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Friday 28th August 2015

The Independent

  • How the NHS is being dismantled in 10 easy steps.

    Nobody's told you, but the government’s Health and Social Care Act has legally abolished the NHS. On the surface, it appears that nothing has changed. You can still see your GP or go to hospital and receive care free at the point of delivery. But behind the scenes, something else is going on: the NHS is being privatised. As a GP in Tower Hamlets, I want to tell my patients what’s really going on. Over the last 30 years, successive governments have dismantled our national health service – and here’s how they did it. 1. Create a Market: Ken Clarke, Health Secretary under Margaret Thatcher, got the ball rolling by introducing a market into the NHS. This introduced competition by turning hospital trusts into providers of services and GP/ Community trusts into purchasers of services. The result ? Administration costs actually rose, and this internal market alone accounts for up to 10 per cent of the budget or £10 billion a year. 2. Introduce Public-Private partnerships: New Labour expanded complicated financial models known as Private Finance Initiatives (PFI) - originally developed under John Major's government and intended to reduce government borrowing by bringing private investors into public sector projects - to build infrastructure including new hospitals. The original cost of hospital PFI projects is estimated at £11.6 billion. However, repayments are now projected to reach approximately £80 billion – for hospitals that are already built. The total PFI tab will top £301 billion , despite an original cost of £54.7 billion. The difference of nearly £250 billion would cover the entire NHS budget for more than two years.

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Pulse

  • Patients campaign to save popular GP practice and walk-in clinic.

    Patients are campaigning to save a highly rated GP practice and walk-in centre in Portsmouth, after the CCG proposed it should be merged into another facility two miles away. To date, 1,559 patients have signed a petition launched against the plans to get rid of the centre, which has seven GPs and is open 8am-8pm seven days a week, in March next year. In a consultation on plans, NHS Portsmouth CCG said that its ‘preferred approach’ would be to ‘move the GP walk-in service from Guildhall Walk to St Mary’s, to work alongside the existing nurse-led service there’ and also keep a GP urgent care centre at the Queen Alexandra Hospital linked to the A& E department. The consultation said the CCG ‘has been asking GPs and city residents about this system, and it is clear that many people feel the current set-up is complicated, making it harder to know which is the right service to use, and when’. The CCG said combining the two centres would be better because ‘[t]he walk-in service would have GPs and nurses working together as a team, with easy access to diagnostics (X-rays, etc)’ and that it would be more efficient and accessible. It said: ‘Currently the NHS pays for two separate walk-ins within two miles of each other.’ But Guildhall Walk Healthcare Centre service manager Kim Dennis told The News that moving the clinic, which was only set up six years ago as a ‘flagship’ scheme, would be the wrong decision. She said: ‘We deliver now what the Government sees as the future – we are open seven days a week and people can see a GP in that time. We help some of the most vulnerable, like the homeless, and have built a good relationship. I don’t think moving this centre is the right decision at all.’ Patients signing the petition to save the clinic, which is rated at 94% positive on NHS Choices, said the planned relocation must be halted as the St Mary’s walk-in clinic was already perceived to be under pressure.

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HSJ

  • No more savings can be made, trusts tell regulators.

    Trusts have told regulators they will not be able to improve their financial positions without affecting frontline services, senior acute trust leaders have told HSJ. Monitor and the NHS Trust Development Authority wrote to trusts earlier this month asking them to submit plans by 21 August for how they could improve their 2015-16 financial positions, either by reducing their planned deficit or improving their surplus. Acute trusts are facing a deficit of at least £2bn this year, according to their forecast positions. One trust chief executive said they had told the TDA they could not improve their financial position “without a significant compromise to access standards, the provision of service and quality of care”. They added: “With the array of regulatory requirements, including from Monitor and TDA, we cannot improve our position unless we are specifically advised that other standards and requirements can be dropped in the short term. “It is the centre that has over-promised and the centre that needs to rebalance between what the service offers and what can be afforded.” Several foundation trust finance directors said they would not be able to cut their deficits any further without affecting patient safety and they had said this to Monitor.

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Thursday 27th August 2015

Guardian

  • Labour must clean up the mess it made with PFI, and save the health service.

    Jeremy Corbyn, candidate for the UK Labour leadership, writes: The last Labour government’s investment in the NHS and in new hospitals was welcome – but too much of it was carried out under private finance initiative (PFI) schemes, which is like buying your house on a credit card. Even though the party was elected on a landslide in 1997, ministers were too petrified to make the argument for conventional borrowing, and instead fell for the city’s con trick. New Labour was cowed by the press, and duped by the money men. They can’t say they weren’t warned. At the party conference in 2002, Unison tabled a motion calling for a moratorium on PFI deals and a review. Party members and affiliates backed the motion overwhelmingly. To add to its case, Unison commissioned an ICM poll to test public opinion on the matter; 63% of voters supported the conference-backed call for a moratorium on PFI while an independent review took place. I raised my concerns in parliamentary debates, questions and committee hearings from 1998, and with renewed intensity from 2000 when my local hospital was threatened with the imposition of a PFI scheme. I continued to raise concerns with ministers in the Treasury, the Department of Health and the then Department for Education and Skills year after year, as did numerous Labour MPs, our union affiliates, health service workers and economists. The leadership ignored us all: MPs, councillors, public sector workers, members and conference itself. Our pleas fell on deaf ears. Now NHS patients are paying the price, with services and staff cut so that PFI debt repayments can be made. In the last parliament, NHS trusts were given a £1.5bn bailout to fund PFI repayments while waiting lists grew and grew. For some hospitals, the debt is unsustainable. Two-thirds of NHS trusts in deficit have PFI debts. Figures from the Unite union show that 15 NHS trusts are spending over 5% of their annual budget on PFI financing, while five spend over 10%. Every penny paid to a PFI company is money withdrawn from those waiting for an operation, money removed from the training of clinicians, and money denied for life-saving treatments. Much of the PFI debt is now owned offshore, to avoid paying tax on the profits generated from the taxes you and I pay. Huge profits from public money are being made by tax dodgers. This isn’t the NHS that Nye Bevan built. Labour has a duty to remove the PFI burden from the NHS – this really was our mess, and we have to clear it up. In opposition we need to campaign for a fund to be set up to bail out NHS trusts from PFI schemes forced upon them. This will save our NHS, rebuild our economic credibility and, most important, save lives.

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  • The Secret Doctor: people would use the NHS less if they knew the true price tags.

    'The Secret Doctor' writes: There is a resounding lack of insight from a patient perspective into how much the services they receive cost. But should they know ? I think yes. Maybe it’s time to hold a national social experiment where people attending hospital are presented with a bill at the end. Not one to be paid, but certainly to be reflected on. One of the first steps in saving the NHS has got to be increasing patient understanding of the price tag on treatments. Only by knowing how much each encounter costs, can they begin to accept responsibility for directly depleting the purse. Then some patients might choose to conserve their use of the NHS for the day when they really do need it.

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Independent

  • How the NHS is being dismantled in 10 easy steps.

    Nobody's told you, but the government’s Health and Social Care Act has legally abolished the NHS. On the surface, it appears that nothing has changed. You can still see your GP or go to hospital and receive care free at the point of delivery. But behind the scenes, something else is going on: the NHS is being privatised.
    As a GP in Tower Hamlets, I want to tell my patients what’s really going on. Over the last 30 years, successive governments have dismantled our national health service – and here’s how they did it.
    1. Create a Market
    Ken Clarke, Health Secretary under Margaret Thatcher, got the ball rolling by introducing a market into the NHS. This introduced competition by turning hospital trusts into providers of services and GP/ Community trusts into purchasers of services. The result ? Administration costs actually rose, and this internal market alone accounts for up to 10 per cent of the budget or £10 billion a year.
    2. Introduce Public-Private partnerships
    New Labour expanded complicated financial models known as Private Finance Initiatives (PFI) - originally developed under John Major's government and intended to reduce government borrowing by bringing private investors into public sector projects - to build infrastructure including new hospitals. The original cost of hospital PFI projects is estimated at £11.6 billion. However, repayments are now projected to reach approximately £80 billion – for hospitals that are already built. The total PFI tab will top £301 billion , despite an original cost of £54.7 billion. The difference of nearly £250 billion would cover the entire NHS budget for more than two years.
    3. Facilitate the Corporate Takeover
    From 2003, Foundation Trusts were introduced converting hospitals into semi-independent businesses. These trusts – which own and manage hospitals - can now make up to half their income from private patients. Meanwhile, the privatisation of Out of Hours Care by the likes of Harmoni and Serco has been followed by allegations of cost-cutting and sub-standard care. GP services have also been outsourced. Virgin Assura claims to look after 3 million GP patients.
    4. Install a Revolving Door
    A succession of health secretaries and ministers went off to work for private healthcare after leaving government. NHS Chief Executive Simon Stevens previously worked for giant US healthcare corporation UnitedHealth after a stint as Blair’s senior health policy advisor.
    5. Organise a Great Big Sell Off
    Private companies are engaged in an “arms race” to win NHS contracts. Virgin, Circle, Bupa, Serco, UnitedHealth and even Lockheed Martin are all in the running. Last year alone, out of £9.63 billion deals signed, £3.54 billion (nearly 40 per cent) went to private firms.
    6. Run a Smear Campaign
    The Government’s case for change largely rests on the premise of the NHS no longer being affordable and that it needs to be modernised. Yet we spend significantly less than the EU average and the likes of France, Germany and the Netherlands. It is overwhelmingly popular with the public.
    7. Legislate for the Dismantling of the NHS
    The Health & Social Care Act removes the Government’s responsibility for the NHS, passing it down to a series of other bodies instead. Clinical Commissioning Groups (CCGs) are forced to open contracts to unlimited privatisation. Private companies are “cherry-picking” lucrative contracts leaving NHS trusts with even less money. CCGs are to set to be privatised. It is difficult to believe but CCGs are now legally obliged to provide only emergency care and ambulances; the rest is up to their discretion. This translates into unlimited rationing.
    8. Plot Against the NHS
    A series of 1980s thinktank papers (one of which was authored by Conservative MPs Oliver Letwin and John Redwood) provided the blueprint for key policies. Back in 2005, Jeremy Hunt co-authored a book Direct Democracy calling for the NHS to be dismantled. It included the line: “Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain”. David Cameron’s health advisor Nick Seddon, formerly of private healthcare company Circle, suggests that CCGs should be merged with private insurance companies and those who can afford to should contribute towards their health care.
    9. Brew the Perfect Storm
    The Government consistently claims the health budget is protected. In reality, the NHS has been forced to make cuts of up to £15-20 billion and these are being extended. Tens of NHS trusts are in danger of going bust with PFI debts as a major factor. Sixty-six hospitals face closures of some kind. Never mind that buying out or renegotiating PFI contracts would solve this problem at a stroke.
    10. Introduce Universal Private Health Insurance
    Personal health budgets – which allow patients, rather than doctors, to decide how money is spent on treating their conditions - will be extended to 5 million people by 2018. This is likely to lead to co-payments funded through private insurance. The Government’s efforts to remove universal healthcare from each and every one of us makes my blood boil. I have one question for David Cameron: who gave you permission to break up our NHS and sell it off ? It’s now over to the public to save our NHS. It’s up to you.

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Open Democracy

  • Labour values, the NHS and me.

