS England and Monitor’s proposed national tariff, the representative body for NHS providers said its members will have to take decisions that will have “profound implications for patient services”, such as reducing the size of critical care units and halting plans to expand neonatal care if a marginal rate for specialised services is introduced. A marginal rate for specialised services would see providers paid only half the cost of treatment once activity rises above agreed levels. These are generally expected to be the same as providers’ 2014-15 contracted levels. NHS Providers said such an approach might force some providers to stop providing specialised services, which could mean patients have to travel further for treatment. The consultation response also said the introduction of the tariff would “adversely affect” all providers of specialised services, not only dedicated specialist trusts. This, it said, undermined one of the national bodies’ justifications for the policy: the stronger financial performance of specialist hospitals compared to other providers. NHS Providers said its members are concerned there is a conflict of interest because NHS England is jointly responsible for setting the tariff, “but at the same time is the beneficiary of this policy” as the commissioner of specialised services.

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Friday 2nd January 2015

The BMJ

  • A third of NHS contracts awarded since health act have gone to private sector, BMJ investigation shows.

    We were very concerned to read the BMJ investigation on NHS contracting, which reported that one third of NHS contracts were awarded to private providers and described ‘cherry-picking’ of simple procedures. Both the Royal College of Ophthalmologists and the British Association of Dermatologists have expressed serious concerns about threats to complex service provision, fragmentation of services and training. Many of these concerns are also emerging in the sexual health and HIV service provision across England. These were not covered by this investigation as they are predominantly commissioned outside the NHS. We believe the quality, safety and future of these key clinical services are under threat, as a result of dysfunctional commissioning practices. In April 2013, for the first time local authorities became responsible for commissioning services for sexual health, HIV prevention and testing. Treatment and care for HIV remained as a specialist service commissioned by the NHS and abortion services, after a brief period of commissioning by local authorities, became commissioned by clinical commissioning groups. After a short moratorium local authorities in some areas started to procure sexual health services using tender processes. Since then our Association has received reports from its members across England about issues with commissioning, compromised patient pathways and fragmentation of sexual health services. We are aware of models of contracting where the focus on cost efficiency appeared to override that of quality; where patient pathways, including those for complex sexual infections and specific groups, such as men who have sex with men (MSM), have been put at risk; and where postgraduate training has been seriously compromised because the service specifications have failed to take these requirements into account. Some local HIV services have been de-stabilised and access to testing and treatment for sexually transmitted infections (STIs) for people living with HIV has been reduced.

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Hospital Doctor

  • A new bill which proposes to halt the privatisation of the NHS will be scrutinised by MPs in 2015 having winged its way through two readings in the House of Commons.

    Labour MP Clive Efford’s private members bill, which aims to reverse elements of the 2012 Health and Social Care Act, has been committed to a Public Bill Committee after being voted for by 241 MPs with only 18 against, during its second reading debate in the House of Commons. The bill proposes to abolish the Section 75 rules that embed competitive tendering into the NHS commissioning process; scrap the competition framework; end any role for the Competition and Markets Authority in the NHS and change Monitor’s role as an economic regulator enforcing competition in the NHS. “The NHS as we know it today will disappear if we continue to allow services to be contracted out to private companies,” says Mr Efford. “The government’s own figures for 2013-14 show that more than £10bn was spent on the purchase of healthcare from non-NHS bodies. If this is allowed to continue it will seriously undermine the capacity of the NHS to provide services in the future, leaving us at the mercy of the private sector. This bill will halt the rush to privatisation and put patients rather than profits at the heart of our NHS.”

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The Guardian

  • Making NHS seven-day service could threaten patients’ safety, say doctors.

    Doctors have warned that plans to transform the NHS into a seven-day service are a waste of vital resources that could threaten the quality of care during the week and prove a danger to patient safety. In a strongly worded attack, the British Medical Association accuses NHS England of pushing ahead with an “unfunded, undefined” strategy that is “wholly unrealistic” given the health service’s chronic staffing and financial problems. Offering a full range of NHS services at weekends is “neither desirable nor feasible”, not needed in order to meet medical need and unlikely to attract enough patients to justify such a huge change, the doctors’ union says. Putting on outpatient clinics and performing routine operations on Saturdays and Sundays will inevitably lead to some of those services being cancelled during the week, it adds. The BMA’s broadside against the plans is contained in a detailed submission it has made to the Doctors and Dentists Review Body (DDRB), which advises ministers on doctors’ salaries, for its inquiry into what medics should be paid in a seven-day NHS. “Ill thought through implementation could threaten both the standard of service patients receive and the viability of the service … We believe that pursuing an ill-informed seven-day service model would be at best wasteful for the NHS and at worst threaten patient safety,” the BMA says in the executive summary of its evidence, which it published on Friday . NHS England has pledged to start offering a wide range of services on all seven days of the week in order to improve the care patients receive at weekends and tackle the high death rates that occur on Saturdays and Sundays, and also to better fit in with patients’ working lives.

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  • NHS emergency care on wobbly legs.

    If the NHS’s recent performance underwent one of the service’s own health checks, the readings would have the doctor concerned prescribing urgent medical intervention. Almost every day brings new evidence of an increasingly worrying situation that looks ominously as if it is building slowly and relentlessly into a full-blown crisis. The three legs of the stool that is NHS emergency care – A& E, GPs and ambulance services – are all wobbling dangerously. Emergency departments’ ability to treat the required 95% of patients within four hours has declined sharply in recent weeks, with just 84.7% treated within that time – its worst ever level. Hospital-based A& E units have now missed the 95% target every week for well over a year while patients are spending more time on trolleys in corridors than they should or being shuffled from one A& E to another. GP surgeries are wilting under the strain of increasing demand and too few family doctors. The line of people pictured on the front page of the Daily Mail recently as they queued from 6.30am to get an appointment at their local surgery was a microcosm of a widespread problem. Ambulance services are also wobbling. Three of England’s 10 regional ambulance services are, or very recently have been, on a state of “critical” alert. Like their colleagues elsewhere in the NHS, their capacity to respond quickly enough to genuine medical need is fraying at the edges. In March, London ambulance service reached the target 75% of critically ill patients facing a life or death emergency within the maximum eight-minute response time in all 32 boroughs. By June, it did not manage that in any of them. In some boroughs crews reached just 48% of such patients on time. Surveying the NHS’s decline, one minister said privately: “One of the slightly scary things is that no one, including the best brains in the health system, really knows what’s going on. It’s a complex picture and there’s no one factor.”

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