    Marcus Chown, a victim of the 'labour purge', writes: Last week I received an e-mail from the Labour Party telling me it had reason to believe I did not support its aims and beliefs and it was excluding me from voting in the leadership election. I have voted Labour in every election since I was 18. I have been a full member of the Labour Party and even campaigned on the doorstep. But I did not agree with Labour’s policy of privatisation of the NHS (public funding of private health companies, according to the WHO definition, is privatisation). So I joined a party, formed by doctors, nurses and patients, to truly defend the NHS. David Cameron explicitly promised "no more top-down reorganisation of the NHS". But, when the Conservatives came to power in 2010, they introduced the Health & Social Care bill, which they had concealed from the electorate during the election and which was bigger than the bill that had created the NHS in 1948. It removed the government's "duty to provide" healthcare for you and your family, a founding principle of the NHS, replacing it by a mere "duty to promote". Even the health minister would no longer have responsibility for your health. It would be left to the "market". In effect, the bill made possible to gradual abolition of the NHS. My publisher had got me to do Twitter and, at the start of 2012, I noticed a tweet about Dr Clive Peedell, a consultant oncologist, who was trying to highlight the H& SC bill by running 160 miles to Downing Street from the former South Wales constituency of Nye Bevan, the founder of the NHS. I was training with my wife, an NHS nurse, for the London Marathon. So, on a freezing day, we jogged out to Notting Hill. And that is how I met Clive and ran the final kilometres to Downing Street with him and Clare Gerada, chair of the Royal College of GPs (and her Jack Russell, Lucy). Nine months later, Clive founded the National Health Action Party with ex-MP Dr Richard Taylor and other doctors, nurses and patients who were appalled at the way all the main political parties were wedded to the privatisation of the NHS, which all evidence shows is worse for patients. I can't remember how I got invited to an executive meeting (I should stress I have never been on the executive committee) but I remember, when it came to "any other business", saying the party's Twitter feed was full of acronyms and doctor jargon. Little did I know that, Clive, sitting across the table, was NHA's Twitter feed! To his credit, over a cup of tea and cake, he said: "Why don't you help with our Twitter ? Here’s our username and password.” NHA saw the London euro election of 2014 as an opportunity to raise public awareness of what the government was doing to the NHS, which the UK media had failed to cover or critique, ignoring the overwhelming level of opposition. NHA's candidate was inner London GP Dr Louise Irvine, who had run the Save Lewisham Hospital campaign. When a court supported her and ruled that the government had acted illegally in downgrading Lewisham’s A& E and maternity departments, the government simply changed the law. Every party was allowed 8 candidates, in the London euro election, with all accumulated votes going to Louise. I got asked to stand and surprised myself by saying, yes. The others included an A& E consultant, a nurse, trainee surgeon, and actor and comedian Rufus Hound. I should point out that NHA is not a party of power. It has resources only to contest a handful of seats. In the 2015 GE election it was careful not to inadvertently help a Conservative into power, recognising that the Conservatives are a bigger danger to the NHS than Labour. And so I come to the point of this statement. Rules are rules. I understand that. And, yes, I have helped another party, which rules me out from voting in the leadership election. But NHA, the party I have helped, stands for exactly what the Labour Party should be standing for. I joined NHA in desperation because Labour had been heavily involved in privatisation of the NHS, and PFIs, which have plunged hospitals into enormous debt. Admittedly, Labour’s 2015 manifesto called for the repeal of the H& SC Act. But it pledged simply to “stop the drive towards privatisation” and “cap the profits” of existing private providers. The party said nothing about ending the wasteful “internal market”, which is estimated to divert 15 per cent of NHS money away from patients into bureaucracy. It does not seem right to accuse me of not sharing Labour values simply because I have criticised its NHS policy. I would like the Labour party to get into power with a leader who is committed to a publicly funded, publicly delivered NHS, which is what is wanted by the overwhelming majority of people in the UK.

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Daily Telegraph

  • Complaints about cancelled NHS appointments soar in one year.

    Complaints about cancelled and delayed NHS appointments have shot up by one fifth in a year, new figures show. Official data shows the number of patients raising concerns about outpatient appointments has risen from 9,040 in 2013/ 14 to 10,800 in 2014/ 15. There was a similar rise in complaints about ambulance services, the new figures from the Health and Social Care Information Centre show. Experts said the figure could reflect the fact a number of ambulance services took over the running of the 111 “non-emergency” line.

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Tuesday 25th August 2015

Health Investor

  • Monitor: Draft tariff could cut private providers’ income by 6.8%.

    Health watchdog Monitor has said that its draft proposals for the NHS tariff 2016-17 could cut private providers’ income by as much as 6.8%. The proposals could “cause independent sector provider revenue from nationally priced services to fall by 6.8% from £917 million to £854 million” the watchdog said. It is compared to a revenue change of just 2.5% for the majority (90%) of NHS providers. The variation in revenue streams was because of “case mix differences” between independent and NHS providers, said Monitor. For instance, notable cuts to orthopaedic services under the proposed prices would adversely affect independent providers more so than NHS services. This is due to 40% of private provider revenue from nationally priced services coming from orthopaedic services, compared to only 8% of revenue for NHS providers in England. However, Monitor noted that there were six areas where higher draft prices were expected to improve revenue for independent providers, by around £11 million.

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Nursing Times

  • Public health cuts 'short sighted, short term and unwarranted'.

    Cutting public health budgets by £200m is “short sighted, short term and unwarranted”, according to bodies representing council leaders. The warning comes from the Local Government Association and the Society of Local Authority Chief Executives and Senior Managers (SOLACE). Public health budgets have been targeted for cuts by the Treasury because of a multi-million pound underspend in 2013-14. In a joint response to the Department for Health’s consultation, the LGA and SOLACE said there had been a “fundamental misunderstanding” of how councils had managed public health budgets to date. It said: “The underspend in most cases is not an underspend at all, but rather a planned approach to public health service development across several years and may therefore now be committed in contracts. Councils took time to manage their new contracts, disinvest from services that were not delivering improved outcomes and they took time to plan more prudently,” it said. “That was something that the ringfenced budget and funding levels announced for multiple years was supposed to incentivise, ensuring that end of year budgets are not squandered on last minute spending in order to meet their annual allocation,” it added. Nursing Times’ sister title Local Government Chronicle reported last month that councils face a flat 6.2% cut to their 2015-16 public health budgets. Finding the savings would be “challenging”, the LGA and SOLACE said, adding that they wanted clarification that the cuts would come with “no further strings”. They said: “Anything less will create a ringfence within a ringfenced budget and make the task of finding the reduction more difficult.” The organisations said the £200m cuts would “undermine” shared objectives to improve the public’s health and reduce the pressure on the NHS and adult social care services. The NHS Five Year Forward View said the NHS would support “hard hitting” advocacy on public health, and back stronger public health related powers for councils and elected mayors.

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Pulse

  • Majority of practice managers have applied for new jobs.

    More than half of practice managers have applied for new jobs, with most wanting to leave practice management altogether, according to research by the Institute of Healthcare Management (IHM). The survey of 112 practice managers found that 57% had applied for a new job, with workload and excessive bureaucracy cited among the main reasons. This is a big increase on the 44% of practice managers who said they were thinking of applying for a new job when a similar survey by recruitment firm First Practice Management was carried out in 2013. The IHM has called for NHS England and the DH to reduce bureaucracy, specifically citing the Workforce Data Requirement, and for practice managers to be made partners in GP practices. The institute also said that the prospect of moving towards seven-day working had also had a negative effect on their working. It comes amid warnings about the number of GPs leaving the UK, while one in 10 GP posts is vacant, and the number of people wanting to enter the profession continues to decrease.

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Daily Mirror

  • Doctor attacks Tories' 'dishonest' reply to her open letter that was shared 180,000 times.

    An NHS doctor has attacked the Tories' 'dishonest' reply to an open letter she wrote that was shared 180,000 times. Janis Burns sparked a mass trend when she penned a searing missive to David Cameron over the Tories' 7-day NHS plans. Fresh from a weekend of graveyard shifts, she complained her colleagues already work all week long and she earns less than a Pret a Manger coffee shop manager. And she sarcastically congratulated the PM on his 'inflation-busting pay rise' as NHS staff flooded Twitter with selfies under the hashtag #ImInWorkJeremy. Now the £34,000-a-year junior anaesthetist has received a signed two-page response from health minister Ben Gummer. But she's not happy - claiming his reply doesn't answer her questions and misses out key facts. Mr Gummer's letter told the 34-year-old: "Consultants who exercise their right to opt out do work weekends, nights and evenings, but the NHS often has to pay them rates of up to £200 an hour." This figure appears to be from a 2013 Public Accounts Committee report which said these consultants were paid 'between £48 and £200 an hour'. And it seems it only applied to doctors who've opted out of weekends, just three of whom out of 4,356 existed at 17 hospital trusts. The other 4,353 at the NHS trusts, which were the first to reply to Freedom of Information requests, either didn't opt out of weekends or weren't allowed to. Ms Burns also complained about Mr Gummer's claim that a 2014 pay report 'found earnings levels for junior doctors compare reasonably well with comparator groups'. The same report also showed nurses' pay dropped 5% and consultants' pay 0.1% in real terms from 2002 to 2012. Only general medical practitioners saw a big benefit, with a real-terms rise of 13%. Ms Burns has now written a second open letter to the minister on Facebook complaining about his reply. She's also angry that David Cameron - who she wrote to originally - didn't reply personally. She told Mirror Online: "The reply doesn't address the issues. It just repeats the same facts that they can't really back up. It's more annoying and upsetting than if they hadn't replied in the first place." Ms Burns had more than 1,000 Facebook friend requests after her original letter on Facebook went viral last month.

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Milford Mercury

  • Call for Crabb to protect NHS from TTIP 'secret trade deals'.

    Health campaigners in Pembrokeshire have again called on local MP Stephen Crabb to support a campaign to protect the NHS from privatisation. Members of the People's NHS Wales pressure group protested outside the Preseli-Pembrokeshire MP's office, against an EU trade deal which they say 'threatens local services with irreversible privatisation'. More than 2.5m people have signed a Europe-wide petition calling on the EU and its members to stop the Transatlantic Trade and Investment Partnership (TTIP). Designed to 'ease the flow of goods and services across the Atlantic', the TTIP pact seeks to create the world's largest free trade zone, but there are concerns that it could pose a threat to services such as health care. A senior UN official recently called for controversial trade talks between the European Union and the US to be suspended over fears that it could undermine human rights, by allowing corporations to bypass laws set by government. Angela Newman, from the People’s NHS Wales, said: “The people of the Pembrokeshire are sending Stephen Crabb a clear message that we do not believe it is right for the NHS to be part of an EU trade deal which threatens irreversible privatisation." Hundreds of local households have also shown their support for the campaign by erecting 'estate agency-style boards' outside their home, calling for 'NHS out of TTIP'. Preseli-Pembrokeshire is the latest constituency to join the movement, which has brought together many thousands of people across the country.

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Northumberland Chronicle

  • Calls for rethink over decision to close Northumberland medical practice.

    Worried residents have demanded a review of plans to close a medical practice at “scandalously short notice”. Harbottle Medical Practice is due to shut its doors on Friday, affecting up to 800 patients. NHS England announced that the facility will close from August 28, while its branch surgeries at Rothbury Community Hospital and Otterburn village hall will also be affected, in what has been described as being an ‘exceptional situation’. Now parish council leaders have written a letter to Dr Craig Melrose, interim medical director for NHS England Cumbria and the North East, in the hope of helping the hundreds of affected patients. The letter asks for a consultation to be carried out with the public before any closures.The practice has built up an excellent reputation that has resulted in it attracting new patients from neighbouring practices thus offering choice to local people, an important element in maintaining standards. Dr Melrose said: “We can confirm Dr Miah at Harbottle Surgery has had difficulty in providing access to services for patients within recent weeks and, unfortunately, these issues have not been resolved. NHS England’s main priority is to ensure patients have access to high-quality GP services, therefore the practice will close from August 28, 2015, with no further service provided at Harbottle or the practice’s two branch surgeries at Rothbury and Otterburn. In light of this exceptional situation, patients will need to register with a new practice to ensure continuity of care.”

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Bristol Post

  • Protest over £28m privatisation of NHS Children's services in Bristol and South Gloucestershire.

    Campaigners will mount a protest after it was revealed Sir Richard Branson's Virgin Care could take over an NHS service in Bristol. More than 6,200 people have signed a petition against the privatisation of children care in Bristol and South Gloucestershire. North Bristol NHS Trust gave notice this summer it would it would no longer run the Children's Community Health Partnership (CCHP) contract beyond March next year. The interim £28 million contract, which will be for a year and start in April 2016, was sent out to tender. Two groups were shortlisted. One of them was Virgin Care. The other is a partnership of Sirona Care, Bristol Community Health CIC and Avon and Wiltshire Mental Health Partnership (AWP) NHS Trust. CCHP currently runs services such as school nurses, health visitors and mental health services in the community. The petition, which calls for the services to continue to be maintained by the NHS, will be presented to the Bristol Clinical Commissioning Group (CCG), which is set to make a final decision soon. Mike Campbell, from the Protect our NHS group, said: "It is incomprehensible that a company like Virgin Care, whose primary aim is to make profit, should be considered by the CCG as a fit organisation to run services for vulnerable children." A member of staff currently working for CCHP told the Bristol Post privatisation will be "bad news" for staff and patients. She said: "It is not feasible. We shouldn't be selling off our NHS in this way. The patients will be the one to suffer. Private firms are about making money, and children care is more important than profit-making. The thing is, most people don't know this is happening right under their noses."

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Monday 24th August 2015

HSJ

  • Public health cuts 'short sighted, short term and unwarranted'.

    Cutting public health budgets by £200m is ‘short sighted, short term and unwarranted”, according to the Local Government Association and the Society of Local Authority Chief Executives and Senior Managers. Public health budgets have been targeted for cuts by the Treasury because of a multimillion pound underspend in 2013-14. In a joint response to the Department for Health’s consultation, the LGA and SOLACE said there had been a “fundamental misunderstanding” of how councils had managed public health budgets to date. It said: “The underspend in most cases is not an underspend at all but rather a planned approach to public health service development across several years and may therefore now be committed in contracts. Councils took time to manage their new contracts, disinvest from services that were not delivering improved outcomes and they took time to plan more prudently. “That was something that the ringfenced budget and funding levels announced for multiple years was supposed to incentivise, ensuring that end of year budgets are not squandered on last minute spending in order to meet their annual allocation.” HSJ’s sister title Local Government Chronicle reported last month that councils face a flat 6.2 per cent cut to their 2015-16 public health budgets. Finding the savings would be “challenging”, the LGA and SOLACE said, adding that they wanted clarification that the cuts would come with “no further strings”.

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  • Exclusive: CSU procurements paused amid uncertainty over costs.

    A least two procurements for commissioning support services have been paused, HSJ has learned. This comes amid uncertainty over how stranded costs will be paid for if a commissioning support unit loses a contract. Both procurements involve a group of clinical commissioning groups jointly tendering for a full package of “end to end” support services, such as back office finance and HR, or GP IT services, HSJ has been told. They were due to set up new contracts for externally provided support services via NHS England’s “lead provider framework”. The procurement mechanism was established at the beginning of 2015, giving CCGs a choice of nine accredited providers of end to end support services. The paused procurements are in the south of England. One, which was widely anticipated by suppliers, was stopped before it was formally launched. The other was paused after bids had been invited. A note on the procurement framework’s web portal said the closing date for the procurement had been pushed back by four weeks to 2 September. This was described as “a temporary indicative extension”, rather than a firm deadline.

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National Health Action Party

  • Key points on funding and NHS privatisation.

    The NHS is not unsustainable or unaffordable. It's underfunded. We spend the least of all G7 nations on health. The NHS is now in the sixth year of the longest funding squeeze in its history. While the budget in England increased by an average of 0.8% over the last Parliament, spending has not kept up with patient demand and rising costs (put at 4%). Privatisation waste billions of pounds because it relies on a market which means money is wasted on bureaucracy and legal costs rather than being spent on patient care. Private companies put profit ahead of patients leading to worse services, they're less acountable, they poach staff trained by the NHS and cherry-pick the most profitable services leaving NHS with the costly complex ones and walk out on patients if they're not making enought money. Privatisation also means fragmented care and undermines collaboration which has led to important medical advances. This government is wasting billions of pounds of your money which could and should be spent on patient care: £3bn on a damaging top-down NHS reorganisation that no one wanted or voted for, at least £4.5bn running the NHS as a market, £2.5bn/ year on locums because it both fired staff to cut costs and has failed to train and retain enough doctors and nurses, £1.8bn on redundancy payouts, tens of £millions on management consultatants and spin doctors, and £2bn/ yr on PFI repayments. We need a strong NHS for a strong economy. The NHS is not a "drag" on the economy. Investing in healthcare stimulates economic growth and keeps the workforce healthy, while austerity increases the need for health services.

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The Guardian

  • NHS competition could waste millions says Labour, after Care UK complains.

    Labour has warned that the NHS could be forced to spend millions on competition lawyers after the UK’s biggest private healthcare provider demanded an immediate investigation into a decision to award an elective care contract to a local health trust. Care UK has been branded a bad loser after lodging a complaint with the NHS watchdog Monitor over the management of a contract by commissioners in north London. Monitor has now begun an investigation into the decision by four GP-led clinical commissioning groups (CCGs) to award a contract to the Barking, Havering and Redbridge University Hospitals NHS Trust. The trust said it was extremely disappointed by the investigation and warned that it would delay the opening of a care centre. Andrew Gwynne, the shadow health minister, said the new competition rules could force the NHS to waste millions on competition lawyers. “This is a worrying sign of what lies ahead for the NHS under the Tories,” Gwynne said. “David Cameron promised to put doctors in control, but his competition rules allow large private health companies to challenge the awarding of contracts to the NHS. It’s a ridiculous state of affairs that ministers need to urgently address.” Care UK, the UK’s largest private provider of health and social care, said that the GP-led commissioning groups had applied the wrong criteria in awarding the contract, with too much emphasis on price and too little weight on quality. The contract covers a range of services, including general surgery, orthopaedics and ophthalmology, for 965,000 people. Care UK, which has supplied elective care services in the area for several years, said the CCGs’ decision to take away the contract was discriminatory. Campaign groups warned that the NHS could face high legal costs if private companies begin regularly appealing CCG decisions. Prof Sue Richards, the co-chair of Keep Our NHS Public, said big private sector companies such as Care UK were full of the virtues of competition in theory, but claimed that they called in the lawyers when NHS hospitals were shown to be able to do a better job at a lower price.

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Global Research

  • Towards the Privatization of Britain’s National Health Service (NHS)?

    NHS For Sale: Myths, Lies and Deception by Tamasin Cave, Jacky Davis, Paul Evans, John Lister, Martin McKee, Harry Smith, and David Wrigley (Merlin Press, 2015) argues that the Health and Social Care Act of 2012 is a government policy whose component parts are together a significant step toward the privatization of Great Britain’s National Health Service (NHS). John Lister and six co-authors demonstrate that the British reform debate about healthcare is polluted with myths about the performance of the NHS, how capitalist economies work, the proper economic and social role of government in them, and what conditions are required to maximize political freedom. These discourses are related and the mainstream views are used to justify and in the hands of some seek to even deny the existence of the expanding role of capitalist businesses, motivated fundamentally by profits, who want the production and distribution of healthcare to be determined by them. While economists advocating privatization argue that markets are more effective at compelling cost efficiency than the government can, critics have responded by pointing to the lack of evidence that markets are more efficient in healthcare. In particular, there are many properties of health services that make it unique compared to commodities that capitalists normally produce. John Lister: The U.S. graphically demonstrates, private provision of healthcare is more expensive, less efficient, and less effective in tackling ill-health than universal healthcare systems. As the U.S. shows us, private systems also bring with them more fraud, more temptations to over-treat, more obstacles for the poor and those with chronic health problems to access healthcare, and more bureaucratic waste of resources – on advertizing and marketing, on administration and financial services, and on lobbying to secure competitive advantage. But the U.S., spending around 18 per cent of its GDP on a healthcare system that still excludes around 20 million Americans and leaves tens of millions of low-paid Americans seriously under-insured, also shows that it’s not the amount of money spent on healthcare which troubles neoliberals: it’s the level of public spending, collective coverage which annoys them. Of course, they are not even very consistent in this, because when the Medicare system that cares for much of the cost of health services for older Americans, and the Medicaid system that subsidizes states in supporting families on low income, are taken into account, along with the hefty tax concessions for larger companies offering health insurance for their staff, it has been calculated that even in the U.S. public spending accounts for half the health budget. So 9 per cent of GDP is spent on healthcare by government (state and Federal) in the U.S. – about the average for European countries. The difference is that for the same amount in most European countries offer universal healthcare to their population.

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Thursday 20th August 2015

Shields Gazette

  • ‘Our fight is not over’ – bed-push protest in battle to save NHS centre.

    A protest was held by Save Jarrow Walk In Centre.

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Medical Xpress

  • Patients will resist medical record sharing if NHS bosses ignore their privacy fears.

    Can it really be that giving pharmacists access to their customers' prescription information, even those pharmacists based in a supermarket, is viewed as a problem ? After all, when done so using their professional credentials and code of conduct, with your explicit permission to do so, it seems an example of sensible data sharing. But in England in 2015, this exact scenario has been reported as "Now Tesco has access to your medical records", with the implication the medical data will be used for marketing purposes. This looks like a serious overreaction – even though there are justified concerns about the introduction of this scheme and its operational processes. One particular centralised NHS patient database is called the Summary Care Record, from which this particular use of medical data is drawn. There are some uncertainties on what data is included now and in the future, and on what consent patients have given. But these are not nearly as substantial as the many problems that already surround the – entirely different – care.data database. And that is the problem: the painful, two year saga over care.data has significantly eroded public trust in NHS England and in the government's capacity to treat people's medical records responsibly and competently. Not nearly enough has been done to regain that trust before embarking on other ill-defined schemes. On the contrary, only this June the government sought to access GP appointment data including sensitive details, bypassing GPs and patients and instead going directly to the medical systems suppliers. The backlash on this move was effective and a U-turn rapidly followed, but it confirmed what many already suspected about the government's cavalier attitude to medical confidentiality. Rebuilding trust is not easy, and it never happens fast. The public needs to be convinced of both competence and honourable intentions within NHS authorities and the government. So far, both are lacking. Ultimately, what NHS England and the UK government should do is to face privacy and security risks head-on. Newspaper headlines and the public's response reveal that these are not just the concerns of fringe privacy campaigners, worries that stand in the way of great health research and public service efficiencies. People are rightly concerned about where their medical data goes, and it's about time the government and NHS authorities shouldered the responsibility of listening and doing something about it.

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Tuesday 18th August 2015

Local Government Chronicle

  • Local authorities could take powers from failing CCGs.

    Clinical commissioning groups failing for more than a year could have their responsibilities removed and handed to other organisations, new guidance indicates. NHS England chief executive Simon Stevens told LGC’s sister title Health Service Journal in June that struggling groups could have their powers given to other CCGs, local authorities or providers; but there has so far been no mechanism for this. Guidance on CCG assurance and CCG special measures distributed by the national organisation last week appears to partly formalise such an approach, HSJ reports. NHS England also used its intervention powers against three more CCGs. The document explaining how special measures can be used for CCGs in future says the regime will be “applied to a CCG facing persistent performance, financial or governance problems where it cannot demonstrate the leadership capability and capacity to deliver improvement on its own”. NHS England will closely oversee and work with the CCG for a year after imposing special measures. They can then be removed if the CCG has sufficiently improved or the measures extended for a short time. However, where CCGs have “not made expected progress” after the year, the national organisation can “trigger changes in the management, governance or structure of the CCG’s responsibilities, with the potential for other CCGs or relevant bodies to take over aspects of the local commissioner’s responsibilities”. Mr Stevens said in June NHS England would be “more vigorous” with CCGs with serious problems and that, in addition to replacing senior leaders, it could pass their responsibilities to other CCGs, local authorities or “an integrated provider”. Although the law allows NHS England to take control of CCGs itself or pass their responsibilities to other CCGs, it is not clear whether it has the legal powers to transfer them to councils or providers. NHS England has not yet placed any groups in special measures.

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Pulse

  • Largest GP partnership in the UK to launch with 'nearly 200' partners.

    A group of GP practices in the Midlands are in the process of merging into what has been described as ‘the largest GP partnership in the NHS’. CCG leaders have told GP colleagues that the new Birmingham and Sutton Coldfield super-partnership Our Health Partnership could end up with as much as 180 GP partners, although the group itself said it was unable to comment on the size while negotiations with GP practices about joining were still ongoing. According to its website, the super-practice will be jointly led by a chief executive and financial and operations officers appointed by an elected seven-member partnership board, however board minutes from NHS Birmingham CrossCity CCG indicated that the merging practices would retain their individual GP contracts and patient lists.GPs close to discussions, who wished not to be named, suggested the large-scale merger was a bid to be able to survive in partnership model and retain doctor-patient relationships despite ongoing erosion of contractual funding.

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Monday 17th August 2015

LSE Blog

  • What do we do when the public services market fails?

    What happens when outsourced contractors are no longer able or willing to continue with the provision of public services ? Bob Hudson explores the downsides of outsourcing public services and finds the proposals currently in train to address ‘market failure’ in both health and social care to be lacking. He goes on to explore alternative approaches and writes that public services should be seen as something more than a contract put out to the market to secure ‘value for money’. Public services are being outsourced across the world. Over the last year alone the annual contract value for outsourcing across Europe, the Middle East and Africa has increased by 29 per cent. In 2011, David Cameron declared that he wanted to ‘release the grip of state control’ on public services. This is one promise he has definitely kept – the amount spent on outsourcing public services in the UK has doubled to £88 billion since 2010. Overall the British outsourcing market is the second largest in the world outside of the USA. Health and social care represent two interesting illustrations of this trend – social care has been effectively privatised for many years and now there is evidence that the NHS is beginning to go the same way in the wake of the 2012 NHS and Social Care Act. All of this creates a new policy dilemma: what happens when these outsourced contractors are no longer able or willing to continue with provision ?

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Pulse

  • Government focused on chasing headlines rather than future of NHS, says BMA.

    The Government’s first 100 days of office has been focused on alienating NHS staff, and chasing headlines promising thousands of more GPs, the BMA has said. The chair of the BMA, Dr Mark Porter, has launched a weighty attack on the Government’s ‘poor performance on the NHS’ over its first 100 days in office, adding that there are ‘serious questions marks’ behind some of the recent announcements – including how the NHS workforce crisis will be addressed. As part of Dr Porter’s interrogation of the Government’s performance on the NHS, he also claims that there has been no detail about how the £22bn black hole in NHS finances in England can be reduced, and no definition about the viability of rolling out a seven-day NHS. Instead of ‘taking urgent action to address the real health and social care issues,’ Dr Porter said, the Government has focused on ‘attacking doctors’ professionalism.’ This attack from the BMA comes after Pulse recently reported that a fifth of GP training places in the UK remain unfilled after two rounds of recruitment - while the Government’s pledge to increase GP access to seven days a week has recently been hit by a slew of pilots across the country scrapping the scheme due to lack of demand. But the BMA has subsequently been accused by health secretary Jeremy Hunt for being out of touch with its members, claiming he had ‘yet to meet’ a doctor not in favour of weekend working. However, a petition has since been launched calling for a vote of no confidence in Mr Hunt, after he angered consultants during a speech, in which he threatened to impose his terms for the new junior doctor contract.

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  • NHS survival group calls for major public inquiry into future of the NHS.

    A campaign group for the survival of the NHS is set to launch this weekend, with the ambition to secure investment for the sustained future of the NHS and introduce protected hours and pay for staff. NHS Survival, an ‘umbrella organisation’ made up of groups of NHS staff, patients, and the public, is calling for the Government to establish a Royal Commission to work with all these groups to explore the future of the NHS. In particular they call for the commission to investigate the best course of action across five key points: sustainable funding for a safe NHS, what are safe staffing levels, ensuring patients are treated with dignity, and that the NHS is accountable to the public. And finally, guaranteeing that staff working hours are safe, and that they are suitably trained and motivated to stay in their chosen profession. A statement from the group says: ‘Staff recruitment and retention crises continue to spread across the board in a way that is already compromising safety in many key services including primary care, community services, hospitals and the ambulance service. ‘Decisions about the NHS are currently being made politically, with short-term vision, little cross-party consensus and almost no recourse to evidence. This is not how to ensure a safe, sustainable NHS fit for the future. As patients, public, and professionals, we are coming together to safeguard our NHS.’ This comes after a petition calling for MPs to debate a vote of no confidence in health secretary Jeremy Hunt has hit more than double the number of signatures required to trigger a debate in parliament. Pulse covered the petition last month, and it has since reached 217,000 signatures, the Government gave a mandatory response but have yet to set a date for the debate. Shadow health secretary Andy Burnham has said he will press for one when parliament returns from summer recess.

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  • Practices suffering 'significant and unpredictable' disruption due to privatisation of support services.

    Practices are receiving ‘misleading financial statements’ and seeing IT projects potentially fail as a result of the transition to the privatisation of primary care support services, the country’s largest CCG has said. NHS England this week confirmed the terms of the £330m seven-year contract, which will see Capita will take over the running of primary care support services (PCSS), and centralise support services including management of GP practice payments, medical records and national cervical and breast cancer screenings from 1 September. But NHS Birmingham CrossCity CCG has reported that the transition to this has seen disruptions to services ‘caused by reductions in staffing and the relative inexperience of the remaining staff’. GPs have raised concerns about the support services in the past, especially regarding the issue of payments, but the intervention by the CCG represents the most high profile criticism by NHS managers. LMC leaders have warned that problems are likely to get worse when the contract becomes fully privatised, with a plan to centralise services to three ‘centres of excellence’ each dealing with a single service area: screening services; payment services; and medical records, registrations and performers list services. . NHS England revealed its plan to outsource the PCSS contract as part of a bid to cut costs by £40m last year. Following on from this, it dropped responsibility for ‘non-core’ PCS services in April, including maintaining the patient population database and practice closure administration. In June Capita was selected as the preferred provider for the new contract in a bid thought to be worth as much as £400m over a period of seven years. But NHS Birmingham CrossCity CCG has said that practices are already suffering as NHS England has cut staff in preparation of the handover. Minutes from the CCG’s primary care committee – which manages primary care under new delegated co-commissioning arrangements - state: ‘These on-going changes are continuing to have a significant but unpredictable impact on both operational work and general system resilience, seemingly caused by reductions in staffing and the relative inexperience of the remaining staff.

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Friday 14th August 2015

OnMedica

  • One in five GP trainee places in England unfilled.

    One in five GP trainee places in England remains unfilled, adding up to more than 600 current vacancies, indicate the latest figures from the National Recruitment Office for GP Training. The figures have prompted doctors’ leaders to reiterate that government plans for GP services, which include 5,000 new recruits and seven-day opening, are “undeliverable,” particularly as one in three existing GPs plans to retire in the next five years. The figures for the 2015 recruitment round show that 632 GP training places are currently unfilled, with some areas of the country particularly badly affected. In the North East, almost half of these posts are vacant, with more than one in four empty in the East Midlands and around a third unfilled in Wessex, the West Midlands, and the North West. Only Kent, Surrey, Sussex, and the Thames Valley regions have eluded the shortfalls, the figures show. Dr Chaand Nagpaul, BMA GP committee chair, said that the figures laid bare the “huge scale” of the crisis facing GP services and patient care. “The failure to recruit new GPs is happening at the same time as a third of existing GPs are intending to retire in the next five years. GP practices are rapidly facing a situation where they do not have either new or experienced GPs to deliver enough appointments to patients and maintain high quality services,” he said. "With medical graduates turning their backs on general practice, there is no sign that the government will be able to fulfil its pledge to recruit 5,000 GPs and open all surgeries seven days a week. Whatever the rhetoric, on the ground these plans are completely undeliverable,” he insisted.

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Hospital Doctor

  • NHS trusts with largest deficits are least able to end costly private sector deals.

    NHS trusts under the most serious financial pressures are the least likely to be able to terminate expensive private sector deals, an expert warns. Hellowell, a senior lecturer at the University of Edinburgh, says dealing with the problem of PFI payments “is likely to need a coordinated response from central government to ensure that trusts are reimbursed for their related costs”. He describes how, in 2013, Northumbria Healthcare NHS Foundation Trust borrowed £114m from the local council to pay off private contractors who built and ran Hexham General Hospital, saving £14.3m over 25 years. Other NHS bodies are likely to want to replicate such an approach to easing their financial pressures, but how feasible is this, asks the author in The BMJ ? He points to a number of potential obstacles for trusts that would like to follow this example. Firstly, only a small number of foundation trusts have the finances to fund the large amounts required to terminate a PFI deal, he explains. Thus, trusts with the largest deficits, for whom the savings associated with termination are most important, are the least able to pursue this option. Secondly, the Hexham termination was possible only because of a local county council’s willingness and ability to provide a loan. Given the tight financial constraints faced by local authorities in the coming years, few trusts are likely to have this option, he warns. Thirdly, the termination fee may be so high that any savings would be negligible or even non-existent. For some trusts, he says, securing financing on such a scale may not be financially feasible.

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HSJ

  • BMA pulls out of junior doctor contract talks.

    The British Medical Association has walked out of talks with NHS Employers over junior doctors contracts. The trade union said its decision was prompted by government “insistence” that it accept all recommendations on a new contract made by the Doctors’ and Dentists’ Review Body on Remuneration. The BMA said such a move would not allow junior doctors to negotiate over proposals it believes are unsafe for patients and unfair to doctors. A BMA statement said that in order to return to negotiations, the union wanted the government to drop its position on some of the DDRB’s recommendations, which it said would: extend routine working hours from 60 hours a week to 90 hours a week; remove certain safeguards which discourage employers from making junior doctors work excessive hours; and
    break the link between pay levels and experience gained during training. Under NHS Employers’ offer junior doctors would see an increase in their basic pay but would lose automatic pay progression in favour of a system based on their level of responsibility.

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  • 'Other bodies' could take powers from failing CCGs

    Clinical commissioning groups failing for more than a year could have their responsibilities removed and handed to other organisations, new guidance indicates. NHS England chief executive Simon Stevens told HSJ in June that struggling groups could have their powers given to other CCGs, local authorities or providers; but there has so far been no mechanism for this. Guidance on CCG assurance and CCG special measures distributed by the national organisation this week appears to partly formalise such an approach. NHS England has also this week used its intervention powers against three more CCGs. The document explaining how special measures can be used for CCGs in future says the regime will be “applied to a CCG facing persistent performance, financial or governance problems where it cannot demonstrate the leadership capability and capacity to deliver improvement on its own”. NHS England will closely oversee and work with the CCG for a year after imposing special measures. They can then be removed if the CCG has sufficiently improved or the measures extended for a short time. However, where CCGs have “not made expected progress” after the year, the national organisation can “trigger changes in the management, governance or structure of the CCG’s responsibilities, with the potential for other CCGs or relevant bodies to take over aspects of the local commissioner’s responsibilities”. Mr Stevens said in June NHS England would be “more vigorous” with CCGs with serious problems and that, in addition to replacing senior leaders, it could pass their responsibilities to other CCGs, local authorities or “an integrated provider”.

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Our NHS

  • Simon Stevens' disastrous funding deal is failing the NHS.

    Last week's call from NHS regulator Monitor for NHS Trusts to fill only essential vacancies is very worrying, even if, as later clarified, the advice is directed at non-clinical staff as this has a knock-on effect on the whole workforce. Sadly this news comes as no surprise to me. The National Health Action Party has consistently been warning that the NHS is on a financial cliff edge and that underfunding threatens to push it over. The £8bn that NHS CEO Simon Stevens asked for, and George Osborne allocated in the summer budget, is clearly inadequate as it is predicated on £22 billion of efficiency savings that even senior figures at NHS England, as well as leading health think tanks, now agree are unfeasible. The NHA Party gave fourteen separate warnings that Mr Stevens' plans were unworkable. What is particularly galling is that Jeremy Hunt is now able to bat away calls for more funding by saying he has given Mr Stevens everything he has asked for. Effectively, 'stop whingeing and get on with it'. As if that's not bad enough, Mr Hunt is at the same time demanding the NHS squeezes a fully operating seven day service out of an already inadequate budget. As predicted, the voices of those who seek to undermine the founding principles of the NHS and call for patient charging are growing louder. Both Jeremy Hunt and his health minister in the Lords, Lord Prior have recently publicly called into question the premise of a tax-funded NHS – and just last week the financial think tank CIPFA warned that the government might have to take this controversial step Research shows that charging for services merely shifts costs to those who use the system the most: sick people who tend to be the poor and the elderly. And evidence from Germany has also proven that user fees hit socially deprived groups hardest and even a small charge deterred patients from using health services. That's why they ended up dropping the so-called Praxisgebuehr charge.

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The Bristol Cable

  • Investigation: Bristol’s most vulnerable children face sell-off threat to services.

    In a surprising move North Bristol NHS Trust (NBT) have announced that they are not bidding for the contract to continue providing their current Children’s Community Health Partnership (CCHP) services. This could mean the privatisation of CCHP, which includes all community child health and child and adolescent mental health services (CAMHS) in Bristol and South Gloucestershire, including services like community paediatrics and school nursing. NBT won a £150 million contract to run the CCHP services in April 2009, at the time the largest ever tendering process for clinical services in the UK. But are now relinquishing these services due to the “non-core nature of the service”, a “lack of management capacity” and “financial pressure”, according to a Bristol Clinical Commissioning Group (CCG) statement. These changes add pressure to an already underfunded service facing increasing demands in Bristol. The city has a burgeoning child population, an estimated 27,600 vulnerable children and 15,000 children with mental health needs. Also one in four children in Bristol are growing up in poverty, according to the children’s charity Kids Company Bristol that has recently been forced to close. This is in the national context of £85 million cuts to child mental health services in the past five years. In the last financial year £9.6 billion worth of NHS contracts were awarded through competition, the majority of which have consistently been won by private companies. CCG announced last week that two providers have been shortlisted to run CCHP for a one-year interim period, until a provider for a further five year contract is awarded in September 2016. The winner of the interim contract will be well positioned to acquire the next contract.

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Pulse

  • Patients should be allowed to register with any GP practice they want, says think-tank.

    GP practice boundaries should be disposed of completely and patients allowed to register with any CCG in the country, accessing all primary care providers within that region, according to a new report by the Institute of Economic Affairs think-tank. The report published today, ‘A Patient Approach: Putting the consumer at the heart of UK healthcare’ discussion paper, calls for an NHS overhaul to allow CCGs to privatise, specialise and ‘compete’ for patients, through merging and demerging with other CCGs. As a result, patients should be able to ‘choose freely among primary care providers, it says. The Government has already introduced its ‘patient choice’ scheme, which allows practices to open up their boundaries and take on patients from out of areas. As previously reported by Pulse, only 10,000 patients have registered with a GP away from their home since practice boundaries were abolished in October 2014, despite original claims from the Department of Health that up to 6% of patients were keen on moving to practices closer to their work. But the IEA says that the Government should go further, and allow all patients to choose practices across the country, without practices opting in to the scheme. The report says: ‘The whole concept of “catchment areas” should be abolished. Patients should be able to register directly with any CCG they see fit, and choose freely among primary care providers. Meanwhile, CCGs should be able to operate nationally, and to merge and de-merge with other CCGs, as well as provider organisations. CCGs would effectively become social health insurers, and the sector should be opened to private insurers as well.’ The think-tank also said it was ‘very much an open question’ whether GPs are the best people to lead CCGs.

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Thursday 13th August 2015

Grimsby Telegraph

  • GP 'in shock' following termination of surgery's contract with NHS.

    The GP at the centre of a storm surrounding a Grimsby doctor's surgery has said she is still in a state of shock her contract with the NHS was terminated. Dr Reeta Singh, who led the Ashwood Surgery on Ladysmith Road, was described the situation as "diabolical" and claimed her former patients were no safer following the decision. As previously reported, NHS England decided to terminate its contract with Dr Singh "in the interests of patient safety." Dr Singh said she was currently receiving legal advice over the situation, which she branded absolutely disgusting. "I'm still in a state of shock and I feel like I have been unfairly treated," she said. "I don't believe the patients are any safer because they are now being seen by doctors they don't know in a different place. If they had given me more time instead of making these changes over night it would have been better for the patients."

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Full Fact

  • Nobody knows how many lives could be saved by a seven-day NHS.

    Does a lack of staff or poor care on NHS wards at the weekend cost thousands of lives per year ? It’s impossible to say. Researchers can estimate the difference between the number of weekend patients who die and the number who would have died had they had the same chance of mortality as weekday patients. That gives an idea of the number of “excess deaths” related to going into hospital at the weekend—but not why they happen. Some of the increased mortality might be due down to the type of patient who is admitted at the weekend, and while the various research projects have tried to account for that, critics have argued it’s not possible to control for everything. There’s evidence behind excess death figures of 3,000 and 4,400. The variety is explainable: they look at different time periods and different types of hospital admissions, and use different methods We’re still not aware of any published information to suggest either that the service would save 6,000 lives, as had been claimed by the Health Secretary, or would save up to 6,000 lives. So at the moment any claim about how many lives would be saved by a full “7-day NHS” service should be taken with a pinch of salt. It would be fairer to say that up to a given number of lives might be saved.

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Daily Record

  • Number of NHS patients sent for private care at public expense doubles in a year.

    The number of NHS patients sent for private care at public expense has doubled in a year.Around £37million of taxpayers’ cash was handed to private firms to provide services on the NHS in 2014-15 – up from £35.8million in the previous year. And despite repeated SNP pledges to keep health care public, the number of referrals to private companies soared from almost 13,000 to more than 28,000.The dramatic increase is largely explained by the growing demand for specialist services such as MRI scans in Glasgow. Other health boards admitted patients were only being sent for private treatment because of strict Government waiting time guarantees or because of a lack of availability in local hospitals. The figures for 2014-15 emerged through freedom of information requests to Scotland’s regional NHS boards. They revealed little difference in the scale of private health care on the NHS in the majority of boards compared with last year. But in Glasgow, the number shot up from a reported 989 in 2013-14 to 14,535. Despite the increased reliance on outside help, the cost dropped from £2million to £1.8million.

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Newcastle Chronicle

  • Nursing staff levels at Newcastle addict centre to be slashed by about a third.

    Nursing staff levels at a service provided for drug and alcohol addicts in Newcastle could be slashed by about a third. It is understood the Northumberland, Tyne and Wear NHS Foundation Trust (NTW) which runs it on behalf of Newcastle City Council is now consulting with staff to reduce numbers. At present the Newcastle Clinical Drug and Alcohol Service has 33 full time or equivalent nursing staff there. According to documents seen by the Journal, that is expected to be reduced to 23 after the consultation process is complete.

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Get Surrey

  • NHS privatisation campaigners protest in Egham over EU trade deal.

    Campaigners marched through Egham to have their say over plans which they say will lead to the ‘irreversible privatisation of the NHS’. People wearing doctors outfits and face masks raised banners and placards emblazoned with the message get the ‘NHS out of TTIP’. They are angry about the Transatlantic Trade and In-vestment Partnership (TTIP), a series of trade negotiations between the EU and the US. The group fears it will "make the ongoing privatisation of the NHS irreversible", and are calling on Prime Minister David Cameron to veto the talks and for the Runnymede MP Philip Hammond to intervene.

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Tuesday 11th August 2015

Huddersfield Examiner

  • Kirklees NHS 111 service struggling to recruit GPs despite £900 fee per shift.

    The service that runs NHS 111 in Kirklees has admitted it is struggling to entice GPs to work for it - despite paying doctors as much as £900 a shift. The health hotline is run on behalf of Yorkshire Ambulance Service by Local Care Direct (LCD), which runs out-of-hours clinics. But members of North Kirklees Clinical Commissioning Group (NKCCG) have been warned by LCD that it is having difficulty recruiting clinicians to offer telephone advice and make out-of-hours visits. Officials say family doctors have been particularly hard to hire as many have launched their own independent out-of-hours schemes, some of which that are better paid. The Curo Federation of GPs in North Kirklees has been running its own system offering Saturday and Sunday appointments.A report to NKCCG says LCD is considering using more agency doctors and increasing the rate it pays GPs.

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Grimsby Telegraph

  • GP surgery with 4,400 patients faces closure after NHS strips its contract.

    A troubled doctor's surgery which was put into special measures last month could face closure after its contract with the NHS was terminated "in the interests of patient safety". The decision to end the contract of Ashwood Surgery was made by NHS England after concerns were raised over the quality of care provided by the practice. The move to put Ashwood Surgery into special measures, coupled with concerns over staffing levels, led to NHS England's decision. Its 4,400 patients have been told to continue attending the surgery as normal if they require an appointment with their GP for the immediate future.

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Daily Telegraph

  • NHS spending on private ambulances soars to meet demand.

    Ambulance services are becoming increasingly reliant on the private sector to cope with rising demand on the NHS. In 2014-15, England’s 10 ambulance services spent £57.6m on private or voluntary services - an increase of 156 per cent since 2010-11. The College of Paramedics criticised the reliance on the private sector as a “short term solution”, saying that the ambulance service needs to find more sustainable options as there are “currently not enough paramedics to provide a safe and effective service”

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Guardian

  • Are foreigners really gaming the NHS to pay for their medical treatment abroad?

    Monday’s Daily Mail splashed on the revelation that foreigners were charging the NHS for care in their own country. The newspaper claims the NHS is handing out 5 million European health insurance cards (Ehics) per year. It also seems to imply that Ehics are intended for Britons. Anyone who is “ordinarily resident” in the UK, and of British, other EU/ EEA or Swiss nationality, is eligible for the Ehic – that’s a pool of nearly 60 million people according to ONS data, the vast majority of whom are British (for example, there are 2.6 million EU citizens in the UK and 23,000 Swiss nationals). An Ehic is valid for up to five years, after which it needs to be renewed. In light of all this, the 5 million figure without details of who the cards are issued to is meaningless, and quite possibly negligible. Moreover, the Ehic isn’t a perk of the NHS. The card exists in all EU/ EEA countries and is issued by the health service provider of each country. It is not clear what incentive users would have to replicate such behaviour at scale; Ehic applicants would need to go to great length with no evident gain at the end. The treatment wouldn’t have been any different from that of a Hungarian resident using their own country’s healthcare.The Mail piece uses a handful of stories in an attempt to construct a partial picture of systemic failure and allege that eastern Europeans are extensively exploiting the NHS. But there is simply insufficient evidence, in the newspaper’s story or otherwise, to support such a claim.

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Monday 10th August 2015

Pulse

  • GP groups sign indemnity deals with private insurance firms in attempt to reduce costs.

    An insurance broker has cut a deal with three GP groups and is in talks with several others to provide indemnity cover to GPs independently of the medical defence organisations. Insurance broker Lockton said a GP federation, formed of 15 practices, had signed a deal that would save GPs an estimated 75% compared with their previous combined indemnity costs, while two out-of-hours groups had also signed deals with profit-making companies. However, the established medical defence organisations (MDOs) said that the premiums signed with private companies will not necessarily provide the same level of indemnity as their own. It comes as there has been mounting concern over the cost of indemnity, with one out-of-hours GP claiming that they had been quoted premiums of up to £30,000 by the medical defence organisations. Pulse also reported yesterday that GPs were facing escalated indemnity fees based on Government plans for seven-day access, while out-of-hours providers had warned they were increasingly struggling to fill shifts due to hikes in costs of GP defence subscriptions to cover out-of-hours shifts. GPs working for Vocare - a social enterprise that runs GP out-of-hours services as well as urgent care centres - will save ‘hundreds of thousands of pounds’ through the deal, Lockton said. Under the deal, GPs working for Vocare will have all of their out-of-hours shift work covered by the provider, while they will still have to indemnify themselves for their regular in-hours work, which will significantly reduce their premiums. Kevin Culliney, partner and healthcare specialist at Lockton, said incidents against out-of-hours providers are ‘few and far between’.

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The Huffingtonpost

  • 100 Days of Dave - The NHS.

    I was politically ambivalent about the general election. Like a lot of NHS staff, I was torn between knowing that things were bad in the health service, especially in general practice, but equally knowing that a change of government would inevitably mean some sort of re-branding, reorganisation and changes of priorities. I knew an NHS on its knees already wouldn't cope with that. When the result came in, it was going to be more of the same. No massive changes, just slogging on trying to get the government to listen. I was totally wrong. Hoping that the status quo would be maintained turned out to be hugely optimistic. There have been three big stories for the NHS in the last 100 days. Firstly, the "new deal" for general practice. My expectations were low; they should have been lower. The language was strong, the spin was high. In essence the government wanted unfunded seven day routine general practice from primary care; in return they offered... nothing of substance. Longer training, a marketing campaign and some data. That was it. Instead of simply being disappointing, it suddenly became a real threat. If the government forced through routine seven day surgeries, on top of the existing GP out of hours cover and struggling five day service, where would the doctors come from ? The training schemes are empty and have been for the last three years. Jobs are unfilled. No one wants to take on the responsibility to becoming a partner and being tied to the governments whim with insufficient GPs to staff the hours. It became a real, direct threat. Within days, notices were being handed in. Practices close to me terminated their contracts with NHS England; more did so across the country. GP partners moved their retirements forward, or swopped to salaried and locum roles so they wouldn't face being tied to unsafe working. I lost count of the number of times I heard colleagues saying "but we don't have enough doctors to open five days a week - I don't understand how we can do any more ?" Morale plummeted. Out of this came the second big story. GPs had enough. They had enough of muttering in the background; of the government thinking they could be walked all over. Instead of complaining to each other, they did something. They got together. They formed a new group. They called it GP Survival. I am part of this group, and the 3,500 colleagues who have joined me all have their personal reasons. Some are from rural practices, some from cities. Some are in larger partnerships, some are single handed. Some are partners, salaried doctors and locums. But they all feel that GPs are not being listened to, and that General Practice is inherently at risk. When I ask colleagues what they think NHS primary care will be like in five or 10 years time, many of them shrug: "It probably won't exist". So we are up for a fight.

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Big Up The NHS

  • The Future of our NHS – if we do nothing.

    In part one of this series I described some of the threats to our NHS in its present form. While nobody can predict the future with accuracy it is worth taking a moment to consider where we are heading if nothing is done to protect the service. You will find this hard reading. No doubt some will accuse me of scaremongering. I concede that the picture I will paint is grim but I truly believe it to be a real possibility. I will not suggest a precise timescale these events – that would really be stretching it too far – but suffice to say we are talking months to a couple of years rather than decades. To follow the logic of my argument you need to have read part 1 of the series. Let’s start from the current situation. Emergency departments in hospital trusts are under extreme pressure. Ambulances cannot offload at hospitals so there are not enough vehicles on the road for new emergencies. Hospital bed occupancy is near 100%. Mental health bed occupancy is over 100% with patients sitting for days in emergency departments waiting for places. Primary care is struggling to cope with increasing demand. GP workloads have rocketed and we cannot recruit enough GPs to replace those taking early retirement. Social care is near breaking point with limited community places and no cash for care packages. We have already started to see a deterioration of performance against government operational and financial targets affecting all sectors of the health economy. Emergency department 4 hour waits, ambulance pick up times and cancer treatment targets have all deteriorated. Two thirds of acute trusts are in financial difficulties and some may go bankrupt.

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The Telegraph

  • No extra cash for A&E when winter strikes, Government confirms.

    Hospitals will struggle to find extra money for staff and beds if there is a leap in demand for Accident and Emergency services this winter, it has been claimed. The Government has said that there will be no additional money to cope with winter pressures above the £380m pot for resilience and emergency contingencies allocated last December for the year 2015/ 16. This money is about half the amount allocated in the previous year for National Health Service contingencies, and this winter’s reserves have already been raided because of pressures in A& E departments, sparking fears that there will be little cash left to cope. The admission that there would be no extra funding was announced quietly in a parliamentary written answer by a Health minister just before the summer recess. Labour warned that many clinical commissioning groups, who run local NHS budgets, had already been forced to eat into forthcoming winter reserves just before the election, meaning that a flu epidemic or another kind of health crisis would put services under severe strain. The announcement does not amount to funding being cut, and some of the first tranche of cash, which will have paid for extra bed space and equipment, will still be available. But if there is an A& E crisis there will be concerns about the lack of funds available for extra staff and other resources.

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Friday 7th August 2015

Open Democracy

  • Open up your eyes to 'Devo-Manc'.

    I’m a member of Tameside (Greater Manchester) Keep Our NHS Public and my local Patient Participation Group (PPG). In July I attended 6 meetings in one week connected to KONP. Over 40 years in Social Work I’ve worked in 9 hospitals, with people with disabilities and older people. Current Health and Social Care policies seriously concern me: hence all the meetings. These meetings opened my eyes. The government is devolving a £6bn budget to the ‘Greater Manchester Combined Authority’ next April. All Greater Manchester Local Authorities and all Clinical Commissioning Groups must work together within this budget. They’re somehow expected to save money, reducing the use of hospital beds, following the government’s mantra of “paying off the deficit”. I’ve seen NO open discussion locally about how ‘Integrated Care’ can work. Heavy cuts have been made to Local Authorities’ Adults Services' budgets, and are truly worrying. A 13 July Panorama programme ‘NHS: The Perfect Storm’ showed the ramifications of such cuts threatening care provision for the elderly in Liverpool. Samih Kalakeche, Liverpool Director of Adult Services and Health admitted “having sleepless nights” about this: his budget was cut by £100million. The ‘Healthy Liverpool’ programme involved Liverpool City Council and CCG in “an all-out attack on unhealthy lifestyles combined with a massive shift of care and resources – from hospitals into the community, and a joining up of the NHS with other health and social care services”. The new Liverpool Royal Hospital has fewer beds than the hospital it replaces; fewer hospitals in Liverpool altogether are predicted.

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The King's Fund

  • Back in June, with no prior warning, the Treasury announced that the 2015/16 public health grant to local authorities would be reduced by £200 million.

    Last week, the Department of Health finally released the consultation on these ‘in-year savings’ (for the rest of us that means cuts). Given the delay in doing so following the announcement, you’d be forgiven for thinking that it is an extensive, highly technical document setting out complex options. But it’s not – it’s 20 pages, including annexes. So why the delay ? Why is the consultation open for just four weeks ? And why does it take place in August, when many people are likely to be on leave ? Presumably because it is already desperately late to be cutting in-year budgets – suggesting the cut caught the Department of Health by surprise. Not so long ago, the Department was trying to give local authorities planning certainty by issuing multi-year budgets – the contrast between this and an in-year cut could hardly be more stark. We have set out our view elsewhere on the wisdom of cutting public health budgets, arguing that it will undermine commitments to prevention and discourage integration. And the consultation does answer some of the questions we posed there, including whether funding for public health services for children aged 0–5 – which is only being transferred from the NHS to local authorities from 1 October – can also be cut now that it is no longer protected by the NHS ring fence. The answer is yes, as long as statutory responsibilities are met. This may be sensible, giving local authorities maximum room for manoeuvre, but it sits uncomfortably with the government’s claim that these are ‘non-NHS’ cuts.

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GP Online

  • The Chartered Institute of Public Finance and Accountancy (CIPFA) warned that the NHS was not able to 'react fast enough' to achieve the unprecedented £22bn of savings the service and ministers have committed to by 2020.

    In a briefing document on The Health of Health Finances the experts said the plans were too optimistic and failed to take account of the government’s election commitments to seven-day GP services, same-day appointments for over-75s, and training 5,000 more GPs by 2020. The £8bn of additional funding by 2020 promised by the government will not be enough, the document said, even if £22bn of savings were delivered. Ministers face the choice of either adding further to the NHS budget, charging users more, or reducing services, it said. The NHS could, CIPFA suggested, consider a flat rate contributory fee to see a doctor, paying a proportion of treatment costs, or an insurance approach. Ministers have said they are committed to keeping the NHS free at the point of use. Proposals to introduce charges for GP appointments were overwhelmingly rejected at the annual LMCs conference in 2014 by GP leaders who said it would be 'mistaken and dangerous' step that would destroy patient trust in their doctor. Chief Executive of CIPFA Rob Whiteman said: ‘Without radical transformation, we will struggle to offer a high quality public health service for future generations. The NHS is presently beset by a Five Year Forward View and resource assumptions that will not add up.'

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HSJ

  • BMA and NHS Employers in 'exploratory' talks.

    Representatives from the British Medical Association and NHS Employers have held talks that could lead to the resumption of formal negotiations over changes to medical contracts, HSJ can reveal. At least two meetings were due to take place this week between the two sides to discuss the future of the consultant contract, HSJ understands. No meetings have taken place in relation to changing junior doctors’ contracts but initial plans to meet have been agreed. The talks are at the very early stages with both sides seeking to understand possible discussion points that could form the basis of future formal negotiations, HSJ has learned. It is believed the BMA is willing to discuss losing consultants’ weekend opt-out but will demand stronger safeguards, which NHS Employers could be willing to discuss if they are in line with those suggested in a report by the Review Body on Doctors’ and Dentists’ Remuneration body. A BMA spokeswoman described the talks as “exploratory”. A Department of Health spokeswoman said: “It is encouraging that both the consultants and the junior doctors at the BMA have agreed to pre-negotiation talks with NHS Employers.” They come after health secretary Jeremy Hunt issued an ultimatum to the association last month warning he would impose a new consultant contract if progress was not made on negotiations for seven day working. This came after the BMA walked away from negotiations without warning in October after 18 months of talks.

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Thursday 6th August 2015

Guardian

  • NHS patients may face widescale charges, warns financial thinktank.

    Ministers will have to consider charging patients for seeing a GP, attending A& E, and using the food, power and water of hospitals, unless better long-term solutions for funding the NHS can be found, public finance experts have warned. Contributions towards the cost of treatments and patients taking out health insurance are among other options that must be on the table if the comprehensive spending review in November fails to address the issue, the Chartered Institute of Public Finance (Cipfa) says in a briefing. The document says that the hope of NHS leaders to save £22bn over five years to 2020-21 is optimistic and does not take account of David Cameron’s pledge to increase seven-day services nor of the introduction of the new national living wage. Other general aspirations, such as making the UK a “world leader” in tackling cancer and dementia and raising spending on mental health, have not been explicitly costed either, Cipfa says.

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  • Thousands of blood donors turned away by NHS as staff are too busy.

    The NHS has turned away thousands of potential blood donors because staff are too busy, despite complaining of a 40% slump in people coming forward and a potential shortage of future stocks. The health service’s blood and transplant unit revealed, after a freedom of information request, that 1,986 people complained they had been turned away from walk-in sessions in the year 2013-14; a similar number (1,949) said they did not have their blood taken even when they had made an appointment. In total, 6,798 people complained to the NHS about not being able to give blood, including about the lack of appointment slots and cancellation of sessions, in the 12 months to June 2014. The figures emerged after a Freedom of Information Act request prompted by Emma Hayes, a regular donor from Brighton, who reported concerns at the number of people being turned away.

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Essex Daily Gazette

  • North East Essex Clinical Commissioning Group cut NHS funded vasectomies.

    NHS bosses in north Essex say they have no choice but to cut services after criticism from medics’ organisations. The North East Essex Clinical Commissioning Group has cut NHS-funded vasectomies and female sterilisation, stopped free prescriptions of gluten free food and scrapped elective surgery for some smokers and obese patients. It wants to stop most free IVF treatment, subject to a three month consultation. The cuts will save £14m a year. Sam Hepplewhite, acting chief officer at the group, said it has a duty to get as much good healthcare for people with the money it has available.

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Tuesday 4th August 2015

Health Investor

  • NHS private pay income up 14% in two years.

    The amount NHS foundation trusts (FTs) earn from private patients has increased 14% in the last two financial years. This rose from £346.1m in 2012-13 to £395.9m for 2014-15 according to their annual accounts which were analysed by HSJ.

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  • Capita to cut nearly 1,000 NHS jobs following outsourcing contract win.

    Outsourcing firm Capita is planning to cut nearly 1,000 jobs once it takes on the £400 million primary care support services contract it won from the NHS. These plans were revealed as part of NHS England’s discussions with unions ahead of the transfer of personnel to Capita in September. Almost 80% of the employees in the primary care support services division will lose their jobs and 28 of 30 offices will be shut. Under the terms of the contract Capita take on back-office services such as payments administration and management of clinical records for NHS primary care providers including GPs, opticians, pharmacists and dentists. The £400 million contract was tendered through a framework that allowed for deals worth up to £1 billion. The difference in value is because the initial contract only covers NHS England but Capita could stand to earn up to £1 billion if NHS Wales or NHS Scotland agree to join the deal. The contract will last for seven years with an option to extend for a further three. Nick Bradley, national officer for Unison, told the Financial Times the job cuts were devastating and put three million patient records at risk. This would be because Capita would be centralising “functions like payments to every GP, pharmacy, dentist and optician in England; responsibility for cancer screening services and all notifications to the public”, he said. Dr Clive Peedell, leader of the National Health Action Party, also told the Financial Times: “The pursuit of private profit inevitably means staff cuts increasing the welfare bill and reducing spending power in local economies.” In May, Capita also won a 10-year, back-office support contract with Central London Community Healthcare NHS Trust worth £80 million.

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Stoke Sentinel

  • Funding crisis could force health centres to close, GPs have warned.

    Doctors have warned GP practices are at risk of closure because of a funding crisis. The nine health centres are facing an uncertain future after being hit by massive increases in utility, maintenance and cleaning bills. They include Goldenhill Medical Centre, Biddulph Primary Care Centre and Weston Coyney Medical Practice. Now GPs running the practices fear the increased bills threaten the future of the practices. The utility, maintenance and cleaning costs were subsidised by the NHS under the LIFT scheme until April 2014. It was part of moves to encourage surgeries to relocate to bigger and more suitable premises. But GPs have been left shocked at the size of the NHS bill handed out by the Community Health Partnership (CHP). Dr Chandra Kannaganti, who works at Goldenhill Medical Centre, was stunned to receive a £22,000 bill in January, backdated to April 2014. The bill rose from £5,000.

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Hull Daily Mail

  • Hull NHS bosses strike deal to reduce cost of locum doctors after paying millions.

    Hospital bosses have struck a deal with agencies providing NHS staff to drive down the cost of locum doctors. The Mail revealed paying doctors to work overtime and hiring agency locums had cost more than £8m in the past 15 months, with one doctor paid almost £2,000 for a single shift. Now, Hull and East Yorkshire Hospitals NHS Trust has reached an agreement with agencies providing locum doctors to reduce the bill. Unions, NHS campaigners and nurses have all reacted angrily after discovering how much the trust is having to pay locum doctors. Dermot Rathbone, of Save Our NHS Hull, said: "It is morally indefensible but the doctors are responding to the environment they have been placed in by the Government. If you create a market environment, people will behave according to that market and what we have seen is the marketisation of our health service."

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Independent

  • Less than one per cent of NHS consultants use control loophole to 'opt out' of weekend work.

    Jeremy Hunt’s justification for reforming NHS working practices has been called into question, after it was revealed that less than one per cent of consultants actually use a contract loophole to “opt-out” of weekend work. Freedom of Information responses from 23 hospital trusts show that only 35 out of the 5,661 consultants they employ “actively opt out” of doing non-emergency work at weekends. The Health Secretary, who has angered doctors by calling on their union, the British Medical Association (BMA) to “get real” over the need for more weekend working in the NHS, has said he wants to remove the “opt-out” clause for newly qualified doctors. He argues that 6,000 people were losing their lives every year because of a lack of a “proper” seven-day hospital service.

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The Star

  • Almost 50 jobs to go as Sheffield NHS blood unit’s closure confirmed.

    Around 45 people are to lose their jobs as the closure of a specialist NHS service in Sheffield that processes blood for use in patient operations was confirmed. The NHS Blood and Transplant board of directors have now agreed plans to shut the blood supply chain manufacturing facility on Longley Lane, close to the Northern General Hospital. Manufacturing services currently based in Sheffield and Newcastle are being transferred to Manchester. The plans follow the amount charged to hospitals for blood being reduced to save the NHS £3m per year. The two sites are not expected to shut until 2017 ‘at the earliest’. Fears had been raised by Unison that moving services to Manchester could put patients ‘at risk’ with the possibility of bad weather or heavy traffic affecting transport times across the Pennines. But the NHS has said safety and continuity of blood supply is a ‘top priority’.

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Guardian

  • How to sell off the NHS – in nine easy steps.

    So you want to sell off the NHS ? The 67-year old behemoth has radically improved people’s quality of life for nearly a century, so it won’t be easy. Here’s a handy step-by-step guide to privatising the health service.
    1. Know your enemy
    In 2010, a King’s Fund poll put NHS satisfaction at above 70% – the highest ever recorded approval rating. United Kingdom is joint fourth in the world for child mortality outcomes, joint fourth in the world for life expectancy (male), and joint eighth in the world for maternity mortality. However, it currently spends only 9.1% GDP on healthcare or US$3,598 per person, which is free at the point of service. The US spends twice as much (17.1% of GDP or US$9,146) and scores sixth in child mortality, sixth in the world for life expectancy and 24th for maternal mortality. To sum up, you’re faced with a well-liked, efficient, life saving machine. You won’t be able to try a head-on approach; public opinion will need to be swayed first.
    2. Misinformation
    The great thing about the NHS is most voters at any given election will not have had much experience of its services. Start early by pervading a message of improvement and efficiency. Steer every news piece towards this same message, regardless of context. Before you know it the NHS will be percieved as failing.
    3. Divide and conquer
    It doesn’t matter what you campaigned for – once you’re elected you only have to apologise occasionally and you can do whatever you want.
    4. Wash your hands early
    When no one is looking, make sure the government no longer has a legal duty to provide a NHS.
    5. Open market
    Everyone knows they get a better deal when one supermarket opens next to another one. Use that knowledge to your advantage. Meanwhile once the law has changed, open up the NHS to private contracts bit by bit.
    6. Undermine NHS staff
    NHS staff will see what’s happening, and people will listen to them if you don’t do something about it. Politicians are the least trusted individuals in the country, while doctors are the most; start early on with subtle denigration of the perception of all NHS staff.
    7. Make cuts
    Cut it, and cut it hard. People use A& E and the GP the most – keep these areas stripped of cash and drive up demand. Eventually, locum agency costs to cover staff gaps will cripple failing departments, and smaller GP closures will domino into bigger ones.
    8. It’s showtime!
    If you’ve followed the above steps then this will be a doddle. You’ve got a demoralised and depleted workforce, an unhappy electorate and you aren’t even spending very much on it all. You’ll need to do some handwringing, some lamenting, some explaining away. Hopefully by this time you will have got private companies into at least 20% of services.
    9. Sit back and relax
    All your hard work no doubt has been a lot of stress. And those long hours of drinking and smoking and missing the gym have really taken their toll. You deserve some time off. Don’t worry about the newspaper backlash – it’ll come eventually, and there won’t be a hint of apology as the same papers that supported you will hypocritically tear you down. And don’t worry about that chest pain you’ve been having. You’re insured right ? Oh you lost your job ? But what about the end game – the cushy seat on the board of the health companies ? Oh, you’re politically toxic now and all those backroom offers disappeared ? And you didn’t save anything ?
    Oh.
    Goodbye.

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  • NHS told to fill only essential vacancies due to 'almost unprecedented' finances.

    NHS trusts have been told by Monitor, the health service regulator, to fill vacancies “only where essential” as it warned that current financial plans are “quite simply unaffordable”. In a letter to NHS trusts, Monitor’s chief executive David Bennett warned of an “almost unprecedented financial challenge” as he said no stone should be left unturned to find savings. Bennett wrote in the letter, which was seen by the Health Service Journal, that financial forecasts for 2015-16 are unsustainable as he called for greater savings. The HSJ has reported recently that the provider sector has forecast a deficit of £2bn in 2015-16.

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Monday 3rd August 2015

BMA

  • Mr. Hunt: You want the NHS to fail, and you want it to be seen to fail.

    Dear Mr. Hunt, I know you probably won’t read this. But if you do, you might appreciate it; you might even find some useful advice in what I have to say. Don’t worry; I suspect that the nuances of the doctor’s contract negotiations confuse you, so I will speak to you in a language that you hopefully do understand: the language of Politics. Now, we doctors have generally been a pretty non-political bunch. We are too busy patching up the broken bones and broken spirits of our patients to pay too much attention to politics. We don’t philosophise much either. There’s no room for philosophy when you are trying to get a chest drain into a critically unwell patient’s chest. But, Mr. Hunt, it appears that although we had been generally uninterested in politics, Politics has been very, very interested in us. When, in the wake of the DDRB report, you made your disingenuous comments about us as a profession, we were initially rather puzzled. Why would you want to alienate doctors in your quest for a 24/ 7 NHS ? Why would you not even try to take us forward with you in a spirit of partnership and dialogue ? We then started to realise something. We started thinking about the events of the last few years. We started to see the big picture. And we are coming to the conclusion that you do not actually have the interests of a viable NHS at heart at all. 5 years ago, your Coalition government made a specific political decision to address the financial crisis of 2008 largely through public sector cuts. After systematically transferring the debts of the private banking sector into the public sector; the Prime Minister then informed us that our public finances were in crisis. Then, instead of increasing tax on those best able to pay, or regulating corporate tax avoiders effectively, your Government chose to place the burden of the financial crisis onto the shoulders of the ordinary people of this country. You called this Austerity. Now, the NHS is by a wide margin the biggest employer in the country. It’s also one of the single biggest areas of spending by Government. So of course, in the name of Austerity, you just had to drive through your so-called “reforms”

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Pulse

  • GPs to be offered 'simplified' conditions under plans to tempt practices away from national contract.

    GPs will be offered ‘simple and attractive’ conditions to encourage them away from the national contract and join the ‘new models of care’ that are being tested across the country, say NHS bosses. NHS England says that practices will be offered a ‘reimagined and simplified’ QOF and explicit ‘rights of return’ back to the national contract, under the plans published today. The document published today details the next steps for setting up the GP-led multispeciality community providers (MCPs) and hospital-led primary and acute care systems (PACS) that are designed to better integrate care. It reveals that there will be a ‘new payment structure’ that will see GP, community and - potentially also secondary care - budgets pooled together and given to the new organisations, which will be based on capitated payments. It says: ‘The MCP model is based on a GP registered list. The structure will build in additional community and mental health services and social care as appropriate, converting these into an amount per patient that can be combined with core general practice funding.’ But it admits that one of the ‘most complex issues’ will be how the new organisations will incorporate GP budgets and persuade practices to opt out of the national GP contract. The document said: ‘One of the most complex issues for the programme to deal with – both for MCPs and PACS - will be developing simple and attractive options for existing GP practices to migrate from their current funding and contractual arrangements, including ways to enable “rights of return”.’

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HSJ

  • Updated: DH proposes across the board public health cut.

    Local authorities look set to face a flat 6.2 per cent cut to their 2015-16 public health budgets under plans put out for consultation by the Department of Health this morning. The consultation comes almost two months after chancellor George Osborne first announced a £200m in year cut to the public health budget. This equates to a 6.2 per cent cut to the £2.8bn ringfenced public health grant, after funding for the commissioning of health visitors and other services for children aged 0-5, due to transfer to councils in October, is included. The consultation sets out four options for how the cut could be applied, but makes clear the DH’s preferred option is for this cut to be applied equally across all authorities with responsibility for public health. The other options would be: to devise a formula that resulted in greater cuts for the councils that receive more than their “target” allocation; apply greater cuts to councils carrying forward large underspends to 2015-16; or apply a flat percentage cut, except where councils can show that would result in particular hardship. The consultation says an across the board 6.2 per cent cut would be the “simplest and most transparent option to implement and would enable the department to provide [local authorities] quickly with certainty on what would be required of them”.

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BBC News

  • Staffordshire NHS trust pulls out of £690m cancer contract.

    A hospital trust has pulled out of a £690m, 10-year contract to run cancer services in Staffordshire. The BBC understands that University Hospitals North Midlands NHS Trust is worried about the financial risks involved. It was one of three partners in the private-public sector consortium. But one of the four clinical commissioning groups (CCGs) involved said the project was still on track and a consortium was still in place. It was formed after two of the original five bidders for the contract pulled out. The remaining bidders, private firm Interserve Investments, University Hospitals North Midlands and the Royal Wolverhampton Hospitals Trust combined forces. The contract is intended to streamline services across Staffordshire and improve the outcomes for patients. It would cover the areas controlled by Stafford and Surrounds, Cannock Chase, Stoke-on-Trent and North Staffordshire CCGs. But the trust foresees a 10% increase in cancer patients being treated without any extra money. Mark Hackett, trust chief executive, told BBC News: "We share the goals and objectives with the commissioners, but we don't think the context and circumstances are right and we will be announcing shortly our reasons for that."

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New Statesmen

  • An open letter from a doctor to Jeremy Hunt.

    Your plans are neither safe, nor sustainable, nor morally okay. “Make the care of the patient your first concern.” This is the cardinal rule of Good Medical Practice, the handbook issued to every medical student by the GMC at the dawn of their training. Ask any doctor: we have this rule as deeply ingrained throughout medical school as any physiological action or pharmacological mechanism. We probably mumble it in our sleep. And we try to. We try so damned hard. Along with the nurses, the allied healthcare professionals, and all the auxiliary teams – we do what we can with meagre staffing levels and stretched resources pitted against relentless “efficiency savings“. We work and work and work, in a miasma of demoralisation that has only thickened over the past weeks and months as the true depth and breadth of the cuts has become horrifyingly apparent. The patients are more numerous and sicker than ever before; partly due to the ageing population, but also because the patients getting admitted to hospital have been disproportionately disadvantaged by the decimation of health and social care provision both in hospitals and nationwide in the community. The estimated funding gap for adult social care this decade ? £4.3 billion.Charity funding cut by £1.3 billion; personal care cut; mental health services cut ; disability benefits cut; carers in crisis; benefit caps inexorably tightening; all welfare increasingly inaccessible to the most vulnerable members of society: the unwell, the poor, the young, the disabled. Given the above, it is indisputable that the actions taken by this government and the last have made the British population sicker. The knock-on effect on healthcare resources is both predictable and inevitable. Vulnerable, isolated older people are arguably the worst hit; the sterling work by Age UK shines a light on the shameful state of things for this demographic. These are the patients who bounce in and out of hospital and “bed-block“, often due to multiple morbidities and complex psychosocial needs. Hospital admission should always be a last resort. Unfortunately, in so many cases, things are so bad in the community that last resorts are all we have.

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The Guardian

  • Government defeat highlights the limits of NHS devolution plans.

    A little reported Lords defeat for the government over its plans to devolve powers to major cities has major implications for local control of the NHS. Last week an amendment was moved successfully by Labour peer Norman Warner to the cities and local government devolution bill which stops the transfer of NHS regulatory functions held by national bodies. Crucially, if the amendment is not reversed in the Commons, it will ensure any devolved services adhere to national service standards and are still nationally accountable. The bill, part of the “northern powerhouse” drive to devolve responsibilities to major cities, has become the vehicle for devolving £6bn of health and care spending to Greater Manchester. The amendment underscores Labour suspicions that the Conservatives want to whittle away the health secretary’s ultimate responsibility for providing a national health service. This caused a row during the passage of Andrew Lansley’s NHS reforms during the last parliament, when the government had to accept an amendment spelling out the requirement for the health secretary to remain accountable no matter how much control was passed to NHS England. When the government announced the NHS devolution plans, shadow health secretary Andy Burnham immediately attacked the idea of one part of the country having a different version of the NHS. This amendment means Manchester will be unable to take on any regulatory or supervisory powers from the Care Quality Commission, NHS England or Monitor and its successor, NHS Improvement. As HSJ reported in February, the Greater Manchester authorities initially sought “a new set of relationships” with regulators and inspectors to give the oversight regime a clear focus on the local health economy. While the precise legal implications of the amendment would need to be tested, philosophically it goes to the heart of the moves towards devolving control of the NHS. Those who see themselves as the guardians of the NHS see any erosion of its national character as inimical to the idea of universal health provision; national oversight and accountability are bulwarks against those who are indifferent to the NHS’s long term survival and are willing to contemplate systems where personal payments play a much larger role.

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Friday 31st July 2015

Hospital Doctor

  • Massive support for vote of no confidence in health secretary Jeremy Hunt.

    A former Labour health secretary has pledged his support for a vote of no confidence in current health secretary Jeremy Hunt in response to an online petition. In a tweet, Andy Burnham stated: “On behalf of the 196,000 people who have no confidence in @Jeremy_Hunt, I will apply for debate when House returns.” Over 204,000 people have now signed the Parliamentary Petition which calls for a debate on the vote of no confidence. The petition was created in response to Mr Hunt’s threats to impose – rather than negotiate – a new contract on NHS consultants, which includes the intention to create a “seven day NHS.” Many doctors have pointed out that they already work over seven days, providing on-call services over night and at weekends. It led to the hashtag #ImInWorkJeremy trending on Twitter, with doctors sending selfies to the health secretary to prove how out of touch he is with the NHS workforce. Parliament is required to consider all petitions with 100,000 signatories or more for a debate. But the Government response didn’t address the calls for the no-confidence vote – instead presenting a defence against criticisms of the seven day NHS plan itself. It said: “The Government is committed to delivering seven day services to make sure that patients get the same high quality, safe care on a Saturday and Sunday as they do on a week day.”

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London Evening Standard

  • NHS needs thousands of nurses as London wards are shut in ‘perfect storm’.

    Hospital wards and operating theatres are being closed because of a “perfect storm” shortage of nurses in London, the Standard can reveal today. Barts Health, which runs five east London hospitals, has almost 1,200 vacancies — one in five of its nurses and midwives. Almost one in six nursing posts were vacant in May at the Royal Free trust, which has three north London hospitals; at Imperial College Healthcare, which has five west London hospitals; and at St George’s in Tooting. Experts believe the capital is short of “several thousand” nurses. Jan Stevens, interim chief nurse at Barts Health, said: “It’s like a perfect storm. Everyone is fishing in the same pond for nurses but there is a shortage. “This is not just for Barts Health — it just looks worse for us because we are the biggest trust in the country. Obviously the vacancies we have sound staggering, but there are a lot of vacancies across the country.” At St Bartholomew’s hospital the new Barts Heart Centre has been forced to close two theatres and two catheter labs. Staff shortages have forced the closure of 15 per cent of beds at the hospital in Smithfield, the Barts Health board was told yesterday. Professor Charles Knight, director of Barts Heart Centre, said it had 120 nurse vacancies. Eighty job offers have been made, including to 44 nurses from the Philippines. At Whipps Cross hospital, in Leytonstone, staff shortages have forced the closure of a midwife-led birth unit on 15 days so far this year. Beds were also closed on the trauma and orthopaedic wards at Whipps Cross. Inspectors from Health Education England have sounded the alarm over two “adverse incidents” at Newham hospital’s maternity unit relating to a lack of cover. Across the trust, 46 “red flag” warnings were raised in June in relation to staffing. The shortage of permanent staff has sent the trust’s bill for agency staff and overtime soaring to £14.3 ?million a month. As a result, Barts Health is facing a £134.9 ?million deficit by next March, the biggest ever seen in the NHS.

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Left Foot Forward

  • Times admits ‘scandal of NHS end-of-life care’ story was incorrect and misleading.

    The Times has admitted a story claiming hundreds of thousands of people endure a ‘painful, undignified or lonely death’ due to poor NHS care was completely false. The story published on May 20 was headed: Scandal of ‘appalling’ end-of-life NHS care. But today the Times’s corrections box called the story ‘incorrect and misleading’. The correction begins: “We stated that ‘Hundreds of thousands of people endure a painful, undignified or lonely death because of ‘appalling’ end-of-life care right across the NHS’ (News, May 20). It notes the parliamentary health ombudsman’s report on which the claim was based said nothing of the kind. The report in fact said: “there is a potential to improve the experience of care in the last year and months of life for approximately 355,000 people” [the number of expected yearly deaths]. The Times correction continues: “It [the report] did not state or suggest that the majority of NHS patients currently receive poor end-of-life care.” The paper says the word ‘appalling’ came from the Department of Health in reference to just 12 cases of very poor care in the report. Somehow, 12 cases were taken as representative of hundreds of thousands. A correction on this is welcome, even in a tiny box on page 28 and three months late.

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The NewStatesman

  • The long summer break can’t have come too soon for Jeremy Hunt.

    In the last 10 days alone, two separate waves of vitriol from the medical profession have come crashing down on him, and as he scarpers off to sun himself he must be wondering what type of mood he’ll be coming back to. First there was the #Iminworkjeremy campaign, a fierce rebuttal of Hunt’s attack on the BMA over consultants’ supposed unwillingness to work seven days. This must have seemed like a breeze though, compared with the last week’s bruising. Cue #weneedtotalkaboutjeremy, an even angrier backlash sparked by the government’s response to a petition which has gathered more than 200,000 signatures (and rising), calling for a debate of no confidence in the Secretary of State. The reply was meant to silence the mob – it’s had the opposite effect, and been branded as “manipulative and misleading” by Dr Hamed Khan who I know speaks for many doctors out there. The whole saga has yet further uncovered a bitter divide, a growing rift between the Secretary of State for Health and the medical profession. Yes, the government’s response to the no-confidence petition made the valid point that reports by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) and the NHS Pay Review Body (NHSPRB) both cited consultants’ rights to opt-out of weekend and evening work as something needing to be examined. But somehow that seems beside the point – the anger it sparked certainly suggests it is. It’s at best tactless, at worst downright insulting to effectively blame consultants – the vast majority of which do work weekends by the way – for 6,000 deaths a year without proper proof. Especially when you’ve just handed them another four years of pay-freeze; when you’ve already incensed a straitened profession by shrugging off doctors who tell you that they see dangerous levels of understaffing before their eyes; and when you’ve compounded their stresses and strains by cutting social care and public health funding.

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The Independent

  • NHS treatments such as vasectomies and hip operations to be rationed because of cost-cutting.

    More patients could be denied NHS treatments as a result of cost-cutting by health authorities, with hearing aids, vasectomies and knee and hip operations among services set to be rationed in some areas. An investigation into 19 Clinical Commissioning Groups (CCGs), which pay for NHS health services at a local level, carried out by the GP magazine Pulse, found that several are planning to restrict access to routine care. In some areas controversial requirements for smokers to give up and for obese people to lose weight before being offered certain surgical procedures, will be used to reduce costs. NHS Great Yarmouth and Waveney CCG introduced weight loss and smoking cessation criteria for all smokers and people with a body mass index (BMI) over 35 requiring hip and knee replacements, earlier this year. Patients in Luton will also have to undergo a weight loss programme or quit smoking before certain elective surgical procedures, Pulse reported. A plan to implement a similar scheme in Devon was dropped last year shortly after it was announced, following criticism from surgeons. Other rationing measures include an NHS North Staffordshire CCG plan to deny access to hearing aids to patients with mild and moderate hearing loss – a move labelled “cruel” by the charity Action on Hearing Loss.

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HSJ

  • Exclusive: CCG plans handover to 'accountable care organisation'.

    A clinical commissioning group is proposing to hand its budget and nearly all its functions to a provider led ‘accountable care organisation’, in what could be a first in the NHS. Northumberland CCG’s proposal is part of the health economy’s work to overhaul its models of care and contracting. It was one of the 29 national vanguard sites identified in March and is developing a primary and acute care system. Sources working on the move, which will be the subject of discussion in the area over coming months, told HSJ it would represent a very substantial reduction of the CCG’s functions, and a substantial move away from the current commissioner/ provider divide. They plan to establish a special purpose vehicle (SPV) organisation, which the CCG budget would be delegated to, along with the primary care budget for the area. Those leading the work said the SPV would be akin to an “accountable care organisation” – provider networks being developed in the US to take on substantial delegated responsibility and risk for planning and funding services for their populations.

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